Frozen Shoulder

Adhesive Capsulitis of Shoulder

What is Frozen Shoulder?

Frozen shoulder is a condition that characteristically causes pain and stiffness in the shoulder without any abnormal changes on XRay. It can be very painful and debilitating.

The ball and socket (glenohumeral) joint of the shoulder is surrounded by a normally thin stetchy lining called the capsule. In frozen shoulder this capsule lining becomes inflamed and thickened. This inflammatory and fibrotic condition of the shoulder capsule. The inflammation in the capsule gives rise to pain in the shoulder when it is stretched particularly with sudden movement. The fibrosis or scarring of the shoulder capsule causes stiffness in the ball and socket leading to loss of shoulder movement.

What are the symptoms?

Patients commonly have a gradual non traumatic onset of pain felt over the upper arm, worse at night and worse with shoulder movement, particularly with sharp or sudden movements. The shoulder gradually becomes stiff and a loss of range of movement is noted.

Who gets Frozen Shoulder?

Frozen shoulder is a common problem, occurring in about 1 in 50 people in the UK every year. It is slightly more common in women than men, is most common in the 40-60 year old age group, and is more common in people with Diabetes.

What causes Frozen Shoulder?

Although we understand a lot about the condition the exact cause of primary frozen shoulder is unknown. About 20% of patient report a minor injury to the shoulder preceding the onset of symptoms.

Secondary frozen shoulder is pain and stiffness in the shoulder with a clear cause such as after a fracture or significant injury to the shoulder and should be probably be better referred to as post traumatic stiffness.

Does Frozen Shoulder get better on its own?

The natural history of frozen shoulder is for the symptoms to improve with time.

Characteristically passing through 3 phases, a painful phase, followed by a painful and stiff phase, followed by a resolving or recovery phase. Symptoms can last from a few months up to 2-3 years in some cases.

How can Frozen Shoulder be treated?

If symptoms are severe and not improving despite oral anti-inflammatory tablets then further treatment will be discussed with you. We follow The British Elbow and Shoulder Society and British Orthopaedic Association (BESS/BOA) Patient Care Pathway guidelines for treatment of Frozen Shoulder (link). A stepwise approach to management of frozen shoulder is recommended.

Physiotherapy:

Physiotherapy can be helpful in the treatment of frozen shoulder, it is often most useful once the severe pain has improved or after injection treatment or after surgery.

Shoulder Injection:

The shoulder joint is dilated with fluid in order to stretch up the shoulder capsule, most commonly steroid or cortisone is used in the injection. The aim is to reduce inflammation in the shoulder and hopefully speed up the recovery of frozen shoulder. These injections are often performed by the radiologist under X Ray guidance to ensure correct positioning of the injection.

Manipulation Under Anesthetic (MUA):

This is a general anaesthetic and regional nerve block procedure (link to your shoulder anaesthetic) often done as a day case. The shoulder is carefully manipulated in a controlled fashion to tear the capsule and improve the range of movement, it is supplemented with a steroid injection at the time and with physiotherapy to maintain the range of movement.

Arthroscopic Capsular Release and MUA: (link to surgery guideline)

This is a general anaesthetic and regional nerve block procedure often performed as day case. A camera and probe are placed in the shoulder with key hole arthroscopic surgery. The inflamed thickened capsular lining is divided under direct vision releasing some of the tight lining of the shoulder, and a controlled manipulation is performed.

Patients are often home the same day, but some stay overnight and go home the following day. Patients are in a sling for comfort for the first couple of weeks after the procedure. The sling can be removed for exercises once the nerve block has worn off. Wound dressings are mostly waterproof allowing patients to wash and shower over the dressings, the wounds are often well healed by 2 weeks after the procedure. Patients often see improvement in their symptom after the surgery but can often take a number of months to see the improvement. There are risks and complications that can occur after the surgery these include, infection, persistent or recurrent symptoms requiring further treatment, injury to structures such as the bone, joint, nerves or blood vessels.