What is Frozen Shoulder?

Frozen shoulder is a common, but ill-understood disorder. It affects
the glenohumeral joint, possibly involving a non-specific chronic inflammatory
reaction, mainly of the subsynovial tissue, resulting in capsular
and synovial thickening. It has a number of medical synonyms including
scapulo-humeral periarthritis, adhesive capsulitis, periarthritis, pericapsulitis,
stiff shoulder, and obliterative bursitis. In traditional Chinese
medicine (TCM), it is termed ‘shoulder at the age of 50 years’.
Frozen shoulder is used to denote a limitation of shoulder motion,
without abnormalities of the joint surface, fracture, or dislocation. The
onset of frozen shoulder is usually gradual and idiopathic, but it may be
acute and associated with a previous history of minor injury to the shoulder
joint. The disease occurs mainly in middle-aged individuals and is usually
self-limiting, but the duration and severity may vary greatly.



Most patients recover within 2 years of the onset, although
for some symptoms may last longer. The clinical
picture of frozen shoulder is characterised by pain and
restriction of the range of active and passive motion of
the shoulder. Pain, which can be severe, may cause
pronounced sleep disturbance. Restriction of the range
of motion is usually more marked with external
rotation, but less prominent with abduction and
internal rotation.

Information on the conventional treatment and prognosis of
frozen shoulder is inadequate and based largely on
individual practice experience rather than randomised
controlled clinical trials. There is as yet no definitive
agreement on the most effective form of treatment.
Initial treatment is aimed at reducing inflammation and
increasing the range of movement. Thus analgesic and
anti-inflammatory drugs are commonly used. Most
types of treatment focus primarily on restoration of
mobility. Although physical therapies such as massage,
heat application, ultrasound, interferential treatment,
osteopathic and chiropractic techniques, and
stretching and isometric exercise therapy are routinely
prescribed, the efficacy is variable. Controversial
results are reported with manipulation under anaesthesia,
distension arthrography, and arthroscopic
surgery. In osteoporotic or postsurgical frozen
shoulder, an open release with lysis of adhesions and
capsule release is recommended. Intra-articular
corticosteroid injection, and suprascapular nerve
block have also been strongly advocated. Metaanalysis
of randomised controlled trials evaluating
interventions for painful shoulder from 1966 to 1995,
however, failed to find evidence to support or refute
the efficacy of these interventions.