Frozen Shoulder

Adhesive capsulitis (frozen shoulder):

  • Common condition affecting 3 – 5% of the general population and 20% of the diabetic population.
  • Often described as self-limiting; the majority of which resolve in 1-3 years although some patients will experience longer term movement deficit which lasts up to 10 years.
  • A typical patient  would be  female in her 5th to 7th decade of life 
  • Rarely occurs simultaneously bilaterally although it can occur sequentially bilaterally.
  • Normally classified as either primary: insidious onset of pain and progressive loss of movement at the shoulder or secondary; generally due to some form of trauma or subsequent immobilisation.

There are three distinct clinical phases:

  • Freezing/painful stage; pain, worse at night decrease active and passive movement. Generally lasts for 3 – 9 months and is characterized by an acute synovitis of the glenohumeral joint
  • The frozen/transitional stage. There is little change to the level of pain during this stage but range of movement loss can progress further. Lasts 4 – 12 months. A capsular pattern is therefore evident with most loss of external rotation followed by flexion/abduction and then internal rotation
  • Thawing stage; starts when range of movement at the joint begins to improve. Generally lasts 12 – 42 months

 

Frozen Shoulder

Pathology and pathogenesis of primary frozen shoulder

 

Subjective History:

  • The patient will present with insidious onset of shoulder and upper arm pain which may progress down the arm coupled with gradually reducing range of movement.
  • Occasionally the patient may present with the onset of the above symptoms following trauma
  • Pain is often worse at night time.

Objective Examination:

  • On examination there will be a marked reduction in passive range of movement of the shoulder joint in a capsular pattern with most loss of external rotation followed by flexion/abduction and then internal rotation
  • Passive abduction of the shoulder will produce early scapular rotation ( typically below 80 degrees abduction)
  • Radiograph will be clear and help rule out differential diagnosis of pathologies which would produce a capsular pattern at the shoulder such as osteoarthritis.

Treatment:

Conservative – Refer to physiotherapy for:

  • Manual therapy in some incidences
  • Active assisted range of movement exercises

Non-operative:

  • Intra-articular corticosteroid injections
  • Capsular distension injections (Hydrodilitation +/- corticosteroid)

Operative:

  • Manipulation under anaesthetic
  • Arthroscopic capsular release

 

References

  • Image from OpenI – Licensed by CC

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