Written by Mr Nicholas Ferran for Doctify
Ever wondered exactly what a Frozen Shoulder is? Here to enlighten us is Orthopaedic Surgeon, Mr Nicholas Ferran.
What is Frozen Shoulder?
Frozen shoulder is a common condition that results in inflammation developing in the lining (capsule) of the shoulder shoulder joint resulting in scarring of the capsule particularly at the front of the joint. The condition commonly affects people between the ages of 40 – 65 and is more common in women than in men. The diagnosis is often made clinically by your surgeon, a normal shoulder X-ray is required for the diagnosis and in difficult or atypical cases scans may be required.
What are the symptoms?
The inflammation that occurs in frozen shoulder results in pain and the scarring of the joint capsule results in stiffness. Symptoms can sometimes progress in three phases:
- The Freezing Phase – pain is the predominant feature. There can be a constant dull ache which is worse on doing particular movements such as putting on a jacket or reaching out to the side. Patients often notice they are unable to lay on the affected shoulder due to pain. Stiffness is mild and often missed.
- The Frozen Phase – pain is present but not as severe as the initial onset while stiffness predominates and usually limits work or recreational activity.
- The Thawing Phase – here pain improves considerably and movement slowly becomes easier as the stiffness subsides.
Are there people who are more likely to suffer from a Frozen Shoulder than others?
The cause of Frozen Shoulder is still unknown, most of the time it occurs without reason. Frozen shoulder often occurs after rotator cuff injuries. Frozen shoulder is very common amongst diabetics. Diabetics often have more aggressive disease, a higher chance of the condition affecting both shoulders and are more likely to have it in both shoulders at the same time.
Some conditions can have symptoms similar to frozen shoulder, they include post-surgical stiffness, and post-traumatic stiffness which occur after surgery or shoulder fractures respectively.
Is it a recurring condition?
Frozen shoulder can recur, or can affect the opposite shoulder. Diabetics are at a higher risk of recurrence of frozen shoulder.
What are the treatment options?
Self management
Frozen shoulder has been described as a self limiting condition that usually gets better with time. While it was common to advise patients that symptoms would resolve in 2 years, more recent research studies suggest that symptoms, particularly stiffness, can persist for a long time, up to 7 years in one study. If symptoms are mild patients can try anti-inflammatory tablets to help with the pain and keeping active to maintain their shoulder movement.
Non-operative management
If the shoulder is too painful to be controlled with self management, patients should see their GP for a referral to a Shoulder Surgeon for an opinion. If the diagnosis is confirmed, then a single steroid injection into the shoulder joint itself is a good first line of treatment. The steroid helps to calm the inflammation and soften scar tissue improving pain and range of motion. This procedure is quick and safe and can be performed in clinic on the day of appointment if the diagnosis is confirmed. Experience shows that up to 50% of patients may benefit from a single steroid injection into the shoulder Joint and not require further treatment.
Operative treatment
The most common surgical procedure to treat frozen shoulder is an arthroscopic capsular release. This is relatively short, key-hole procedure, that is done as a day-case. The aim of the procedure is to burn away the inflamed scare tissue at the front of the shoulder joint to help with pain and regain movement. In my practice I perform this with the patient awake so that they can see inside their shoulder, understand the problem and procedure, and gain confidence in their rehabilitation. POS-operative physiotherapy is key to recovery.
How long is the recovery time?
As mentioned before although Frozen Shoulder is a self limiting condition symptoms can persist up to an beyond 7 years. Recovery from a steroid injection into the joint can be as soon as a few days to several weeks. The normal recovery from key-hole surgery can be as soon as 3 months.
Are there preventative measures you can take?
There is no proven preventative measure for frozen shoulder. Diabetics should try to keep their diabetes well controlled. Post-operative patients should adhere to their physiotherapy program in order to reduce the risk of recurrence.
