Frozen shoulder basics

1. Frozen Shoulder -
Basics
Puneet Monga

2. Frozen shoulder
• Adhesive capsulitis
• Pathology
• similar to dupuytren’s
• fibroblastic proliferation

3. Associations
• Diabetes
• Dupuytren’s contracture

4. Presentation
• The Story
• The examination
• Screening test; Passive External
Rotation

5. Natural history
• 3 phases-
• Freezing
• Frozen
• Thawing

6. Investigations
• XRAYS - to Exclude other mimicking
conditions
• THIS is a clinical diagnosis

7. Differentials
• Sudden onset severe pain
• Adhesive capsulitis
• Calcific tendonitis
• PT syndrome
• Loss of ER
• Adhesive capsulitis
• OA
• Locked Post dislocation

8. Management
• Options?

9. Non operative mgx
• Steroid: good for Pain not ROM
• Hydrodilation: moderate ST relief- High
patient satisfaction
• Laser: Strong evidence
• Oral steroids: short term moderate
effect
• SS nerve block: Pain reliefClin J Sport Med. 2012 Mar;22(2):168-9.
The effectiveness of nonoperative treatment for frozen
shoulder: a systematic review.
Tashjian RZ.

10. Physiotherapy
• + Safe
• - May be too painful to be effective

11. Hydrodilatation
• + High patient satisfaction
• - Availability, pain

12. Operative treatment
• 89.5% can be treated non-operatively
• 10% pts’ needed release at 12 months
from the onset of symptoms
J Shoulder Elbow Surg. 2007 Sep-Oct;16(5):569-73. Epub 2007 May 24.
Nonoperative management of idiopathic adhesive capsulitis.
Levine WN, Kashyap CP, Bak SF, Ahmad CS, Blaine TA, Bigliani LU.

13. MUA
• + Technically easy
• - Risk of fractures

14. A’scopic capsular
release
• + Precise and safe in the right setup
• - Surgical risks

15. Normal A’scopy

16. A’scopic images

17. Release

18. Post-release

19. Questions?