Frozen Shoulder Review
Frozen shoulder is a subject of considerable uncertainty in both scientific literature and clinical pratice. Codman in 1934 and then Bunker in 2009 updated the definition:
'This is a condition which comes on slowly with pain over the deltoid insertion, inability to sleep, painful incomplete elevation and external rotation, the restriction of movement being both active and passive, with a normal radiograph, the pain being very trying and yet all patients are able to continue their daily habits and routines.'
S Abrasart, F Kolo, et al. Frozen Shoulder is ill defined. How can it be described better? EFORT Open Rev 2020:5:273-279.
This is a very common complaint for people aged in their 40’s and 50’s. Women are more likely to develop a frozen shoulder than men and diabetics have a greater risk for developing this condition.
Frozen shoulder as a term does not give a sense of severe pain (described as a constant burning) suffered by patients, which is a primary aspect of the disease along with the functional restriction of both active and passive shoulder motion. Bunker T. Time for a new name for frozen shoulder-contracture of the shoulder. Shoulder and Elbow 2009: 1:4-9
The pathophysiology of a frozen shouder likely involves capsular inflammation, which ultimately leads to capsular fibrosis. The various treatments available for this condition relies on correct diagnosis and pain management and can include physiotherapy with gentle range of motion exercises and capsule stretches, corticosteroid injection, manipulation under anasethetic and surgical release.
The natural history available of the disease is that it often sees short term-improvement, but which bears a high chance of ongoing low-level restriction and pain. Wong CK, Levine WN, Deo K, et al. Natural History of frozen shoulder:fact or fiction? A systematic review. Physiotherapy 2017; 103: 40-47
If you would like further information on this condition contact:
Jan Naughton Sports Physiotherapy Ph: 0294891246.
About the author:
Dr Jan Naughton received her PhD at Sydney University where she was lecturing in Sports Medicine and undergraduate physiotherapy. She specialises in shoulder injuries and has a sports physiotherapy practice in Wahroonga on Sydney's upper north shore working with two other specialist colleagues.