c) No findings in the case history or in the clinical or radiological ex- amination which could explain the decrease of the range of motion

4.1 Classification of frozen shoulder according to Lundberg [81]

A) Primary frozen shoulder

Primary frozen shoulders were defined as follows:

a) The total elevation in the shoulder joint restricted to 1358 or less.

b) The restriction of motion localized to the humero-scapular joint.

c) No findings in the case history or in the clinical or radiological ex- amination which could explain the decrease of the range of motion;

by the latter criterion cases with post-traumatic conditions, rheuma- toid arthritis, osteoarthritis, hemiplegia and other more obvious changes, were excluded.

B) Secondary frozen shoulder

The range of motion was similarly decreased but following a traumatic le- sion. The associated injuries were soft tissue injury to the shoulder region, intra- and juxtaarticular fractures and other fractures of the upper limb.

4.2 Stages of frozen shoulder according to Reeves [109]

Three consecutive stages:

n Stage 1: pain

Duration: 10 to 36 weeks

No difference between men and women

No difference between affected dominant and nondominant shoulder No correlation with age

In the early stages there is a full range of movement under an anaes- thetic

Classifications of frozen shoulder 4

n Stage 2: stiffness Duration: 4 to 12 months

Without improvement of movement

n Stage 3: recovery

Duration: 5 months to 2 years 2 months Spontaneous recovery of movement

First a gradual regaining of external rotation; then a gradual return of abduction and internal rotation

The short recovery period was associated with a short previous painful period, and a long recovery period was often associated with a prolon- gation of the painful period.

The stiffness stage was usually related to the duration of the recovery stage: the longer the stiffness stage is, the longer is the recovery stage.

4.3 Arthroscopic stages of adhesive capsulitis according to Neviaser [103]

Adhesive capsulitis is a specific entity consisting of four identifiable stages by arthroscopy.

n In stage 1, patients usually present with signs and symptoms of the impingement syndrome. Their motion usually is restricted very little if at all, and that restriction fools the physician into believing this loss of motion and increased pain are due to a rotator cuff tendinitis (the impingement sign). The usual treatment for the impingement syndrome fails, often to the point that decompression of the acromial arch is contemplated. If the decompression is carried out, the postop- erative course will be severely drawn out, with the capsular struc- tures undergoing all the stages of adhesive capsulitis superimposed upon a postoperative course of an acromial arc decompression. Ar- throscopy prior to decompression surgery would show an erythema- tous fibrinous pannus over the synovium best seen in and around the dependent fold.

n In stage 2, the synovium is red, angry, and thickened, and one can actually visualize adhesions growing across the dependent fold onto 14 4 Classifications of frozen shoulder

the humeral head. There is complete loss of the normal interval be- tween the humeral head and glenoid as well as the space between the humeral head and biceps tendon. The most impressive finding on physical examination is the severe loss of motion in all planes with pain in all ranges of motion.

n In stage 3, there is only a pink synovitis that is not as abundant as in stage 2, but the dependent fold is now noted to be at least half its original size. The humeral head remains solidly pressed against the glenoid and bicipital tendon, even with traction.

n In stage 4, no more synovitis is present; however, the dependent fold is severely contracted and motion is at its worst. The humeral head remains compressed against the glenoid and the biceps tendon as in stage 2 and 3.

a 4.3 Arthroscopic stages of adhesive capsulitis according to Neviaser 15