Frozen shoulder
Encyclopedia
Frozen shoulder, medically referred to as adhesive capsulitis, is a disorder in which the shoulder
capsule
, the connective tissue surrounding the glenohumeral joint
of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain
.
Adhesive capsulitis is a painful and disabling condition that often causes great frustration for patients and caregivers due to slow recovery. Movement of the shoulder is severely restricted. Pain is usually constant, worse at night, and when the weather is colder; and along with the restricted movement can make even small tasks impossible. Certain movements or bumps can cause sudden onset of tremendous pain and cramping that can last several minutes.
This condition, for which an exact cause is unknown, can last from five months to three years or more and is thought in some cases to be caused by injury or trauma to the area. It is believed that it may have an autoimmune component, with the body attacking healthy tissue in the capsule. There is also a lack of fluid in the joint, further restricting movement.
In addition to difficulty with everyday tasks, people who suffer from adhesive capsulitis usually experience problems sleeping for extended periods due to pain that is worse at night and restricted movement/positions. The condition also can lead to depression, pain, and problems in the neck and back.
Risk factors for frozen shoulder include diabetes, stroke
, accidents, lung disease, connective tissue disorders, and heart disease
. The condition very rarely appears in people under 40.
Treatment may be painful and taxing and consists of physical therapy
, medication, massage
therapy, hydrodilatation
or surgery. A doctor may also perform manipulation under anesthesia
, which breaks up the adhesions and scar tissue
in the joint to help restore some range of motion. Pain and inflammation can be controlled with analgesics and NSAIDs. The condition tends to be self-limiting: it usually resolves over time without surgery, but this may take up to two years. Most people regain about 90% of shoulder motion over time. People who suffer from adhesive capsulitis may have extreme difficulty working and going about normal life activities for several months or longer.
. The condition is sometimes caused by injury, leading to lack of use due to pain
, but also often arises spontaneously with no obvious preceding trigger factor (idiopathic
frozen shoulder). Rheumatic disease
progression and recent shoulder surgery
can also cause a pattern of pain and limitation similar to frozen shoulder. Intermittent periods of use may cause inflammation
.
In frozen shoulder, there is a lack of synovial fluid
, which normally helps the shoulder joint, a ball and socket joint
, move by lubricating
the gap between the humerus
(upper arm bone
) and the socket in the scapula
(shoulder blade). The shoulder capsule thickens, swells, and tightens due to bands of scar tissue (adhesions
) that have formed inside the capsule. As a result, there is less room in the joint for the humerus, making movement of the shoulder stiff and painful. This restricted space between the capsule and ball of the humerus distinguishes adhesive capsulitis from a less complicated, painful, stiff shoulder.
People with diabetes, stroke
, lung disease, rheumatoid arthritis
, or heart disease
are at a higher risk for frozen shoulder. Injury or surgery to the shoulder or arm may cause the capsule to tighten from reduced use during recovery. Adhesive capsulitis has been indicated as a possible adverse effect
of some forms of highly active antiretroviral
therapy (HAART).
The condition rarely appears in people under 40 years old and, at least in its idiopathic form, is much more common in women than in men (70% of patients are women aged 40–60). Frozen shoulder in diabetic patients is generally thought to be a more troublesome condition than in the non-diabetic population, and the recovery is longer.
Cases have also been reported after breast and lung surgery.
joint
fully moving to prevent a frozen shoulder. Often a shoulder will hurt when it begins to freeze. Because pain discourages movement, further development of adhesions
that restrict movement will occur unless the joint continues to move full range in all directions (adduction
, abduction
, flexion
, rotation
, and extension
). Physical therapy
and Occupational therapy
can help with continued movement.
People complain that the stiffness and pain worsen at night. Pain due to frozen shoulder is usually dull or aching. It can be worsened with attempted motion, or if bumped. A physical therapist may suspect the patient has a frozen shoulder if a physical examination
reveals limited shoulder movement. Frozen shoulder can be diagnosed if limits to the active range of motion (range of motion from active use of muscles) are the same or almost the same as the limits to the passive range of motion (range of motion from a person manipulating the arm and shoulder). An arthrogram
or an MRI scan may confirm the diagnosis, though in practice this is rarely required.
