In patients with frozen shoulder, the movement of the shoulder is severely restricted and there is loss of both active and passive range of motion [7]. Presentation is the same for both idiopathic frozen shoulder and frozen shoulder as a result of injury. Apart from restriction of movement, vertebral pressure, headache and insomnia are among common presentations.

• Pain

  Patients get pain at rest, with activity and also pain at night. There is significant restriction of motion. The FROZEN PHASE displays progressive stiffness, lasting up to 12 months. [orthosports.com.au]

  If you experience pain along with a loss of range of motion, life can be that much harder. Many conditions involving your shoulder can lead to pain and decreased range of motion. A doctor is working with a patient's shoulder. [livestrong.com]

  It develops in three stages: Freezing - In the"freezing" stage, you slowly have more and more pain. As the pain worsens, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months. [emoryhealthcare.org]

  During this stage people describe sharp pain at end ranges of motion, achy pain at rest, and sleep disturbances. [en.wikipedia.org]

  The shoulder capsule is the connective tissue surrounding the glenohumeral joint of the shoulder and its inflammation brings about chronic pain. The pain is often constant, worse at night and with cold weather. [symptoma.com]

• Inflammation

  The steroid injection works by decreasing the inflammation present in the shoulder joint capsule. [kennethcutbush.com]

  Future studies should be directed to give light to the pathogenesis of inflammation to better treat or prevent primary FS. [ncbi.nlm.nih.gov]

  There are a number of therapies and treatment options one can opt for to treat the pain and inflammation caused by frozen shoulder. Hot and Cold Therapy – Hot and cold therapy is majorly used to relieve pain and reduce inflammation. [healthproductsforyou.com]

  Frozen shoulder can be caused by inflammation, such as when the lining of a joint becomes inflamed (synovitis), or by autoimmune reactions, where the body launches an “attack” against its own substances and tissues. [riverdalept.com]

• Swelling

  Arthritis Treatment for arthritis may include: Medicines to help with pain and swelling. Physical therapy. If you injure a shoulder, try the following: Rest. Don’t use your shoulder for 48 hours Ice. [niams.nih.gov]

  Stronger pain and swelling relief – prescribed painkillers. Maybe steroid injections in your shoulder to bring down the swelling. Getting movement back – shoulder exercises once it's less painful. This can be at home or with a physiotherapist. [nhs.uk]

  More than 90% of patients improve with relatively simple treatments such as: Non-steroidal anti-inflammatory medicines - Drugs like aspirin and ibuprofen reduce pain and swelling. [emoryhealthcare.org]

  Other symptoms can include swelling and local tenderness. A frozen shoulder is typically the result of an immobilized shoulder joint for a prolonged period of time. [livestrong.com]

  The bandage will usually be removed the day after surgery and waterproof dressings applied by your nurse It is normal for the shoulder to swell after the surgery. Placing ice-packs on the shoulder will help to reduce swelling. [shouldersurgery.com.au]

• Surgical Procedure

  The other option is surgical intervention for refractory cases lasting longer than 3 months with no improvements in pain or motion. The Surgical Procedure The surgical procedure is performed through an arthoscopic approach. [orthodayton.com]

  Capsular release is another surgical procedure that is supported by expert opinion and published case series, but currently high quality research is not available. [ncbi.nlm.nih.gov]

  The surgical procedure is known as arthroscopic surgical release (sometimes call lysis of adhesions, or LOA) and manipulation under anesthesia (MUA). [jeremyburnhammd.com]

  For those who don't experience relief after physical therapy, surgical procedures are available to help to regain motion. [medstargeorgetown.org]

  Minimally invasive surgical procedures, such as arthroscopy and manipulation, may also be performed with a goal of stretching or freeing up the contracted joint capsule. [orthopedicshoulder.com]

• Arm Pain

  People with frozen shoulder typically have pain with arm movement, so they try to avoid it. But avoiding arm movement can lead to more stiffness. Mobility improves and may be completely restored as the condition gets better. Trouble sleeping. [sports-health.com]

