clinical features

Last reviewed 01/2018

Frozen shoulder classically occurs in patients between 40 to 60 years of age, often, but not necessarily, following minor injury. Patients with this condition characteristically have

• severe painful restriction of passive and active shoulder movements, especially of external rotation of the shoulder joint.

Three overlapping phases in the history have been described:

• painful freezing phase:
• duration 10-36 weeks
• characterized by pain in the shoulder at rest and with movement
• pain is worst at night and the patient is unable to sleep on the affected side causing difficulty sleeping
• aching in the shoulder and arm becomes progressively painful with restriction of movement in all directions
• restrictions in external rotation occur first followed by internal rotation and abduction
• adhesive phase (frozen phase):
• after several months (occurs at 4-12 months), the pain begins to subside but the shoulder stiffness remains
• pain is apparent only at the extremes of movement
• gross reduction of glenohumeral movements, with near total obliteration of external rotation
• difficulty in daily activities e.g. -  brushing hair or difficulty in reaching for something in the cupboard
• recovery phase (thawing phase):
  • over a further period of 12-42 months there is a gradual, although possibly incomplete, return of shoulder movement (1,2)

The affected shoulder usually shows slight muscle wasting and often, some tenderness.

Mean duration from onset of frozen shoulder to the greatest resolution is over 30 months.

Note:

• patient may demonstrate “pain-predominant” or “stiffness-predominant” frozen shoulder (3)

Reference:

• (1) Dias R et al. Frozen shoulder. BMJ 2005; 331:1453-1456
• (2) van de Laar SM, van der Zwaal P. Management of frozen shoulder Orthopedic Research and Reviews 2014;6:81-90   
• (2) Rangan A, Hanchard N, McDaid C. What is the most effective treatment for frozen shoulder? BMJ. 2016;354:i4162