Frozen Shoulder

Patient resources

NHS Lothian MSK Self Help Resources Webpage

Definition

Typically presents as insidious onset shoulder pain and stiffness persisting more than 3 months.  Characterised by fibrosis of the shoulder capsule. Can be either primary (idiopathic) or secondary. Previously known as adhesive capsulitis.

Typical signs and symptoms 

Pain dominant stage: Progressive shoulder pain, particularly at night and with sudden or unexpected movements. Night pain can be a dominant feature. Pain can be diffuse although usually localised to shoulder and upper arm. Progressive global loss of active and passive movement of the shoulder in a capsular pattern.

Stiff dominant stage: pain typically improves while capsular stiffness persists, especially loss of passive external rotation. Can range from mild to severe restriction.

Prevalence and risk factors

Lifetime prevalence of frozen shoulder is estimated to be 2-5% general population (8.2% male & 10.1 % female of working age). Up to 60% of people with diabetes may develop a frozen shoulder. The opposite shoulder can become affected within 5 years in up to 20% of patients.

Risk factors: Metabolic and hormonal changes including: diabetes, stroke, thyroid disorders, shoulder injury/surgery, Dupuytren’s disease, primary neurological conditions e.g. Parkinson’s disease, cancer, cardiovascular disease, complex regional pain syndrome, smoking, obesity, autoimmune diseases, genetics (ethnicity and family history of frozen shoulder).

Prognosis/ risk factors for poor outcome

On average can take 2-4 years (mean 30 months) to reach a satisfactory recovery. Some cases can take longer with 10- 50% of patients reporting residual shoulder stiffness and disability up to 7 years.

Risks factors for poorer outcomes include diabetes, thyroid and metabolic disorders, inflammatory conditions, obesity, sleep deprivation, multi-site pain, previous pain episodes, anxiety and/or depression, adverse coping strategies, low social support, low self-efficacy, lifestyle factors e.g. smoking, alcohol, physical activity levels.

Other considerations

Rare in patients under 40 & over 70 years old.

Differential diagnoses

• glenohumeral joint osteoarthritis
• avascular necrosis
• malignancy (e.g., Pancoast tumour)
• subacromial pain/rotator cuff related shoulder pain
• shoulder dislocation
• fracture
• post stroke shoulder subluxation
• referred pain

Relevant standards and guidelines

BESS Patient Care Pathway: Frozen Shoulder

NICE Clinical Knowledge Summaries: Frozen Shoulder

P.A & M.A – 15-7-26