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Key Features

  • Self-limited but very debilitating disease

  • Caused by acute inflammation of the capsule followed by scarring and remodeling

  • Very painful shoulder triggered by minimal or no trauma

  • Pain out of proportion to clinical findings during the inflammatory phase

  • Commonly seen in patients 40- to 65-years-old

  • More common in women than men, especially in perimenopausal women or in patients with endocrine disorders, such as diabetes mellitus or thyroid disease

Clinical Findings

  • Painful shoulder that has limited range of motion

  • Strength is usually normal but can appear diminished when the patient is in pain

  • There are three phases

    • Inflammatory phase usually lasts 4–6 months; patients complain of a very painful shoulder without obvious clinical findings of trauma, fracture, or rotator cuff tear

    • "Freezing" phase usually lasts 4–6 months; shoulder becomes progressively stiffer even though the pain is improving

    • "Thawing" phase can take up to a year as the shoulder slowly regains its motion

  • Total duration of an idiopathic frozen shoulder

    • Usually about 24 months

    • Can be much longer for patients who have trauma or an endocrinopathy

Diagnosis

  • Usually a clinical diagnosis; an extensive work-up is not necessary

  • However, standard anteroposterior, axillary, and lateral glenohumeral radiographs are useful to rule out glenohumeral arthritis

  • Imaging can also rule out calcific tendinitis

Treatment

  • During the acute "freezing" phase,

    • NSAIDs and physical therapy are recommended

    • Intra-articular corticosteroid injection or oral prednisone may provide short-term benefit

  • Anti-inflammatory medication is not as helpful during the "thawing" phase as it is during the "freezing" phase

  • Surgical treatments include manipulation under anesthesia and arthroscopic release

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