Abstract
Shoulder stiffness can be caused by various etiologies such as immobilization, trauma,
or surgical interventions. The Upper Extremity Committee of ISAKOS defined the term
“frozen shoulder” as idiopathic stiff shoulder, that is, without a known cause. Secondary
stiff shoulder is a term that should be used to describe shoulder stiffness with a
known cause. The pathophysiology of frozen shoulder is capsular fibrosis and inflammation
with chondrogenesis, but the cause is still unknown. Conservative treatment is the
primary choice. Pain control by oral medication, intra-articular injections with or
without joint distension, and physical therapy are commonly used. In cases with refractory
stiffness, manipulation under anesthesia or arthroscopic capsular release may be indicated.
Because of various potential risks of complications with manipulations, arthroscopic
capsular release is preferred. After the capsular release, stepwise rehabilitation
is mandatory to achieve satisfactory outcome.
Level of Evidence
Level V, evidence-based review.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Itoi E. Arce G. Bain G. Shoulder stiffness: Current concepts and concerns. Springer, Heidelberg2015
- The shoulder: Rupture of the supraspinatus tendon and other lesions in and around the subacromial bursa.Thomas Todd Company, Boston1934
- Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty.J Bone Joint Surg Am. 1990; 72: 601-618
- Frozen shoulder.in: Matsen 3rd, F.A. Fu F.H. Hawkins R.J. The shoulder: A balance of mobility and stability. American Academy of Orthopaedic Surgeons, Rosemount, IL1993
- The pathogenesis and classification of shoulder stiffness.in: Itoi E. Arce G. Bain G. Shoulder stiffness: Current concepts and concerns. Springer, Heidelberg2015
- New techniques in elbow arthroscopy.in: Savoie 3rd, F.H. Field L.D. AANA advanced arthroscopy: The elbow and wrist. Saunders Elsevier, Philadelphia2010
- Current review of adhesive capsulitis.J Shoulder Elbow Surg. 2011; 20: 502-514
- Secular trend of adhesive capsulitis.Arthritis Care Res. 2011; 63: 1571-1575
- Epidemiology of frozen shoulder.in: Itoi E. Arce G. Bain G. Shoulder stiffness: Current concepts and concerns. Springer, Heidelberg2015
- A profile of patients with adhesive capsulitis.J Hand Ther. 1997; 10: 222-228
- Upper extremity: Emphasis on frozen shoulder.Orthop Clin North Am. 2006; 37: 531-539
- Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment.J Bone Joint Surg Am. 2000; 82: 1398-1407
- Evaluation of arm and shoulder mobility and strength after modified radical mastectomy and radiotherapy.Acta Oncol (Stockholm, Sweden). 2004; 43: 280-283
- Clinical and laboratory parameters in adult diabetics with and without calcific shoulder periarthritis.Calcif Tissue Int. 1991; 49: 288-291
- Risk factors for idiopathic frozen shoulder.Isr Med Assoc J. 2008; 10: 361-364
- Shoulder adhesive capsulitis and shoulder range of motion in type II diabetes mellitus: Association with diabetic complications.J Diabetes Complications. 1999; 13: 135-140
- Drug-induced musculoskeletal disorders.Drug Saf. 2007; 30: 27-46
- Case report: Bilateral adhesive capsulitis, oligoarthritis and proximal myopathy as presentation of hypothyroidism.Rheumatology. 1988; 27: 62-64
- Periarthritis of the shoulder and diabetes mellitus.Ann Rheum Dis. 1972; 31: 69-71
- Association of diabetes mellitus with the risk of developing adhesive capsulitis of the shoulder: A longitudinal population-based followup study.Arthritis Care Res. 2013; 65: 1197-1202
- The prevalence of a diabetic condition and adhesive capsulitis of the shoulder.South Med J. 2008; 101: 591-595
- Arthroscopic observations before and after manipulation of frozen shoulder.Arthroscopy. 1993; 9: 181-185
