Frozen-Shoulder

Syndrome

Pulmonary
BY

1,om

J.

T.

H.

I Ime DCJ)am(

As
long

M.D.,

10 C 0 t of

BALTIMORE,

8mmrgcry,

IIo/)ki?m.s

its

l)iti..-ion
I!osjnl

commsult.aimt
iim ortimOl)aediC
surgery
time lmiglm nmci(lence
of time so-called

noted

patients

ilm these

associated!

imospit.als.

Aitimougim

witim car!iac

an(!

with

Tuberculosis

JOHNSON,

JoIm

in Patients

it

otimer

of

(ii,

to

MARYLAND

SO rgcry,

Om( Imopac(lu

Bait

on

L((

sammitaria,
I imave
syIm(!mOiIme aiimommg time

several
tuberculosis
frozen-slmould!er

is veil

kmmown

dei)iiit-ating

that

timis

illnesses

syndronme

is often

time literature

is quite

concerimimmg
its relatiolmsimii)
with
i)ulilmOmmaiY t-uimerculosis.
Franklin
alm(! Nemmmcik noted! a lmigim immcli!ence
of slmOUi(ler conmplaints
immg degree
immtuberculous
pat-ieimts
at Fitzsimimons
Armmmy Hospital.
Timese
w.ci.e not followed
for ammy iengtlm of time,
but time autimors
were discouraged
5l)it15C

l)00i
results
obtained!
by aimy mmmetlmod of treatimment.
Einaudi
imigim immci(lence
of l)eriartlmritis
of time simoulder
in tuberculous

ime too

(!id!

result

not

of this

colmd!ition,

etmlosis

timmme. 1\Ioimmmt \Vilsoim

I1C11
Baltnmmore-in

are

t.ietted.

time frozen-simoulder

immtllC

SeIidS.

l)LtiemmtS
(Iiffictmit-y

Time calendar
obviously

patiemits

of

year
wimo

weme

their
imad

seen

was
of all

ages

shoulders
in
been
afflicted

Time

all

1955,

its

otimers

a given

efficient
of tuber-

were
timis,

colmtinue(!

to soimme degree
to be immelU(!e(!

but

i)atients

period
SU(im

the

eventual
in

degrees

ammd all

in timat

colm(htion

(imrOImie

and!

imospital

mmmo(!ern,

witim

cimosen,

me

by

in Italy,

selectedl-a

was

by

patients

in one

patients

reported

timese cases.
time clinical
course

cases

1956
seen

mmmeant, in a

first
had
d!istress
wit-im
omi immto 1957,
but
all

but

Hospital

State
wimicli

syndronme
rFimis

of

any

to clarify

l)eiiOd!
of
institimtiomm

lolmg-term)m
follow-up
imot oimiy time immcidence
I decid!ed!
to follow
all

imave

ord!er

In

recently

of aiy-

witim
included

timat

sommme

to

have

imm 1956.
Un(lem time termim

mmext PIoblemmm itS

to clarify
wimat was
\lany
patieimts
imad paimm and! soimme d!egree
of stiffimess
witimout
real
freezimmg
ever developing.
Timerefore,
an arbitramy
nmimmimmiummmof 50 pei cent
lmmitat.iomm of scapuloimuimmeral
nmotion
was
set ; timis wits
furtimer
(lefined
as inability
to
iti)i!Uct
time simoimltler
eitimer
actively
or passively
beyond
90 degrees.
Time grad!ing
of pemTclmtage
of stiffness
was
necessarily
rough
because
factors
like appreimemmsion

f IOZCFi

and!

S/lOl4l(le1.

iaimm

cOUl(1

imot be

excluded,

i)ut

with

l)ractice

a fairly

accurate

estimate

could

i)e mmmade.
In (l(lI1fl

CC

Tvemmtv-mmimme
\.e1.e

seemm imm 1956;

six simoul(lers.

Most

tul)erculosis
ummt-il l(COVdVV.

