Frozen shoulder is much misunderstood and frequently over diagnosed condition. It often mistakenly thought of by patients and sometimes general practitioners that any shoulder which is stiff and painful is frozen shoulder. However, a shoulder that is stiff and painful can encompass a huge variety of different problems, ranging from shoulders that are actually too wobbly (but will feel stiff), subacromial impingement, rotator cuff tendinitis, to older patients with arthritis. A restricted or stiff shoulder is not diagnostic of frozen shoulder in itself.
Background and diagnosis
Frozen shoulder more commonly occurs in women in the 50s age group. There has usually been no history of trauma or previous shoulder problems. The pattern is of insidious onset shoulder pain, often felt half way down the arm. This pain increases and lasts for a 6 to 7 week period. One noticeable feature at this stage is that any movement is painful and in all directions (including movements below shoulder level). This comes on straight away with active movement. In other kinds of shoulder conditions there are usually some movements which are ok.
Pain that develops suddenly, and is only apparent with certain movements - such as over head is more likely to be some other shoulder condition such as subacromial impingement.
After this 6 -7 week (painful phase) the pain will usually start to subside and then restriction and stiffness becomes more apparent over several months. Eventually there is complete loss of movement in all directions. This is called a "capsular pattern" - which makes it different from other kinds of shoulder conditions. Following this, over time, the movement gradually starts to improve.
Key points towards a true frozen shoulder in first phase
- Insidious onset
- No apparent trauma (though sometimes secondary to a trauma)
- No previous history of shoulder problems
- Gradually increasing pain, (often felt midway down arm) over several weeks.
- Movement in ALL directions painful from start of movement
- Pain at night
Key points for Frozen shoulder in second phase
- Decreasing pain
- Gradual development of global restriction in ALL direction
- Then over time slow improvement in range of movement - but note natural history
Natural history
The commonly held concept that frozen shoulder returns to normal in 2 years is unfortunately is not true. It has been found in studies that after 7 years 50% still have some discomfort and 60% some restriction of movement - especially external rotation.
For information treatment of frozen shoulder and exercises
See my blog Treatment and management of frozen shoulder
My Website Frozen shoulder
