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Frozen shoulder is a term used to describe a number of different conditions that all result in a shoulder that cannot move as much as it normally would. This loss of movement is because the shoulder is physically “stuck” (stiff). Frozen shoulder is distinct from conditions where the loss of movement is due to weakness or pain alone (e.g. asymptomatic rotator cuff tear).
Shoulder stiffness can occur after an injury such as proximal humerus fracture or after shoulder surgery. These cases usually improve with physiotherapy exercises.
The classic form of frozen shoulder (adhesive capsulitis) does not have a clear cause. The condition usually starts out with a period of pain in the shoulder that then gives way to marked stiffness. The shoulder is usually not sore at rest but sudden movements can be extremely painful. Over many months the condition eventually settles of its own accord, although the shoulder may still have slightly reduced motion compared to normal. The entire process can take 18 months to 2 years to run its course. The degree of stiffness is variable between patients. The symptoms are often more significant for a patient with certain medical conditions such as type 1 diabetes or thyroid problems.
Treatment of a stiff shoulder is based around trying to manage the symptoms whilst the condition ultimately resolves itself. Treatment methods include gentle physiotherapy, shoulder hydrodilatation injections and occasionally, surgery to release the tight capsule.
To diagnose a frozen shoulder, it is important to rule out other causes for a stiff shoulder such as shoulder arthritis, fractures and shoulder dislocation.