1mm 1956,

etr,

for

vitim
imad!

renmarkable

frozen
was
277

at

least

bilateral
of all,

all

time average
of

stay

isevelm

sammitaniunm,

it

i)iOI)iti)ilit.v
imOsl)it-ttl

imatiemmts

patiemmts

d!aily
simotii(ler
days,
so

50 i)(1 cent
hinmitatiomm of simoulder
motion
limmmitatiomm. Timere was timus a total
of thirtyand a trii)ute
to time advantages
of study
in
were
followed!
for at least
six mmmontims, om

cemmsus

of

the

408

imosl)ital

7. 1 per
cent.
ommiv 904 patieimts

per
were

patient.
in time

sotmme for ts little

as a (ity,
soimme for time entire
year.
1956,
time ilmci(lelmce
of frozen
simoul(ler
3.2 ier

patients,

year.
imospital

Countimmg
cent.

so

time

Time average
during
time

total

Patiemmts

.lqc
Time I)tttidmmts
eight

vetls

time average

being

VOl..

5. JULY

4i-A.

vitlm

frozemm

ommlv omme vas

NO.

50.8
1959

years.

simotliders

under
In

fort,

1tmmged
and!

time hospital

in

only
at

age

timree
large

frommm t-imirt.y-sevemm

over
time

sixty

average

years
census

to

sixty-

old,
was

witim
170
877

878

J.

T.

H.

JOHNSON

time group
of patients
forty
to sixty
years
Old!.
As our
iat-ients
in timis age
group,
time average
incidemmce
per
to sixty-year
group
was
14.7 per cent
(nearly
one case

i)atientS
in
twenty-five
in the forty
group

under

forty,

time ilmcidenCe

sixty

yeais,

only

3.7

a immimmute 0.55

was

i)er

cent,

series

simowed

imosi)it-al

year

in six

Tim time

amm(! imm time group

over

cent.

l)e1

Sex
In

i)e

timis

seiies

33 pe

were

twenty

of men.

of

Body

It was

uith

timat

However,

patients

sid!e,

Shoulder

believed

significance.

witim

giving

ratio

time side

time lesion

was

nine

wonmeim,

7.3 per

of time body

series

on

(47

and

time imospital

showing

averaged

wimat.

67

ier

cemmt mmmenand! 6.6

seemmmedi to

cemmt mmmeimammdl

ier

cemmt wommmen.

Lesion

in this

seventeen

nmen

Hovever,

cemmt wonmemm, so time final

Side

ten

timere

i)rel)olmderance

it

per

timere

time right

cent)

side,

riglmt

simoulder

with

were

seven
and!

twelve

simoulders

stiffness

patients
with

and

mmmigimt be of

affected

i)ilaterally,

time lesion

nineteen

(53

on

time left

pcI cent)

left

simoulders.
A-ide of

Body

rFler

with

are

Pulmoiwry

numerous

Lesion

timeories

that

l)eriartimritis

of

time

shoulder

is

related

to

reflex neurological
cimanges
stimulated!
i:mg timis line of thought,
it would
be

by )atimOlogica1
logical
to expect

predonminate
in an area with the same
it was anticipated!
that
timere would
witim time lung
lesion
with time side of
it was found
that
time major
lung
lesions
tier in only 13 per cent and were on

general
reflex arc as time affected
simoulder
and!
be some
correlation
of time side of time body
time body
with the affected
shoulder.
Instead,
were
on time same
side as time frozen
simoultime opposite
side in 27 per ceimt, wimereas
time

luimgs

were

Patients.
statistically

only

equally

affected

Time

a)parent
significant
time Sidle of

timat.

Scverittj

of

Timere

Imowever,

ity

of time I)uhlmonary
was
mild ; in 35 per
I)uration

of

timere

and

imad onset

cent

to

of simoulder

a definite

note

timose

seemmmed

correlation

to

tlmat

symptoms

witim

none

involved

between

iim 60

frozen

of

the

severe

and

patients,
before

of timis
or

connection

symptonms.

in time first

period,

simould!ers

policy

be a definite

of simoulder

to six-month

tariuimm , Imad frozen

It is time gemmeral
especially

were

per

ceimt

shoulders

tuberculosis.
In 13 pei cent of our patients
cent,
immoderate
; and in 52 per cent,
severe.

time onset

in time timree

esting

simoulders

of

time

to be
slmow

the

ammd sever-

tuberculosis

Hospitalization

Sinmilarly,

Pitalization

botim

predilection
for the opposite
side
was
mmot considered
in this
small
series,
and
it was
felt
timat time figures
time body
witlm the lung
lesion
is not important.

