Frozen shoulder, or adhesive capsulitis, describes the common shoulder condition characterized by painful and limited active and passive range of motion (ROM). Frozen shoulder is reported to affect 2% to 5% of the general population, 4,13,64,88 increasing to 10% to 38% in patients with diabetes and thyroid disease. 4,5,13,64,71,88 Individuals with primary frozen shoulder are commonly between 40 and 65 years old, 79,82,83 and the incidence appears higher in females than males. 4,9,43,64,71,109 The occurrence of frozen shoulder in 1 shoulder increases the risk of contralateral shoulder involvement by 5% to history, clinical presentation, and recovery. Codman 22 described frozen shoulder as "a condition difficult to define, difficult to treat, and difficult to explain from the point of view of pathology." Nevaiser 80 introduced the term adhesive capsulitis to describe the inflamed and fibrotic condition of the capsuloligamentous tissue. The term frozen shoulder will be used, because it encompasses both primary frozen shoulder (adhesive capsulitis) and secondary frozen shoulder related to systemic disease and extrinsic or intrinsic factors, excluding cerebral vascular accident, proximal humeral fracture, and causative rotator cuff or labral pathology. This paper will present an overview of the classification, etiology, pathology, examination, and plan of care for frozen shoulder.T he absence of standardized nomenclature for frozen shoulder causes confusion in the literature. Lundberg 64 first described a classification system identifying primary frozen shoulder as idiopathic and secondary frozen shoulder as posttraumatic. Nash and Hazelman 77 expanded the classification system by including diseases such as diabetes mellitus, myocardial infarction, or various neurologic disorders under secondary frozen shoulder. Zuckerman 128 proposed a classification schema where primary 34%, and simultaneous bilateral shoulder involvement occurs as often as 14% of the time. 16,39,64,107 To date, the etiology of frozen shoulder remains unclear; however, patients typically demonstrate a characteristic Frozen shoulder or adhesive capsulitis describes the common shoulder condition characterized by painful and limited active and passive range of motion. The etiology of frozen shoulder remains unclear; however, patients typically demonstrate a characteristic history, clinical presentation, and recovery. A classification schema is described, in which primary frozen shoulder and idiopathic adhesive capsulitis are considered identical and not associated with a systemic condition or history of injury. Secondary frozen shoulder is defined by 3 subcategories: systemic, extrinsic, and intrinsic. We also propose another classification system based on the patient's irritability level (low, moderate, and high), that we believe is helpful when making clinical decisions regarding rehabilitation intervention. Nonoperative interventions include patient education, modalities, stretching exercises, joint mobilization, and corticosteroid injections. Gle...