The normal course of a frozen shoulder has been described as having three stages:
A native x-ray of a frozen shoulder is usually inconspicuous. At the best there is sometimes a slight osteopeny due to the biomechanical inactivity or a discrete humeral head elevation due to the shrinkage of the capsule. In addition, physiologically age-related degenerative changes like calcium deposits may also be present and should not lead to a false positive diagnosis.
Arthrography of the glenohumeral joint has for a long time been considered to be the only reliable diagnostic tool for a frozen shoulder. Given the possible multitude of risks and complications, it should nowadays only be applied restrainedly. The sometimes significantly reduced capsule volume, down to only 10-12 ml, has been documented repeatedly through arthrography. It often showed an irregular limitation of the joint space and its outline. Additionally there is often to see a variable filling of the inferior recesses, the subscapular bursa and the biceps tendon sheath. An association between capsular shrinkage and restricted movement has been described. However, correlation between the arthrographic diagnosis and the prognosis are contradictory. 6-10% of patients with a frozen shoulder have had an inconspicuous arthrography.
Mengiardi et al. defined following MR arthrographic findings as characteristical for frozen shoulders: Thickening of the coracohumeral ligament, thickening of the capsule at the rotator cuff interval and complete obliteration of the fat triangle under the coracoid process, the so-called subcoracoid triangle sign.
It is important to mention that the diagnosis of a frozen shoulder, respectively, of an adhesive capsulitis, in spite of all the actual findings and evidences, is still a diagnosis via preclusion.
or rotator cuff tear
may be needed.
Medications frequently used include NSAIDs; corticosteroids are used in some cases either through local injection or systemically. Physiotherapy may include massage therapy and daily extensive stretching.
If these measures are unsuccessful manipulation
of the shoulder under general anesthesia to break up the adhesions is sometimes used. Hydrodilatation
or distension arthrography is controversial.Surgery
to cut the adhesions (capsular release) may be indicated in prolonged and severe cases; the procedure is usually performed by arthroscopy
.
Shoulder
The human shoulder is made up of three bones: the clavicle , the scapula , and the humerus as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder make up the shoulder joints. The major joint of the shoulder is the glenohumeral joint, which...
capsule
Joint capsule
An articular capsule is an envelope surrounding a synovial joint.-Layers:Each capsule consists of two layers:* an outer layer composed of avascular white fibrous tissue...
, the connective tissue surrounding the glenohumeral joint
Glenohumeral joint
The glenohumeral joint, or shoulder joint, is a multiaxial synovial ball and socket joint and involves articulation between the glenoid fossa of the scapula and the head of the humerus...
of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain
Chronic pain
Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and...
.
Adhesive capsulitis is a painful and disabling condition that often causes great frustration for patients and caregivers due to slow recovery. Movement of the shoulder is severely restricted. Pain is usually constant, worse at night, and when the weather is colder; and along with the restricted movement can make even small tasks impossible. Certain movements or bumps can cause sudden onset of tremendous pain and cramping that can last several minutes.
This condition, for which an exact cause is unknown, can last from five months to three years or more and is thought in some cases to be caused by injury or trauma to the area. It is believed that it may have an autoimmune component, with the body attacking healthy tissue in the capsule. There is also a lack of fluid in the joint, further restricting movement.
In addition to difficulty with everyday tasks, people who suffer from adhesive capsulitis usually experience problems sleeping for extended periods due to pain that is worse at night and restricted movement/positions. The condition also can lead to depression, pain, and problems in the neck and back.
Risk factors for frozen shoulder include diabetes, stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
, accidents, lung disease, connective tissue disorders, and heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
. The condition very rarely appears in people under 40.