Lesion

Lung
sas,

or

changes
elsewimere.
Followthe patimological
cimanges
to

tlmree

21 er
except

between

Only

time lengtim

of imos-

eemmt of time l)at-ients

nmontims
of imospitalizatiolm,
58 per
cent after
six mnontims. It is intertwo

21 per

trammsfers

froimm aimotimer

stmmi-

adnmission.
and!

nmod!crately

other

tuberculosis
severe

imospitals

lesions,

on

at least timree to six immontims. Excessive

exercise
is discouraged,
emphasis
oim rest and d!ire predictiomms
of time consequences
to restrain
recalcitrant
patients.
All patients
were receiving
antituberculosis
drugs,
and
comimi)ination
of drugs.
Therefore,
an accurate
correlation
and
frozen
simoulder
was immmpossible.
Froni
time figures,
it seenms t-imat time debilitated
person
years
of age, after
three
mnontims of i)ed! rest,
is time ideal
shoulder.
THE

JOURNAL

to

relative

put

i)atielmts,

h)e(!

of activity
many

tie

were

any

of

forty

from

OF BONE

for

AND

overnee(le(l

receiviimg

between

candlidate

for

rest

almdl soimmet-ummes

JOINT

oime d!rug
to

sixty

a frozen

SURGERY

I-ItozI:x-smn)ULI)F:It

( llfltC(tl

(ourse

I vts
1(Stmlt.s

Fimis

t-OIIitt

of

iC

eXpltifl

i)(

\V.tS

I oi j

1(

imow

(inmicai

their

faire

or

I(tt

immeimt-

Wttcimft1l

iomm of imett-5()

Fim(

( lovim

lIst.

t I ie I mal 1, vimo

aimd

for

timeir

simotmisylmip-

t imat. t ime imttiima1

to

\\t5

c()l1se

r(t5St1lC

time

iI1mJ)1()VIIi
1(f(1
t i1(Iim

i)efore

t0

I 1o\id

iiit(

(11(1

Fort.u-

\\aitilmg-Jtist-

ti)i)rotcim

i)1lIliitIl

course

seemm eisevimere.

ait.imotmgim time commditioim

mmmigiit \\)1mieIm
I(ill ly ((1tttilm.
I t. WitS (VeIm 11101C Vtltlitl)i(

i)1it(t

Wt

see

iti)i)hicitt

Oi)S(1V(d.

timat

oim t im(i 1

to

lis.e

I occtsiomm:tl

tli(

1((O\(1(

5OII1((fli(

ptti(Imts

Pitt iemmts vit.im frozen

simoulder
1e((
ied
P1it(t
i(itll\
t lie saimme t

essemmtitilv

(0111(1

to

t-im(se

wam

iiett-ioim

audi

(1(1it-I1tl

t (1

imdSe

(olm(iitiolm

i)tti(1mt

fohlow

vitim timose
pat ielmtm

treat.immeimt

Iii((

time

to

eager

(onhi)tr(d
:tll of t

ImtteiV,

(1(15.

879

SYNI)RUME

time sanme

froum

(olm( lit ion.

1l

t me Patiemmts

I )tt

ielmt

of

meriart

t I m(lt

t\Si(iti

its

ii

\Vit

\\as

seenme(l
itCt

ii lit

IS

a \iti lai

imot

to

i)e

(!onmg

t iii )(1(t1lOSiS.
I to

1\(

\\(1(

t( I\is(

(iS(S,

to

(to,

tmm(1 simow]m

timel(
( )i )j (Ct i\e

e\:tit1tt

1m t I mt

itS5O(litt

((

it

little

\\ts

i)tlt.

imo

ion

(72

cent

simoul(lers

i)er

l)(1

((Imt

hinmit :ttid)Im

\.its

to 80 per cent liinitatiomm

tm (e1i t. Ioss o I I I mot iomm
I im t-il( itveritge
frozeim
i

glemmoimunmertl

I )i lt5(5----O1ie
itmm(! stilflmems.
F((OglmiZ(,

\it

foil

lime
\sOtll(!
t

i((td(

t15((!

it.