  Symptoms of Frozen Shoulder Dull achy pain in one shoulder Pain in shoulder muscles around the top of your arm Upper arm pain Intensity of pain increases at night Stages of Adhesive Capsulitis Freezing: Pain is experienced when you try to move the shoulder [healthproductsforyou.com]

  Painful symptoms are typically most severe in the early course of the disease, or when moving the arm, especially when movement is sudden. [shorelineortho.com]

  In the subscapularis muscle, they produce a signature pain-referral pattern. Pain concentrates on the back of the deltoid muscle. From there, it can extend onto the back, over the scapula, and/or down the back side of the upper arm. [acutakehealth.com]

  If the patient suffers arm pain, redness or swelling, or have shortness of breath at any stage, contact [doctor] Serious medical problems can lead to ongoing health concerns, prolonged hospitalisation or rarely death. [shouldersurgery.com.au]

• Vomiting

  […] pharynx including damage to teeth and artificial crowns during intubation, Hypoxemia, Hypercapnia and hypocapnia, Hypoventilation, Aspiration pneumonia, Perioperative neuropathy, Minor idiosyncratic/allergic reaction to agents, producing nausea and vomiting [frozenshoulderclinic.com]

• Frozen Shoulder

  Frozen Shoulder (Adhesive Capsulitis) Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder. Over time, the shoulder becomes very hard to move. Frozen shoulder occurs in about 2% of the general population. [emoryhealthcare.org]

  Frozen shoulder: a consensus definition. J Shoulder Elbow Surg. 2011 Mar. 20 (2):322-5. [Medline]. Lundberg BJ. The frozen shoulder. Clinical and radiographical observations. The effect of manipulation under general anesthesia. [emedicine.medscape.com]

  Having patients move their shoulders soon after injury or surgery is one measure prescribed to prevent frozen shoulder. Pain from frozen shoulder is usually dull or aching. [orthoinfo.aaos.org]

• Shoulder Pain

  Provide a written patient information leaflet on shoulder pain. [patient.info]

  A person that has shoulder pain and limited abduction is often described as having a frozen shoulder; however, there are a number of problems that may actually cause shoulder pain and limited range of motion in abduction. [massagetoday.com]

  We measured shoulder pain, shoulder range of motion, and American Shoulder and Elbow Surgeons shoulder scores immediately prior to MUC, 1 week after MUC, and 1 year after MUC. [ncbi.nlm.nih.gov]

  shoulder are: Decreased motion of the shoulder Pain Stiffness Frozen shoulder without any known cause starts with pain. [nlm.nih.gov]

• Stiffness of the Shoulder

  Adhesive capsulitis, better known as frozen shoulder, is a condition that causes pain and stiffness in your shoulder. Frozen shoulder is a condition that gradually appears over time, and it is not the result of an injury. [deserthandtherapy.com]

  Frozen shoulder (adhesive capsulitis) is a disorder characterized by pain and loss of motion or stiffness in the shoulder. It affects about two percent of the general population. [health.uconn.edu]

  Frozen Shoulder (Adhesive Capsulitis) Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder. Over time, the shoulder becomes very hard to move. Frozen shoulder occurs in about 2% of the general population. [emoryhealthcare.org]

  Frozen shoulder (FS) is a musculoskeletal disease, and causes pain and stiffness in the shoulder. The relationship between FS and psychological disorders has rarely been investigated. [ncbi.nlm.nih.gov]

• Muscle Strain

  If motion is limited only in the active range, the symptoms could be the result of other conditions, such as muscle strain or tendonitis.. [lifemark.ca]

  Conditions DOMS - Delayed Onset Muscle Soreness Muscle Strain Overuse Injuries RSI - Repetitive Strain Injury Systemic Conditions Fibromyalgia Rheumatoid Arthritis Referred Pain Neck Arm Pain Pinched Nerve Thoracic Outlet Syndrome Call PhysioWorks Book [physioworks.com.au]

  An injury to one shoulder muscle can easily lead to straining in other areas, making an overall recovery hard to initiate. For example, a serious muscle strain in the right rotator cuff can often lead to over-straining of the left rotator cuff. [aidmyfrozenshoulder.com]

