A frozen shoulder is specifically characterized by progressive shoulder pain and stiffness.

The cause of the condition is unknown. It may result from overuse or minor tears of the rotator cuff. A subacute vascular response may be initiated which involves the entire cuff and capsule.

Movement is lost in all directions but the main diagnostic sign is loss of external rotation and abduction by at least 50% (1).

• three overlapping phases in the history are recognised (1,2):

  • painful freezing phase:
    • duration 10-36 weeks
    • pain and stiffness around the shoulder with no history of injury

  • adhesive phase:
  • after several months (occurs at 4-12 months), the pain begins to subside but the shoulder stiffness remains
  • pain is only apparent but only at the extremes of movement
  • recovery phase:
  • over a further period of 12-42 months there is a gradual, although possibly incomplete, return of shoulder movement

The time from onset to recovery is about 30 months (2).

Nearly all patients recover, but normal range of movement may never return (2).

Reference:

1. The Practitioner 1997; 241: 158-60.
2. Dias R et al. Frozen shoulder. BMJ 2005; 331:1453-1456.