Frozen Shoulder
What is Frozen Shoulder?
Frozen Shoulder (Adhesive Capsulitis) is an extremely painful condition in which the shoulder is completely or partially unmovable. Frozen shoulder often starts out of the blue but may be triggered by a mild injury or jarring to the shoulder. The condition historically has been thought to be a self-limiting but can run a prolonged course of up to 3 years from the start. The condition usually passes through three phases, starting with pain, then stiffness and finally a stage of resolution as the pain eases and most of the movement returns. Sometimes the movement does not recover completely. The stages may overlap each other.
The lining of the shoulder joint, known as the capsule, is normally a very flexible elastic structure. Its looseness and elasticity allows the huge range of motion that the shoulder has. With a frozen shoulder this capsule (and its ligaments) becomes inflamed, swollen and contracted.
Clinical Presentation
Typical frozen shoulder develops slowly, and resolves over a period of 12 –24 months in three stages:
- Stage One –Freezing: Pain increases with movement and is often worse at night. There is a progressive loss of motion with increasing pain and may last 2 to 9 months. Typically, pain is made worse with activity and at night. Often physiotherapy will make the pain worse.
- Stage Two –Frozen: Pain diminishes, however, the range of motion is reduced, as much as 80 percent less than in the other arm. This stage may last 4 to 12 months.
- Stage Three –Thawing: The condition starts to resolve with a gradual restoration of motion over the next 12 – 24 months.
Risk Factors and Causes
Frozen shoulder has a higher association with diabetes, high cholesterol, hypothyroidism, Parkinson’s disease, heart disease and is also seen in patients with scar tissue in their hands, a condition called Dupuytren¹s contracture. Frozen shoulder can develop after a shoulder is immobilized for a period of time or after surgery.
Investigations:
The diagnosis usually based on history and clinical examination, although your doctor may need to get plain radiographs and MRI scan to rule out other conditions.
Treatment:
- Analgesics–Painkillers and anti-inflammatories may be helpful.
- Physiotherapy –This may be under the direct supervision of a physiotherapist or via a home program. Therapy includes stretching or range-of-motion exercises for the shoulder. In the early stages physiotherapy often makes the pain worse as there is micro trauma with stretching.
- Injections –Steroid injections may be useful in early stages of disease to reduce inflammation and provide pain relief but it does not always help with range of movements.
- Gleno-Humeral Joint Release –in this technique a large volume of fluid – is injected in the shoulder joint to release the joint. This works better in early stages and post surgical stiffness.
- Manipulation under Anaesthesia – this is an historical procedure which Prof Singh no longer uses as its uncontrolled and can cause damage to the shoulder
- Shoulder Arthroscopy – is used in resistant cases, where in a small camera is used to inspect the joint and special instruments used to release / cut the joint lining. At the end of the procedure a gentle manipulation is often used to gain full movements.
More than 90 percent of patients improve with these relatively simple treatments. Usually, the pain resolves and motion improves. However, in some cases, even after several years the motion does not return completely and a small amount of stiffness remains. In patients with diabetes the results can be a bit unpredictable.
