This is a condition where the shoulder becomes extremely stiff and very painful. In fact it is one of the most painful conditions a person can experience in their shoulder.
In this condition the capsule of the shoulder is affected. The capsule is the elastic bag that the joint itself sits in, it’s job is to hold the small amount of lubricating fluid that nourishes the joint in the right place.
In frozen shoulder this capsule becomes very thick, stiff and inflamed. This all combines to lead to the stiffness and the pain.
Frozen shoulder can happen after an injury or surgery, but equally it can happen for no reason at all. It is seen more often in people with diabetes and in people with the hand condition Dupuytren’s contracture.
The condition tends to follow 3 stages:
Freezing: This is the first phase. It is characterised initially by pain, which is felt on movement. Then the shoulder range of movement is progressively lost.
Frozen: In this second phase the pain may start to diminish, but stiffness is the main problem. In this phase the shoulder may be profoundly stiff.
Thawing: The final phase of frozen shoulder is when the stiffness reduces and the shoulder starts to return to near normal.
The timescale for these 3 phases is very unpredictable. Usually it is expected to be around 2 year, but it can be longer. In people with diabetes the condition tends to last longer.
The diagnosis is made on a combination of the patient’s story (history), how the shoulder moves (examination) and the investigations performed.
There are only a few conditions that cause severe stiffness, and usually those would show on an X-ray. So it is important to have an X-ray prior to the diagnosis being made.
It also very common to have an ultrasound scan to make sure the small tendons around the shoulder are working.
In most people this condition will get better by itself. This means that for some people it may be right to perform no treatment at all and just wait for it to get better. This is only usually acceptable if the condition has moved past it’s most painful phase.
Otherwise there are a number of other active treatments that can help people’s symptoms or move them quickly through the phases of frozen shoulder.
Painkillers: Are very important to help manage the pain associated with frozen shoulder
Physiotherapy: In isolation can help stop the shoulder stiffening up, but physiotherapy becomes really important after injections, hydrodilatation and surgery to ensure the best response is achieved.
Injections: Can help reduce pain and inflammation.
Hydrodilatation: Is an injection performed by a radiologist under guidance into the shoulder joint. It works very well to improve pain, and range of movement especially if physiotherapy is also used.
Arthroscopic surgery: Is where the capsule of the joint is precisely cut in a keyhole operation to release the tightness in the shoulder. This works very well and predictably improves both pain and movement.