Frozen Shoulder (Adhesive Capsulitis)

Question 1

What is the normal clinical presentation of frozen shoulder?

Answer 1

• Gradual onset of pain + stiffness
• Usually idiopathic: most common atraumatic 45-75 years.
• Px reaching up and back i.e. doing up bra (pattern of pain will depend on the stage of the condition)
• negative impingement tests

Question 2

What are the stages of frozen shoulder?

Answer 2

Stage I - pain
Stage II - pain (+ stiffness)
Stage III - stiffness (+ pain)
Stage IV - recovery

Question 3

What is the capsular pattern of frozen shoulder?

Answer 3

• limited abduction, less limited flexion, more limited external rotation.

Question 4

The presence of which full passive movement would exclude frozen shoulder?

Answer 4

• Full PROM external rotation

Question 5

What are the main treatment options for stage I & II frozen shoulder?

Answer 5

• Injection

- Any Px relieving modality; TENS. mobs, NSAID’s, active movements.

Question 6

What are the main treatment options for stage III frozen shoulder?

Answer 6

• Mobs/manips (may give early increase in ROM but can cause short term soreness)

Question 7

Which treatment option is unlikely to effective in stage III?

Answer 7

Injections

Question 8

What treatment options are available for stage IV?

Answer 8

• Mobilisations to improve hand behind back etc.

- Treatment USUALLY unnecessary

Question 9

What is the current thinking/concepts for the treatment of frozen shoulder?

Answer 9

• Vast majority will resolve within 2 years.
• No cliniclal imperative to treat -> decision is up to the patient
• No need for regular robust stretching if pt is going to continue to use shoulder in the same way
• Diabetes, trauma, age and other comorbidities can compound problem.