A patient who presented with bilateral frozen shoulders and unrecognized hyperthyroidism is described. Both frozen shoulder and the related shoulderhand syndrome may occur in this setting. These poorly understood rheumatic conditions often are complications of stroke, spinal cord injury, or diabetes. Dysfunction of the autonomic nervous system is thought to be of pathogenic importance. It is postulated that the close resemblance of hyperthyroidism to activation of the sympathetic nervous system may underlie its association with frozen shoulder and shoulder-hand syndrome.Thyroid disease may have rheumatic complications (1). A patient with bilateral frozen shoulders who had unrecognized hyperthyroidism prompted a review of this infrequently encountered association.Case report. The patient, a 62-year-old man, was referred for evaluation of restricted motion of the shoulders. Six months earlier he had begun losing weight, in spite of a good appetite. While moving into a new house, he noted unusual difficulty lifting boxes and furniture, and found he was having trouble getting out of a car. He discovered that he could not raise his arms beyond 90" and had discomfort over the anterior shoulder region when reaching backward. His weight, Submitted for publication August 20, 1986; accepted in revised form November 18, 1986. which had been 160 pounds, reached a low of 129, and then rose to 136 pounds. At the time of the visit, he was feeling well; his only complaints concerned the failure to regain all of his lost weight, and the restriction of shoulder motion. There was no history of shoulder problems, and no personal or family history of diabetes.An extensive diagnostic evaluation had been fruitless. On 2 occasions, serum levels of muscle enzymes were normal. A random serum glucose level was 101 mgldl and a fasting level was 96 mgldl. Radiographs of the shoulders, chest, and gastrointestinal tract gave normal results. Nerve conduction studies and electromyographic study of both upper extremities disclosed no evidence of neuropathy, myopathy, or radiculopathy. Muscle biopsy was not believed to be indicated. Thyroid tests were not done.At physical examination, he was a calm man who appeared exceedingly thin, but not ill. The blood pressure was 120/70 mm Hg, with an irregularly irregular pulse rate of 120 beats per minute. The hands were steady, and his skin was of normal texture. There was no exophthalmos, and no lid lag. His thyroid was not palpable. Both shoulders were limited to 45" of passive glenohumoral abduction, with virtually no internal or external rotation, and there was atrophy of the shoulder girdle musculature (Figure 1). Proximal strength was diminished in the upper, as well as the lower, extremities, but was still at or above 4/5 in all muscle groups. The deep tendon reflexes were normal.The remainder of the examination results were unremarkable.An electrocardiogram (EKG), obtained a few minutes later, showed sinus rhythm at a rate of 90;
