What is Frozen Shoulder?
Frozen Shoulder (Adhesive Capsulitis) is an extremely painful condition in which the shoulder is completely or partially unmovable (stiff). It is one of the most painful conditions of the shoulder. (Others being Rotator cuff tendinitis, Shoulder Impingement, Calcific tendinitis).
Frozen shoulder often starts without any specific reason, but may be triggered by a mild injury to the shoulder. The condition usually goes through three phases, starting with pain, then stiffness and finally a stage of resolution as the pain eases and most of the movement returns. This process may take a long time, sometimes as long as two or more years.
Frozen shoulder may be associated with diabetes, high cholestrol, heart disease and is also seen in patients with scar tissue in their hands, a condition called Dupuytrens contracture. It may follow an injury to the shoulder or surgery.
The lining of the shoulder joint, known as the ‘capsule’, is normally a very flexible elastic stucture. It’s looseness and elasticity allows the huge range of motion that the shoulder has. With a frozen shoulder this capsule (and its ligaments) becomes inflamed, swollen, red and contracted. The normal elasticity is lost and pain and stiffness set in.
It was once believed that frozen shoulder was associated with personality disorders, but recent evidence does not support this contention.
A frozen shoulder is diagnosed when the shoulder has limited motion in all directions, without a history of prior injury or surgery and with AP and Axillary x-rays showing a normal joint space.
If nothing is done most frozen shoulders improve significantly over 2-4 years after onset. However the pain and limitations of the stiff shoulder generally require treatment. The treatment required depends on the severity of the pain and stiffness. These include:
- Physiotherapy – to prevent any further stiffness and regain range of motion
- Painkillers and anti-inflammatories
- Injections – reduce inflammation and provide pain relief
- Hydrodilatation Procedure – more effective than simple injections in relieving severe pain and imrpoving range of motion
- Surgery – Surgery has been shown to be of benefit in both the early and later stages of a Frozen Shoulder. This may involve an arthroscopic Capsular Release or Manipulation Under Anaesthetic (MUA). We prefer the Capsular Release procedure. It is excellent for both pain relief and restoring movement, with a success rate of 96% at 6 months. Intensive physiotherapy is essential after the surgery.
Exercises for Early frozen shoulder