Capsulitis/ Frozen shoulder

Frozen shoulder, or capsulitis is an inflammatory condition causing fibrosis of the glenohumeral joint capsule, it is a highly painful condition causing progressive stiffness of the joint, typically external rotation first affected. It can be primary or secondary to other conditions causing a period of immobility.

• Mechanism of onset, location of symptoms, severity and longevity of symptoms, limitation to function
• History of trauma/diabetes/thyroid
• Night pain
• Exclude red flags
• Age (most common 40-60)

• Assess neck movements/ neurology to exclude
• Loss of passive external rotation and capsular loss of movement
• In frozen shoulder alone, no pain and true weakness on muscle testing.

X-Ray to exclude pathology such as osteoarthritis and calcific tendinitis.

• Cervical spine/ radiculopathy
• Glenohumeral OA, AVN
• Calcific tendinitis
• Subacromial pain
• Consider red flags and inflammatory pathology.

• Pain relief in line with agreed formularies/guidance
• Patient education
• Consider early steroid injection into the joint
• Range of movement exercises
• NHS AAA MSK website, Versus Arthritis.

Early referral to MSK.