Everything You Need To Know About Frozen Shoulder
Adhesive Capsulitis, more commonly known as “Frozen Shoulder”, is a debilitating and often highly painful condition caused by the capsule surrounding the shoulder joint becoming stiff, tight and painful. Symptoms can often last for months, sometimes even years, which are often worse at night and, without treatment. often become progressively worse¹. However, it can be treated very successfully, often without surgery.
About your shoulder
The shoulder is a highly mobile joint, which allows you to use your arm and hands in a wide variety of positions. The ball at the top of the arm bone, the Humerus, fits into the shallow socket, the Glenoid, of the shoulder blade, the Scapula. There is a loose ‘bag’ surrounding the joint called a capsule. This contains fluid to lubricate the joint and is supported by ligaments and muscles.
With Frozen Shoulder, the loose bag (the capsule) surrounding the joint becomes thickened, inflamed and appears to tighten or shrink around the joint, resulting in a reduced range of movement and pain.
What causes Frozen Shoulder?
There are two types of frozen shoulder, primary and secondary. Primary frozen shoulder is idiopathic, meaning arises spontaneously and the causes for it happening are not fully understood. Secondary frozen shoulder can be a result of trauma, shoulder impingement, cardiovascular disease or diabetes.
Symptoms often continue for extended periods of time and the “total timeline” of a frozen shoulder, from presentation to full recovery, can be from 12 – 42 months. Frozen shoulder is usually resolved with no formal medical intervention. Nobody knows the exact causes of a frozen shoulder.
In many patients the exact cause cannot be found. However, there is emerging evidence that it is related to general health status and if you are diabetic, obese, have thyroid dysfunction, heart disease, your risk of developing frozen shoulder increases. Increasing age (particularly those between 40 and 60) and shoulder injury are also well known causes.
About 10% of those who present with Frozen Shoulder will also go on to have the condition in the other shoulder sometime during the next 5 to 7 years.
What are the signs and symptoms of Frozen Shoulder?
There are two core symptoms of Frozen Shoulder; pain and stiffness. The degree of each in relation to the other can vary between patients. Usually, there are three main phases to the condition².
Is there any test for Frozen Shoulder diagnosis?
If it is suspected that you may have a frozen shoulder, an X-Ray is required to rule out other causes of your pain. The x-ray should look normal, even with frozen shoulder present.
Diagnosis is achieved via clinical assessment by an appropriately qualified healthcare professional, who will advise if you require an X-Ray.
What treatments are available?
There are various treatment options available for Frozen Shoulder. Some treatments are aimed at managing pain, which is usually useful during the first phase of the condition (the freezing phase). Other treatments are aimed at improving stiffness, which is often more present in the second and third phases.
Treatments for pain
- Modify activities to avoid causing excess pain. It is safe to continue with sports or activities, however, they may cause pain
- Simple painkillers such as paracetamol or anti-inflammatories, which can be bought over the counter, can be helpful. Any medication usage should always be discussed with your pharmacist before use
- Exercising improves blood flow, releases natural painkillers, slows down stiffness and prevents the shoulder getting weak
- Cortisone (steroid) injections can reduce inflammation in the gleno-humeral joint and may be useful to reduce pain levels in phase one (the painful stage) of the condition
- Some people report that acupuncture can help to manage pain, however, the evidence behind this is inconclusive
Treatments for stiffness
- Regular and gentle shoulder exercise is important to try and maintain and improve range of movement at the shoulder. Many people have Physiotherapy to learn which exercises are best for their individual circumstances. Most Physiotherapists will design a personalised exercise plan tailored to your specific needs
- If you are still limited by stiffness after a course of physiotherapy, or have had the condition for a prolonged amount of time, then other treatment methods are available. Usually at this point, you may be referred to a shoulder specialist to discuss these options which frequently include Hydrodilatation (a large volume capsule injection) in order to stretch the capsule and improve the range of possible movement, or surgery (see below)
- There are two most common surgical interventions; Anterior Capsular Release (“ACR” – keyhole surgery) and Manipulation Under Anaesthetic (“MUA” – when a surgeon moves the shoulder to stretch the capsule whilst the patient is sedated)
- Physiotherapy is essential following Hydrodilatation or surgery. All Surgeries carry relative risk and these are always fully discussed with your surgeon.
What happens without treatment?
Based on the largest published series of patients with a mean follow-up of 4.4 years from onset of symptoms, 59% made full recovery, 35% had mild to moderate symptoms, with pain being the most common complaint, and 6% had severe symptoms at follow-up.
What can I do myself?
Trying to maintain as much range of movement and strength as possible during the lifetime of the condition is essential to optimise recovery. Follow the guidance of your Physiotherapist with a home exercise routine and consider other options to help you move better, such as Personal Training, Pilates and Yoga.
Other useful sources of information
The British Elbow & Shoulder Society (BESS) – http://www.bess.org.uk/index.php/patients
Arthritis Research UK – https://www.arthritisresearchuk.org/
NHS Choices – https://www.nhs.uk/conditions/frozen-shoulder/