Frozen shoulder

First introduced by Codman in 1934, the term 'frozen shoulder' describes a glenohumeral disorder characterised by shoulder pain or limitations, or both on active and passive elevation and external rotation (1).

• the condition is also known as adhesive capsulitis
• commonly seen in people who are in their 50s

The pathophysiology of the condition is unknown.

• thought to result from fibrosis and thickening of the joint capsule and adherence to the humeral head
• can occur in one shoulder or both shoulders simultaneously.
  • non-dominant shoulder is slightly more likely to be affected (2)

Frozen shoulder is a self limiting condition

• time from onset to recovery is usually between 12 - 42 months (3)
• nearly all patients recover, but normal range of movement may never return (2)
• long term disability is seen in 15% of the patients (3)

Frozen shoulder can be

• primary or idiopathic
• secondary to another cause
  • most common association is diabetes
    • a patient with diabetes has a lifetime risk of 10%-20% of developing frozen shoulder (1)

A review notes (4):

• diabetes patients are at higher risk of developing frozen shoulder and having bilateral symptoms than the general population
• recovery times are variable
  • can be years, and some patients are left with residual pain or functional impairment
    
    
• physiotherapy is the most commonly used intervention and can be supplemented by intra-articular steroid injections
  
  
• treatments offered in secondary care include joint manipulation under anaesthesia, arthroscopic capsular release, and hydrodilatation
  
  
• the UK FROST trial compared manipulation under anaesthetic, arthroscopic capsular release, and early structured physiotherapy with intra-articular corticosteroid injections, and found that none of the interventions were clinically superior

Reference:

• (1) Uppal HS, Evans JP, Smith C. Frozen shoulder: A systematic review of therapeutic options. World Journal of Orthopedics. 2015;6(2):263-268.
• (2) Dias R et al. Frozen shoulder. BMJ 2005; 331:1453-1456.
• (3) van de Laar SM, van der Zwaal P. Management of frozen shoulder Orthopedic Research and Reviews 2014;6:81-90
• (4) Karbowiak M, Holme T, Mirza M, Siddiqui N. Frozen shoulder BMJ 2022; 377 :e068547 doi:10.1136/bmj-2021-068547.