Frozen Shoulder
The stiffness of frozen shoulder gives the condition its name, but it does not describe accurately the pain that accompanies it. The condition is one of the most painful that can affect your shoulders, but, with Sports Med London help is on hand.
What Is A Frozen Shoulder?
Frozen shoulder is a condition in which the capsule of the shoulder and its ligaments become swollen, thick, red, and contracted, which causes pain and stiffness. The capsule usually is a relatively thin structure that is elastic and loose. It is filled with fluid that lubricates the joint.
The condition usually arises without an identifiable cause. Frozen shoulder is often seen in patients who:
- Are in their late 40s and 50s
- Suffered a minor injury
- Have diabetes, Dupytrens disease (nodules and scars in the hands), heart disease, high cholesterol, or thyroid disease
- Suffered a torn tendon, fracture, or other trauma
- Had surgery
Frozen Shoulder Symptoms
Most cases of frozen shoulder pass through three phases. The symptoms vary from phase to phase.
Freezing phase symptoms:
- Severe pain that worsens when you move
- Inability to lie on the affected side at night
- Increasing stiffness in your shoulder
Frozen phase symptoms:
- Pain may be less severe than in the freezing phase
- Your arm movement is restricted significantly, especially when rotating your arm outwards with the elbow by the side
- Pain associated with sudden movements may bring tears to your eyes
- Pain on your upper arm’s outer side
Thawing phase symptoms:
- Your arm movement is restored gradually
Frozen shoulder usually is self-limiting, and it often lasts from two to four years. However, not all patients have arm movement fully restored. Non-surgical or surgical treatment should help to restore movement in such cases.
Diagnosis And Treatment
At Sports Med London, diagnosing frozen shoulder usually includes a conversation with the specialist about the history of your condition, and a physical examination. The specialist may send you for an X-ray or MRI scan to rule out other conditions.
Non-surgical treatment includes:
- Physiotherapy
- Painkillers (analgesia and anti-inflammatories)
- Injections to reduce swelling and relieve pain, such as hydro dilatation (which is followed by intense physiotherapy)
Our specialist will recommend the surgical treatment they think is best, if required:
- Keyhole surgery to release the tight shoulder capsule (arthroscopic arthrolysis)
- Manipulation under anaesthesia
Surgery is followed by a personalised intensive physiotherapy programme. You will begin the programme under the surgeon’s supervision a day after surgery to prevent your shoulder from re-freezing.
Technical Information:
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.