Frozen shoulder- Considerations relating to diagnosis
Link to NICE CKS 2017 definitions and diagnostic considerations here;
https://cks.nice.org.uk/shoulder-pain#!backgroundsub
Link to BESS/ BOA definitions and diagnostic considerations here;
https://www.boa.ac.uk/wp-content/uploads/2016/11/Frozen-Shoulder.pdf
Key points from the above documents (not exhaustive)
- Typically ages 40-60
- Primary (idiopathic) or secondary (associated with trauma, cardiovascular disease, diabetes, thyroid dysfunction, rotator cuff disease)
- Clinical presentation typically in three overlapping phases- phase 1- lasting 2-9 months, painful phase, progressive and increasing pain on movement, pain tends to constant and diagnosis in early stages before movement is lost can be difficult; phase 2- lasting 4- 12 months, stiffening phase, gradual reduction of pain, but stiffness persists with considerable restriction in range; phase 3- lasting 12-42 months, resolving phase gradual improvement in range of movement with resolution of stiffness
- As overlap between phases, more recently terminology favours classifying into “pain predominant” and “stiffness predominant” phases
- Reduced passive external rotation key sign
- Global limitation in active and passive range of shoulder movements with disproportionately severe reduction in passive external rotation
- Important to note that restricted passive external rotation is seen in other disorders such as glenohumeral osteoarthritis, avascular necrosis and dislocation.
- BESS/BOA guideline recommend performing xray in patients with a clinical impression of frozen shoulder to rule out “mechanical glenohumeral incongruity such as arthritis, avascular necrosis or dislocation of the shoulder which produce a similar clinical picture”
