Case Manager's Corner

Mechanism of Injury:

May be due to minor trauma to the shoulder, but often there is no identifiable cause. Associated with diabetes, thyroid disease, and following chest or breast surgery.

Subjective Symptoms:

Pain and restricted range of active and passive glenohumeral motion.

Objective Signs:

Initially, patients complain of pain with range of motion (Stage 1). Patients then progress through a stiffening phase with limited range of motion (Stage 2). Eventually, patients may demonstrate gradual returns in motion (Stage 3).

Natural History:

Usually self-limiting and passes through three distinct stages:

Stage 1: Painful phase
Stage 2: Stiffening phase
Stage 3: Thawing phase

The time for recovery varies, but most patients experience improvements in motion within 12 to 18 months.

Nonsurgical:

Treatment options include local steroid injections, physical therapy and modalities. Emphasis is on passive stretching with a dedicated home exercise program.

Surgical:

If conservative treatment fails, especially if motion is limited to < 90 degrees of forward elevation or 0 degrees of external rotation despite 3 to 6 months of physical therapy, arthroscopic debridement and manipulation under anesthesia may be required.

Nonsurgical:

12-18 months

Within limits of motion

Surgical:

3-6 months

Within limits of motion