Frozen Shoulder

Definition

  The term was coined in 1934 by Codman

 “Frozen shoulder was characterised by slow onset, pain near the insertion of the deltoid, inability to sleep on the affected side, painful and restricted elevation and external rotation, and a normal radiological appearance.”

Codman's 12 Criteria:

1. The condition comes on slowly

2. Pain is felt near the insertion of deltoid

3. Inability to sleep on the affected side

4. Painful & incomplete shoulder elevation

5.  plus external rotation

6. restriction of both spasmodic

7. and adherent type

8. Atrophy of the spinatii

9. Little local tenderness

10. X-rays negative except for bony atrophy

11. The pain was very trying to every one of them

12. but they were all able to continue their daily habits & routines.

The stiff painful shoulder can be classified into two groups.

•  Patients with primary frozen shoulders are those who fit Codman's criteria and in whom all other pathology is excluded

• Patients with secondary frozen shoulders are those who fit Codman's criteria but in whom the condition is secondary to soft-tissue injury, fracture, arthritis, hemiplegia, or any other known cause.

 Incidence

  Quite rare, 5% (70/1,324) of consecutive new patients attending a shoulder clinic (Bunker et al)

Clinical Presentation

•  Age (Mean 56 years) presents with an insidious onset of true shoulder pain. and difficulty sleeping on the affected side

• Male = Female

• L = R

 On examination

1. Patient may suffer from depression because of the relentless night pain

2. There is usually no wasting

3. Deltoid may be wasted as a result of disuse

4.  May be tenderness lateral to the coracoid process (not consistent)

5.  Active and passive movements are markedly restricted Combined elevation is less than 100 degrees (combined elevation 83.2 º)

6.  External rotation (passive) should be less than 50% of the unaffected side

7. Reduction of passive external rotation is the pathognomonic sign of frozen shoulder

8. Gross limitation of passive external rotation is present only in three conditions: arthritis, locked posterior dislocation, and frozen shoulder. (average ER 9.4 º)

9. Internal rotation is similarly restricted both actively and passively.  Patient can just reach buttock level