1 4 l)(1

itiid

sligimt.

good

IIt

)i(

silii

of niot.iomm

(Vititlitt

at

was,

(X(F-

(!Omm(.

lummit at-ioim

iOu

iii

50 to 65

vorst,

simoul( tels
( I I i i
I 6 per cemmt t there

hitste(1

freely.

ioliiti

t t

(elmt
w:ts

amm(l ( list ilm(t-

t I me

)itt i(Iit

limis

was

tmSlUthl\

rim

ritlmge

loimgtr

fl()

(oincide(i

vitim

tt

of

1
over

(iilmical

iv

mouths

i)itt ieimt

ler

cemmt
as

tmaiiy.

hot iRre(!

imm

er

1 10

patients

sonme

for nmtny

nmotioim,

80 per

ietst

tb ree

( 76
evaluate

I. Event

Siglmifictflt

than

ommlv tlmree

i)atiemmt-s

I ut I i)eemm tt t :tiIle(

reeov(rv

1(55

in

it moimt ims

iUtI( l(l to

(S)((iitily

ilimi)1OVeIlmeImt..

ftmlmct

\vimi(im

tt.

ft er,
t im(se

ut-her

\v(l.e

to

timere

t W()

st iffll(55

foti m

t ; OV(I

((lit

( htiiitt

silO\\

it fter

t lit

ii

\Vit

tl1(

(Xer(iS(S

.-c(or(Inmg

t1(

for

iim time imealiimg i)ilase \\(me

timese

four
simoul(iers

t ii(rC

tS

mOl)e )uilimmg,

; in

timree
to four
immoimt his iim twenty-two
iomm of ( 1(eretsilmg
st i ulimess ts

t ; tlmd

((lit-

I)ti1m

ilmelditsilmg

5(11e5.

Ett.ieflt

l(1

mOlli(

tgaiimst

immf1tiimtmmtt-ori
i )iiitse
i)OSSii)le
iim immot ions
t hat

t(t.1V(

1atients

ilm\OlVedI

immfive

and!

t ime
111t1(Im

I t iiCI(it

1t1(Ste(

of ilm(lC:tsiIig
I )t111
t1n I st i fIll(ss,
t1i( I omme of gra(htlaily
tl((r(tsiImg
pitin
.A.ltiiotmuimtime ilividing
line
is mmot- ti)rupt.,
niost.
i)at-ients
are
itl)lC to
imiim t
\\-((j.5
whm(lm time t-i(l( turlme(l
umd i1impro\lime1it
stitFte(l.

Jim t his
Olmi\

those

1e(

(lecided

rim
tS

I 1)1ii(.

immot ion

()

\\eil
(olme(rlme(!

ly

imot

\tS

\\5

eiilmmi)nmg.

5V11(

of

:tli

imOtV

)111iit11

molml( 1(1

of

\Vthl

d)\(i

frozemm-.l

t.w(Imtv-six

80

(10,

101

wts

fi 1st

Cortisone

stretehiimg.

to

(olmt

at.

A.l 1 i )tt ieimt

t I 1(11 t1I1mS

liSP

(li(limot imurt-, i)tIt imot.to try itinfti

t( 1\is((l

well.

)Oilmt

liv

t ime

((mmt of imornmal

nmoimtiis
se-

\\l

um(l

tllii

of

riumge

miiot-iomm.
I mm fi ye
r((OV(IV

timaim

four

(elmt.)

i )tt iemmt 5 ( I 7 i r
1(55 t I mtim t Imlee

\\tS

nmoimtims. ;g:tnm.

tim(

(lllFittiOli

Wt5

t I IC ( 1iiitt

(cut.

lou

immoimt him. I Im se\im

for time

lmovever.
timle(

to

four

of

1imtJOrity.

st i lllm(ss

(I((retsi1mg

utt iemmts

( 24

l er

to

(elmt t it. was

semmteemm

relative
greater
(59

i)ttieIits

i)(m

nmoimtims.

