Frozen Shoulder

Frozen shoulder is also known as adhesive capsulitis. It is a condition that results in pain and stiffness (loss of movement) in the shoulder. It usually happens in three phases.

Who gets frozen shoulder?

The short answer is anyone! Most patients are over 40 years old. It can come on by itself, but is more common if you have diabetes, thyroid problems or have recently had a heart attack or heart surgery. People with calcific tendonitis can also quickly develop a very severe case of frozen shoulder.

Almost everyone who suffers an injury to their shoulder, such as a shoulder fracture will develop an element of frozen shoulder. This is also common after shoulder surgery. This is why it is important to start to move your shoulder as soon as possible after an injury or surgery to reduce the chance of stiffness.

What causes frozen shoulder?

It is not clear exactly what causes frozen shoulder for most people. When we look inside someone’s frozen shoulder with a camera, its lining looks very red and inflamed. The shoulder lining thickens and loses its stretch, which is why you lose movement.

Certain types of injury, including surgery, can set off the inflammation in your shoulder. However it is not well-understood why people with diabetes are more prone to frozen shoulder. It is certainly more pronounced in people why have poor control of their sugar levels, and one of the reasons why it is important to get good diabetic control.

Symptoms

01 Freezing phase: Initially, the shoulder feels very painful, particularly at the front and side of the shoulder. This often affects your sleep. All movements are painful but not necessarily limited early on. This can continue for several weeks or months.

02 Frozen phase: The pain by now has reduced but all shoulder movements become stiff. It is difficult to reach up high and getting dressed and undressed becomes difficult. Since you struggle to reach behind your back, it is often difficult to put on a bra or reach the back pocket in your trousers. This can continue for 6-12 months.

03 Thawing phase: At this stage, your shoulder slowly starts to regain its movement and the pain can subside further. It can take 1-2 years for pain to get close to normal.

How is frozen shoulder diagnosed?

This starts with a conversation with your doctor to describe the problems you are experiencing with your shoulder. You will then be examined, with some specialised tests, paying careful attention to your shoulder movements. Often, your doctor will request an X-ray to look for a deposit of calcium in the tendon. People with frozen shoulder usually have a completely normal X-ray. Occasionally, signs of frozen shoulder can be seen on ultrasound or MRI scans, although these tests are usually not required to diagnose frozen shoulder.

Treatment options

Non surgical

Simple painkillers and waiting

For some people, just knowing what the problem is, and having the reassurance that there is no major damage to the shoulder is enough. The pain can be controlled with simple painkillers, such as paracetamol and anti-inflammatories (if you can take them). This may be coupled with simple changes to your lifestyle, such as sleeping on the opposite side or putting items on lower shelves at home.

It can take 2-3 years to recover from frozen shoulder. Not everybody recovers fully, in spite of any treatment they have. The aim of other treatments such as injections or surgery is to reduce your pain and make you recover quicker.

Non surgical

Physiotherapy

A course of physiotherapy can be helpful for frozen shoulder. Your physiotherapist will assess your movements and teach you ways of stretching your shoulder. It is important to do your exercises regularly and with the correct technique. Stretching takes time and patience, so to make the most of your physiotherapy, it is important to move your arm to the limit of movement and hold for several seconds. Pain can sometimes make it difficult to do your exercises and if that is the case for you, it is important that you tell your physiotherapist or doctor. It can take several months to get the full benefit of physiotherapy, so it is important to work hard early on, even if you do not feel an immediate benefit.

Non surgical

Hydrodilatation

You may be offered a special injection into your shoulder called hydrodilatation. This involves injecting a mixture of steroids, local anaesthetic and fluid into your shoulder to gently stretch the joint lining. This can be very effective and within a few days or weeks make your pain and movement much better. It is extremely important that you start your physiotherapy within days of hydrodilatation to stop your shoulder from stiffening up again.

Surgical

Surgery

If the above treatments are not successful, surgery may be helpful to treat frozen shoulder. This is usually performed 'keyhole' and is often referred to as an arthroscopic capsular release.

Recovery

It is worth noting that for most people, frozen shoulder gets better by itself, but it can take 2-3 years. Interestingly, it is extremely rare to get frozen shoulder twice in the same shoulder.

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