Clinical Notes : Orthopedics and Trauma

72. Frozen Shoulder

Frozen Shoulder

Etiology

Diagnosis

Management

- References -

- CPD Quiz -

If the presenting shoulder pain is not referred from the neck then consider :

​

1. Frozen shoulder

2. Acromioclavicular joint pain

   • AC disruption

   • AC osteoarthritis

3. Rotator cuff pain

   • Impingement

   • Tear

   • Calcific tendonitis

4. Shoulder instability

   • SLAP tear

   • Dislocation

5. Glenohumeral arthritis

Video : True shoulder pain vs referred neck pain (5:01)

Shoulder pain mapping :

Urgent referral if shoulder pain in the presence of :

• History of trauma with acute pain & weakness

  • AC joint tear or displacement

  • Rotator cuff tear

• History of trauma or epileptic fit leading to loss of rotation

  • SLAP tear

• History of instability or subluxation

  • Dislocation

• Mass/swelling/erythema

  • Infective process

Video : Complete shoulder examination for the GP (3:39)

Rotator Cuff and Shoulder Conditioning Program

AAOS : American Academy of Orthopedic Surgeons

Selected stretching and strengthening exercises, adaptable for individualised management and rehabilitation after shoulder injury or surgery.

Frozen Shoulder

In frozen shoulder (adhesive capsulitis)  the capsule of the shoulder joint becomes inflamed, thickened and scarred, causing pain and stiffness of the shoulder.

• occurs in about 2-5% of the population

• most commonly in those aged 40 to 60 years old

• more often in postmenopausal women

Etiology

• often unidentifiable

• after injury

• after surgery

• after prolonged immobility

• more common in diabetes and hyperthyroidism

Diagnosis :

There are usually three phases of a frozen shoulder:

• Freezing:

  • This phase lasts for between 6 weeks to several months.

  • The shoulder also gradually gets very stiff and loses most of its range of motion

  • Pain

    • gradual onset that becomes progressively worse

    • usually aching in nature and felt over the back and outer shoulder area and down the arm.

    • aggravated by trying to move the shoulder

    • can be extremely severe and cause sleepless nights.

• Frozen:

  • This phase lasts for approximately 6 months.

  • Pain itself may get better but the stiffness remains.

• Thawing:

  • The stiffness slowly improves.

  • Complete recovery back to normal, or near normal strength and range of motion takes up to a further 2 years.

Xray to exclude arthritis

MRI to demonstrate fluid or synovitis

Video : Frozen shoulder examination (1:26)

Management :

Although frozen shoulder usually gets better by itself over the course of 3 years, the symptoms are often severe enough to require treatment.

The main aim of treatment is to relieve the pain and maintain and restore the range of motion

• Non-surgical

  • NSAIDs

  • stretching excercises

  • physio, including Transcutaneous Electrical Nerve Stimulation (TENS)

  • steroid injection

• Surgical

  • Capsule stretching under anaesthesia

  • arthroscopic release

Video : Frozen shoulder stretch excercises (4:08)

The pathology of frozen shoulder.

Hand GC, Athanasou NA, Matthews T, Carr AJ. J Bone Joint Surg Br. 2007;89:928–932

Access

Adhesive capsulitis: a review of current treatment.

Neviaser AS, Hannafin JA: Am J Sports Med, 2010, 38: 2346–2356.

Access

Frozen shoulder—a stiff problem that requires a flexible approach.

Guyver PM, Bruce DJ, Rees JL: Maturitas, 2014,78: 11–16

Access

The natural history of idiopathic frozen shoulder: a 2- to 27-year followup study.

Vastamäki H, Kettunen J, Vastamäki M: Clin Orthop Relat Res, 2012, 470: 1133–1143

Access

Effectiveness of sustained stretching of the inferior capsule in the management of a frozen shoulder.

Paul A, Rajkumar JS, Peter S, et al. : Clin Orthop Relat Res, 2014, 472: 2262–2268.

Access

CPD Quiz and Certificate

This activity attracts 1,0 CPD point