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Incidence and clinical presentation of frozen shoulder

This article discusses the incidence of frozen shoulders and how patients typically present with symptoms at the physiotherapy clinic. 

How common is frozen shoulder?

Frozen shoulder is a rare condition, with a frequency of 5% in more than 1300 new patients attending one shoulder surgeon’s clinic. It occurs equally in the right and left shoulders, and it makes no difference which is your dominant hand.

About 10% of people with this condition will get a frozen shoulder on the other side within five years. Ouch! Having this condition in both shoulders is more common in diabetics.

Clinical presentation - how people present in the clinic

Insidious onset (that’s medic speak for slow and sneaky) of true shoulder pain in a middle aged person is one of the key points. Average age of onset is 56 years of age. Men are as likely to suffer from this problem as women.

The most important symptom is severe and unrelenting pain, often particularly bad at night. Then the shoulder stiffens, often quickly and severely.

Normal function of the shoulder is severely affected, with both stiffness and pain getting in the way of normal activities. Typically affected activities are doing up a bra or tucking in clothes to trousers (these movements need inward rotation of the joint), and dressing and hair care (needing outward movement of the joint).

Patients typically have many treatments, often over a long period, including steroid injections and physiotherapy, without much success.

Examination

Due to the long period of pain and sleepnessness, a patient with frozen shoulder often appears depressed and tired. They have had a bad time, and people tell us the pain is really severe and does not go away for a long time.

Muscle wasting is usually not present but movement is severely restricted, both the patient’s ability to move their own shoulder and the surgeon’s ability to move it too. If you lose active motion of a joint it may mean your muscles are weak or the joint is too painful to move.

If however someone else can’t move it either, it means it is stiff and the joint itself has become tight and is preventing movement.

The differences on examination between active (self generated) movement and passive (someone else moves you) movement is very important diagnostically.

Raising the arm at the shoulder is less than 100 degrees typically and may be around 80 degrees. Passive outward rotation of the shoulder is less than half of the unaffected side, which is one of the cardinal signs of true frozen shoulder. Less than 10 degrees is common.

Active and passive internal rotation is also very limited, with people often being able to reach round to their buttock but no higher.

There are various associated conditions which are relevant to frozen shoulder.



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