DipMSK Revision Guide · Chapter 1 of 18

Frozen Shoulder

The capsular pattern, the phases that drive treatment, and the stiff shoulder that is something else.

Syllabus: Frozen Shoulder

Written by Dr David Palethorpe, MBBS, BSc (Hons), MRCGP · NHS GP PartnerReviewed 14 September 202617 min readChapter 1 of 18

Before you start

Try this first

Which single passive movement carries the diagnosis, and how do you test it?

Passive external rotation, with the elbow flexed to 90° and tucked to the side. Loss here, out of proportion to the other planes, is the single most useful sign in the shoulder examination.

2 more warm-up questions in the full chapter.

What this chapter covers

  • 1.1Frozen shoulder — recognising the capsular patternGlobal restriction with disproportionate loss of passive external rotation at the side, and a normal radiograph. Active…Preview below
  • 1.2Primary or secondary? Finding the driverMembers
  • 1.3Treatment by phase — what to offer whenMembers
  • 1.4The stiff shoulder that is not a frozen shoulderMembers
  • —Referral, by timeframeRed flags below

Frozen shoulder — recognising the capsular pattern

Core Lens — the takeaway

Global restriction with disproportionate loss of passive external rotation at the side, and a normal radiograph. Active and passive are restricted to a similar degree — that equality is the diagnostic point.

Recognise

  • Insidious, often unprovoked shoulder pain that progresses over weeks to months into global stiffness. Peak incidence is in the fifth and sixth decades; cumulative incidence is around 2.4 per 1,000 people per year.
  • Pain is worse on movement and becomes constant. It characteristically disturbs sleep — patients cannot lie on the affected side, and that is often what brings them in.
  • The hallmark is a capsular pattern: global restriction of movement with disproportionately severe loss of passive external rotation with the arm by the side. Active and passive ranges are restricted to a similar degree.

The rest of this chapter is in the DipMSK guide

3 more topics, every section opened up, the recall questions and the guidance summaries — written and reviewed by practising UK doctors.

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Referral, by timeframe

Same day · Emergency
  • Suspected septic arthritis or an unreduced dislocation (an acute traumatic rotator cuff tear is urgent, within 2 weeks, not same day)
  • Suspected giant cell arteritis with visual symptoms or jaw claudication — treat as an emergency

Also in the full chapter: Cancer pathway · Urgent · Routine.

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