Frozen Shoulder

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  • Anatomy
• Frozen shoulder is also called adhesive capsulitis
• Frozen shoulder is a relatively common cause of shoulder pain and stiffness
• The loss of range of motion and function in the shoulder joint can significantly impair activities
• Frozen shoulder most commonly affects people in middle age
• Diabetes is a key risk factor for adhesive capsulitis
• Types of adhesive capsulitis

  • Primary
  • Secondary
• Pathophysiology of adhesive capsulitis


  Inflammation and fibrosis in the joint capsule lead to adhesions (scar tissue) which bind the capsule and cause it to tighten around the joint, restricting movement
• Typical course of symptoms in frozen shoulder

  1. Painful phase - shoulder pain is often the first symptom and may be worse at night

  2. Stiff phase - shoulder stiffness develops and affects both active and passive movement (external rotation is the most affected) - the pain settles during this phase

  3. Thawing phase - there is a gradual improvement in stiffness and a return to normal
• The entire illness of frozen shoulder lasts 1 – 3 years before resolving, with up to 50% of patients having persistent symptoms
• Differential Diagnosis for shoulder pain not preceded by trauma or acute injury

  • Supraspinatus tendinopathy
  • Acromioclavicular joint arthritis
  • Glenohumeral joint arthritis
• Main differentials in a patient presenting with shoulder pain not preceded by trauma or an acute injury

  • Supraspinatus tendinopathy
  • Acromioclavicular joint arthritis
  • Glenohumeral joint arthritis
• Rare but important differentials to keep in mind

  • Septic arthritis
  • Inflammatory arthritis
  • Malignancy (e.g., osteosarcoma or bony metastasis)
• Shoulder pain preceded by trauma or an acute injury may be due to

  • Shoulder dislocation
  • Fractures (e.g., proximal humerus, clavicle or rarely the scapula)
  • Rotator cuff tear
  • Supraspinatus tendinopathy
• Supraspinatus tendinopathy

  Involves inflammation and irritation of the supraspinatus tendon, particularly due to impingement at the point where it passes between the humeral head and the acromion
• Empty can test (AKA Jobe test)

  The patient abducts the shoulder to 90 degrees and fully internally rotates the arm as though they are emptying a can of water. The examiner pushes down on the arm while the patient resists. The test is positive if there is pain or the arm gives way
• Acromioclavicular (AC) joint arthritis


  Can be demonstrated on examination by tenderness to palpation of the AC joint, pain worse at the extremes of shoulder abduction, and positive scarf test
• Last updated

  August 2021