Shoulder / Arm

Frozen Shoulder

Definition

Frozen shoulder or capsulitis of the glenohumeral joint is aseptic inflammation of this joint, and is seen very frequently in general practice.

Aetiology

The cause of a frozen shoulder can be traumatic, related to diabetes, or due to a shoulder operation (postoperative capsulitis). However, in a large percentage of patients the aetiology is unknown.

Segmental dysfunction of the cervical spine and cervicothoracic junction can play a role in the clinical picture. Therefore, in addition to the evaluation of shoulder function, it is very important to examine the cervical spine as well.

Signs and symptoms

The natural course of an uncomplicated frozen shoulder is self-limiting, and the majority of patients recover completely.

In the first phase, lasting from two to nine months, pain is the predominant factor, in the second phase, lasting between four and 12 months, motion restriction is more predominant than pain, and in the final phase, lasting between five and 24 months, gradual recovery occurs.

The complaint pattern is characterised by increasing shoulder pain after each time it takes a load. Nocturnal pain and the inability to sleep on the affected shoulder point in the direction of an inflammation.

The location and radiation pattern of the pain can provide information on whether it is caused by a primary pathology of the shoulder, or that it is located outside the shoulder.

In particular, in non-traumatic shoulder pain with an abnormal natural course, other serious diseases, such as generalised joint pain, fever, malaise, weight loss, dyspnoea and angina pectoris, should be explored. Most importantly, a pancoast tumour must be excluded.

Diagnostics

Physical Examination

Examination of a frozen shoulder:

Three groups of shoulder tests are important in examination of the shoulder: 1. active and passive shoulder abduction; 2. active and passive shoulder external rotation; and 3. active and passive horizontal shoulder adduction. Serious shoulder pathology, presenting as brachialgia, can be diagnosed by means of these tests.

In addition, it is important to perform passive shoulder abduction in external rotation. Passive abduction should be performed as often as possible in the frontal plane.

The most characteristic motion restriction in frozen shoulder is serious or absent active and passive external rotation.

 

DISORDER

Passive External Rotation restriction

Active Abduction restriction
in
Neutral Position Arm

Passive Abduction restriction
in
External Rotation Position Arm

Passive Horizontal Abduction restriction

Osteoarthritis Glenohumeral Joint

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Capsulitis Glenohumeral Joint

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Additional Somatic Diagnostics

  • In the initial phase of uncomplicated shoulder complaints, no imaging techniques or laboratory examinations are indicated.
  • When systemic diseases or other serious conditions are suspected in shoulder pain, blood tests are indicated (CRP, Hb, BSE, rheumatoid factors).
  • When shoulder pain persists, X-ray, ultrasound and MRI scan are indicated.
  • A bone scan is indicated when metastases or primary tumours are suspected.

Somatic Treatment

Pharmacological treatment

Other Treatments

Interventional Pain Treatment