- 1 Other Names
- 2 Background
- 3 Pathophysiology
- 4 Risk Factors
- 5 Differential Diagnosis
- 6 Clinical Features
- 7 Evaluation
- 8 Classification
- 9 Management
- 10 Rehab and Return to Play
- 11 Complications
- 12 See Also
- 13 References
- Frozen Shoulder
- Idiopathic-type Frozen Shoulder
- This page describes adhesive capsulitis of the Glenohumeral Joint
- Primarily a self-limited clinical diagnosis based upon history and physical exam
- Characterized by pain and functional loss of shoulder range of motion
- First described by Simon-Emmanuel Duplay as ‘scapulohumeral periarthritis’ or ‘Periarthritis’
- The term 'frozen shoulder' came later from Dr Codman in 1934
- 2-5% of general population (need citation)
- 11-20% of those with diabetes mellitus (need citation)
- Pathological process in which the body forms excessive scar tissue or adhesions across the glenohumeral joint, leading to stiffness, pain and dysfunction
- Inflammatory process leading to thickening, fibrosis, and adherence of the capsule to itself and humerus
- Fibroblastic proliferation with abundant type III collagen
- Typically involves non-dominant extremity
- Up to 40-50% of cases are reported to be bilateral
- Primary (or idiopathic)
- Occurs spontaneously without any clear inciting event
- Occurs secondary to some other injury or pathologic process
- Most commonly after a fracture, dislocation, or post-operatively
- Female sex (up to 70% of cases are female)
- Age over 40
- Race: white
- Conditions involving a period of shoulder immobilization (e.g. post-surgical)
- History of trauma
- HLA-B27 Positive
- Dupuytrens Contracture
- Dislocations & Seperations
- Muscle & Tendon Injuries
- Rotator Cuff
- Ligament Injuries
- Onset is most often insidious
- Patients typically report shoulder pain followed by loss of range of motion
- Boyle-Walker et al: 90.6% of patients develop pain before loss of ROM
- Physical: Physical Exam Shoulder
- External rotation is often the first motion most commonly affected
- Pain is worse at extremes of motion when the capsule is under tension
- Firm endpoints in passive ROM suggest mechanical rather than pain-related restriction
- Special Tests
- Standard Radiographs Shoulder
- Generally normal, helpful to exclude other etiologies
- May show 'disuse osteopenia' in prolonged cases
- Not required to make diagnosis
- Thickening of the coracohumeral ligament greater than 2 mm
- ≥4mm (95% specificity, 59% sensitivity)
- Subcoracoid fatty infiltration
- Thickening of the joint capsule in the axillary recess
- ≥7mm (86% specificity, 64% sensitivity)
- Reduced joint volume of 5-8 mL (normal 13-15 mL)
- Thickening of the coracohumeral ligament greater than 2 mm
- Thickening of the joint capsule
- Continuous limitation of the sliding movement of the supraspinatus tendon against the acromion of the scapula
- Sensitivity of 91% and a specificity of 100%
- Per Neviaser and Neviaser
- Stage I (Freezing/ Painful): Gradual onset of diffuse shoulder pain pain (6 wks to 9 mos)
- Worse at night, motion preserved, synovitis on arthroscopy
- Stage II (Frozen/Stiff): Decreased ROM affecting activities of daily living (4 to 9 mos or more)
- Characterized by early adhesion formation, capsular contraction
- Stage III: Global loss of ROM, extreme pain
- Synovitis resolved, axillary fold obliterated
- Stage IV (chronic): persistent stiffness, no pain
- Can see thawing, gradual return of motion (5 to 26 mos)
- Generally considered a self limited disease that self resolves in 1-3 years
- 20-50% of patients develop longer lasting symptoms
- Diabetics have worse functional outcomes compared to non-diabetics
- First line management
- Physical Therapy
- In conjunction with other modalities, PT alone is not well supported in the literature
- Need to get past the painful phase of capsulitis (i.e. phase II) to actively participate in PT
- Can be combined with can Therapeutic Ultrasound, Transcutaneous Electrical Nerve Stimulation, short-wave therapy, Low Level Laser Treatment and hydrotherapy
- Corticosteroid Injection
- Hyaluronic Acid
- Suprascapular Nerve Block (SSNB)
- Whole Body Cryotherapy
- Improved VAS, active ROM when combined with physical therapy when compared to physical therapy alone
- Botulinum Toxin Injection
- No difference in pain, range of motion compared to triamcinolone but may be an option for those where steroids are contraindicated
- Refractory to conservative treatment
- Manipulation under anesthesia (MUA)
- Arthroscopic capsulotomy
- Open capsulotomy
Rehab and Return to Play
- Needs to be updated
Return to Play
- Needs to be updated
- Residual Stiffness
- Chronic pain
- Shoulder Pain (Main)
- Elbow Pain (Main)
- Neck Pain (Main)
- Shoulder Anatomy (Main)
- Physical Exam Shoulder
- D’Orsi GM, Via AG, Frizziero A, et al. Treatment of adhesive capsulitis: a review. Muscles Ligaments Tendons J 2012; 2: 70–78.
