What is Frozen Shoulder?
Frozen shoulder, also known as Adhesive Capsulitis, is best described as an inflammatory condition of the shoulder joint lining. Its cause is unknown and, although it can occur after injury to the shoulder tendons, often there is no trigger. It usually occurs in middle age and affects women more than men. Diabetics can also get a more severe form of the condition, however most patients do not have diabetes.
How is Frozen Shoulder diagnosed?
Frozen shoulder is normally diagnosed after taking a careful history and performing a clinical examination. Imaging of the shoulder is recommended to rule out any other problems with the bones or joint and sometimes an ultrasound or MRI scan is used to rule out problems with the soft tissues around the joint.
What are the symptoms of Frozen Shoulder?
The main symptoms of frozen shoulder are pain and stiffness. The inflammation of the joint lining causes the pain and becomes thickened which leads to the stiffness. Pain and stiffness can also be due to spasm in the muscles surrounding the shoulder joint.
What can I do for Frozen Shoulder?
Without treatment Frozen shoulder normally settles with time, however this can sometimes take many years. Therefore, a lot of patients opt for some form of treatment.
Frozen shoulder is typically described in 3 stages with treatment options varying according to each stage.
Stage 1: Inflammation
In this stage pain due to inflammation of the joint lining is the main symptom. This is usually a constant ache felt in the upper arm with sudden, severe pain during movements of the arm. The pain can be especially severe at night making it impossible to lay on the affected side and impacting sleep.
If the pain is mild, then over the counter anti-inflammatory medication such as ibuprofen (if your Doctor has advised this is safe to take) may help. Many people find that physiotherapy exercises can be very irritating, so we generally advise keeping the shoulder moving gently but avoiding overuse or too much stretching of the joint.
If the pain is more severe and not helped by the above treatment, then national guidelines recommend the use of a steroid joint injection to settle the inflammation. The earlier this is provided the better the response and the more quickly the condition can settle.
Ultrasound guidance of injections has also been shown to improve accuracy and clinical response compared to non-guided injections
Stage 2: Stiffness
In this stage the inflammation has largely settled so pain will be a lot less severe. However, due to thickening of the joint lining, the main symptom is stiffness which can significantly restrict daily activities and quality of life.
In the past, stage 2 treatment normally involved manipulation of the joint under anaesthetic however, as this procedure has been associated with an increased risk of bone and soft tissue injuries, surgeons now prefer to perform a procedure under keyhole surgery called capsular release. This is very effective with good outcomes.
For patients who wish to avoid surgery, another treatment has been introduced involving the injection of a large volume of fluid into the joint under ultrasound or x-ray guidance to free up the thickened joint lining. This technique is called either hydrodistension or hydrodilatation and can be performed in the clinic. Dr Collins undertakes this procedure frequently with good evidence of benefit. However, should this procedure not improve symptoms sufficiently then capsular release remains a treatment option.
Stage 3: Thawing
At this point the stiffness starts to settle and the arm can be moved more freely so we typically recommend avoiding injections or surgery and, instead, suggest working with a physiotherapist to improve strength and function of the shoulder to promote a return to normal activities.
Please contact us to discuss the treatment of Frozen Shoulder and the procedures Dr Collins provides for this.