Inflammation and fibrosis of the joint capsule leading to contracture of the shoulder joint

Aetiology

• Age 40s-50s
• Higher incidence in females
• Aetiology unclear - sometimes history of a triggering injury but often there is not, may also occur after shoulder surgery
• Association with diabetes, hypercholesterolaemia and endocrine disease and Dupuytren's disease

Pathophysiology

1. Freezing or painful stage: minimal synovitis with pain, causing a limitation of motion
2. Frozen or transitional stage: pain decreases but proliferative synovitis with contraction of the capsule and adhesion of the axillary recess increases
3. Thawing stage: inflammation decreases, movement slowly improves

Clinical features

Symptoms

• Gradual severe pain
  • Pain at night
  • Pain at rest
  • Anterior pain
• Stiffness
• Can be bilateral
• Self-limiting course - pain subsides after around 2-9 months and stiffness will increase for around 4-12 months

Signs

• Global restriction in ROM, especially in external rotation (<50% of normal)

Investigations

• Clinical diagnosis