Frozen Shoulder

Frozen shoulder


  • Poorly understood condition causing substantial pain and movement restriction.
  • Can be differentiated into primary (idiopathic) and secondary onset.
  • Secondary FS can be intrinsic, extrinsic, or systemic.
  • Inflammation and capsular fibrosis are likely due to metabolic syndrome and chronic low-grade inflammation.
  • The disease process progresses from inflammation to capsular fibrosis


  • Primary FS affects 2 to 5.3% of the general population.
  • Secondary FS prevalence increases with diabetes mellitus and thyroid disease.
  • Most cases occur between ages 40 and 65, slightly higher prevalence in women.
  • Contralateral occurrence within five years was reported in 17% of cases.
  • Non-dominant side may be affected more often.

Clinical Picture

  • Shoulder pain radiating into the upper arm, severe and diffuse.
  • Onset is sudden or gradual with progressive pain and stiffness.
  • Pain is described as constant, severe, and exacerbated by movement.


  • Equal loss of active and passive range of motion. External rotation loss of at least 50% of 30° and 25% loss in at least 2 other planes compared to the other side
  • Medical history includes diabetes, cardiovascular disease, smoking, and high cholesterol.
  • Active muscle guarding may contribute to loss of range of motion. Test Pseudo-Frozen Shoulder with the Coracoid Pain Test


  • Tailored physiotherapeutic treatment based on reactivity degree.
  • Steroid injections are effective for pain, function, and self-reported success in the early stages.
  • Hydro-distension injections provide short-term benefits in pain and range of motion.
  • Manipulation under anesthesia and arthroscopic capsular release are last-resort options with limited evidence and potential complications.

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Carbone, S., Gumina, S., Vestri, A. R., & Postacchini, R. (2010). Coracoid pain test: a new clinical sign of shoulder adhesive capsulitis. International orthopaedics34, 385-388.

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Lee, S. Y., Park, J., & Song, S. W. (2012). Correlation of MR arthrographic findings and range of shoulder motions in patients with frozen shoulder. American Journal of Roentgenology198(1), 173-179.

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Pietrzak, M. (2016). Adhesive capsulitis: an age related symptom of metabolic syndrome and chronic low-grade inflammation?. Medical Hypotheses88, 12-17.

Ryan, V., Brown, H., Minns Lowe, C. J., & Lewis, J. S. (2016). The pathophysiology associated with primary (idiopathic) frozen shoulder: A systematic review. BMC musculoskeletal disorders17, 1-21.

Tasto, J. P., & Elias, D. W. (2007). Adhesive capsulitis. Sports medicine and arthroscopy review15(4), 216-221.

Vermeulen E, Schuitemaker R, Hekman K, van der Burg D, Struyf F. Fysiotherapie bij Frozen Shoulder: aanbevelingen vanuit SchouderNetwerken Nederland. FysioPraxis: vakinformatie voor de fysiotherapeut in de praktijk.-Houten, 1992, currens. 2017;26(7):13-7.

Xiao, R. C., Walley, K. C., DeAngelis, J. P., & Ramappa, A. J. (2017). Corticosteroid injections for adhesive capsulitis: a review. Clinical Journal of Sport Medicine27(3), 308-320.

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