What is frozen shoulder?
Frozen shoulder, also known as adhesive capsulitis, is an inflammatory condition that affects the capsule (joint lining) of the shoulder joint. This condition is common in the UK and I see several cases a week in both NHS and private care. Frozen shoulder affects females more than males and commonly occurs between the ages of 40 to 65 years.
What causes frozen shoulder?
The cause of frozen shoulder is unknown. We do not know what triggers the condition. It most often has no cause. Frozen shoulder can occur after some acute traumatic rotator cuff tears, but usually it is not associated with trauma. Stiffness that happens in the shoulder after a fracture or surgery is called post-traumatic or post-surgical stiffness and this behaves differently to frozen shoulder. Diabetics can get more aggressive frozen shoulder and can have the condition in both shoulders at the same time, however most of my patients with frozen shoulder are not diabetic.
What are the symptoms of frozen shoulder?
The main symptoms of frozen shoulder are pain and stiffness. The inflammation that occurs in frozen shoulder results in pain and the scarring of the joint capsule results in stiffness. Pain can also cause muscle spasm which contributes to the stiffness. Symptoms can sometimes progress in three phases:
The Freezing Phase – pain is the predominant feature. The pain is often described as a constant dull ache (some patients describe it like tooth ache) in the shoulder, with sharp pain on certain movements such as reaching behind for the seatbelt or reaching out to the side to put on a jacket. Patients often notice they are unable to lay on the affected shoulder due to pain. Stiffness is mild and often missed.
The Frozen Phase – pain is present but not as severe as the initial onset while stiffness predominates and usually limits work or recreational activity.
The Thawing Phase – here pain improves considerably, and movement slowly becomes easier as the stiffness subsides.
How is frozen shoulder diagnosed?
Frozen shoulder is usually a clinical diagnosis which a specialist makes after taking a history and performing a clinical examination. Commonly the only test needed for a diagnosis of frozen shoulder is an x-ray of the shoulder which should be normal and have no other causes for stiffness. In some complex cases an MRI may be needed to differentiate between frozen shoulder and other conditions.
Will frozen shoulder get better on its own?
Frozen shoulder has often been described as a self-limiting condition that usually gets better with time. While it was common to advise patients that symptoms would resolve in 2 years, more recent research studies suggest that symptoms, particularly stiffness, can persist for a long time, up to 7 years in one study.
What are the treatment options for frozen shoulder?
In the early stages if pain is mild, over the counter anti-inflammatory tablets can help with pain. Patients are advised to keep their shoulders moving and avoid not using the arm, or overdoing repetitive exercise.
Some patients find that physiotherapy often flares up the pain as the repetitive nature of the exercises can further irritate an inflamed joint. Simple stretching exercises can be done in the shower, using the warm water to relax your muscles, keeping the body still and crawling the arm up the wall in front of you and out to the side.
If pain and stiffness are progressing the first line of treatment should be an intra-articular steroid injection which can be given in clinic. If caught early up to 50% of patients would get better with a single injection. We do not recommend more than one injection for this condition. You can find out more about steroid injections here.
For patients with frozen shoulder who do not respond to steroid injections, we recommend surgery in the form of an arthroscopic capsular release.
The following video discusses what frozen shoulder is, its symptoms, and options for treatment:
What happens during frozen shoulder surgery?
I prefer to do surgery for frozen shoulder with the patient awake if we decide it is right for them. The operation to treat frozen shoulder is called an arthroscopic capsular release. During this procedure, the scar tissue at the front of the shoulder is vaporised and a gentle manipulation is done at the end of the procedure with injection of steroid into the joint to reduce recurrence.
What are the risks of arthroscopic capsular release?
It is important that before surgery you understand what is involved in the procedure and what to expect after the surgery. In this video we discuss the procedure of an arthroscopic capsular release, the post-operative rehabilitation, and risks of the procedure. In clinic prior to deciding on surgery we would discuss any risks that may be specific to you. On the day of surgery we then complete the consent process by discussing these risks again before you sign a consent form.
Further patient information about frozen shoulder surgery can be found at aboutmyhealth.org
What is the recovery after arthroscopic capsular release?
Arthroscopic capsular release is usually a day-case operation. After the operation a physiotherapist will see you on the ward prior to discharge and will start moving the arm while the regional nerve block is still working. Patients are usually sent home with a temporary sling which is removed the day after surgery once the block has worn off. The arm should be used straight away, and we usually recommend physiotherapy should start by day 2 post-op.
We encourage patients to use the arm as much as possible after surgery. Patients can do their physiotherapy exercises at work or at home, and you can use some simple tool such as broom sticks, umbrellas, or even your discarded sling to help do regular stretches throughout the day to maintain the movement gained from surgery.
Patients need to be aggressive with their physiotherapy in order to stretch the new scar tissue formed after surgery. In most cases we expect recovery from frozen shoulder surgery to be 3 months.
Click here to download my post-operative rehab protocol for your physiotherapist.
Our instructions for post-op care and recovery after shoulder surgery can be found here.