{"id":14444,"date":"2023-03-13T14:57:42","date_gmt":"2023-03-13T14:57:42","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=14444"},"modified":"2024-12-27T09:46:21","modified_gmt":"2024-12-27T09:46:21","slug":"frozen-shoulder","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/musculoskeletalphysiotherapy\/shoulderelbow\/frozen-shoulder\/","title":{"rendered":"Frozen Shoulder"},"content":{"rendered":"\n<p><strong>Frozen shoulder- <\/strong>Considerations relating to diagnosis<br><br>Link to NICE CKS 2017 definitions and diagnostic considerations here;<br><a href=\"https:\/\/cks.nice.org.uk\/shoulder-pain#!backgroundsub\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/cks.nice.org.uk\/shoulder-pain#!backgroundsub<\/a><br><br>Link to BESS\/ BOA definitions and diagnostic considerations here;<br><a href=\"https:\/\/www.boa.ac.uk\/resources\/frozen-shoulder-pdf.html\" data-type=\"URL\" data-id=\"https:\/\/www.boa.ac.uk\/resources\/frozen-shoulder-pdf.html\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.boa.ac.uk\/wp-content\/uploads\/2016\/11\/Frozen-Shoulder.pdf<\/a><br><br>Key points from the above documents (not exhaustive)<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Typically ages 40-60&nbsp;<\/li>\n\n\n\n<li>Primary (idiopathic) or secondary (associated with trauma, cardiovascular disease, diabetes, thyroid dysfunction, rotator cuff disease)&nbsp;<\/li>\n\n\n\n<li>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&nbsp;<\/li>\n\n\n\n<li>As overlap between phases, more recently terminology favours classifying into \u201cpain predominant\u201d and \u201cstiffness predominant\u201d phases&nbsp;<\/li>\n\n\n\n<li>Reduced passive external rotation key sign&nbsp;<\/li>\n\n\n\n<li>Global limitation in active and passive range of shoulder movements with disproportionately severe reduction in passive external rotation<\/li>\n\n\n\n<li>Important to note that restricted passive external rotation is seen in other disorders such as glenohumeral osteoarthritis, avascular necrosis and dislocation.&nbsp;<\/li>\n\n\n\n<li>BESS\/BOA guideline recommend performing xray in patients with a clinical impression of frozen shoulder to rule out \u201cmechanical glenohumeral incongruity such as arthritis, avascular necrosis or dislocation of the shoulder which produce a similar clinical picture\u201d<\/li>\n<\/ul>\n\n\n\n<p><strong>M.A. &amp; P.A. 13-03-23<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>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) M.A. &amp; P.A. 13-03-23<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4425,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[901],"class_list":["post-14444","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-frozen-shoulder"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/shoulder-elbow\/https-apps-nhslothian-scot-refhelp-frozen-shoulder\/\" rel=\"tag\">Frozen Shoulder<\/a>","rttpg_excerpt":"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) M.A. &amp; P.A. 13-03-23","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14444","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=14444"}],"version-history":[{"count":3,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14444\/revisions"}],"predecessor-version":[{"id":22146,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14444\/revisions\/22146"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4425"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=14444"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=14444"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}