Treatment may be painful and taxing and consists of physical therapy
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
, medication, massage
Massage
Massage is the manipulation of superficial and deeper layers of muscle and connective tissue to enhance function, aid in the healing process, and promote relaxation and well-being. The word comes from the French massage "friction of kneading", or from Arabic massa meaning "to touch, feel or handle"...
therapy, hydrodilatation
Hydrodilatation
Hydrodilatation or hydraulic arthrographic capsular distension or distension arthrography is a medical treatment for adhesive capsulitis of shoulder. The treatment is applied by a radiologist assisted by a radiographer. Contrast medium, a local anaesthetic and cortisone are injected into the joint...
or surgery. A doctor may also perform manipulation under anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
, which breaks up the adhesions and scar tissue
Granulation tissue
Granulation tissue is the perfused, fibrous connective tissue that replaces a fibrin clot in healing wounds. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size it heals...
in the joint to help restore some range of motion. Pain and inflammation can be controlled with analgesics and NSAIDs. The condition tends to be self-limiting: it usually resolves over time without surgery, but this may take up to two years. Most people regain about 90% of shoulder motion over time. People who suffer from adhesive capsulitis may have extreme difficulty working and going about normal life activities for several months or longer.
Presentation
Movement of the shoulder is severely restricted, with progressive loss of both active and passive range of motionRange of motion
Range of motion , is the distance that a movable object may normally travel while properly attached to another object. It is also called range of travel, particularly when talking about mechanical devices and in mechanical engineering fields...
. The condition is sometimes caused by injury, leading to lack of use due to pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
, but also often arises spontaneously with no obvious preceding trigger factor (idiopathic
Idiopathic
Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease...
frozen shoulder). Rheumatic disease
Rheumatism
Rheumatism or rheumatic disorder is a non-specific term for medical problems affecting the joints and connective tissue. The study of, and therapeutic interventions in, such disorders is called rheumatology.-Terminology:...
progression and recent shoulder surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
can also cause a pattern of pain and limitation similar to frozen shoulder. Intermittent periods of use may cause inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
.
In frozen shoulder, there is a lack of synovial fluid
Synovial fluid
Synovial fluid is a viscous, non-Newtonian fluid found in the cavities of synovial joints. With its yolk-like consistency , the principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during movement.-Overview:The inner membrane of synovial joints...
, which normally helps the shoulder joint, a ball and socket joint
Ball and socket joint
A ball and socket joint is a joint in which the distal bone is capable of motion around an indefinite number of axes, which have one common center...
, move by lubricating
Lubrication
Lubrication is the process, or technique employed to reduce wear of one or both surfaces in close proximity, and moving relative to each another, by interposing a substance called lubricant between the surfaces to carry or to help carry the load between the opposing surfaces. The interposed...
the gap between the humerus
Humerus
The humerus is a long bone in the arm or forelimb that runs from the shoulder to the elbow....
(upper arm bone
Bone
Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
) and the socket in the scapula
Scapula
In anatomy, the scapula , omo, or shoulder blade, is the bone that connects the humerus with the clavicle ....
(shoulder blade). The shoulder capsule thickens, swells, and tightens due to bands of scar tissue (adhesions
Adhesion (medicine)
Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue that connect tissues not normally connected.-Pathophysiology:...
) that have formed inside the capsule. As a result, there is less room in the joint for the humerus, making movement of the shoulder stiff and painful. This restricted space between the capsule and ball of the humerus distinguishes adhesive capsulitis from a less complicated, painful, stiff shoulder.
People with diabetes, stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
, lung disease, rheumatoid arthritis
Rheumatoid arthritis
Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...
, or heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
are at a higher risk for frozen shoulder. Injury or surgery to the shoulder or arm may cause the capsule to tighten from reduced use during recovery. Adhesive capsulitis has been indicated as a possible adverse effect
Side effect
In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequences of the use of a drug.Occasionally, drugs are...
of some forms of highly active antiretroviral
Retrovirus
A retrovirus is an RNA virus that is duplicated in a host cell using the reverse transcriptase enzyme to produce DNA from its RNA genome. The DNA is then incorporated into the host's genome by an integrase enzyme. The virus thereafter replicates as part of the host cell's DNA...
therapy (HAART).
The condition rarely appears in people under 40 years old and, at least in its idiopathic form, is much more common in women than in men (70% of patients are women aged 40–60). Frozen shoulder in diabetic patients is generally thought to be a more troublesome condition than in the non-diabetic population, and the recovery is longer.
Cases have also been reported after breast and lung surgery.
