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Condition/Disorder Synonym

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  • Frozen shoulder syndrome

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ICD-9 Code

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  • 726.0 Adhesive capsulitis (AC) of shoulder

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ICD-10 Code

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  • M75.00 AC of unspecified shoulder

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Practice Pattern

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Key Features

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Description

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  • Self-limiting shoulder pain and dysfunction due to the following:

    • - Localized inflammation of glenohumeral joint capsule

    • - Paucity of synovial fluid

    • - Fibrosis of capsule causing adherence to humeral head

  • Three pathologic pathways

    • - Primary (idiopathic)

    • - Secondary

    • - Can be attributed to a known intrinsic, extrinsic, or systemic cause

    • - Tertiary

    • - Postoperative

    • - Postfracture

  • AC can be divided into following four stages:

    • - Stage 1: "Preadhesive"

      • Near-normal ROM, pain at end points of motion and mild synovitis

    • - Stage 2: "Freezing"

      • Marked loss of motion, pain at end points with thickened read synovitis

    • - Stage 3: "Frozen"

      • Marked loss of motion, painless ROM with capsule fibrosis and adhesions

    • - Stage 4: "Thawing"

      • Improved glenohumeral motion, painless ROM. No synovitis present.

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Essentials of Diagnosis

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Demographics

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  • Affects 2% to 5% of the general population.

  • Affects 10% to 38% of patients with thyroid disease or diabetes mellitus.

  • Primary AC generally affects individuals of 40 to 65 years.

  • Greater incidence in females versus Males.

  • Occurrence in one shoulder increases the risk of contralateral shoulder involvement in 5% to 34%.

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Clinical Findings

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Signs and Symptoms

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  • Pain in anterior lateral shoulder is described as achy at rest and sharp with end-range motion.

  • Symptoms typically have been present for fewer than 3 months if stage 1.

  • Nighttime pain and pain when reaching behind the back are common.

  • Active ROM (AROM) and passive ROM (PROM) are equally limited.

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Functional Implications

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  • Pain/limitation with overhead activities

  • Pain/limitation with reaching

  • Pain/limitation with lifting

  • Pain/limitation with dressing

  • Pain/limitation with sustained or repetitive shoulder activities

  • Pain at night (sleep disruption)

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Possible Contributing Causes

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  • Degenerative changes at the acromioclavicular (AC) joint

  • Rotator cuff tendinopathy

  • Bicipital tendinopathy

  • Humeral fracture

  • Capsular tightness

  • Increased thoracic kyphosis and suboptimal posture

  • History of trauma

  • Diabetes mellitus

  • Treatment with antiretroviral therapy

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Differential Diagnosis

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  • Cervical radiculopathy

  • Referred pain from lungs or diaphragm

  • Full-thickness rotator cuff tear

  • Glenohumeral arthritis

  • Glenohumeral contracture

  • Labral tear

  • Subacromial impingement

  • Neuropathy (suprascapular nerve)

  • Internal impingement

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