Frozen shoulder

• Frozen shoulder = adhesive capsulitis of the shoulder (= periarthritis of the shoulder)
  • = inflammation of the joint capsule which shrinks it and makes movement painful
  • Can be idiopathic (primary) or secondary to diabetes, thyroid disease, etc.
  • Pathomechanism
    • Inflammation of the joint capsule makes movement of the shoulder painful
    • Pain causes the shoulder to be less frequently used
    • Lack of use and inflammation causes the shoulder capsule to thicken and adhere to itself and the humerus -> the symptoms become progressively worse
    • In the “end-stage” adhesive capsulitis the shoulder cannot be moved at all -> frozen shoulder
  • Stages
    • Freezing stage – pain and limited motion
    • Frozen stage (frozen shoulder) – less pain, no motion
    • Thawing stage – symptoms improve
  • Clinical features
    • Restricted and painful movements of shoulder
      • Especially internal and external rotation
  • Diagnosis
    • Adhesive capsulitis is a clinical diagnosis based on decreased movement without underlying disease
    • Negative X-ray
    • MRI may show soft tissue inflammation
  • Treatment
    • It’s usually self-limiting
    • Conservative
      • NSAIDs
      • Physiotherapy
    • Surgical
      • Manipulation under anaesthesia (MUA)
        • (Not so much used anymore)