Frozen shoulder is seen as a “waste-can diagnosis”, often applied to any stiff and painful shoulder. This implyies that the shoulder will eventually thaw, and thereby doesn't need treatment. Due to differences in nomenclature, “frozen shoulder contracture syndrome” (FSCS) has been suggested as uniform name.
No gold standard test to diagnose FSCS exists.
Diagnosis is based on (i) clinical examination, (ii) exclusion of other pathologies and (iii) normal glenohumeral radiographs. The most simple clinical diagnostic is equal restriction of active and passive glenohumeral external rotation and a normal shoulder radiograph.
Thickening and fibrosis of the rotator interval, destruction and scaring of the subscapular recess, neovascularity, increased cytokine concentrations, contraction of the axillary recess, reduced joint volume, contraction and fibrosis of the coracohumeral ligament, proliferation of fibroblasts and myofibroblasts, presence of contractile proteins, and uncertainty regarding inflammatory changes are commonly reported abnormalities. Adhesions of the capsule to the humeral head do not occur.
Diabetes, family history, possibly hypothyroidism, genetic predispostion and ethnicity have been described as possible risk factors.
Management involves a great part of patient education. Joint mobilization and exercises produce better outcomes than ultrasound and massage. Documentation about the use of corticosteroids is not definitive. Manual therapy and exercise performed after an eventual procedure may better the outcome.
> From: Lewis, Man Ther 20 (2016) 2-9. All rights reserved to Elsevier Ltd. Click here for the Pubmed summary.