Frozen Shoulder

What is it? Frozen shoulder (FS) is a fibrous contracture of the coracohumeral ligament and rotator interval coming on insidiously, or after minor trauma, and resulting in a global loss of active and passive movement especially in external rotation – and in the presence of a normal x-ray!

Statistics: Frozen shoulder is a painful, debilitating disorder reportedly affecting 2–5% of the general adult population (Lundberg, 1969) and 10–20% of people with diabetes (Miller et al., 1996).

This shoulder joint disorder affects roughly two-percent of the population and up to 20-percent of diabetics.

Important Facts: Primary frozen shoulder is classically described as having three stages, with stage I involving pain, stage II pain and restricted movement, and finally stage III, involving painless restriction (Reeves, 1975).

Left to its own devices the shoulder will start to thaw and slowly a near normal shoulder will come back.

Sadly FS is misdiagnosed some three times out of four. This is a particular error in the older age-group where I regularly find patients in their 70’s and older told they have FS when a simple x-ray would have revealed that they have osteoarthritis or shoulder joint disease and really could do with a shoulder replacement. If you see a 70 year old with a stiff painful hip or knee, you would automatically and usually correctly, think arthritis. It is a myth to think that OA of the shoulder is rare.

Frozen shoulder (FS) is a fibrous contracture of the coracohumeral ligament and rotator interval coming on insidiously, or after minor trauma, and resulting in a global loss of active and passive movement especially in external rotation – and in the presence of a normal x-ray!

Treatment Duration: Most cases resolve over the course of 18–30 months. However, a minority of patients have a protracted course with ongoing restriction.

Do’s/Don’ts: It was only later when I read Doctor Cameron’s book that I discovered that exercises too early in the frozen shoulder situation can actually aggravate things. It seems that the best time to do exercises is near to the end of the business – when the frozen shoulder is in its thawing out stage. Of course, there was no way for me to know that so I just assumed that I must be making a meal of it and tried to just plod on as normal.

Once the diagnosis has been made – restricted passive external rotation and a normal x-ray – I offer my patients two alternatives: they can sit it out in the knowledge that it will all get better eventually or I can accelerate their recovery by doing an arthroscopic capsular release.

Common Myths: In the early stages FS and tendonitis can be indistinguishable. If the examining physician doesn’t actually try and move the arm themselves then they could believe that the shoulder doesn’t move but that is only because the patient doesn’t want to lift it any higher. Then a diagnosis of FS is made, a steroid injection is given and the symptoms all go away. Thus steroid injections cure FS!