An Approach to Diagnosis and Management of the Frozen Shoulder

Bob McCormack, MD, FRCSC, Dip Sport Med, Assistant Professor, Head of Division of Arthroscopy and Athletic Injuries, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC.

Frozen shoulder, or adhesive capsulitis, is a frustrating condition for both patients and physicians. Pain and a limited range of motion restrict upper extremity function and significantly affect the patient’s quality of life. The goal of this article is to present an organized review of the assessment and management of a frozen shoulder, so the physician can formulate a treatment algorithm. Special considerations for the older patient will be highlighted.

Key words: shoulder, stiffness, capsulitis, older people, treatment.

Frozen shoulder is a descriptive term for a clinical syndrome whereby soft tissue contractures cause a limitation of both active and passive range of motion of the glenohumeral joint. The primary role of the shoulder is to place the hand in space; to achieve this, it is necessary to maintain shoulder mobility.

As outlined in Figure 1, frozen shoulder can be divided into primary and secondary types. The primary, or idiopathic, form is commonly referred to as adhesive capsulitis. Secondary forms are important to identify as they often require a different treatment approach.