Frozen Shoulder (adhesive capsulitis)

What is it?
- Painful stiffening of the shoulder of unknown aetiology
Who gets it?
- It is more common in middle aged women
- Diabetics are at an increased risk
Symptoms
- There may not be a trigger or a minor incident as the trigger
- 4 stages
  - Initial - pain and no stiffness - unable to diagnose
  - Freezing – very painful and starting to stiffen
  - Frozen – dull ache and very stiff
  - Thawing stage – resolving
Signs
- Dependent upon the stage
- Freezing
  - Often full range which is very painful
  - Cuff and impingement tests painful
- Frozen
  - Global restriction of range with some pain
  - Cuff and impingement tests have mild pain
- Thawing
  - Resolving
Investigations
- It is a clinical diagnosis of a painful and stiff (all directions) shoulder that is not due to Osteoarthritis
- Investigations are aimed at co-existant problems
  - XR – rule out osteoarthritis
  - US or MRI – for e.g. rotator cuff or bursal problems
Treatment
- The body can resolve this condition by itself
- Analgesics - especially in the early stage
- Physiotherapy in the first stage may be very painful
- Corticosteroid injections
- Hydrodilation
- Surgery
Prognosis
- Unfortunately each stage may be prolonged possibly 3-9 months
- After 2-3 years a majority of people are functionally normal (that means there is a slight restriction of motion that does not affect their lifestyle)

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