tot iti (lii rat iomm of tim( (OliditiOlm

\itS
umm(Ier six nmoimtims iii four
pttieimts
six t o eigl mt. I mmoimtims in t.weimty-oime
i ttient
5 1 72
)(1 edit
t tlm( I OV(I
eight.
lmmolmtiis ilm four
l)ttielmts
14 per
ccimt t
Iii( (Vtlt1ttiO1m
of time f1liti
Iemmtlit
is timmo moiimevimat.
iimtccur:tt-e
ts
SO1iiC
J)tti(mmtS
\\(1(
iitSt
5((Ii
OImiV
SiX
to (igi I t. mmmolmtIiS after
()lis(t.
of timeil syl1i)tOlims.
1 im tii(Se
a
fiimdilmg of 80 i)(1 ((lit- of 1mOI1imtilmlotioli \tOtli(l)1Ji)ti)ly, um a f.
1ii1(
Iiiolmtims.
(1 mammge t ti 90 01 I 00 )(I ((lit
:\. few. ot imer I )at ielmt S \\ere
fohiowed
closely
for mmmc
Ii mommt-imm-t 0 t Vet
1 1)(iOl(
t I mev mit t ai 1i(( I Sat isftct
orv
nmot iou ; t.ime \\(le
t I mem ( hisriiml1s

(I4

per

t ime

((lit-)

#{149}

(imtrg((1

I
-

1 Ut)

I1o1Il

70 i

110111
(litSslfi((!
i l (elmt.

m:t1 ; bit
e1

((lit

1
.

Ti

1111tim(1 Oi)S(lVittiO1m.
time fiim:tl ritng(
01 Iimotiolm
of

II i
i(S(

it. i)fl)lm(imO(tlt.ttIleOtlS

oime l)ttt-ielitVOL.

4m-A.

NO.

; foti

noinm:ti
e1

((lit

t vo

htst-

f1stUlt

imad timoracoj)lastv
5.

JULY

1939

it ((Ii

t t o

in

si m l I i( 1(15

i )( ()

)(l

si molll( 1(1s

\V(1(

siXt((Ii

I (Olmmi )i(t (ls

oim time affected
side.

vimiclm

ilt(

simOlIi(i(ls

(44

pci

cliti

to he 95

39 1 l ((lit ) t ( I e 90 t i 95 i 1 (elit
(
((lit
: t11( 1 t \Vd) si m(itIl( 1(15 I 6 1(1 ((lmt t to I fl
(011 1 )i i(itte(
I I v 511 lgery
; one Pitt ant
I ma I
t

S(t1l((l

(!OWIm his

scapula,

tlm(I

880

J.

Subjective

Clinical

T.

H.

JOHNSON

Course

The second
major
clinical
cimaracteristic
of the frozen-shoulder
syndrome
is
time purely
subjective
one of pain.
Timis is very
hard
to evaluate
accurately
but
most
patients
can be classified
ratimer
easily
as having
mild,
moderate,
or severe
pain.
Almost
all patients
will have
pain
on stretciming
or strenuous
use of time involved
arm. Most
patients
have
fairly
comfortable
use of timeir arms
during
ligimt
activity,
with
the elbow
near
the side.
Therefore,
pain
at rest-particularly
at
night-was

felt

to

be

a more

accurate

guide

of

time

degree

of

severity.

All

patients
were
asked
about
nigimt pain.
If timey rarely
lost mmmore timan an
hours
sleep
because
of pain,
the pain
was
classified
as mild.
If timey
lost
one to
three
hours
sleep for one to three
weeks,
pain was considered
moderate.
Anytiming
worse
than
this
was classified
as severe.
When
this criterion
was used, fifteen
cases
(52 per cent)
were considered
nmildl;
five cases
(17 per cent) , moderate;
and nine cases
(31 per cent) , severe.
Localization

of

Pain

All

patients
were asked
to localize
time areas
of greatest
Almost
all said that the pain moved
about,
sometimes
worse
sometimes
over the lateral
part
of the simoulder
and upper
occasionally,
in the forearm.
The most
common
area
was
the upper
part
of the arm, near
the deltoid
insertion.
Timis
area
of maximum
tenderness
in many
patients,
altimough
whose
pain was in the acute
phase,
had tenderness
in many
groove
was frequently
tender
but rarely
more
so timan other
nearby
coracoid
process.
Biceps-tendon
tests
gave
no more
other
tests
that
put strain
on an acutely
inflamed
shoulder.
Psychological

pain
and! teimderness.
on top of time simould!er,
part
of time armmm, and,
the lateral
portion
of
also seemed
to be time
most,
especially
timose
areas.
Time bicipital
areas,
including
the
positive
results
timan

Reaction

Most
authors
unstable
persons
periarthritic

have noted
a high
and frozen
shoulder.

personality.

