Periarthritis of the Shoulder

Periarthritis, or capsulitis, of the shoulder is characterized by severe pain and progressive limitation of movement of unknown cause. In most cases the symptoms increasingly dominate the patient's activities and interfere with his sleep for many months. The pain and spasm gradually abate and the shoulder becomes stiff (frozen shoulder). Movement usually recovers slowly until full function is regained with either a normal range of movement or limitation so trivial as to cause no functional disability. This paper presents the results obtained by injecting hydrocortisone into the shoulder-joint while manipulation was being carried out under anaesthesia during the irritable and painful stage. These results are compared with those obtained by oral cortisone in one group, and in some respects with those following palliative physiotherapy, rest, and occasional late manipulation in another group. Consideration of the results of any form of treatment in periarthritis demands accurate diagnosis and a knowledge of the natural history of the disease. Precise diagnosis is necessary because shoulder pain may be due to a number of causes within and without the joint of varying severity and prognosis. A knowledge of the average time between onset and recovery is of outstanding importance if the effects of treatment are to be assessed in a disease which usually resolves spontaneously.