Frozen Shoulder: An Introduction

Frozen shoulder or Periarthritis of shoulder or Adhesive capsulitis is one of the most commonly seen cases, presenting with remitting shoulder pain and stiffness.

Codman in 1934 described some classic diagnostic criteria of this condition

• Global restriction of shoulder movement
• Idiopathic etiology
• Usually painful at onset
• Normal X-ray
• Limited external rotation and abduction

CLASSIFICATION

PRIMARY/IDIOPATHIC FROZEN SHOULDER:  is a distinctive pathological condition in which there is global restriction of shoulder range due to loss of compliance or elasticity of the capsule. Usually the age group affected is 40-50 years of age with or without history of diabetes mellitus.

SECONDARY FROZEN SHOULDER: is typically present after an injury or surgery, usually associated with conditions like shoulder impingement or rotator cuff tear.

NATURAL HISTORY

The frozen shoulder history typically passes through three stages:

FREEZING PHASE (0-3 months) this is associated with pain and loss of range of motion.

FROZEN PHASE(3-9 months) with pain relatively eases but there is extreme loss of range of motion and marked stiffness.

THAWING PHASE (9-18 months) : usually this stage is painless and stiffness starts to gradually resolve at this stage.

PATHOLOGY

The macroscopic appearance is the thickening of the anterior capsule, particularly the coracohumeral ligament and middle glenohumeral ligament. Contractures of the capsular ligament restricts the movement of glenohumeral joint.

Coracohumeral ligament: external rotation in neutral

Medial glenohumeral ligament: external rotation in midelevation

Anteroinferior glenohumeral ligament: external rotation in abduction

Inferior capsule: abduction in neutral rotation

Posteroinferior capsule: internal rotation

Posterosuperior capsule: internal rotation in abduction

Villonodular synovitis within the rotator interval with thickeneing and contracture of coracohumeral ligament is primary pathology.

SPECIAL TESTS to Diagnose Frozen shoulder

• Hands up. Raise both your hands straight up in the air, like a football referee calling a touchdown.
• Opposite shoulder. Reach across your chest to touch your opposite shoulder.
• Back scratch. Starting with the back of your hand against the small of your back, reach upward to touch your opposite shoulder blade.

TREATMENT OPTIONS

1) Physiotherapy                               

2) Distension injections

3) Locally acting steroid injection

4) Manipulation under anaesthesia

5) Open/ arthroscopic capsular release

Primary idiopathic frozen shoulder is extremely disabling condition, which does pass through a typical 3 stage progression. Early intervention during early phases of the the condition can improve the outcome of the condition.