Review of diabetic frozen shoulder

Frozen shoulder is a painful debilitating condition which can be diagnosed clinically. It is a condition of chronic inflammation and proliferative fibrosis resulting in painful limitation of shoulder movements with classical clinical signs. Diabetic patients are more likely to develop the disease and more likely to require operative management. Diabetic frozen shoulder is a difficult condition to manage, and the clinician must strike a balance between improving range of movement and treating pain, but not over-treating what is an essentially self-resolving condition. Treatment options principally include physiotherapy and intra-articular injections, and progression to hydrodilatation, manipulation under anaesthetic, or arthroscopic capsular release as required. In this article, we review the available literature to assess best management, and correlate with practice at our unit, proposing a management strategy for treating patients with diabetic frozen shoulder. Management decisions should be agreed upon jointly with the patient and be based upon comorbidities, severity and the natural history of the condition.