• Arthritis of Shoulder

  The shoulder can become stiff because the joint surfaces have lost their normal smoothness--as in arthritis. Finally, shoulder motion can be restricted by limited scapulothoracic motion (motion between the shoulder blade and the chest wall). [orthop.washington.edu]

  Adhesive Capsulitis Frozen Shoulder Shoulder Bursitis Bursitis Shoulder Shoulder Instability Shoulder Dislocation (Instability) Acromioclavicular Joint AC Joint Injury Bone Injuries Shoulder Arthritis Broken Shoulder / Fractured Humerus Fractures Stress [physioworks.com.au]

• Confusion

  There are three common conditions of the shoulder that are often confused: rotator cuff tear, shoulder arthritis and frozen shoulder. Shoulder stiffness is a common symptom of each of them. Shoulder stiffness is diagnosed as shown here. [shoulderarthritis.blogspot.com]

  The term “frozen shoulder” encompasses many of the concepts of the terms in Table 1, but it too is confusing and not always accurate. [aafp.org]

  Frozen shoulder is commonly misdiagnosed or confused with rotator cuff injury by inexperienced shoulder practitioners. It is important to get an accurate diagnosis. [physioworks.com.au]

  These conditions are commonly confused, especially the frozen shoulder and rotator cuff tear. The following information will provide you with insight into the two conditions to detail their differences. [orthoatlanta.com]

Frozen shoulder is majorly a clinical diagnosis but imaging can also be used to exclude other causes of shoulder pain and depict findings that increase the confidence in clinical diagnosis. Arthrography is usually seen as the standard for imaging diagnosis [8].

Laboratory studies are rarely required in the evaluation of adhesive capsulitis. However, if a predisposing medical condition that may be contributing to adhesive capsulitis is suspected, the patient may be subjected to the following tests:

• CBC
• Erythrocyte sedimentation rate (ESR)
• C-reactive protein
• Serum blood sugar
• Thyroid stimulating hormone (TSH)
• Free thyroxine index (FTI)

In managing this disorder, the focus is on restoring joint movement and reducing shoulder pain. This may involve medications, physical therapy and surgical intervention [9]. The treatment may continue for months but there is no clear evidence on the best approach to take for treatment. Surgical evaluation of other complications such as the rotator cuff tear or subracomial bursitis may be needed.

Medications used most of the time are NSAIDs but corticosteroids are used in other cases either locally via injection or systemically. Manual therapists such as chiropractors and physiotherapists may also administer extensive stretches each day and massage therapy. The Spencer technique may also be used to treat the shoulder [10].

As discussed in the pathophysiology, most patients regain function range of motion but 10-15% suffers from remaining handicap which may be either pain or restricted motion [6]. Ten years down the line however, improvement may be seen with the handicap. Recurrence of primary frozen shoulder is very rare.

There is a lack of clear evidence linking frozen shoulder to a specific etiology but there are various triggers that may predispose patients to this problem [2]. Some etiologic agents that have been identified in cases of adhesive capsulitis include the following:

• Various shoulder ailments
• Diabetes
• Inflammatory disease
• Surgery
• Trauma

Additionally, an autoimmune theory has been postulated with elevated levels of C-reactive protein as well as an increase incidence of HLA-B27 histocompatibility antigen often seen in patients with this condition.

Substantial on-going research is required to better understand; epidemiology, patho-aetiology, assessment, best management, health economics, patient satisfaction and if possible prevention. Copyright © 2014 Elsevier Ltd. All rights reserved. [ncbi.nlm.nih.gov]

Also Read: Adhesive Capsulitis or Frozen Shoulder: Epidemiology, Types, Signs, Symptoms, Causes, Risk Factors, Treatment Ayurvedic Treatment for Frozen Shoulder First Signs of Frozen Shoulder & its Treatment Also Watch: Understand the Causes, Signs, Symptoms [epainassist.com]

Original Article, 111 - 115 Prediction of hamstring injury in professional soccer players by isokinetic measurements Dauty M., Menu P., Fouasson-Chailloux A., Ferréol S., Dubois C Original Article, 116 - 123 Epidemiology of soccer players traumatic injuries [dx.doi.org]

