Typically described as having 3 phases:

  1. Freezing or pain/inflammatory phase
  2. Frozen or stiffness phase
  3. Thawing or recovery
  • Primary frozen shoulder is associated with an idiopathic onset, whereas secondary occurs following trauma or forced inactivity.
  • Average duration of 30 months (Reeves 1975).
  • Patients with systemic illnesses such as diabetes carry an increased risk, as do those with thyroid abnormalities and heart disease.


  • Clinical diagnosis with the exclusion of other pathologies.
  • Normal glenohumeral radiographs.
  • A pattern of progressively restricted joint movement.
  • Typically an equal restriction of active and passive glenohumeral external rotation.

Normal rotator cuff and bursal complex

Primary objective assessment finding: Loss of external rotation

Commonly visualised sonographic abnormalities include:

  • Small increase in joint fluid
  • Thickening and fibrosis of the rotator interval with neovascularity
  • Contraction and thickening of the anterior and inferior capsule (axillary recess)
  • Contraction and fibrosis of the coracohumeral ligament

Small joint effusion

Rotator thickening and neovascularity

CHL proximal thickening and neovascularity

Posterior joint thickening and oedema

Axillary pouch/IGHL thickening

One method often employed in the management of Frozen Shoulder with supporting evidence is that of ultrasound guided intra-articular glenohumeral joint injections of corticosteroid and volume of local anaesthetic (Yoon et al 2013).


Bryant, M., Gough, A., Selfe, J., Richards, J., & Burgess, E. (2017). The effectiveness of ultrasound guided hydrodistension and physiotherapy in the treatment of frozen shoulder/adhesive capsulitis in primary care: a single centre service evaluation. Shoulder & Elbow. 9. https://doi.org/10.1177/1758573217701063.

Lewis, J. Frozen shoulder contracture syndrome – Aetiology, diagnosis and management, Manual Therapy, Volume 20, Issue 1, 2015, Pages 2-9, ISSN 1356-689X, https://doi.org/10.1016/j.math.2014.07.006.

Reeves, B. (1975). The Natural History of the Frozen Shoulder Syndrome. Scandinavian journal of rheumatology. 4. 193-6. https://doi.org/10.3109/03009747509165255.

Yoon, S., & Lee, H., Jung Lee, H., & Kwack, K. (2013). Optimal Dose of Intra-articular Corticosteroids for Adhesive Capsulitis A Randomized, Triple-Blind, Placebo-Controlled Trial. The American journal of sports medicine. 41. https://doi.org/10.1177/0363546513480475.

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