Frozen shoulder in office workers

🩺 Case Scenario: Frozen Shoulder in a 50-Year-Old Office Worker – Right Shoulder (Non- Diabetic)

📌 Patient Profile

• Name: Mr. R. (initials only)

• Age: 50 years

• Gender: Male

• Occupation: Office worker (sedentary, 8–9 hours daily typing/computer work)

• Medical History: No trauma, non-diabetic, no previous surgeries

• Lifestyle: Sedentary, occasional mild back pain

📌 Presenting Complaint

Mr. R. reports:

• Gradual stiffness in the right shoulder for 4 months

• Pain mainly at night, affecting sleep

• Difficulty performing daily tasks:

  • Reaching overhead

  • Picking files from high shelves

  • Dressing (wearing jackets/shirts)

Pain level: 6/10 on VAS during movement, 3/10 at rest.

📌 Clinical Examination

🔹 Inspection

• Slight shoulder droop on affected side

• No visible swelling or deformity

• Protective posture observed (holding arm close to body)

🔹 Palpation

• Tenderness over anterior and superior shoulder capsule

• Mild muscle tightness in deltoid and trapezius

🔹 Range of Motion (ROM)

• Flexion: 100° (restricted)

• Abduction: 90°

• External Rotation: 40°

• Internal Rotation: 50°

🔹 Special Tests

• Painful Arc → Positive

• Capsular Pattern (ER > ABD > IR) → Present

Diagnosis: Right Shoulder Adhesive Capsulitis (Frozen Shoulder), Stage II – Frozen Stage

📌 Pathophysiology

Frozen Shoulder occurs when the shoulder joint capsule becomes thickened and tight, limiting mobility and causing pain.

• Common in middle-aged adults

• Associated with sedentary lifestyle and repetitive strain

• Leads to gradual restriction of flexion, abduction, and external rotation

📌 Physiotherapy Management Plan

🔹 Stage 1: Freezing Stage (Painful Stage, if caught early)

Goals: Pain relief, maintain available ROM, prevent stiffness

• Modalities:

  • Hot packs (10–15 mins before exercise)

  • TENS for pain relief

• Exercises:

  • Pendulum exercises (gentle circular movement)

  • Assisted ROM with stick or pulley

  • Isometric contractions of deltoid and rotator cuff

  • Posture correction exercises (shoulder retraction)

🔹 Stage 2: Frozen Stage (Current Stage for Mr. R.)

Goals: Improve ROM, reduce stiffness, maintain strength

• Manual Therapy:

  • Glenohumeral joint mobilizations (Grade II–III)

  • Capsular stretching (focus on external rotation and abduction)

• Exercises:

  • Wall climbing (flexion and abduction)

  • Pulley-assisted abduction/flexion

  • Theraband exercises for scapular stabilizers

  • Gentle yoga stretches for shoulder mobility

• Home Program:

  • Daily stretching (10–15 mins)

  • Encouraged functional use of the arm in safe range

🔹 Stage 3: Thawing Stage (Recovery Phase)

Goals: Restore full ROM, strengthen shoulder, regain function

• Progressive Resistive Exercises:

  • Theraband strengthening (rotator cuff, scapula stabilizers)

  • Dumbbells (1–2 kg) for progressive resistance

• Functional Training:

  • Overhead reaching and lifting light weights

  • Work-simulated exercises for office tasks (typing posture, file reaching)

• Proprioception & Coordination:

  • Ball passing against wall

  • Closed kinetic chain exercises for shoulder stability

• Patient Education:

  • Recovery may take 12–24 months

  • Compliance with daily exercises is key

  • Maintain correct posture during work

📌 Progress Notes (Expected)

• Week 2–4: Pain reduces to 4–5/10; pendulum and assisted exercises tolerated

• Week 6–8: Flexion 120°, abduction 110°, improved functional use

• Month 3: External rotation 55°, able to reach overhead, sleep improves

• Month 6: Near full ROM, performs daily activities independently

📌 Discussion & Learning Points

• Frozen Shoulder in sedentary office workers is common due to repetitive strain and poor posture

• Early recognition and physiotherapy prevent prolonged stiffness

• Postural education and ergonomic correction are as important as exercises

• Patient motivation and adherence to the home program are crucial

📌 Key Takeaway for DPT Students

Frozen shoulder rehabilitation focuses on pain relief, gradual mobilization, and functional restoration. Posture and work ergonomics play a crucial role in preventing recurrence.

FAQs

1. What are the stages of frozen shoulder?

• Freezing stage: Pain and stiffness gradually increase (2–9 months).

• Frozen stage: Pain decreases, but stiffness remains (4–12 months).

• Thawing stage: Movement slowly returns (6–24 months).

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2. What causes frozen shoulder in teachers or desk workers?

Long hours of sitting, poor posture, lack of movement, and repetitive shoulder strain can contribute.

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3. Can frozen shoulder heal without treatment?

It may improve over time, but without physiotherapy recovery is much slower (sometimes 2+ years). Early intervention speeds up healing.

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4. What is the best exercise for frozen shoulder?

• Pendulum swings

• Wall climbing exercises

• Towel stretches

• Gentle passive stretching (under guidance)

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5. Can frozen shoulder come back after recovery?

Yes, in rare cases it can recur, especially if posture issues or diabetes are present. Maintaining mobility exercises helps prevent relapse.