Frozen Shoulder (adhesive capsulitis)

• What is it?
  • Painful stiffening of the shoulder of unknown aetiology
• Who gets it?
  • It is more common in middle aged women
  • Diabetics are at an increased risk
• Symptoms
  • There may not be a trigger or a minor incident as the trigger
  • 4 stages
    • Initial – pain and no stiffness – unable to diagnose
    • Freezing – very painful and starting to stiffen
    • Frozen – dull ache and very stiff
    • Thawing stage – resolving
• Signs
  • Dependent upon the stage
  • Freezing
    • Often full range which is very painful
    • Cuff and impingement tests painful
  • Frozen
    • Global restriction of range with some pain
    • Cuff and impingement tests have mild pain
  • Thawing
    • Resolving
• Investigations
  • It is a clinical diagnosis of a painful and stiff (all directions) shoulder that is not due to Osteoarthritis
  • Investigations are aimed at co-existant problems
    • XR – rule out osteoarthritis
    • US or MRI – for e.g. rotator cuff or bursal problems. You can see thickening of the capsule and thickening of coracohumeral ligaments
    • There are suprascapular nerve blocks and some have tried Platelet Rich Plasma injections
• Treatment
  • The body can resolve this condition by itself
  • Analgesics – especially in the early stage
  • Physiotherapy in the first stage may be very painful
  • Corticosteroid injections
  • Hydrodilation
  • Surgery
• Prognosis
  • Unfortunately each stage may be prolonged possibly 3-9 months
  • After 2-3 years a majority of people are functionally normal (that means there is a slight restriction of motion that does not affect their lifestyle)