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Frozen Shoulder

Frozen shoulder is a common disorder of diminished shoulder motion which can be erroneously attributed to workplace causes.  It is a condition of uncertain etiology, characterized by restriction in both active and passive range of motion of the shoulder joint.  It can occur in the absence of any abnormality of the shoulder joint itself.

The cause of frozen shoulder is unknown, however several etiologies have been theorized including both an immunological basis and suprascapular nerve compression - neither of which has been proven.

The reported cumulative risk of one episode of frozen shoulder is thought to be approximately 2%.  It is more frequent in females, more common between the ages of 40 and 60 and involves the left more than the right arm.

Persons who suffer from diabetes manifest a much greater incidence of frozen shoulder than non-diabetics (up to 11%).

Trivial trauma has been postulated as being an important factor in the evolution of frozen shoulder, especially if such trauma is followed by a period of immobilization.  In  many cases, this does appears to be the sequence of events.  However, the majority of people who sustain minor trauma to the shoulder do not develop the condition.

Frozen shoulder is believed to result from a combination of host factors (predisposition) as well as extrinsic factors such as hormonal changes, collagen vascular diseases, cervical radiculopathy and cardiopulmonary conditions in addition to diabetes and trauma.

Clinical Presentation

History reveals an insidious onset with either no or minimal trauma.  There is a gradual loss of function associated with vague discomfort in the region of the shoulder joint.  This discomfort usually increases at night, interfering with sleep and is coincident with restriction of overhead and behind-the-back activities.

There is limitation of both active and passive range of motion.  Early scapulo-thoracic motion with a firm end point of shoulder joint range is present.

The condition is thought to consist of three phases:  i) pain, ii) stiffness, and iii) restoration of range of motion.  The painful phase usually lasts two to nine months, followed by loss of motion, which, in turn, is followed by gradual improvement. 

Frozen shoulder is classically a self-limited disorder with a duration of 18 to 24 months.

The goal of treatment is to relieve pain while at the same time restoring the range of motion.  Physical treatment modalities may influence the duration of symptoms and limited movement.  Analgesic, anti-inflammatory agents and injections may be utilized.

Manipulation under anaesthetic is sometimes considered for patients who have not improved despite compliance and a well-supervised ongoing rehabilitation program.

References

American Academy of Orthopaedic Surgery:  The Shoulder - A Balance of Mobility and Stability, 1992

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