FROZEN SHOULDER
Introduction
Adhesive shoulder capsulitis, or arthrofibrosis, describes a pathological process in which the
body forms excessive scar tissue or adhesions across the glenohumeral joint, leading to stiffness,
pain and dysfunction. Painful stiffness of the shoulder can adversely affect activities of daily
living and consequently impair quality of life.
Adhesive capsulitis, also known as frozen shoulder, is an inflammatory condition characterized
by shoulder stiffness, pain, and significant loss of passive range of motion.
Frozen shoulder occurs when the strong connective tissue surrounding your shoulder joint (called
the shoulder joint capsule) becomes thick, stiff and inflamed. The joint capsule contains the
ligaments that attach the top of your upper arm bone (humeral head) to your shoulder socket
(glenoid), firmly holding the joint in place. This is more commonly known as a ball-and-socket
joint.
The condition is called “frozen” shoulder because the more pain you feel, the less likely you’ll
use your shoulder. Lack of use causes your shoulder capsule to thicken and become tight,
making your shoulder even more difficult to move — it’s “frozen” in its position.
Common names for Frozen Shoulder include:
Adhesive Capsulitis
Painful stiff shoulder
Periarthritis
This inflammatory condition causes fibrosis of the GH joint capsule, is accompanied by
gradually progressive stiffness and significant restriction of range of motion (typically external
rotation).
SHOULDER JOINT
The shoulder complex is the connection of the upper arm and the thorax. Comprising numerous
ligamentous and muscular structures, composed of the clavicle, scapula, humerus and sternum,
and an intricately designed combination of four joints, the Glenohumeral Joint, the
Acromioclavicular (AC) Joint and the , Sternoclavicular (SC) Joint and a "floating joint", known
as the . Scapulothoracic (ST) joint
,The GH, AC and SC joints link the upper extremity to the axial skeleton at the thorax. The ST
joint allows for the scapula to glide over the contours of the posterior thoracic wall. All four
joints work collectively together to achieve normal shoulder girdle movements.
Osteology
The osseous segments of the shoulder complex comprise of the clavicle, scapula (shoulder
blade), the humerus and the sternum (the link to the thoracic cage).
Joints
In all, there are four major articulations associated with the Shoulder Complex involving the
sternum, clavicle, ribs, scapula, and humerus, which work together to provide large ranges of
motion to the upper extremity in all three planes of motion. Movement at the Shoulder Complex
occurs as a result of movement at each of these four joints, listed below.
1. Glenohumeral Joint,
2. Acromioclavicular Joint
3. Sternoclavicular Joint
4. Scapulothoracic Joint
Soft Tissue : Static And Dynamic
Shoulder stability is achieved through the interplay of both static and dynamic stabilisers, which
work in synchrony to maintain shoulder stability during movements of the shoulder.
Static: Non Contractile
The bony geometry of the glenohumeral joint is conducive to excessive joint mobility but
sacrifices osseous stability. It is thicker at the periphery and provides the foundation for the
concavity-compression effect of Rotator Cuff Muscles.
, Glenoid labrum
The Glenoid labrum is a fibrocartilaginous, ridge-like connective tissue which increases articular
surface area for the humeral head by deepening the glenoid fossa. It provides the primary
attachment for the glenohumeral ligaments and gives rise to the long head biceps tendon,
capsule, and scapular neck. It conforms to the curvature of the humeral head and as such
contributes to approximately 50% of the depth of the shoulder joint. Stretches out anteriorly with
external rotation, stretches out posteriorly with internal rotation. A loss of labrum integrity has
been shown to decrease the resistance to the translation by 20%
Joint Capsule
The joint capsule that surrounds the glenohumeral joint is also an important passive stabilizer of
the shoulder joint. The glenohumeral joint capsule is thickened at the front of the capsule and is
twice the size of the humeral head. It provides most of its extensibility anteriorly and inferiorly
and it “Winds up” during abduction and external rotation. The joint capsule and glenohumeral
ligaments are intimately adherents anatomically and mainly function as stabilizers at the
extremes of motion. This static end-range stabilization is very important when all other
stabilizing mechanisms are overwhelmed. The joint capsule has an inherent negative intra-
articular pressure that holds the joint together.
