Frizen shoulder
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"frozen shoulder" OR "adhesive capsulitis"
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Here is a complete overview of Frozen Shoulder (Adhesive Capsulitis):
Definition
Frozen shoulder is an idiopathic condition causing progressive pain and stiffness of the glenohumeral joint due to fibrotic thickening and contracture of the joint capsule. It most commonly affects females in their fifties.
Risk Factors / Associations
- Female sex, middle age (40s-60s)
- Diabetes mellitus (also prolongs course significantly)
- Heart disease
- Thyroid disease
- Prior shoulder surgery or painful shoulder conditions
- Minor trauma (sometimes recalled, but of uncertain relevance)
Clinical Features
- Onset: Often spontaneous; patient may recall minor trauma
- Pain: Severe, initially dominant; often worse at night
- Stiffness: Global loss of both active and passive shoulder movement
- Pathognomonic sign: Loss of active external rotation
- Radiographs are normal (helps distinguish from osteoarthritis)
Clinical Course - Three Phases
| Phase | Features | Duration |
|---|---|---|
| Freezing (Painful) | Severe, progressive pain; movement restricted by pain | Weeks to months |
| Frozen (Stiffening) | Pain subsides somewhat; stiffness predominates | Months |
| Thawing | Gradual return of motion | Months to years |
Total course: 1-2 years, often considerably longer in diabetics.
Differential Diagnosis
- Calcific tendinitis
- Rotator cuff tear
- Osteoarthritis (X-ray distinguishes this)
- Infection
- Fracture
Treatment
Phase 1 (Painful/Freezing):
- Analgesia and NSAIDs
- Corticosteroid injection (subacromial or glenohumeral)
- Encourage active and passive movement despite pain
Phase 2 (Frozen/Stiffening):
- Corticosteroid injections (more commonly used here)
- Distension injection (hydrodilatation): 20-30 mL of local anaesthetic +/- saline injected into the joint to stretch the capsule; facilitates physiotherapy
Physiotherapy:
- Active and passive range-of-motion exercises throughout all phases
- Muscle energy techniques and joint mobilisation (shown effective in recent systematic review, PMID 39420459)
Operative (for prolonged/refractory stiffness):
- Manipulation under anaesthesia (MUA)
- Arthroscopic capsular release - usually produces reliable pain relief and motion improvement
Prognosis
- If untreated, spontaneous resolution occurs in the majority
- Most patients are left with no significant functional deficit
- Diabetes markedly prolongs the course
Recent Evidence
A 2024 network meta-analysis (PMID 38538951) assessed pharmacological interventions for early-stage frozen shoulder, providing updated guidance on which injections and oral agents are most effective. A 2024 systematic review (PMID 39420459) confirmed that muscle energy techniques and joint mobilisation significantly improve range of motion, pain, and function.
Source: Bailey and Love's Short Practice of Surgery, 28th Edition, p. 552
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