Clinical Guidelines in the Management of Frozen Shoulder: An Update!

Vivek Pandey, Sandesh Madi, Vivek Pandey, Sandesh Madi

Abstract

Among all the prevalent painful conditions of the shoulder, frozen shoulder remains one of the most debated and ill-understood conditions. It is a condition often associated with diabetes and thyroid dysfunction, and which should always be investigated in patients with a primary stiff shoulder. Though the duration of 'traditional clinicopathological staging' of frozen shoulder is not constant and varies with the intervention(s), the classification certainly helps the clinician in planning the treatment of frozen shoulder at various stages. Most patients respond very well to combination of conservative treatment resulting in gradual resolution of symptoms in 12-18 months. However, the most effective treatment in isolation is uncertain. Currently, resistant cases that do not respond to conservative treatment for 6-9 months could be offered surgical treatment as either arthroscopic capsular release or manipulation under anaesthesia. Though both invasive options are not clinically superior to another, but manipulation could result in unwarranted complications like fractures of humerus or rotator cuff tear.

Keywords: Adhesive capsulitis; Arthroscopic capsular release; Conservative; Frozen shoulder; Manipulation; Review; Shoulder; Treatment.

Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interest.

© The Author(s) 2021.

Figures

Fig. 1
Fig. 1
a–c Shows the MUA of left shoulder with a ‘short-lever arm’ while arm being taken in flexion, abduction and external rotation in 90° abduction. Of-note: during abduction beyond 90°, head of the humerus is supported with a fist of assistant in axilla to prevent inferior subluxation of head while tearing of inferior capsule. During external rotation movement in 90° abduction, the scapula is stabilised by the assistant’s hand over the scapula
Fig. 2
Fig. 2
a–c Shows MUA of left shoulder with a ‘short-lever arm’ while arm is taken in internal rotation in 90° abduction, cross-chest adduction and external rotation with arm by the side of chest. During internal rotation movement in 90° abduction, the scapula is stabilised by the assistant’s hand over the scapula
Fig. 3
Fig. 3
Arthroscopic view (from posterior portal) of inflammed and contracted rotator interval (blue star) of right-side frozen shoulder. SSc subscapularis, BT biceps tendon
Fig. 4
Fig. 4
Arthroscopic view (from anterior portal) of inflamed synovium-capsule over the infraspinatus

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