Epidemiology Most commonly, it affects ages 40-65 years; the median age is 50-55 years. It affects around 3% of the adult population. It is more common in women. [patient.info]

Epidemiology Adhesive capsulitis or “frozen shoulder” affects approximately 2% of the general population. 1 Primary or idiopathic adhesive capsulitis refers to patients who develop the condition in the absence of preceding trauma. [doi.org]

Primary adhesive capsulitis is often considered to be a self-limiting disease that will last for 18-24 months but will heal in most cases, not leaving any residual handicap behind [4]. The condition often develops in three periods with duration of six months in each.

• The first period is freezing
• The second period is frozen
• The third period is thawing

The freezing stage shows an insidious onset where pain is the major clinical picture. Most of the time, subacromial impingement is suspected due to the involvement of the subacromial bursa. By the end of this period, it becomes difficult to carry out a range of motion, making diagnosis very simple.

During the frozen period, there is a reduction of pain but the restricted mobility remains.

The thawing stage shows successive reestablishment of normal or near normal range of motion.

In frozen shoulder, there is a lack of synovial fluid which makes it possible for ball and socket joints to move with its lubricating action between the humerus and the shoulder blade socket [5]. The shoulder capsule also thickens, swells, and tightens due to bands of scar tissue (adhesions) which have formed inside the capsule. As a result of this, there is far less room in the joint for the humerus and this makes movement of the shoulder not only stiff but also painful. The main difference between stiff shoulder and adhesive capsulitis is this restricted space between the capsule and the ball of the humerus.

One of the most common causes of frozen shoulder is the immobility that often results during recovery from a shoulder injury, broken arm or following a stroke. People who have had injuries that make it difficult for them to move their shoulders, should talk to their doctors on what exercises will be best for them to maintain a range of motion in their shoulder joint and avoid a frozen shoulder.

Frozen shoulder or adhesive capsulitis is a disorder that is both painful and of an unclear cause where the shoulder capsule becomes stiff and inflamed [1]. The shoulder capsule is the connective tissue surrounding the glenohumeral joint of the shoulder and its inflammation brings about chronic pain. The pain is often constant, worse at night and with cold weather. Certain movements can also provoke episodes of tremendous pain and cramping. The condition is believed to be caused by injury or trauma to the area and may have an autoimmune component.

1. Lundberg BJ. The frozen shoulder. Clinical and radiographical observations. The effect of manipulation under general anesthesia. Structure and glycosaminoglycan content of the joint capsule. Local bone metabolism. Acta Orthop Scand Suppl. 1969;119:1-59.
2. Binder AI, Bulgen DY, Hazleman BL, Roberts S. Frozen shoulder: a long-term prospective study. Ann Rheum Dis. Jun 1984;43(3):361-4.
3. Binder AI, Bulgen DY, Hazleman BL, Tudor J, Wraight P. Frozen shoulder: an arthrographic and radionuclear scan assessment. Ann Rheum Dis. Jun 1984;43(3):365-9.
4. Lloyd-Roberts GC, French PR. Periarthritis of the shoulder. A study of the disease and its treatment. Br Med J. 1959;1:1569-71.
5. Tveita EK, Sandvik L, Ekeberg OM, Juel NG, Bautz-Holter E. Factor structure of the Shoulder Pain and Disability Index in patients with adhesive capsulitis. BMC Musculoskelet Disord. Jul 17 2008;9:103.
6. Morén-Hybbinette I, Moritz U, Scherstén B. The clinical picture of the painful diabetic shoulder--natural history, social consequences and analysis of concomitant hand syndrome. Acta Med Scand 1987; 221:73.
7. Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol 1975; 4:193.
8. Rizk TE, Pinals RS. Frozen shoulder. Semin Arthritis Rheum 1982; 11:440.
9. Grey RG. The natural history of "idiopathic" frozen shoulder. J Bone Joint Surg Am 1978; 60:564.
10. Simmonds FA. Shoulder pain with particular reference to the frozen shoulder. J Bone Joint Surg Br 1949; 31B:426.