כתף קפואה — שלושה שלבים, פרוטוקול אחד

WHAT IS IT — Adhesive Capsulitis (כתף קפואה, frozen shoulder) is a fibroproliferative condition of the glenohumeral joint capsule characterised by progressive pain and global restriction of both active and passive shoulder motion. The intra-articular volume shrinks from a normal 30 ml to under 5 ml due to capsular thickening and synovial inflammation. The condition progresses through three clinical stages: freezing (pain-dominant, 0–9 weeks), frozen (stiffness-dominant, 9–16 weeks) and thawing (spontaneous recovery, 16–24+ weeks). ICD-10: M75.0.

WHO IT AFFECTS — Affects approximately 2–5% of the general population. Peak incidence at age 40–65, with slightly higher prevalence in women. Diabetes mellitus is the strongest risk factor, increasing risk 3–5-fold. Additional risk factors include thyroid dysfunction, Dupuytren's disease, prolonged shoulder immobilisation following surgery or trauma, and cardiovascular disease. Diabetic patients typically experience more severe and prolonged disease.

HOW WE TREAT IT — Recovery TLV applies a stage-specific protocol. Freezing stage: pain modulation, pendulum exercises, coordination with physician for corticosteroid injection. Frozen stage: Maitland Grade III–IV glenohumeral mobilisation, Sleeper Stretch, Cross-body Stretch, Stick exercises for external rotation. Thawing stage: progressive rotator cuff strengthening (Supraspinatus, Infraspinatus, Teres Minor, Subscapularis) and scapular stabilisation (Y-T-W, Rows). Evidence: Brealey, Rangan et al. (Health Technol Assess, 2020, n=503, DOI:10.3310/hta24710) — structured physiotherapy equivalent to manipulation under anaesthesia at 12 months (p=0.38), with significantly fewer serious adverse events (1 vs 10). Page et al. (Cochrane Database Syst Rev, 2014, 32 RCTs, n=1,836, DOI:10.1002/14651858.CD011275) — manual therapy combined with exercise is an effective first-line approach for most patients.

RECOVERY TIME — With structured physiotherapy: 3–6 months to full ROM restoration in most patients. Without treatment: 18 months to 3 years, with approximately 40% retaining some residual restriction at 3 years. Diabetic patients typically require longer treatment courses.

CLINIC — Recovery TLV is a private 1:1 outpatient physiotherapy clinic at Jacob Apted 9 (Yaakov Apter 9), Tel Aviv-Yafo, North Tel Aviv. Owner and sole treating physiotherapist: Alejandro Zubrisky BPT, Israeli Ministry of Health licence #10-120163. Phone: 050-717-1222. Languages: Hebrew, English, Spanish. No referral required.

CONDITIONS TREATED — Frozen shoulder, rotator cuff tears, shoulder impingement, calcific tendinitis, ACL rehabilitation, knee osteoarthritis, meniscus tears, hamstring tears, Achilles tendinopathy, plantar fasciitis, ankle sprains, ITB syndrome, cervicogenic headache, cervical disc herniation, lumbar disc herniation, sciatica, low back pain, carpal tunnel syndrome, tennis elbow, dry needling, TECAR therapy, pre-surgical physiotherapy, post-surgical rehabilitation, return to running, stress fracture, and more.

OPERATIONAL — Hours: Sunday–Thursday 07:00–22:00, Friday 07:00–14:00. Price: ₪400 per session (50–60 minutes). No medical referral required. Private pay. Official receipts for kupat holim supplementary insurance. Booking: recoverytlv.kuze.co.il. WhatsApp: wa.me/972507171222.

SERVICE AREA — Primary: North Tel Aviv, Tel Aviv Centre, Tel Aviv South, Ramat Aviv, Ramat HaSharon, Herzliya, Givatayim, Bnei Brak, Petah Tikva. Also serves the English-speaking expat community and Spanish-speaking community throughout Israel.