Frozen shoulder is a condition that leads to pain and stiffness of the shoulder. The pain from a frozen shoulder can be severe and is often worse at night. The stiffness can affect the ability to carry out normal everyday activities such as dressing, bathing or driving.
What Causes a Frozen Shoulder?
The shoulder capsule surrounds the ball-and-socket part of the shoulder joint. The capsule is a flexible and loose structure that permits the shoulder to have a large range of motion. This capsule becomes thickened, inflamed and tight in patients with a frozen shoulder. It is not fully understood why this happens but patients who have had a shoulder injury or who have health conditions such as diabetes, high cholesterol, heart disease or a previous stroke are more vulnerable to developing a frozen shoulder.
How is a Frozen Shoulder Diagnosed?
In most cases, the patient’s history and physical examination is all that’s necessary to make a diagnosis of frozen shoulder. X-rays of the affected shoulder are often performed to rule out other causes of a painful stiff shoulder, such as arthritis. Occasionally, an ultrasound or MRI is requested if the diagnosis is uncertain.
Treatment
The condition usually goes through three phases, starting with pain (“freezing”), then stiffness (“frozen”) and finally a stage of resolution (“thawing”) as the pain reduces and the movement starts to improve. This process may take two to three years.
Treatment for a frozen shoulder depends on the stage of the condition and the severity of the pain and stiffness. The “freezing” stage is often the most painful and painkillers such as paracetamol and/or anti-inflammatory medications (such as Ibuprofen) may help. If painkillers don’t work, a corticosteroid (a medicine that reduces inflammation) injection into the shoulder joint may help with pain relief.
In the “frozen” stage, the pain may improve slightly and stiffness becomes the main problem. Gentle stretching exercises and/or physiotherapy may help but in most patients the stiffness will persist for several months. Patients are often referred to a shoulder specialist at this stage. There are two main options of treatment, which are:
- Hydro-dilatation: A x-ray or ultrasound machine is used to guide placement of a fine needle into the shoulder joint. A mixture of contrast (x-ray dye), local anaesthetic, corticosteroid and saline (sterile salt water) are injected through the same needle to stretch and rupture the thickened shoulder capsule.
- Surgery: Arthroscopic capsular release is a minimally invasive or “keyhole” surgery, performed under general anaesthetic as a day-case procedure. Two or three small incisions are made around the shoulder and a special probe is inserted through one of the incisions and used to divide the thickened parts of the shoulder capsule. An alternative type of surgery is manipulation under anaesthetic. During this procedure, the shoulder is moved in a controlled way to stretch the shoulder capsule. Both these types of surgery have been shown to greatly help improve the range of movement.
After hydro-dilatation and surgery, physiotherapy is recommended to help maintain mobility in the shoulder and stretching exercises will need to be continued for at least three months.
