11 Frozen Shoulder

Matthew Baker and Uma Srikumaran

Summary

Initially described by Duplay as “peri-arthritis” in 1872, Codman coined the term “frozen shoulder” in 1934. He described a condition in which there was insidious onset of shoulder pain associated with stiffness and difficulty in sleeping on the side. He also identified the hallmark of the disease, that is, loss of external rotation and elevation. Naviesar coined the term “adhesive capsulitis” in 1945.

Frozen shoulder – adhesive capsuliits

11 Frozen Shoulder

I. Introduction

Idiopathic loss of range of motion of the glenohumeral (GH) joint
Contracture of the GH joint, scarring of the capsule, and ligamentous complex
Histologic evaluation shows capsular fibroblastic proliferation
Natural history is that of eventual recovery:
1. Up to 50% of patients have some residual stiffness/pain.

II. Risk factors

Associated with endocrine disorders:
1. Diabetes mellitus:
  1. Have worse outcomes.
2. Hyper- or hypothyroid
3. Other autoimmune disorders.
Recent surgery:
1. Rotator cuff (RTC) repair
2. Fracture
3. Breast cancer surgery.
Cerebrovascular accident or stroke
Parkinson’s disease
Cardiac disease
Prolong immobilization
Age 40–60 years
Female > Male.

III. Stages

Freezing:
1. Increasing pain and decreased motion
2. Can last from 6 weeks to 9 months.
Frozen:
1. Pain improves, but motion loss
2. Can last 4–6 months.
Thawing:
1. Improvement in motion and function
2. Can take 6–24 months.

IV. Anatomy

Coracohumeral ligament and rotator interval have been described as the essential lesion
Rotator interval (▶ Fig. 11.1 ):
1. Triangular region between the anterior border of the supraspinatus and the superior border of the subscapularis
  
  Fig. 11.1 (a–c) Schematic and MRI scan demonstrating the rotator interval, glenohumeral ligaments, and rotator cuff tendons. BT, biceps tendon; CHL, coracohumeral ligament; COR, coracoid process; IST, infraspinatus tendon; RI, rotator interval; SGHL, superior glenohumeral ligament; SST, supraspinatus tendon; SSC, subscapularis.
  
  Fig. 11.2 (a) Probe is under the coracohumeral ligament. (b) Arthroscopic view of anterior glenohumeral capsule from posterior portal demonstrating significant synovitis in the rotator cuff interval. The subscapularis tendon is seen running horizontally across the bottom half of the image. CP, coracoid process; CHL, coracohumeral ligament.
2. Superior glenohumeral ligament (SGHL) and coracohumeral ligament (CHL) (▶ Fig. 11.2 )
3. Arthroscopic image of synovitis in frozen shoulder.