Ligaments
Introduction
Adhesive shoulder capsulitis, or arthrofibrosis, describes a pathological process in which the
body forms excessive scar tissue or adhesions across the glenohumeral joint, leading to stiffness,
pain and dysfunction. Painful stiffness of the shoulder can adversely affect activities of daily
living and consequently impair quality of life.
Adhesive capsulitis, also known as frozen shoulder, is an inflammatory condition characterized
by shoulder stiffness, pain, and significant loss of passive range of motion.
Frozen shoulder occurs when the strong connective tissue surrounding your shoulder joint (called
the shoulder joint capsule) becomes thick, stiff and inflamed. The joint capsule contains the
ligaments that attach the top of your upper arm bone (humeral head) to your shoulder socket
(glenoid), firmly holding the joint in place. This is more commonly known as a ball-and-socket
joint.
The condition is called “frozen” shoulder because the more pain you feel, the less likely you’ll
use your shoulder. Lack of use causes your shoulder capsule to thicken and become tight,
making your shoulder even more difficult to move — it’s “frozen” in its position.
Common names for Frozen Shoulder include:
Adhesive Capsulitis
Painful stiff shoulder
Periarthritis
This inflammatory condition causes fibrosis of the GH joint capsule, is accompanied by
gradually progressive stiffness and significant restriction of range of motion (typically external
rotation).
SHOULDER JOINT
The shoulder complex is the connection of the upper arm and the thorax. Comprising numerous
ligamentous and muscular structures, composed of the clavicle, scapula, humerus and sternum,
and an intricately designed combination of four joints, the Glenohumeral Joint, the
Acromioclavicular (AC) Joint and the , Sternoclavicular (SC) Joint and a "floating joint", known
as the . Scapulothoracic (ST) joint
,The GH, AC and SC joints link the upper extremity to the axial skeleton at the thorax. The ST
joint allows for the scapula to glide over the contours of the posterior thoracic wall. All four
joints work collectively together to achieve normal shoulder girdle movements.
Osteology
The osseous segments of the shoulder complex comprise of the clavicle, scapula (shoulder
blade), the humerus and the sternum (the link to the thoracic cage).
Joints
In all, there are four major articulations associated with the Shoulder Complex involving the
sternum, clavicle, ribs, scapula, and humerus, which work together to provide large ranges of
motion to the upper extremity in all three planes of motion. Movement at the Shoulder Complex
occurs as a result of movement at each of these four joints, listed below.
1. Glenohumeral Joint,
2. Acromioclavicular Joint
3. Sternoclavicular Joint
4. Scapulothoracic Joint
Soft Tissue : Static And Dynamic
Shoulder stability is achieved through the interplay of both static and dynamic stabilisers, which
work in synchrony to maintain shoulder stability during movements of the shoulder.
Static: Non Contractile
The bony geometry of the glenohumeral joint is conducive to excessive joint mobility but
sacrifices osseous stability. It is thicker at the periphery and provides the foundation for the
concavity-compression effect of Rotator Cuff Muscles.
, Glenoid labrum
The Glenoid labrum is a fibrocartilaginous, ridge-like connective tissue which increases articular
surface area for the humeral head by deepening the glenoid fossa. It provides the primary
attachment for the glenohumeral ligaments and gives rise to the long head biceps tendon,
capsule, and scapular neck. It conforms to the curvature of the humeral head and as such
contributes to approximately 50% of the depth of the shoulder joint. Stretches out anteriorly with
external rotation, stretches out posteriorly with internal rotation. A loss of labrum integrity has
been shown to decrease the resistance to the translation by 20%
Joint Capsule
The joint capsule that surrounds the glenohumeral joint is also an important passive stabilizer of
the shoulder joint. The glenohumeral joint capsule is thickened at the front of the capsule and is
twice the size of the humeral head. It provides most of its extensibility anteriorly and inferiorly
and it “Winds up” during abduction and external rotation. The joint capsule and glenohumeral
ligaments are intimately adherents anatomically and mainly function as stabilizers at the
extremes of motion. This static end-range stabilization is very important when all other
stabilizing mechanisms are overwhelmed. The joint capsule has an inherent negative intra-
articular pressure that holds the joint together.
Ligaments
