Clinical Presentation of Frozen Shoulder

• Frozen Shoulder Clinical Presentation:

  • History:
  • gradual onset of shoulder pain and stiffness
  • pain at rest and at night, with sleep disturbances
  • reduced range of motion and functional ability
  • possible history of trauma (e.g. rotator cuff injury or more commonly a fracture), but often idiopathic (came out of nowhere)
  • may have history of diabetes, thyroid disease or other systemic conditions
  • less commonly, may report history of inflammatory arthropathy - complains of aches and pains at other joints, tenderness and pain at insertion of larger tendons such as Achilles tendon
• Frozen Shoulder Clinical Presentation:

  • History can determine what stage of frozen shoulder pts are in - freezing, frozen or thawing
  • if its in the early stages they will have more important pain, including night pain
  • increased loss of functional range of motion
• Frozen Shoulder Clinical Presentation:

  • subjective:
  • pain and stiffness in the shoulder, especially with movement
  • reduced ability to perform daily activities e.g. dressing, grooming and reaching
  • possible radiation of pain to arm or neck
  • difficulty sleeping due to pain
• Frozen Shoulder Clinical Presentation:

  • objective:
  • reduced range of motion in the shoulder, especially in external rotation and abduction
  • scapular winging or substitution with shoulder movement
  • possible muscle guarding or spasm
  • tenderness to palpation over the shoulder joint
  • reduced strength and function in the shoulder and arm
  • along with active ROM, passive ROM is also limited
  • quality of movement is poor even with accessory movement
• Frozen Shoulder Clinical Presentation:

  • investigations:
  • xrays may be normal or show osteopenia, but are not diagnostic
  • MRI may show thickening of joint capsule, especially in inferior recess
  • arthrography may show reduced joint volume and capsular thickening
  • no specific lab tests are diagnostic, but may be used to rule out other conditions
• Frozen Shoulder - Indications for surgery:

  • pts fail trail of prednisone or NSAIDs (medication isnt helping)
  • no response to glenohumeral or subacromial injections
  • no response to physiotherapy/conservative treatments
• Frozen Shoulder - Contraindications for surgery:

  • pt had inadequate course of steroids or NSAIDs
  • pt had no attempt at conservative therapy
  • theres an acute infection
  • pt has a concomitant malignancy in the shoulder
  • pt has a neurological deficit or nerve complaint originating from the cervical spine
• Frozen Shoulder - Possible Complications:

  • residual shoulder pain and/or stiffness - possible they never get full range back
  • humeral fracture
  • rupture of biceps and subscapularis tendons - quality of tissues changed during frozen shoulder
  • labral tears
  • glenohumeral joint dislocation
  • rotator cuff tear