Frozen Shoulder

Introduction

Frozen shoulder, clinically known as adhesive capsulitis, is a common musculoskeletal condition characterised by progressive pain and restriction of both active and passive shoulder movement (Zuckerman & Rokito, 2011). The condition can significantly impair daily function and quality of life. This overview outlines the anatomical basis of the shoulder, the stages of the condition, and its primary clinical features.

Anatomy of the Shoulder

The shoulder is a highly mobile ball-and-socket joint composed of the humerus, scapula, and clavicle. The humeral head articulates with the glenoid fossa of the scapula, forming the glenohumeral joint, which allows extensive movement in multiple planes (Standring, 2020). Stability is provided by static and dynamic structures, including the joint capsule, ligaments, and surrounding musculature such as the rotator cuff (Neumann, 2017).

The joint capsule is a fibrous structure lined with synovial membrane, which produces synovial fluid to reduce friction and facilitate movement. In adhesive capsulitis, this capsule becomes inflamed, thickened, and contracted, resulting in restricted joint mobility (Zuckerman & Rokito, 2011).

Stages of Frozen Shoulder

Frozen shoulder typically progresses through three overlapping stages:

1. Freezing Stage (Painful Stage)
   This stage involves the gradual onset of diffuse, often severe shoulder pain, particularly with movement and at night. Range of motion progressively decreases. This phase may last from 6 weeks to 9 months (Kelley et al., 2013).

2. Frozen Stage (Stiffness Stage)
   Pain may begin to diminish during this phase; however, significant stiffness persists. Functional limitations become more apparent, affecting activities of daily living. This stage generally lasts between 4 and 6 months (Dias et al., 2005).

3. Thawing Stage (Recovery Stage)
   During this phase, there is a gradual return of shoulder mobility. Although recovery may be slow, many individuals experience substantial improvement. This stage can last from 6 months to 2 years (Hand et al., 2008).

Symptoms of Frozen Shoulder

The clinical presentation of adhesive capsulitis includes:

• Pain: Typically described as a dull, aching pain that may radiate to the upper arm and worsen at night (Bunker, 2009).

• Stiffness: Marked reduction in both active and passive range of motion, particularly in external rotation (Kelley et al., 2013).

• Functional Limitation: Difficulty performing routine activities such as dressing, grooming, or reaching overhead.

• Prolonged Course: Symptoms may persist for 1–3 years, although variability exists among individuals (Hand et al., 2008).

Conclusion

Frozen shoulder is a self-limiting yet often debilitating condition that progresses through distinct stages of pain and stiffness. Early recognition and appropriate management can help reduce symptom severity and improve functional outcomes. Individuals experiencing persistent shoulder pain and restricted movement are advised to seek medical assessment.

References

Bunker, T. D. (2009). Frozen shoulder: Unravelling the enigma. Annals of the Royal College of Surgeons of England, 91(5), 343–346. https://doi.org/10.1308/003588409X428317

Dias, R., Cutts, S., & Massoud, S. (2005). Frozen shoulder. BMJ, 331(7530), 1453–1456. https://doi.org/10.1136/bmj.331.7530.1453

Hand, C., Clipsham, K., Rees, J. L., & Carr, A. J. (2008). Long-term outcome of frozen shoulder. Journal of Shoulder and Elbow Surgery, 17(2), 231–236. https://doi.org/10.1016/j.jse.2007.05.009

Hsu, J. E., Anakwenze, O. A., Warrender, W. J., & Abboud, J. A. (2011). Current review of adhesive capsulitis. Journal of Shoulder and Elbow Surgery, 20(3), 502–514. https://doi.org/10.1016/j.jse.2010.08.023

Kelley, M. J., Shaffer, M. A., Kuhn, J. E., Michener, L. A., Seitz, A. L., Uhl, T. L., Godges, J. J., & McClure, P. W. (2013). Shoulder pain and mobility deficits: Adhesive capsulitis. Journal of Orthopaedic & Sports Physical Therapy, 43(5), A1–A31. https://doi.org/10.2519/jospt.2013.0302

Manske, R. C., & Prohaska, D. (2008). Diagnosis and management of adhesive capsulitis. Current Reviews in Musculoskeletal Medicine, 1(3–4), 180–189. https://doi.org/10.1007/s12178-008-9031-6

Neumann, D. A. (2017). Kinesiology of the musculoskeletal system: Foundations for rehabilitation (3rd ed.). Elsevier.

Standring, S. (2020). Gray’s anatomy: The anatomical basis of clinical practice (42nd ed.). Elsevier.

Zuckerman, J. D., & Rokito, A. (2011). Frozen shoulder: A consensus definition. Journal of Shoulder and Elbow Surgery, 20(2), 322–325. https://doi.org/10.1016/j.jse.2010.07.008