Shoulder Elbow iSAWE 3

Question

A 52 year old woman with type 2 diabetes has 4 months of severe shoulder pain, now with marked stiffness. Radiographs are normal.

Shoulder Elbow iSAWE 3, coronal mr arthrogram of the shoulder
Coronal MR arthrogram of the shoulder. Image by RSatUSZ, Wikimedia Commons, CC BY-SA 3.0.
  1. What is the diagnosis and what are the stages?
  2. What are the examination findings?
  3. How would you manage her?

Answer

Diagnosis

  • Primary frozen shoulder (adhesive capsulitis)
  • Contracture and fibrosis of the capsule and coracohumeral ligament with myofibroblasts
  • Associated with diabetes, thyroid disease, Dupuytren disease and female sex, peak age 40 to 60

Stages

  • Freezing, painful stage lasting weeks to months
  • Frozen, stiffness predominates with less pain
  • Thawing, gradual recovery of motion over months to years

Examination

  • Global loss of active and passive motion, with external rotation affected first and most
  • Normal cuff strength within the available range
  • Exclude locked posterior dislocation and glenohumeral arthritis with an axillary radiograph

Management

  • Explanation that the condition is usually self limiting over 1 to 3 years
  • Analgesia and gentle physiotherapy within comfort
  • Intra-articular corticosteroid injection gives early pain relief
  • Hydrodilatation with steroid
  • Manipulation under anaesthesia or arthroscopic capsular release for persistent stiffness, with release of the rotator interval
  • Optimise glycaemic control, as diabetic patients have a more prolonged course

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.