What is a frozen shoulder?
Also called adhesive capsulitis or pericapsulitis, frozen shoulder can occur after any cause of shoulder pain that leads an affected individual to limit the motion of the shoulder because of pain. Patients with diabetes are particularly prone to develop this condition. With little movement, the shoulder joint capsule and surrounding structures contract, making the range of motion physically restricted in addition to being painful. Examination reveals at least 50% reduction in both active and passive range of motion. Arthrography shows decreased volume of the joint capsule. It is rarely seen before age 40 years. The process typically has three phases:
- • Phase I: increasing pain and stiffness for 2 to 9 months
- • Phase II: substantial stiffness but less pain for 4 to 12 months
- • Phase III: pain resolves and function is gradually restored over 5 to 26 months.
While many patients experience improvement in pain and function over time, complete symptom resolution is uncommon. Options for short-term management are limited by poor data on efficacy. NSAIDs and analgesics are reasonable options for control of pain and may be coupled with gentle range of motion exercises at home (with clear instructions to only engage in exercises within the limits of pain). Other modalities with unclear efficacy include corticosteroid injection, supervised physical therapy, and surgical intervention.