Frozen Shoulder

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: Who Gets It?

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.

These include:

  • Age 40-70 years
  • Diabetes, thyroid disease
  • Recent trauma or surgery
  • Females suffer with frozen shoulder more than males
  • Prior history of adhesive capsulitis: it’s unusual for frozen shoulder to recur in the same shoulder, but a portion of people with frozen shoulder will be affected in the opposite shoulder
  • History of traumatic shoulder injury or prior surgery to the affected shoulder
Frozen Shoulder: Diagnosis

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.

Frozen Shoulder: Stages

Although not necessarily present in all cases, patients can present in any of these stages:

  1. Patients may complain of shoulder pain, especially at night, but may only have small restrictions of movement
  2. Range of motion decreases to a greater extent and pain becomes more severe
  3. Pain is only evident at the extremes of movement but motion is now severely limited
  4. There is minimal pain, but profound loss of motion.

After stage 4, patients gradually experience less stiffness as time goes on.

Frozen Shoulder: Treatment

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.