Frozen Shoulder or adhesive capsulitis

Frozen Shoulder

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Also known as: adhesive capsulitis

What is it?

Frozen Shoulder 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 (the others being Calcific Tendonitis or referred Nerve pain from the neck).

Frozen shoulder often starts out of the blue, 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.

Normal Shoulder Capsule:

Frozen Shoulder Capsule:

Frozen shoulder, as seen at Arthroscopy (note the very swollen and reddened inflamed capsule - it is not surprising that this is such a painful problem!):

Three stages of development:

Typical Primary frozen shoulder develops slowly, and in three phases:

Freezing phase: Pain increases with movement and is often worse at night. There is a progressive loss of motion with increasing pain. This stage lasts approximately 2 to 9 months.

Frozen phase: Pain begins to diminish, however, the range of motion is now much more limited, as much as 50 percent less than in the other arm. This stage may last 4 to 12 months.

Thawing phase: The condition may begin to resolve. Most patients experience a gradual restoration of motion over the next 12 to 42 months

Treatment

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:

1. Physiotherapy - to prevent any further stiffness and regain range of motion
2. Painkillers and anti-inflammatories
3. Injections - reduce inflammation and provide pain relief
4. Hydrodilatation Procedure - more effective than simple injections in relieving severe pain and imrpoving range of motion
5. 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.