To

evaluate

for a history
of neurotic
or unstable
tion. In addition,
the patients
were
-whether

they

were

correlation
Coventry

imigh-strung,

this

between
nervous
and emotionally
even went
so far as to describe
aspect

I examined

beimavior
either
asked
to evaluate
tense,

or

subject

before
their
to

the

both

the

medical

evaluation

and

time

patients

chmarts

or during
imospitalizaown nervous
beimavior

frequent

mmmaladies.

realized
timat hospitalization
for tuberculosis
was
an unsettling
ever,
all of these
patients
were
hospitalized
and many
actually
anxiety
by having
somebody
else look
after
them.
When

patients

own

It

was

experience,
howwere
relieved
of
interpretation

were

used, fourteen
patients
(48 per cent)
were classified
as imaving stable
personalities,
seven
patients
(24 per cent)
as being
moderately
stable,
and eiglmt patients
(28 per
cent)
as hmaving
basically
unstable
personalities.
I felt timat in thmis series
there
was no such thing
as a periarthritic
personality,
and t.imat time mmmalady could
develop
in anyone,
wimether
emotionally
stable
or unstable.
There
was, however,
as might
he expected,
a definite
correlation
betweemm i)r(vious

(her.

emmiotional

Of

instability

time eigimt

nervous

reactions

reactions.
Also, as nmight
of pain
and nervous
severe,

tion

six

always

hmad! severe

arises

and

patients
to their

be expected,
reaction.
nervous

whetimer

the

classified
shoulder

patients

nervous

as emotionally
symptoms,
and

reactions

to

time frozen

simoul-

unstable,
five
imad
three
imad immoderately

severe

severe

there
was
considerable
correlation
between
degree
Of time nine patients
whose
pain
was classified
as
reactions
; one, moderate
; and two, immiid. The
quesit is the pain
that
causes
the nervous
reaction
or time

psycimic
element
that
increases
time apparent
pain.
Timis is, of course,
impossible
answer,
but it can be noted
that of timose patients
com)lamning
of severe
pain,
two
had
severe
objective
stiffness;
thmree, immoderate
stiffness;
and
four,

to

only
mild

stiffness.
THE

JOURNAL

OF BONE

AND

JOiNT

SURGERY

FROZEN-SHOULDER

It is my opinion
frozen-simoulder

the

that
even
timough
the
syndrome
are not directly

nment,

time

I)ain,

make

the

greatest

that

t.imey

form

the

subjective

Previous

were

could

frommm timis study

)receding

fracture

imad

time

onset
were

as

sonic

pimysical

; one

are

simortly

after

for

time

Some
course

mmmont-ims ; one

or

injumy

imad

Tvo

osteo-

shoulder.

disability
could
imave

oim wimonm pulnmonary

inflanmmmmation
were

ill advised

by

had

ttiberculous

involved

timat

of time patients
of time active

worse

in time months
cases
only one

of simoulder
syimmptonms,
and
In botim i)atients
time simoul-

hunmerus
of the
history
of cimronic

of any
disease

to
that

dieposit.
One imad
of time shmouider.

calcium
contusion

time onset

several

of

made

were
and

and

shigimtly

Associated

manipulation

of time shoultriggered
the
operations

made
worse,
or too vigorous

Stiffness

he

cases,

time

in

as

imands

One

occasional

and

witim

in general

time

imunmerus

time acrommmion

and

showed
only
riding
a little
the head
of the

Joints
In

ty)mcal

1111(1 imiild

ratimer

part

immore
and!

ima(!

severe;

syn(lrolmme.

slowly

aimd

less

As

usual

and

1)upuytren.s

these

imad

time

cimronic

artimritis

withm

and
to be a local

contracture

shoulder

rimeummmat-ic

in
than

two

rimeulimat.oidl

time frozen

same
side
these
cases

commmpletely

of time knees

huiater:i

systenmic

in the

quite

mmmild gener:tiz((I

imowever,

of

patients,

was

st.iffimess

of

Patiemmt

In general,

stiffness

shmoulder-imand

svehiing
One

timan

time

nmucim

synmptommms

joints.

a trigger-timuimmi).

time

in six

developed

timree

of
up

mmmaimimad

swollen

condition

between

in time fingers

limi)ered

patiemmts

Pain.

