Frozen Shoulder

Abstract

The frozen shoulder is a commonly encountered condition that is often mistaken for other, potentially concomitant, pathologies. The diagnosis can be made clinically with a loss of external rotation that is present both actively and passively. Radiographs are essential to rule out the other two major causes of rotation loss: glenohumeral osteoarthritis and locked posterior dislocation. Magnetic resonance imaging (MRI) is unnecessary for the diagnosis. However, many patients present to the orthopedic clinic with an MRI already having been obtained. Regrettably, there are few specific findings on MRI. The four most commonly observed direct signs that suggest the diagnosis of frozen shoulder on MRI include thickening of the glenohumeral joint capsule in the axillary pouch, thickening of the coracohumeral ligament, obliteration of the subcoracoid fat triangle, and synovitis of the rotator interval. Management is overwhelmingly nonoperative, with 90 % of patients reporting resolution of symptoms. In those patients who fail to improve, arthroscopic capsular release may be indicated.