- Management of the frozen shoulder.JAMA. 1956; 161: 1219-1222
- Painful conditions affecting the shoulder.Clin Orthop Relat Res. 1983; 173: 63-69
- Soft tissue disorders of the shoulder. Frozen shoulder, calcific tendinitis, and bicipital tendinitis.Orthop Clin North Am. 1975; 6: 521-539
- Periarthritis of the shoulder. I. Aetiological considerations with particular reference to personality factors.Ann Rheum Dis. 1976; 35: 213-219
- The course and prognosis of periarthrosis humeroscapularis with special regard to cases with general symptoms.Acta Med Scand. 1952; 143: 350-360
- Frozen-shoulder syndrome in patients with pulmonary tuberculosis.J Bone Joint Surg Am. 1959; 41: 877-882
- Bilateral adhesive capsulitis and Hashimoto's thyroiditis.Br J Rheumatol. 1989; 28: 451
- Painful shoulder in patients with chronic bronchitis and emphysema.Am Rev Respir Dis. 1966; 94: 455-456
- Frozen shoulder and other shoulder disturbances in Parkinson's disease.J Neurol Neurosurg Psychiatry. 1989; 52: 63-66
- Adhesive capsulitis of shoulder and treatment with protease inhibitors in patients with human immunodeficiency virus infection: Report of 8 cases.J Rheumatol. 2000; 27: 2642-2646
- Frozen shoulder and the Big Five personality traits.J Shoulder Elbow Surg. 2014; 23: 221-226
- Shoulder capsulitis in type I and II diabetic patients: Association with diabetic complications and related diseases.Ann Rheum Dis. 1996; 55: 907-914
- Circulating intercellular adhesion molecule-1, vascular cell adhesion molecule-1, and E-selectin in patients with type 2 diabetes mellitus.Diabetes Res Clin Pract. 1999; 46: 143-148
- Frozen shoulder triggered by cardiac catheterization via the brachial artery.Am J Med. 1994; 96: 90-91
- Arthroscopic capsular release for stiff shoulders.Arthroscopy. 2003; 19: 40-49
- Frozen shoulder syndrome associated with subpectoral defibrillator implantation.J Interv Card Electrophysiol. 1999; 3: 253-256
- Adhesive capsulitis of the shoulder in male cardiac surgery patients.Orthopedics. 2000; 23: 693-696
- Barriers to rehabilitation following surgery for primary breast cancer.J Surg Oncol. 2007; 95: 409-418
- Shoulder pain as a presenting complaint in upper lobe bronchogenic carcinoma: Report of 21 cases.Conn Med. 1966; 30: 273-276
- Periarthritis of the shoulder associated with thyrotoxicosis. A report of five cases.N Z Med J. 1959; 58: 766-770
- Idiopathic adhesive capsulitis of the shoulder: A review.Knee Surg Sports Traumatol Arthrosc. 2007; 15: 1048-1054
- Expression of growth factors, cytokines and matrix metalloproteinases in frozen shoulder.J Bone Joint Surg Br. 2000; 82: 768-773
- Arthrography of the shoulder joint.J Bone Joint Surg Am. 1962; 44: 1321-1359
- Arthroscopic appearance of frozen shoulder.Arthroscopy. 1991; 7: 138-143
- The frozen shoulder. Clinical and radiographical observations. The effect of manipulation under general anesthesia. Structure and glycosaminoglycan content of the joint capsule. Local bone metabolism.Acta Orthop Scand Suppl. 1969; 119: 1-59
- Adhesive capsulitis of the shoulder: A study of the pathological findings in periarthritis of the shoulder.J Bone Joint Surg Am. 1945; 27: 211-222
- The pathology of frozen shoulder. A Dupuytren-like disease.J Bone Joint Surg Br. 1995; 77: 677-683
- Coexistence of fibrotic and chondrogenic process in the capsule of idiopathic frozen shoulders.Osteoarthritis Cartilage. 2012; 20: 241-249
- Frozen shoulder: A consensus definition.J Shoulder Elbow Surg. 2011; 20: 322-325
- The frozen shoulder diagnosis and management.Clin Orthop Relat Res. 1987; 223: 59-64
- Complications after arthroscopic rotator cuff repair.Arthroscopy. 2007; 23: 124-128
- A clinical method of functional assessment of the shoulder.Clin Orthop Relat Res. 1987; 214: 160-164
- Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. 2009; 25: 880-890
- Management of the stiff shoulder.J Orthop Sci. 1999; 4: 462-471
- Effect of immobilization without passive exercise after rotator cuff repair.J Bone Joint Surg Am. 2014; 96: e44
- Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?.J Shoulder Elbow Surg. 2010; 19: 1034-1039
- Arthroscopic rotator cuff surgery: A practical approach to management.Springer Science & Business Media, New York2008
- Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: Aggressive versus limited early passive exercises.Arthroscopy. 2012; 28: 34-42
- Arthroscopic versus mini-open rotator cuff repair: A cohort comparison study.Arthroscopy. 2005; 21: 328-332
- Intratendinous strain fields of the supraspinatus tendon: Effect of a surgically created articular-surface rotator cuff tear.J Shoulder Elbow Surg. 2002; 11: 562-569
- Arthroscopic rotator cuff repair.J Am Acad Orthop Surg. 2006; 14: 333-346
- The role of repair tension on tendon to bone healing in an animal model of chronic rotator cuff tears.J Biomech. 2007; 40: 561-568
- Rotator cuff repair in patients with type I diabetes mellitus.J Shoulder Elbow Surg. 2003; 12: 416-421
- Revision arthroscopic shoulder instability repair.Arthroscopy. 2007; 23: 703-709
- Results of arthroscopic versus open Bankart suture repair.Clin Orthop Relat Res. 1997; 337: 111-117
- Comparison of shoulder stabilization using arthroscopic transglenoid sutures versus open capsulolabral repairs a 5-year minimum follow-up.Am J Sports Med. 2004; 32: 650-654
- Long-term independent evaluation after arthroscopic extra-articular Bankart repair with absorbable tacks: A clinical and radiographic study with a seven to ten-year follow-up.J Bone Joint Surg Am. 2007; 89: 1442-1448
- Absorbable implants for open shoulder stabilization.Knee Surg Sports Traumatol Arthrosc. 2006; 14: 182-188
- Comparison between the results of open and arthroscopic repair of isolated traumatic anterior instability of the shoulder.Acta Orthop Traumatol Turc. 2010; 44: 180-185
- Residual inferior glenohumeral instability after arthroscopic Bankart repair: Radiological evaluation and functional results.Orthop Traumatol Surg Res. 2011; 97: 590-594
- Arthroscopic rotator interval closure effect of sutures on glenohumeral motion and anterior-posterior translation.Am J Sports Med. 2006; 34: 1656-1661
- Quantification of active ROM after arthroscopic Bankart repair with rotator interval closure.Orthopedics. 2009; 32: 408
- Anterior shoulder stabilization in collision athletes arthroscopic versus open Bankart repair.Am J Sports Med. 2006; 34: 979-985
- Comparison of an arthroscopic and an open procedure for posttraumatic instability of the shoulder: A prospective, randomized multicenter study.J Shoulder Elbow Surg. 2001; 10: 105-108
- Revision open Bankart surgery after arthroscopic repair for traumatic anterior shoulder instability.Am J Sports Med. 2009; 37: 2158-2164
- Arthroscopic revision Bankart repair: A preliminary evaluation.Orthopedics. 2011; 34: 17
- Kinematics of the glenohumeral joint with Bankart lesion and repair.J Orthop Res. 1998; 16: 116-121
- Complex shoulder disorders: Evaluation and treatment.J Am Acad Orthop Surg. 2009; 17: 125-136
- The dimensions of the rotator interval.J Shoulder Elbow Surg. 2005; 14: 620-625
- Complications of unconstrained shoulder prostheses.J Shoulder Elbow Surg. 2011; 20: 666-682
- Prognostic factors for bacterial cultures positive for Propionibacterium acnes and other organisms in a large series of revision shoulder arthroplasties performed for stiffness, pain, or loosening.J Bone Joint Surg Am. 2012; 94: 2075-2083
- Arthroscopic management of heterotopic ossification of the subscapularis tendon in a patient with tuberculosis: A case report.J Shoulder Elbow Surg. 2012; 21: e1-e5
