Questionnaire/history: 40-60 years old? Gradual onset of pain in the deltoid region with worsening shoulder stiffness? Difficult to put coat on? Sleep disturbance? Trauma? Rotator cuff disease? CVD, diabetes, thyroid dysfunction? Painful phase with progressive pain on movement (2-9 months)? Stiffness phase with pain becoming less but present at the end of the range of movement and remaining stiffness and reduction in the range of shoulder movements (4-12 months)? Resolution phase with gradual improvement in range of movement with less stiffness? Pain predominant phase? Stiffness predominant phase? Past medical history? Current medication? Drug allergies? Examination: Global restriction in active and passive movements with a capsular pattern (disproportionate severe reduction in passive external rotation and pain at the end of external rotation)? No crepitus? Management: Findings explained Advised: - Pain is the main problem initially, it can be worse in bed and disturb sleep - Pain gradually improves, but stiffness slowly worsens and becomes the main problem, the stiffness then gradually resolves - Frozen shoulder is usually self-limiting, but it can take months to years to resolve - To continue to use the arm - To avoid movements which worsen the pain - Paracetamol +/- ibuprofen +/- codeine prn - Hot packs may be helpful - In bed to support the arm with pillows (to prevent rolling onto the affected shoulder) - Physiotherapy - To consider an intra-articular (glenohumeral) corticosteroid injection early in the course if there is no, or slow, progress with conservative treatment - To consider - To read Patient UK info ‘Frozen shoulder’ - Review if worsening symptoms or no improvement in 3 months Considered an intra-articular (glenohumeral) corticosteroid injection early in the course if there is no, or slow, progress with conservative treatment? Considered referral? Reference(s): NICE CKS: Shoulder pain: Scenario: Frozen shoulder Information for parents/carers: Patient UK: Frozen Shoulder