Prevention
To prevent the problem, a common recommendation is to keep the shoulderShoulder
The human shoulder is made up of three bones: the clavicle , the scapula , and the humerus as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder make up the shoulder joints. The major joint of the shoulder is the glenohumeral joint, which...
joint
Joint
A joint is the location at which two or more bones make contact. They are constructed to allow movement and provide mechanical support, and are classified structurally and functionally.-Classification:...
fully moving to prevent a frozen shoulder. Often a shoulder will hurt when it begins to freeze. Because pain discourages movement, further development of adhesions
Adhesion (medicine)
Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue that connect tissues not normally connected.-Pathophysiology:...
that restrict movement will occur unless the joint continues to move full range in all directions (adduction
Adduction
Adduction is a movement which brings a part of the anatomy closer to the middle sagittal plane of the body. It is opposed to abduction.-Upper limb:* of arm at shoulder ** Subscapularis** Teres major** Pectoralis major** Infraspinatus...
, abduction
Abduction (kinesiology)
Abduction, in functional anatomy, is a movement which draws a limb away from the median plane of the body. It is thus opposed to adduction.-Upper limb:* of arm at shoulder ** Supraspinatus** Deltoid* of hand at wrist...
, flexion
Flexion
In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder...
, rotation
Internal rotation
In anatomy, internal rotation is rotation towards the center of the body.The muscles of internal rotation include:* of arm/humerus at shoulder** Deltoid muscle** Subscapularis** Teres major** Latissimus dorsi...
, and extension
Extension (kinesiology)
In kinesiology, extension is a movement of a joint that results in increased angle between two bones or body surfaces at a joint. Extension usually results in straightening of the bones or body surfaces involved. For example, extension is produced by extending the flexed elbow. Straightening of...
). Physical therapy
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
and Occupational therapy
Occupational therapy
Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...
can help with continued movement.
Signs and diagnosis
One sign of a frozen shoulder is that the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm. The movement that is most severely inhibited is external rotation of the shoulder.People complain that the stiffness and pain worsen at night. Pain due to frozen shoulder is usually dull or aching. It can be worsened with attempted motion, or if bumped. A physical therapist may suspect the patient has a frozen shoulder if a physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
reveals limited shoulder movement. Frozen shoulder can be diagnosed if limits to the active range of motion (range of motion from active use of muscles) are the same or almost the same as the limits to the passive range of motion (range of motion from a person manipulating the arm and shoulder). An arthrogram
Arthrogram
An arthrogram is a series of images, often X-rays, of a joint after injection of a contrast medium. The injection is normally done under a local anesthetic.The radiologist performs the study utilizing fluoroscopy or ultrasound to guide the placement of the needle into the joint and then injects an...
or an MRI scan may confirm the diagnosis, though in practice this is rarely required.
The normal course of a frozen shoulder has been described as having three stages:
- Stage one: The "freezing" or painful stage, which may last from six weeks to nine months, and in which the patient has a slow onset of pain. As the pain worsens, the shoulder loses motion.
- Stage two: The "frozen" or adhesive stage is marked by a slow improvement in pain but the stiffness remains. This stage generally lasts from four to nine months.
- Stage three: The "thawing" or recovery, when shoulder motion slowly returns toward normal. This generally lasts from 5 to 26 months.
Imaging
A native x-ray of a frozen shoulder is usually inconspicuous. At the best there is sometimes a slight osteopeny due to the biomechanical inactivity or a discrete humeral head elevation due to the shrinkage of the capsule. In addition, physiologically age-related degenerative changes like calcium deposits may also be present and should not lead to a false positive diagnosis.
Arthrography of the glenohumeral joint has for a long time been considered to be the only reliable diagnostic tool for a frozen shoulder. Given the possible multitude of risks and complications, it should nowadays only be applied restrainedly. The sometimes significantly reduced capsule volume, down to only 10-12 ml, has been documented repeatedly through arthrography. It often showed an irregular limitation of the joint space and its outline. Additionally there is often to see a variable filling of the inferior recesses, the subscapular bursa and the biceps tendon sheath. An association between capsular shrinkage and restricted movement has been described. However, correlation between the arthrographic diagnosis and the prognosis are contradictory. 6-10% of patients with a frozen shoulder have had an inconspicuous arthrography.
