INTRODUCTION OF FROZEN SHOULDER
Frozen shoulder is asymptomatic in nature with no exact cause. Frozen shoulder
is an advanced stage of periarthritis shoulder.
Frozen shoulder, also known as adhesive capsulitis, is a condition characterized
by capsular adhesion form as a result of inflammation in the capsule and
synovium ,development of dense adhesion ,capsular thickening and capsular
restriction resulting in stiffness and pain in your shoulder joint. “FS is a term
coined by Codman in 1934”. ROM is completely affected in adhesive capsulitis
especially abduction and external rotation. Signs and symptoms typically begin
gradually, worsen over time and then resolve, usually within one to three years. It
occurs at the age of 45+ (insidious type) or after trauma or surgery. Normal bone
and soft tissue lines, are observed. Restricted AROM and limited passive range of
motion. Sensory function and reflexes are not affected. Palpation is not painful
unless capsule is stretched. Negative radiography is seen while in arthrography
decreased capsular size is seen. Normal shoulder capacity is 20 to 30 ml
whereas,a capacity of 5 to 10 ml is present in patients with frozen shoulder.
“Periarthritis shoulder has an inflammation of synovial membrane narrowing of
joint space and slight bone erosion which with time aggrevates and causes a
complete advanced leading to adhesive capsulitis” but the ROM is complete, it is
only due to the pain, the pt. is not able to perform full ROM rather than
intrarticular or capsular contracture and ESR level is increased in PA.
With the erosion there is formation of osteophytes and the capsule is stiffed and
ROM restricted.
1
, ANATOMY OF SHOULDER JT.
TYPE
The shoulder joint, is a synovial joint of the ball and socket variety. The articular
surface , ligaments, bursae related to this important joint are explained below
ARTICULAR SURFACEs
The joint is formed by articulation of glenoid cavity of scapula and the head of the
humerus. Therefore , it is also known as glenohumeral articulation.
Structurally , it is the weak joint because the glenoid cavity is too small and
shallow to hold the head of the humerus in place( the head is 4 times the size of
the glenoid cavity). However , this arrangement permits great mobility. Stability
of the jt. is maintained by the following factors.
1. The coracoacromial arch (acromian and coracoacromian ligament) or secondary
socket for the head of the humerus.
2. The musculotendinous cuff or rotator cuff of the shoulder i.e. supraspinatus,
infraspinatus, teres minor and subscapularis
3. The glenoidal labrum helps in deepening the glenoid fossa
Stability is also provided by the muscles attaching the humerus to the pectoral
girdle, the long head of the biceps brachii , and atmospheric pressure.
2
, LIGAMENTS
1. Capsular ligament
2. Coracohumeral ligament
3. Transverse humeral ligament
4. The glenoidal ligament
BURSAE RELATED TO THE JOINT
1. The subacromial (subdeltoid) bursa
2. The subscapularis bursa
3. The infraspinatus bursa
RELATIONS
1. Superiorly : coracoacromial arch, subacromial bursa, supraspinatus and deltoid.
2. Inferiorly : long head of triceps brachii
3. Anteriorly : subscapularis, coracobrachialis, short head of biceps brachii and
deltoid
4. Posteriorly : infraspinatus, teres minor and deltoid
5. Within the joint : tendon of the long head of the biceps brachii
3
Frozen shoulder is asymptomatic in nature with no exact cause. Frozen shoulder
is an advanced stage of periarthritis shoulder.
Frozen shoulder, also known as adhesive capsulitis, is a condition characterized
by capsular adhesion form as a result of inflammation in the capsule and
synovium ,development of dense adhesion ,capsular thickening and capsular
restriction resulting in stiffness and pain in your shoulder joint. “FS is a term
coined by Codman in 1934”. ROM is completely affected in adhesive capsulitis
especially abduction and external rotation. Signs and symptoms typically begin
gradually, worsen over time and then resolve, usually within one to three years. It
occurs at the age of 45+ (insidious type) or after trauma or surgery. Normal bone
and soft tissue lines, are observed. Restricted AROM and limited passive range of
motion. Sensory function and reflexes are not affected. Palpation is not painful
unless capsule is stretched. Negative radiography is seen while in arthrography
decreased capsular size is seen. Normal shoulder capacity is 20 to 30 ml
whereas,a capacity of 5 to 10 ml is present in patients with frozen shoulder.
“Periarthritis shoulder has an inflammation of synovial membrane narrowing of
joint space and slight bone erosion which with time aggrevates and causes a
complete advanced leading to adhesive capsulitis” but the ROM is complete, it is
only due to the pain, the pt. is not able to perform full ROM rather than
intrarticular or capsular contracture and ESR level is increased in PA.
With the erosion there is formation of osteophytes and the capsule is stiffed and
ROM restricted.
1
, ANATOMY OF SHOULDER JT.
TYPE
The shoulder joint, is a synovial joint of the ball and socket variety. The articular
surface , ligaments, bursae related to this important joint are explained below
ARTICULAR SURFACEs
The joint is formed by articulation of glenoid cavity of scapula and the head of the
humerus. Therefore , it is also known as glenohumeral articulation.
Structurally , it is the weak joint because the glenoid cavity is too small and
shallow to hold the head of the humerus in place( the head is 4 times the size of
the glenoid cavity). However , this arrangement permits great mobility. Stability
of the jt. is maintained by the following factors.
1. The coracoacromial arch (acromian and coracoacromian ligament) or secondary
socket for the head of the humerus.
2. The musculotendinous cuff or rotator cuff of the shoulder i.e. supraspinatus,
infraspinatus, teres minor and subscapularis
3. The glenoidal labrum helps in deepening the glenoid fossa
Stability is also provided by the muscles attaching the humerus to the pectoral
girdle, the long head of the biceps brachii , and atmospheric pressure.
2
, LIGAMENTS
1. Capsular ligament
2. Coracohumeral ligament
3. Transverse humeral ligament
4. The glenoidal ligament
BURSAE RELATED TO THE JOINT
1. The subacromial (subdeltoid) bursa
2. The subscapularis bursa
3. The infraspinatus bursa
RELATIONS
1. Superiorly : coracoacromial arch, subacromial bursa, supraspinatus and deltoid.
2. Inferiorly : long head of triceps brachii
3. Anteriorly : subscapularis, coracobrachialis, short head of biceps brachii and
deltoid
4. Posteriorly : infraspinatus, teres minor and deltoid
5. Within the joint : tendon of the long head of the biceps brachii
3