Other

involvement..

classed

slmoui(lems.
Two

time space

stiffness

simoulder

could

of cases

imigim simoulder

diminished.

Soimme diffuse
time

mmmade in a nunmher

time so-called

time glenoid,

hunierus

seemed

reaction.

J)iseases

Other

of time patiemmts

All
greater

or

)imysenma
there

or

were

few

other

t.imoracic

surgery

1\-Iany
their

tion

of motion

with

only

stiffness

imad nminor

colmmpiicating
except

and

patients
shmouiders

is

was

one
in

41-A.

A few
in

oi)viously

imad

car(Iiac

diseases
timose

infection

in

few

ima(l PulmonarY

pullmmontry
an(1

conditiomms.
no

j)revioUsly

time simoulder-girdle

such

as

em-

In general,
however,
timat any influenced
time
mmmentioned,
wimo had

evidence

I)atielmts,

tuberculosis

conmphications

area.

Shoulders

ever,

It

simoulder

Several

degree.

enmpyemmma.

condition,

mSubfrozen

wit.im frozen

lesser

shoulder

VOL.

with
sinmultaneous

mmmetaphysis

patients

of shoulder
difficulty
Of twenty-nine

simoulder.

1)um-sitis

effort

feature

timerapy.

imigim in

one,

great

created

in an

A relmiarkable

seemmmed to he ilmm)1oving.
worse

tll)l)e

Roentgenograms

of

of

shmoulder

immild osteoporosis

back

of

imas been

problems

factors.

lack

frozen

proi)ai)le

of time frozen
simoulder.
perfornmed
(luring
time

just

as

imistorv

I was inmpressed
i)y time lack
as well as time lack of recent

der

complaining

immml)ressmon

shoulder

previous
predlisposing

time

coimsiderably

of

ai)out

of

timoracopiasty

becalmme

immvehit.is

people,

erroneous

of

sufferers.

time relative

onset

vitim

wimeim tim( frozen

dcis

imervous

the

of

or

was

time

hiadi a clear-cut
vrist

i)atients

one

majority

initiating

Or years

receimt

Since

fuss,

questioned

be

evolve(!
1)atient

and

incidence
and objective
symptoms
connected!
to time patients
tempera-

Problems

patients

if timese

are.

noise
great

Shoulder

All
see

symptoms

881

SYNDROME

never

frozen

the

5.

JULY

that
1959

of aching
i)e included

reacimed.

shoulder

opposite

apparent
NO.

colmml)laine(!
coimld not

Also,
recorded

and

in this
of time
as such,

frequeimtly

series

of

twenty-two

six

somme

because

stiffness

50 per
patients

ima(! some

(legree

; imow-

cent
in

himita-

timis

of pain

series

and

simoulder.
not only

(10 we

not

know

time

cause

of

this con(lit-ion,

but

882

T.

\e

calilmot

at

all.

l)rd(liCt

hmov

JOHNSON

time coimditmomm

SCVCi(

1Timis st t1( IV 1)rilmgs

lmat U

II.

out.

S(\(ltl

will

i)ecoimme

CON CLI.sI()N

commvnmcnmg

st atist

Fime

after

imigii

immci(IeIm(e

4. Fi
tImd

l(

liiit

gelmertl

5.
6.

al

toimeiusiommm

of

d!eVdlOl)

)Ositi\d

of

frozemm

imm a ttil)el(Uid)Sis

simotilder

2.
d)f

3,

of

to

folty

tdlmmission

sixty

to

ycitis.

imosl)ititi

amm(!

lest.

of

01itV

(iilii(tti

(tS(S

(OtIIS(

Ii me eta I 1(sult
itlso

t1(

St1mit.tIitm1im.

glolli)

d)((U

I in

1le(

i(lmts

)tt

it

I m fti il

iimimg

s(VeI(

lisease

(Iei)mhity.

