Frozen shoulder

This is a common condition referring specifically to loss of global range of movement of the shoulder. It is also called “adhesive capsulitis”.

This condition presents with pain and stiffness in the shoulder. As these are common presentations of various shoulder pathologies, frozen shoulder is often mistakenly diagnosed.

The pathology of this is not yet completely understood, but it involves inflammation of the capsule (covering of the joint) which leads to contractures in the ligaments (thickenings within the capsule) and lack in movement.

Frozen shoulder can be idiopathic (unknown cause), associated with diabetes or secondary to other shoulder conditions, such as trauma or surgery. Diabetic frozen shoulder tends to be highly resistant to treatment. Once a patient has frozen shoulder on one side, there is an increased chance of it developing on the other side.

The natural progression will be in 3 stages. At first, the patient will suffer from intractable pain. The next step is the frozen stage where the pain eases off and the stiffness becomes the main problem. Finally the stiffness decreases and there is a gradual increase in movement. The average time period for this whole process is about 18 months.

The diagnosis is usually clinical. Investigations are carried out to rule out other pathologies. However, an MRI scan can show glenohumeral joint effusion and thickening of ligaments.

Treatment of the first stage is targeted at pain relief. Oral analgesia is recommended but intra-articular injection can be considered. Surgery can be considered for the second stage. Once in the third stage then treatment is usually in the form of physiotherapy.