Acta Scientific Clinical Case Reports

Short CommunicationVolume 2 Issue 4

Need for Consensus for Frozen Shoulder Treatment by Physical Medicine and Rehabilitation According to Clinical Phases

Oscar Eduardo Sánchez Valdeolla* and Kenia Montenegro Guerra

Hospital Universitario “Manuel Ascunce Domenech”. Camagüey, Cuba

*Corresponding Author: Oscar Eduardo Sánchez Valdeolla, Hospital Universitario “Manuel Ascunce Domenech”. Camagüey, Cuba.

Received: March 15, 2021; Published: March 24, 2021

Citation: Oscar Eduardo Sánchez Valdeolla and Kenia Montenegro Guerra. “Need for Consensus for Frozen Shoulder Treatment by Physical Medicine and Rehabilitation According to Clinical Phases”. Acta Scientific Clinical Case Reports 2.4 (2021): 47-49.


  Frozen shoulder is one of the main disabling health problems in men today. This condition causes physical limitations to those affected, so that it is necessary to take therapeutic measures to eradicate it. however, various forms of treatment for this condition have been described, all with some degree of efficacy, none of which is better than the others. This entails the need to establish a consensus to carry out a timely treatment according to the clinical phases of this condition, which is why it is our motivation in this study.

Keywords: Frozen Shoulder; Physical Medicine; Rehabilitation

  Frozen shoulder is one of the most common conditions treated in comprehensive rehabilitation services. Due to the great mobility of the shoulder joint, it is the target of multiple injuries [1-3].

  The causes for which frozen shoulder can occur are articular, extra-articular and systemic. Of these, the most frequent are the first and the last. Among these, shoulder bursitis, rotator cuff tear, and diabetes mellitus are the most common conditions [3].

  Taking into account the clinical characteristics of this condition, a classification has been established depending on the symptoms and signs. Frozen shoulder is classified into three clinical phases. Phase I (painful), where pain predominates; phase II (freezing), where functional impotence prevails, and phase III (thawing), which occurs spontaneously according to the opinion of most authors. Different procedures of physical medicine and rehabilitation are applied in each phase for its treatment [4,5].

  The combination and suitability of physical agents, together with kinesitherapy, constitute the main therapeutic elements to achieve the relief of shoulder pain and its mobility. However, there are still discrepancies regarding the use of the procedures in each phase [6-9]. As a result of reading nine articles, the elements shown in the following table were systematized.

Article title







Treated phases of the shoulder


Relevance when applied
1. Physical-rehabilitative treatment of the painful shoulder Bravo T, and others/2009 

Iberoamerican Journal of Physiotherapy

Kinesioterapia + interferential current

Not specified




2. Manual therapy and exercises

Page MJ, and others/2016

Researchgate Cochrane

Intramuscular steroids + manual therapy

Not specified

Steroid injection

3.Effectiveness of manual therapy and exercises in capsulitis adhesive

Ortiz M, and others/2014

Researchgate Cochrane

Manual therapy and exercises

Not specified

Manual therapy

4.       Painful shoulder treatment with therapy Handbook

Gabucio P/2008

Rev Fisio Guadalupe

Manual therapy

Not specified

Manual therapy

5.       Effectiveness of physical agents in painful shoulder

Gomorra García M, and others/2005

Surgery and Surgeons Magazine

Damp heat + current

interferential or humid heat +

therapeutic ultrasound

Not specified

Physical agents

6.       Acupuncture recovers the shoulder frozen


Guant Ley H, and others/2008

Cochrane Database of Systematic


Shock wave therapy + electroacupuncture

Not specified

Physical agents

7.     Capsulitis adhesive

Alcantara S, and




Exercises and therapy


Not specified

Steroid injection

8.       Conservative treatment of painful shoulder

Varas de la Fuente AB, and others/2002

Physiotherapy Magazine

Exercises and therapy


Not specified


Manual therapy

9.       Adhesive capsulitis of the shoulder

Ortiz M, and others 2010

Cochrane Database of Systematic


Manual therapy: Cyriax and Niel-Asher

Not specified

Manual therapy

Table: Presentation of publications on the treatment of frozen shoulder and the procedures of physical medicine and rehabilitation and of natural and traditional medicine.

  As can be seen, none of the studies specify which phase of the condition is being treated. On the other hand, all of them are emphasized to the use of exercises and manual therapy. Only in three the use of physical agents is taken into account. The therapeutic objectives to be achieved must be borne in mind in this condition, since in phase I the first thing to eliminate is pain, and this is difficult to eliminate through kinesitherapy.

  In phase II, greater importance is given to the elimination of joint impotence and then to the disappearance of pain. In phase III the essential thing is to achieve the recovery of joint mobility. The combination of physical agents, or other similar therapy, are the main therapeutic procedures to achieve the disappearance of pain or its relief. Kinesitherapy is then recommended to achieve joint mobility recovery. All these aspects must be kept in mind when it comes to shoulder rehabilitation [6-8].


  There is poor management to counteract this disease, taking into account both the procedures of natural and traditional medicine and those of physical medicine and rehabilitation. Therefore, it is suggested that work on this frequent and complex condition be deepened and expanded.

Conflict of Interests

The authors declare that they had no conflicts of interest to carry out this article.

Authors' Contributions

Oscar Eduardo Sánchez Valdeolla: Writing of the article and review of the literature.

Kenia Montenegro Guerra: Writing of the article and review of the literature.


  1. Rodríguez Martín S and Melogno Klinkas M. “Chronic shoulder pain in instrumental activities of daily life”. Rehabilitation 1 (2018): 38-44.
  2. Ortiz Lucas M., et al. “Adhesive capsulitis of the shoulder: a systematic review”. Physiotherapy5 (2010): 229-35.
  3. Collazo Chao E. “Cervical pain intensity and range of motion in women with myofascial pain receiving acupuncture and electroacupuncture treatment: a randomized double-blind clinical trial”. Revista Int Acupuncture (2015).
  4. Colleen Bockhold. “Ashley Hughes. The ethics of opioids for chronic non-cancer”. Pain3 (2017): 48-52.
  5. Ortiz L and Velasco M. “Chronic pain and psychiatry”. Revista Médica Clínica Las Condes6 (2017): 866-873.
  6. Torres Pascual C and Torre Vallespín S. “Efficacy of Dicke's connective tissue massage in the treatment of pain and severity of spasmodic primary dysmenorrhea in young adults”. Naturopathic Medicine2 (2016): 5-8.
  7. Guillart Larduet J. “Effectiveness of pharmacopuncture in patients with shoulder bursitis”. Medisan 5 (2016): 683.
  8. Tlatoa Ramírez HM., et al. “Update in Sports Traumatology: frozen shoulder”. Revista de Medicina e Investigación 2 (2014): 132.
  9. Montero Alcaraz JC and Rodríguez Vallecillos S. “Subacromial syndrome: clinical-ultrasound correlation with acupuncture points and meridians”. Revista Internacional de Acupuntura2 (2017): 25-35.


Copyright: © 2021 Oscar Eduardo Sánchez Valdeolla and Kenia Montenegro Guerra. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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