Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterised by progressive stiffness of the shoulder joint. It is associated with pain in the joint, which generally improves with time. The exact cause of the condition is uncertain, although it is associated with inflammation and fibrosis of the capsule of the shoulder joint. It is generally a self limiting condition, that usually resolves but can take 18-24 months.
Frozen shoulder can occur in anyone, however there are certain patient characteristics that can put people at more risk of suffering from frozen shoulder. It affects 2% to 5% of the population.
Diagnosing frozen shoulder can be made after a detailed history and examination from a clinical professional. Further imaging is not always necessary to confirm the diagnosis, however investigations such as MRI, X-ray and Ultrasound can be used to exclude other causes for shoulder stiffness and pain.
Although not necessarily present in all cases, patients can present in any of these stages:
Treatment of frozen shoulder requires an individualised approach, tailored to the individual needs of the patient. In the initial stages pain can be a predominant feature, therefore treatment is aimed at relieving pain. Simple pain relief such as paracetamol and anti-inflammatories can be useful, and at times patients will require stronger pain relievers. Injections of local anaesthetic and cortisone to the shoulder joint, delivered under image guidance, can be useful in relieving pain particularly in the earlier stages of the condition when pain is a problem.
Physiotherapy and manual therapies can be useful, however this may be difficult to undertake in the early stages when pain is a big feature. Once the pain subsides, physiotherapy to help improve range of movement can be useful.
Hydrodilatation is a technique where the shoulder joint capsule is distended with saline and corticosteroid under pressure to attempt to stretch the joint capsule.
In general frozen shoulder is a self-limiting condition but occasionally requires more interventional treatments. Occasionally a manipulation under general anaesthetic can improve range of motion, however for very treatment resistant cases surgery may be required to help release the joint and allow movement. In this situation, the use of arthroscopic (key-hole) surgery to release the shoulder capsule and allow more range of movement. Generally this type of treatment is only offered once more conservative measures have been tried and failed.
If you are experiencing a stiff and sore shoulder, make an appointment with Dr Radic to discuss your treatment options.
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Perth Orthopaedic & Sports Medicine Centre
31 Outram Street
West Perth WA 6005
Antony Street Specialist Centre
6-8 Antony Street
Palmyra WA 6157
100 Stephenson Ave
Mount Claremont WA 6010