Frozen Shoulder

Frozen shoulder (adhesive capsulitis) is a painful, progressive loss of both active and passive glenohumeral movement caused by contracture of the joint capsule.

It typically affects people aged 45 to 60, more often women, with a prevalence of around 2% to 5%. It is primary (idiopathic) or secondary to trauma, surgery, immobilisation or systemic disease.

Most people improve, but recovery is slow and often incomplete: in one long-term UK cohort, 41% still had some symptoms, mostly mild, a mean of 4.4 years after onset.

The glenohumeral capsule has recesses, notably the axillary recess and the rotator interval, that allow full movement. In frozen shoulder, fibroblast proliferation and collagen deposition thicken and contract the capsule, particularly the rotator interval, coracohumeral ligament and axillary recess, restricting movement in every plane.

Risk factors:

• •Diabetes: the strongest association, with about 5 times the risk and frozen shoulder in around 13% of people with diabetes. It is associated with bilateral and more protracted disease
• •Thyroid disease, Dupuytren's disease, cardiac disease, stroke and hyperlipidaemia
• •Shoulder surgery, trauma or prolonged immobilisation (secondary frozen shoulder)