Time

Ilm(Ie

i)d(I

)roioImgedl

S1(Id

it. ihl

cc

2. Time great.
mmmaormty
of pttiemmts
were
immtime itge
3. Flit oimset is gelmermtiiy
t imlee
to six limolmtlms after

-il(!(

wimetimer

or

ftirlv

is
ttl

(olmvnmcilmg

S(V(i1tl

hut

sgimificammt

vtrittiomm

si gim i fleant-

pr((!mledtiomm

1ehtt

t imeltl

of a mmegttive

tc(or(hiImg
for

mmmmi(
I.

ively

ammimmimmal

dommclusiomis

Nt)

to

1mttlml(.

lTimele

is:

sex.

shmoul( Icr

lesion

a(eoI(

lnmg

to a

hug

t o :t

al

at it i(tll

body.

time

No

ioimg,
( lespite

goo(!

siglmi fic:umt

tue

correlation

1i

vit

pt1h1lmolmt

lesioim

t((Ol(

I it

It ieiihtm

bod!y.

4.

siglmifictImt.

dorrelatiolm

.5. No

sigmmifiemtnt

(0rreltt

mt

im previous

simotlid(l

iomm \\it ii i)itt memmts

slImpto1mms.

Im(l\Otis

momm ()1

I(t(t

t I l(

)(1itl-

p(rsonaiit.

iIliti(

(OMMENl

)(.(

1rit1timlitis
of
alm( I reiittive

lest

patm(mmt

t.lmi)(m(UlOsis

to

sixty

i \.e t

rett

01(1

\(tl5

tie

this

hats,

(0111(1

ii memmt

vlmo

jim time

as

l)IOl)iti)iY

he

is

omm bed

4
5.

o-(tlied!

iim a(I(IitR)Im,
a

factor,

(ommsmst m1mg

1I

cufi

simouhdem

time

Iegti

rest,
REFEREN

1 . ( )VENrl(Y,
2. 1)FI.-m.tm
3 . iI N .1_I)I

seem
liv lime. 15 l)l)i)itI)lY
(!tI(
to
vimo is itt. t lie age whmeim mmormmial

( !ei)i

O((UlIiimg

factor

mmme(Ii(atiomm

Pievemmt

iim time 1)ttiemmts.

lit at e(1 i)(lSOIm

iim a

tI(

I)e aim eimdocrnme

( Iei)ihit.tt((!

simotihier

(lisuse

(imanges

(!egemmerative
llm:tV

time

but-

stru(t-ures.

p(rio(!,

a(Iremmoco1t-ietl
mmo evi(Ieim(e

It r a
should

ammd otimer
mmmemmoi)umsal

Ilil

be

exer(mses

Tlmere
mtimd

iimsufficieimcv.
for

for

timis

t ime

_A.mmt-ifouimd.

time l)at.iemmt

forty

commsi(Ier((l.

CES

B. : Pmoi)l(mmm of Pmminful
Simolml(l(m. J. .A.mmm
.
\I(ml.
151 : 177-155.
1953.
.-. .
.
I. : Stimger( (mf t Ia Slmotmldem. 1imilmmdeli immmm
, J.
B. Iip (mn(m)t-t, Co., 1950.
.
( , . : I ml i memmmmmt
i-i t ( ( lellmm s mmmilmte
1mmsmn(lmommme s mmmllmt-mnmmmmoml comso mI i t ni )(mmlmlosm
lmollmmomlmmm(. R(tmmm1mmtmsmo.
8: 71-81 . 1956.
FRAN Ki.I N . i:. c.. mln(l
NF:,m
1 K , I. J . : imo1ml(l(m- I )vsfunctioim
in immmlmmmmmmmm-yFimi )(mmlmiosms.
.Iii.
J. M((l.
(1(11((5.
227: 601-608.
1954.
11 Ii.Kl-.R,
.\ . : lime
Shouldei-Hmmn(l
Svndmommme : A ( ommm mlimmmtion of ( mi-mmnmmm-v . mt i-v I )mse:mse.
.mmmm. Immt. \Il.,
31: 303-311, 1949.
\I

THE

JOURNAL

OF BONE

AND

JOINT

SURGERY