Frozen Shoulder

Definition

Frozen shoulder (adhesive capsulitis) is a common condition of painful, progressive restriction of both active and passive movement at the glenohumeral joint, caused by inflammation and fibrosis (contracture) of the joint capsule. It is typically self-limiting but runs a protracted course over months to a couple of years.

Risk Factors & Clinical Stages

It commonly affects people 40–60 years, is associated with diabetes mellitus (an important association), thyroid disease, and periods of shoulder immobilisation. It classically passes through three overlapping phases: a painful ‘freezing’ phase, a stiff ‘frozen’ phase (pain eases but stiffness dominates), and a gradual ‘thawing’ phase of recovering movement.

Management

Management is largely conservative and reassures the patient that most cases resolve. It includes analgesia/NSAIDs, physiotherapy to maintain and restore range, and intra-articular corticosteroid injection (helpful especially in the painful phase). Resistant cases may be treated with hydrodilatation, manipulation under anaesthesia or arthroscopic capsular release. Diabetic control should be optimised.

Investigations & Differential

The diagnosis is clinical. Radiographs are typically normal (helping to exclude osteoarthritis or a locked-in loose body), and are chiefly used to rule out other causes of a stiff, painful shoulder. The main differentials are rotator-cuff disease (passive range is preserved), glenohumeral osteoarthritis and acromioclavicular pathology. In a diabetic patient with global capsular restriction the diagnosis is usually straightforward.

Loss of external rotation, both active and passive, is characteristic.

• Adhesive capsulitis: painful global restriction from capsular inflammation/fibrosis.
• Age 40–60; strong association with diabetes; self-limiting over months–years.
• Phases: freezing (painful) → frozen (stiff) → thawing (recovery).
• Loss of both active & passive movement (esp. External rotation) is the hallmark.
• Conservative: analgesia, physiotherapy, steroid injection; release for resistant cases.