Frozen shoulder

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What is frozen shoulder?

A frozen shoulder – also known as adhesive capsulitis – produces stiffness and pain in the shoulder joint, which can be severe. The condition, which can last from twelve months to two years, usually comes on gradually with three progressing phases:

  • Freezing – you start to experience a more limited range of motion in your shoulder and significant pain when you try to move it due to inflammation in the capsule. As you then move your shoulder less you enter a vicious cycle and progress to the next stage.
  • Frozen – your shoulder becomes stiffer and harder to move, although pain levels may diminish as the inflammation in the capsule settles but it also becomes thicker.
  • Thawing – the range of movement in your shoulder gradually starts to improve and returns to normal.

What causes a frozen shoulder?

A frozen shoulder occurs when the capsule of connective tissue that surrounds your shoulder thickens and tightens, restricting its movement. Doctors are not completely clear on why this occurs in some people, but certain factors are known to increase your risk of developing a frozen shoulder. These include:

  • Certain diseases such as diabetes, Parkinson’s disease, cardiovascular disease, tuberculosis and diseases affecting the thyroid
  • Age – a frozen shoulder is more common in people over the age of forty. Women are more likely than men to be affected
  • Reduced mobility in the shoulder – if you have a prolonged period of reduced mobility in your shoulder, as a result of trauma, rotator cuff injury or surgery for example

What are the symptoms of a frozen shoulder?

The symptoms are of worsening pain and restricted movement of the shoulder.

How is a frozen shoulder diagnosed?

Your consultant will carry out a physical examination to evaluate how much movement you have in your shoulder and the level of pain you are experiencing. You may be given an anaesthetic injection to enable them to check how much active and passive motion you have (passive motion is when the consultant moves your arm rather than asking you to move it yourself). You may be given an X-ray or MRI to rule out other conditions.

How is a frozen shoulder treated?

Most frozen shoulders go away on their own within a year or two. During that time you may be prescribed painkillers and anti-inflammatories and offered physiotherapy to help you to recover more mobility in your shoulder.

If the condition persists, there is a range of surgical and non-surgical treatments that your doctor may recommend, including:

  • Corticosteroid injections to relieve pain and improve the range of movement in your shoulder
  • Joint distension, which stretches the tissue by injecting sterile water into the joint capsule. This makes it easier to move the joint
  • Shoulder manipulation under general anaesthetic, which can help to loosen up tightened tissues in the joint
  • Capsular release: This is a surgical procedure that uses keyhole surgery to release the tight capsule that causes a frozen shoulder. It may be recommended if your condition does not respond to physiotherapy or other treatments. The surgery can be performed under general anaesthetic or by blocking the nerves to the arm so you do not feel the surgeon performing the procedure. Three small incisions are made on the shoulder and an arthroscopic camera and surgical instruments are inserted. The instruments are used to cut the capsule tissues surrounding the shoulder joint and radiofrequency waves cauterise the tissue to minimise any bleeding. The incision sites are closed with sutures or surgical staples. Afterwards, you should experience a greater range of movement in your shoulder and reduced pain