- Neviaser AS and Neviaser RJ. Adhesive capsulitis of the shoulder. J Am Acad Orthop Surg 2011; 19: 536–542.
- Manske RC and Prohaska D. Diagnosis and management of adhesive capsulitis. Curr Rev Musculoskelet Med 2008; 1: 180–189.
- Sheridan MA and Hannafin JA. Upper extremity: emphasis on frozen shoulder. Orthop Clin North Am 2006; 37: 531–539.
- Boyle-Walker KL, Gabard DL, Bietsch E, et al. A profile of patients with adhesive capsulitis. J Hand Ther 1997; 10: 222–228.
- Mengiardi B, Pfirrmann CW, Gerber C, et al. Frozen shoulder: MR arthrographic findings. Radiology 2004; 233: 486–492.
- Ryu KN, Lee SW, Rhee YG, et al. Adhesive capsulitis of the shoulder joint: usefulness of dynamic sonography. J Ultrasound Med 1993; 12: 445–449.
- Neviaser RJ and Neviaser TJ. The frozen shoulder: diagnosis and management. Clin Orthop Relat Res 1987; 223: 59–64.
- Binder AI, Bulgen DY, Hazleman BL, et al. Frozen shoulder: a long-term prospective study. Ann Rheum Dis 1984; 43: 361–364.
- Griggs SM, Ahn A and Green A. Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment. J Bone Joint Surg Am 2000; 82: 1398–1407.
- Green S, Buchbinder R and Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev 2003; 2: CD004258.
- Rhind V, Downie WW, Bird HA, et al. Naproxen and indomethacin in periarthritis of the shoulder. Rheumatol Rehabil 1982; 21: 51–53.
- Buchbinder R, Hoving JL, Green S, et al. Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial. Ann Rheum Dis 2004; 63: 1460–1469.
- Widiastuti-Samekto M and Sianturi GP. Frozen shoulder syndrome: comparison of oral route corticosteroid and intraarticular corticosteroid injection. Med J Malaysia 2004; 59: 312–316.
- Ryans I, Montgomery A, Galway R, et al. A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis. Rheumatology 2005; 44: 529–535.
- Harris JD, Griesser MJ, Copelan A, et al. Treatment of adhesive capsulitis with intra-articular hyaluronate: a systematic review. Int J Shoulder Surg 2011; 5: 31–37.
- Rovetta G and Monteforte P. Intraarticular injection of sodium hyaluronate plus steroid versus steroid in adhesive capsulitis of the shoulder. Int J Tissue React 1998; 20: 125–130.
- Ozkan K, Ozcekic AN, Sarar S, et al. Suprascapular nerve block for the treatment of frozen shoulder. Saudi J Anaesth 2012; 6: 52–55.
- Dahan TH, Fortin L, Pelletier M, et al. Double blind randomized clinical trial examining the efficacy of bupivacaine suprascapular nerve blocks in frozen shoulder. J Rheumatol 2000; 27: 1464–1469.
- Jones DS and Chattopadhyay C. Suprascapular nerve block for the treatment of frozen shoulder in primary care: a randomized trial. Br J Gen Pract 1999; 49: 39–41.
- Quraishi NA, Johnston P, Bayer J, et al. Thawing the frozen shoulder: a randomised trial comparing manipulation under anaesthesia with hydrodilatation. J Bone Joint Surg Br 2007; 89: 1197–1200.
- Buchbinder R, Green S, Youd JM, et al. Arthrographic distension for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev 2008; 1: CD007005.
- Ma SY, Je HD, Jeong JH, et al. Effects of whole-body cryotherapy in the management of adhesive capsulitis of the shoulder. Arch Phys Med Rehabil 2013; 94: 9–16.
- Joo YJ, Yoon SJ, Kim CW, et al. A comparison of the short-term effects of a botulinum toxin type a and triamcinolone acetate injection on adhesive capsulitis of the shoulder. Ann Rehabil Med 2013; 37: 208–214.