Clinical Review

Frozen shoulder

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7530.1453 (Published 15 December 2005) Cite this as: BMJ 2005;331:1453
  1. Richard Dias, specialist registrar in orthopaedics1,
  2. Steven Cutts, specialist registrar in orthopaedics (stevenfrcs@hotmail.com)1,
  3. Samir Massoud, consultant orthopaedic surgeon1
  1. 1 Royal Orthopaedic Hospital, Birmingham B31 2AP
  1. Correspondence to: S Cutts
  • Accepted 3 November 2005

Frozen shoulder is a painful, often prolonged, condition that requires careful clinical diagnosis and management. Patients usually recover, but they may never regain their full range of movement.

Introduction

Frozen shoulder is a disabling and sometimes severely painful condition that is commonly managed in the primary care setting. True frozen shoulder has a protracted natural history that usually ends in resolution. In this article we consider how to diagnose frozen shoulder and how to distinguish it from other painful shoulder conditions. We also look at the current aetiological theories and the effectiveness of conservative and operative management. We reviewed the current literature on this topic and discussed papers of historical interest with consultants in our department. We have also made reference to key papers cited in Clinical Evidence (http://www.clinicalevidence.com/).

What is frozen shoulder?

The term “frozen shoulder” was first introduced by Codman in 1934.w1 He described a painful shoulder condition of insidious onset that was associated with stiffness and difficulty sleeping on the affected side. Codman also identified the marked reduction in forward elevation and external rotation that are the hallmarks of the disease.

Long before Codman, in 1872, the same condition had already been labelled “peri-arthritis” by Duplay.w2 In 1945, Naviesar coined the term “adhesive capsulitis.”w3 Although still in use, this more recent term is unfortunate since, although a frozen shoulder is associated with synovitis and capsule contracture, it is not associated with capsular adhesions.

In clinical practice, the tendency is to label any patient with a stiff, painful shoulder as a case of frozen shoulder. This should be resisted. Frozen shoulder is a specific condition that has a natural history of spontaneous resolution and requires a management pathway that is completely different from such distinct shoulder conditions as a rotator cuff tear or osteoarthritis.

Who gets it?

Frozen shoulder patients usually present …

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