- Alterations in scapular kinematics in subjects with idiopathic loss of shoulder range of motion.J Orthop Sports Phys Ther. 2007; 37: 19-25
- Shoulder kinematics in subjects with frozen shoulder.Arch Phys Med Rehabil. 2003; 84: 1473-1479
- Frozen shoulder: Correlation between the response to physical therapy and follow-up shoulder arthrography.Arch Phys Med Rehabil. 1997; 78: 857-859
- Trapezius muscle imbalance in individuals suffering from frozen shoulder syndrome.Clin Rheumatol. 2005; 24: 569-575
- Three-dimensional scapular kinematics and scapulohumeral rhythm in patients with glenohumeral osteoarthritis or frozen shoulder.J Biomech. 2008; 41: 326-332
- The immediate effects of soft tissue mobilization with proprioceptive neuromuscular facilitation on glenohumeral external rotation and overhead reach.J Orthop Sports Phys Ther. 2003; 33: 713-718
- The relationship of the glenohumeral joint capsule to the rotator cuff.Clin Orthop Relat Res. 1990; 254: 29-34
- Effect of selective capsulorrhaphy on the passive range of motion of the glenohumeral joint.J Bone Joint Surg Am. 2003; 85: 48-55
- The role of the rotator interval capsule in passive motion and stability of the shoulder.J Bone Joint Surg Am. 1992; 74: 53-66
- The anatomy and potential effects of contracture of the coracohumeral ligament.Clin Orthop Relat Res. 1992; 280: 182-185
- Recalcitrant chronic adhesive capsulitis of the shoulder. Role of contracture of the coracohumeral ligament and rotator interval in pathogenesis and treatment.J Bone Joint Surg Am. 1989; 71: 1511-1515
- Adhesive capsulitis of the shoulder.J Am Acad Orthop Surg. 2011; 19: 536-542
- Posterior arthroscopic capsular release in frozen shoulder.Arthroscopy. 2009; 25: 19-23
- Is the extended release of the inferior glenohumeral ligament necessary for frozen shoulder?.Arthroscopy. 2010; 26: 529-535
- Variations in the superior capsuloligamentous complex and description of a new ligament.J Shoulder Elbow Surg. 2007; 16: 821-836
- Gentle thawing of the frozen shoulder: A prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years.J Shoulder Elbow Surg. 2004; 13: 499-502
- The frozen shoulder.Der Orthopade. 2000; 29 (in German): 845-851
- The natural history of the frozen shoulder syndrome.Scand J Rheumatol. 1975; 4: 193-196
- Diagnosis and treatment of chronic painful shoulder: Review of nonsurgical interventions.Arthroscopy. 2005; 21: 333-347
- Evidence-based clinical guidelines for the diagnosis, assessment and physiotherapy management of contracted (frozen) shoulder: Quick reference summary.Physiotherapy. 2012; 98: 117-120
- Rotator cuff lesions in patients with stiff shoulders: A prospective analysis of 379 shoulders.J Bone Joint Surg Am. 2015; 97: 1233-1237
- Periarthritis of the shoulder. Trial of treatments investigated by multivariate analysis.Ann Rheum Dis. 1974; 33: 116-119
- Frozen shoulder: The effectiveness of conservative and surgical interventions—Systematic review.Br J Sports Med. 2011; 45: 49-56
- Oral steroids for adhesive capsulitis.Cochrane Database Syst Rev. 2006; : CD006189
- Corticosteroid injections for shoulder pain.Cochrane Database Syst Rev. 2003; : CD004016
- Adhesive capsulitis of the shoulder: A systematic review of the effectiveness of intra-articular corticosteroid injections.J Bone Joint Surg Am. 2011; 93: 1727-1733
- Open surgical release for frozen shoulder: Surgical findings and results of the release.J Shoulder Elbow Surg. 2001; 10: 353-357
- Operative management of the frozen shoulder in patients with diabetes.J Shoulder Elbow Surg. 2002; 11: 609-613
- Physiotherapy and injection better than injection alone or physiotherapy alone for improving range of motion in adhesive capsulitis.Aust J Physiother. 2003; 49: 145
