A pragmatic regional interdependence approach to primary frozen shoulder: a retrospective case series^*

* The protocol for this case series was approved by the Institutional Review Board of Columbia University Medical Center.

Abstract

Objectives:

Although the shoulder is known to move together with the scapula and other upper quarter joints, the current frozen shoulder clinical practice guidelines describe only physical therapy study treatments directed to the shoulder. None received a strong recommendation, highlighting the need for alternate interventions. This retrospective case series describes a pragmatic regional interdependence approach to frozen shoulder with impairment and functional outcomes, noting whether final ROM approached normal.

Methods:

Five consecutive patients referred with frozen shoulder diagnoses attended 11–21 sessions over 5–10 weeks with one physical therapist. Treatment addressed inter-related regions (shoulder, shoulder girdle, scapulothoracic/humerothoracic, and spine) following a pragmatic approach using impairment-based interventions (joint/soft tissue mobilization, muscle stretching/strengthening) as well as patient education, modalities and warm up that addressed individual presentations.

Results:

All patients improved on all outcomes. Mean shoulder ROM at discharge, the impairment outcome, demonstrated large effect size increases: flexion (117 ± 10–179 ± 12, d = 5.9), abduction (74 ± 8–175 ± 9, d = 9.3), external rotation (23 ± 7–89 ± 2, d = 12.0). The Disability of Arm Shoulder Hand functional outcome score upon follow up demonstrated a large effect size improvement (d = 1.5) from 40.0 ± 19.4–6.2 ± 3.7. Final ROM approached normal.

Discussion:

This case series utilized a regional interdependence approach to frozen shoulder that included manual therapy interventions directed to consistent upper quarter body segments. Shoulder ROM was returned to near normal with functional improvements evident months after discharge. A pragmatic regional interdependence approach addressing multiple joints related to shoulder function may benefit other people with frozen shoulder.

Level of Evidence: 4

Keywords:

• Frozen shoulder
• adhesive capsulitis
• upper extremity
• vertebrae
• manipulation
• mobilization with movement
• strain counterstrain
• soft tissue therapy
• case report
• shoulder
• regional interdependence

Acknowledgments

The authors would like to thank Ivy Rehab Physical Therapy for their support of this manuscript.

Notes

* The protocol for this case series was approved by the Institutional Review Board of Columbia University Medical Center.