Ultrasonography
The sonographic examination of the periarticular soft tissues can only provide circumstantial evidence for a frozen shoulder. Ultrasonographic equivalences of tendo-synovial involvement at the frozen shoulder are thickening of the tendon itself (found in 18.5%) or a hypoechoic yard, a so-called halo phenomenon (found in 42.6%). Compared to the same findings at an adhesive subacromial syndrome of 3.1%, respectively, 13.8%.Scintigraphy
In the frozen shoulder is often an increased accumulation of 99Tc pertechnetate or 99Tc diphosphonate to find. With a positive correlation between increased accumulation and pain intensity, respectively, good response to cortico-steroid injections, but not any association with the duration of symptoms or the prognosis. However, scintigraphy appears to be a nonspecific technique and is definitely not suitable for a diagnostic routine measurement or any broad screening. On the contrary is a scintigraphy recommended if the differential diagnosis involves reflex dystrophy, which then shows accumulation in the whole arm and not only in the shoulder area.Radiotherapy
Compared to other less dangerous methods of therapy it does not offer any benefits and should thus consequently no longer be applied on frozen shoulders.Extra corporal shockwave therapy
Again, there is no indication for the extra corporal shockwave therapy in order to achieve any clinical benefit at a frozen shoulder. On the contrary, even an increased restriction of the movements could occur through intensification of the capsulitis and its soft tissue irritation.Magnetic Resonance Imaging
Coronar and axial MR images with intravenous contrast agent, T1-weighted and fat-saturated. Findings are circular contrast agent absorption along the glenohumeral joint capsule, with emphasis on the axillary recess, around the rotator interval and the biceps tendon anchor.Mengiardi et al. defined following MR arthrographic findings as characteristical for frozen shoulders: Thickening of the coracohumeral ligament, thickening of the capsule at the rotator cuff interval and complete obliteration of the fat triangle under the coracoid process, the so-called subcoracoid triangle sign.
It is important to mention that the diagnosis of a frozen shoulder, respectively, of an adhesive capsulitis, in spite of all the actual findings and evidences, is still a diagnosis via preclusion.
Management
Management of this disorder focuses on restoring joint movement and reducing shoulder pain, involving medications, physical therapy, and/or surgical intervention. Treatment may continue for months, there is no strong evidence to favor any particular approach. Surgical evaluation of other problems with the shoulder, e.g., subacromial bursitisSubacromial bursitis
Subacromial bursitis is a condition caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon from the overlying coraco-acromial ligament, acromion, coracoid and from the deep surface of the deltoid muscle...
or rotator cuff tear
Rotator cuff tear
Rotator cuff tears are tears of one or more of the four tendons of the rotator cuff muscles. A rotator cuff injury can include any type of irritation or damage to the rotator cuff muscles or tendons....
may be needed.
Medications frequently used include NSAIDs; corticosteroids are used in some cases either through local injection or systemically. Physiotherapy may include massage therapy and daily extensive stretching.
If these measures are unsuccessful manipulation
Joint manipulation
Joint manipulation is a type of passive movement of a skeletal joint. It is usually aimed at one or more 'target' synovial joints with the aim of achieving a therapeutic effect.- Biomechanics of joint manipulation :...
of the shoulder under general anesthesia to break up the adhesions is sometimes used. Hydrodilatation
Hydrodilatation
Hydrodilatation or hydraulic arthrographic capsular distension or distension arthrography is a medical treatment for adhesive capsulitis of shoulder. The treatment is applied by a radiologist assisted by a radiographer. Contrast medium, a local anaesthetic and cortisone are injected into the joint...
or distension arthrography is controversial.Surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
to cut the adhesions (capsular release) may be indicated in prolonged and severe cases; the procedure is usually performed by arthroscopy
Arthroscopy
Arthroscopy is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision...
.
External links
- "Frozen Shoulder" from the American Academy of Orthopedic SurgeonsAmerican Academy of Orthopedic SurgeonsThe American Academy of Orthopaedic Surgeons is an orthopaedic organization.-Characteristics:Founded at Northwestern University in 1933, the AAOS has grown to include over 36,000 members. The group provides education and practice management services for orthopaedic surgeons and allied health...
- Radiology image sequence demonstrating CT guided shoulder hydrodilatation
- "Frozen Shoulder" from Harbor Physical Therapy, Baltimore, MD.