What is a frozen shoulder?
A frozen shoulder (also known as adhesive capsulitis or capsular contracture) is a very painful condition of the shoulder which is associated with a variable degree of restricted movement (stiffness). It is one of the most painful conditions in the shoulder – the other being calcific tendinitis.
Why does a frozen shoulder occur?
Often it occurs without an obvious cause and is commonly seen in patients nearing or in their 50s. It may occur after a minor injury and can be associated with diabetes, heart disease, high cholesterol, thyroid disease and is frequently seen in patients with scars and nodules in their hands (called Dupytrens disease). It can also occur after surgery or trauma such as a fracture or a torn tendon. The lining of the shoulder is called the capsule and normally is a loose elastic relatively thin structure. With a frozen shoulder the capsule and its ligaments become inflamed, red, thickened and contracted causing stiffness.
What symptoms occur with a frozen shoulder?
Typically a frozen shoulder will pass through three phases:
Freezing Phase: This is a marked by increasingly severe pain with movement and an inability to lie on that side at night. This is followed by increasing stiffness as the capsule starts to become thickened and contracted.
Frozen Stage: The pain may not be as severe as in the freezing phase but significant restriction in movement occurs particularly with rotating the arm outwards with the elbow by the side (external rotation). Sudden movements may bring tears to their eyes and patients may complain of pain on the outer side of their upper arm
Thawing Phase: The condition starts to resolve with a gradual restoration of movement. Typically the condition is self-limiting with the entire process often lasting 2-4 years. However, it can be variable and often longer with patients not necessarily having a complete restoration of movement.
How is frozen shoulder diagnosed?
The diagnosis is usually made on the basis of the history and a physical examination. An X-ray may be requested to exclude other causes for stiffness such as arthritis or an MRI scan to rule out rotator cuff tendon pathology.
How is frozen shoulder treated? Surgical VS Non-Surgical management
Physiotherapy: To help prevent further stiffening and try to regain range of motion.
Medication: Painkillers and anti-inflammatories.
Injections: These may be performed to reduce inflammation and provide pain relief. A special type of injection called a hydrodilatation can be performed in which a high volume of fluid is injected into the joint capsule to expand the capsule like a balloon.
Surgery: This will depend on the preference of the surgeon and may be either a manipulation under anaesthesia (i.e. with the patient asleep) or a surgical release of the tight shoulder capsule using arthroscopic ‘keyhole’ surgery. This is called an arthroscopic arthrolysis and can be of benefit in both the early and later stages of the condition and can provide rapid pain relief and restoration of movement. Intense regular physiotherapy is essential after hydrodilatation or surgery.
The day following surgery a tailored intensive physiotherapy rehabilitation programme by a specialist shoulder physiotherapist under the surgeon’s supervision is commenced aiming to restore full movement, function and strength. It is crucial to start physiotherapy immediately to prevent adhesion reforming and the shoulder re-freezing.