Frozen shoulder in office workers

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

📌 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.

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