- Frozen shoulder: Evidence and a proposed model guiding rehabilitation.J Orthop Sports Phys Ther. 2009; 39: 135-148
- Arthrographic distension for adhesive capsulitis (frozen shoulder).Cochrane Database Syst Rev. 2008; : CD007005
- Arthrographic joint distension with saline and steroid improves function and reduces pain in patients with painful stiff shoulder: Results of a randomised, double blind, placebo controlled trial.Ann Rheum Dis. 2004; 63: 302-309
- Effects of repeated distension arthrographies combined with a home exercise program among adults with idiopathic adhesive capsulitis of the shoulder.Am J Phys Med Rehabil. 2004; 83 (quiz 547-539): 537-546
- Thawing the frozen shoulder. A randomised trial comparing manipulation under anaesthesia with hydrodilatation.J Bone Joint Surg Br. 2007; 89: 1197-1200
- Frozen shoulder: Arthroscopy and manipulation under general anesthesia and early passive motion.J Shoulder Elbow Surg. 1998; 7: 218-222
- Manipulation for frozen shoulder: Long-term results.J Shoulder Elbow Surg. 2005; 14: 480-484
- Management of frozen shoulder: A systematic review and cost-effectiveness analysis.Health Technol Assess. 2012; 16: 1-264
- Manipulation under anesthesia with home exercises versus home exercises alone in the treatment of frozen shoulder: A randomized, controlled trial with 125 patients.J Shoulder Elbow Surg. 2007; 16: 722-726
- Glenohumeral gliding manipulation following interscalene brachial plexus block in patients with adhesive capsulitis.J Orthop Sports Phys Ther. 1996; 24: 66-77
- Silent manipulation for frozen shoulder.MB Orthop. 2012; 25: 93-98
- Radiofrequency energy on cortical bone and soft tissue: A pilot study.Clin Orthop Relat Res. 2010; 468: 1157-1164
- Comparison of arthroscopic capsular release in diabetic and idiopathic frozen shoulder patients.Arch Orthop Trauma Surg. 2010; 130: 401-406
- The frozen shoulder: Myths and realities.Open Orthop J. 2013; 7: 352-355
- Long-term outcomes after arthroscopic capsular release for idiopathic adhesive capsulitis.J Bone Joint Surg Am. 2012; 94: 1208-1216
- The intra-articular component of the subscapularis tendon: Anatomic and histological correlation in reference to surgical release in patients with frozen-shoulder syndrome.Arthroscopy. 2000; 16: 236-242
- Comparison of manipulation and arthroscopic capsular release for adhesive capsulitis: A systematic review.J Shoulder Elbow Surg. 2013; 22: 1135-1145
- Determining the relationship of the axillary nerve to the shoulder joint capsule from an arthroscopic perspective.J Bone Joint Surg Am. 2004; 86: 2135-2142
- Arthroscopic capsular release for refractory shoulder stiffness.Rev Assoc Med Bras. 2013; 59: 347-353
- Arthroscopic release for chronic, refractory adhesive capsulitis of the shoulder.J Bone Joint Surg Am. 1996; 78: 1808-1816
- Continuous passive motion provides good pain control in patients with adhesive capsulitis.Int J Rehabil Res. 2009; 32: 193-198
- The effectiveness of physiotherapeutic interventions in treatment of frozen shoulder/adhesive capsulitis: A systematic review.J Back Musculoskelet Rehabil. 2014; 27: 247-273
Article Info
Publication History
Published online: May 12, 2016
Accepted:
March 10,
2016
Received:
January 13,
2016
Footnotes
The authors report the following potential conflicts of interest or sources of funding: G.A. receives support from Mitek Sports Medicine. D.G. receives support from Arthrex, Pacira, Smith & Nephew, Donjoy, Breg, Stryker, Medacta, and Holy Cross Hospital. A.B.I. receives support from Arthrex, Arthrosurface, and Medi Bayreuth. E.I. receives support from ALCARE. A.D.M. receives support from Arthrex.
Identification
Copyright
© 2016 by the Arthroscopy Association of North America
