Codman first introduced the term “frozen shoulder” in 1934 in which he described a painful shoulder condition with insidious onset. He noted that it was associated with stiffness and difficultly in sleeping on the affected side with marked reduction in shoulder forward elevation and external rotation.

Frozen Shoulder can be idiopathic or secondary to surgery or trauma. Frozen Shoulder affects approximately 2% of the general population, more commonly women aged between 40 to 70 years. The exact aetiology of Frozen Shoulder is unknown, however there are well established stages of the disease described as "Freezing", "Frozen" and "Thawing". Untreated, Frozen Shoulders usually self rectifies in 2-3 years, however up to 50% of patients never regaining full range of motion.

Ultrasound evaluation of the Coracohumeral ligament and Rotator Interval has been demonstrated to be useful indicators for Frozen Shoulder. The unique feature of Ultrasound over other imaging modalities is that it enables dynamic assessment.
Posterior shoulder capsular compliance can be easily assessed with the patient moving their arm between internal and external rotation. Posterior capsular compliance and joint synovial proliferation is easily assessable and correlates well to the established “stages” of Frozen shoulder. The clinical importance of accurately diagnosing early Frozen shoulder is that studies show, with early diagnosis and intervention, the duration of the disease can be drastically reduced to a few months.

The aim of this presentation is to demonstrate the Sonographic findings various stages of Frozen shoulder that enables the timely intervention to what is otherwise a sticky situation.

References and Suggested Reading

Bal, A. Eksioglu, E. et al. Effectiveness of corticosteroid injection in adhesive capsulitis. Clinical Rehabilitation 2008; 22: 503-512

Dias, R. Cutts, S. Massoud, S. Frozen Shoulder. BMJ Vol 331, 17 December 2005, 1453-1456

Homsi, C. Bordalo-Rodrigues, M., et al. Ultrasound in adhesive capsulitis of the shoulder: is assessment of the coracohumeral ligament a valuable diagnostic tool? Skeletal Radiol (2006) 35: 673-678

Lee, J., Sykes, C., et al. Adhesive capsulitis: Sonographic changes in the rotator cuff interval with arthroscopic correlation. Skeletal Radiol (2005) 34: 522-527

Marx, R G. Malizia, R W., et al. Intra-articular Corticosteroid Injection for the Treatment of Idiopathic Adhesive Capsulitis of the Shoulder. HSSJ (2007) 3: 202-207

Mengiardi, B., Pfirrmann, C W A., et al. Frozen Shoulder: MR Arthrographic Findings. Radiology Nov 2004 No. 2 486-492.

Tonino, P., Gerber, C., et al. Complex Shoulder Disorders: Evaluation and Treatment. Journal of the American Academy of Orthopaedic Surgeons March 2009, Vol 17, No 3, 125-136