Inflammation and fibrosis of the joint capsule leading to contracture of the shoulder joint
Aetiology
Age 40s-50s
Higher incidence in females
Aetiology unclear - sometimes history of a triggering injury but often there is not, may also occur after shoulder surgery
Association with diabetes, hypercholesterolaemia and endocrine disease and Dupuytren's disease
Pathophysiology
Freezing or painful stage: minimal synovitis with pain, causing a limitation of motion
Frozen or transitional stage: pain decerases but proliferative synovitis with contraction of the capsule and adhesion of the axillary recess increases
Thawing stage: inflammation decreases, movement slowly improves
Clinical presentation
Symptoms
Gradual severe pain
Pain at night
Pain at rest
Anterior pain
Stiffness
Can be bilateral
Self-limiting course - pain subsides after around 2-9 months and stiffness will increase for around 4-12 months
Signs
Global restriction in ROM, especially in external rotation (<50% of normal)
Investigations
Clinical diagnosis
Imaging (x-ray, USS, MRI) may be used to rule out other causes of stiffness and pain
Management
Prognosis
Self limiting - resolves after 18-24 months
Pain will subside and stiffness increases, before stiffness gradually 'thaws' out
Nearly all patients have some residual stiffness and 15% have residual pain
Conservative
Physio and analgesia
Intra-articular (glenohumeral) steriod injections can help in the painful phase
Fluroscopic distension
Surgical
Once the pain has settled, if the patient cannot tolerate functional loss due to stiffness, recovery can be hastened by manipulation under anaesthetic (MUA which tears the capsule) or surgical capsular release (usually done arthroscopically) which divides the capsule leading to improved motion
After capsular release, patient will have a short period in a sling before aggressive physiotherapy
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