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Frozen Shoulder (adhesive capsulitis)

  • What is it?
    • Painful stiffening of the shoulder of unknown aetiology
  • Who gets it?
    • It is more common in middle aged women
    • Diabetics are at an increased risk
  • Symptoms
    • There may not be a trigger or a minor incident as the trigger
    • 4 stages
      • Initial - pain and no stiffness - unable to diagnose
      • Freezing – very painful and starting to stiffen
      • Frozen – dull ache and very stiff
      • Thawing stage – resolving
  • Signs
    • Dependent upon the stage
    • Freezing
      • Often full range which is very painful
      • Cuff and impingement tests painful
    • Frozen
      • Global restriction of range with some pain
      • Cuff and impingement tests have mild pain
    • Thawing
      • Resolving
  • Investigations
    • It is a clinical diagnosis of a painful and stiff (all directions) shoulder that is not due to Osteoarthritis
    • Investigations are aimed at co-existant problems
      • XR – rule out osteoarthritis
      • US or MRI – for e.g. rotator cuff or bursal problems
  • Treatment
    • The body can resolve this condition by itself
    • Analgesics - especially in the early stage
    • Physiotherapy in the first stage may be very painful
    • Corticosteroid injections
    • Hydrodilation
    • Surgery
  • Prognosis
    • Unfortunately each stage may be prolonged possibly 3-9 months
    • After 2-3 years a majority of people are functionally normal (that means there is a slight restriction of motion that does not affect their lifestyle)


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