1.    Females > males

2.    Age 40 to 70

3.    Diabetes

4.    Posttrauma (mild to moderate)

5.    Postsurgical

6.    Prolonged impingement

7.    Idiopathic

1.    Global restriction of glenohumeral motions (all planes).

2.    Can have predominantly external rotation loss (interval, anterior capsule).

3.    Less common, predominant internal rotation loss (posterior capsule). Patient must be examined with arm in abduction, with evaluation of magnitude of internal forearm rotation to pick up posterior capsule involvement.

4.    Always evaluate for concomitant conditions: impingement, acromioclavicular (AC) arthralgia, peripheral neuropathy, and calcific tendinitis.

1.    True anteroposterior, outlet view, and axillary radiographs will be normal.

2.    Differential injections of lidocaine and corticosteroid: subacromial space and glenohumeral joint: then reassess motion.

3.    Arthrography—limited joint volume.

4.    Magnetic resonance imaging, computed tomography, EMG, and bone scan offer little diagnostic information except to exclude other pathology.

1.    Still under investigation

2.    Initiating factor seems to be an inflammatory glenohumeral synovitis resulting from an unknown insult

3.    Subsynovial fibrosis

4.    Capsular fibrosis and thickening

5.    Capsular contracture

1.    Patience.

2.    Home stretching and motion.

3.    Formal physiotherapy.

4.    Intraarticular steroid injections.

5.    Systemic steroids.

6.    Analgesics and nonsteroidal anti-inflammatory drug medication.

7.    As motion is restored, the symptoms seem to abate.

8.    Residual motion and functional deficits are not uncommon.

1.    Limitation of passive and active motion

2.    Sleep disturbance

3.    Pain and shoulder dysfunction

4.    Symptoms prevalent for at least 3 months

5.    No response to at least 6 weeks of therapy (surgeon-directed therapy toward the known diagnosis of shoulder stiffness)

1.    Osteopenia

2.    Reflex sympathetic dystrophy

3.    Posttraumatic or postsurgical stiffness

4.    Diabetics—worsens with time after manipulation

5.    Profound loss of motion (<10 degrees of ER at side)

6.    Predominant IR loss (posterior capsule involvement)

1.    General

2.    Scalene block

3.    Intraarticular catheter for “pain pump” local anesthetic administration

1.    Grasp the humerus proximally to apply pressure.

2.    Keep the elbow bent to avoid a long lever arm.

3.    An assistant should apply counterpressure on the acromion/scapula.

1.    Abduction to 90 to 120 degrees

2.    Forward elevation in scapular plane

3.    External rotation at side

4.    External rotation at 90 degrees of abduction

5.    Internal rotation at 90 degrees of abduction

6.    Cross-body adduction/internal rotation

Do not force beyond palm pressure of manipulating hand. Be prepared for manipulation to be unable to restore motion completely.

1.    Idiopathic adhesive capsulitis

2.    Recalcitrant frozen shoulder

3.    Diabetic frozen shoulder

4.    Postsurgical and posttraumatic stiffness

5.    Failed manipulation