Is it really Frozen Shoulder?

Robin Turner

“My friend tells me I have got a frozen shoulder because it's stiff and painful but is it really the case and can anything be done about it?”

This is a common question for Robin Turner, a specialist consultant shoulder surgeon based in Brighton. He explains what frozen shoulder is and how it can be treated.

Frozen Shoulder, or to give it its medical name Adhesive Capsulitis, is when the shoulder becomes stiff and painful to move. It can occur because of an injury but often just happens by itself. Middle-aged people are most usually affected but there is also a link to diabetes and thyroid disease.

It is a condition that is often misdiagnosed, most likely because it has three distinct phases that could be mistaken for something else. But if the diagnosis is correctly made then there are treatments that can help.

The bad news is that the usual course of frozen shoulder runs for about two years, but the good news – if you can call it that – is that the most painful stage comes first. This initial stage, where the pain becomes particularly relentless at night, progresses untreated to a stiffening of the shoulder joint which hurts on movement. In the final stage the pain relents leaving stiffness which gradually improves.

In the early stage the condition is frequently confused with ‘rotator cuff bursitis or impingement’ and it may require an MRI scan to rule these conditions out. As the stiffness develops the picture becomes clearer.

When the condition reaches the middle stiff phase, a key sign of frozen shoulder is when it becomes impossible for the sufferer - or their doctor - to rotate the affected arm out sideways. The only other conditions with this characteristic are shoulder joint arthritis and a locked backward dislocation, both of which can be distinguished by an x-ray.

Treatment depends on which phase the sufferer is in. In the early phase painkillers and anti-inflammatory medication can help - assuming the sufferer has no contra-indication to their use. Physiotherapy in this phase can often be painful and should be gentle, but it is certainly worthwhile in the final recovery phase to improve movement and muscle power.

Many patients find that a well directed or x-ray guided injection into the main shoulder joint provides excellent pain relief. But while these injections seem to advance the healing process they do not give instant return of movement.

Unfortunately this approach does not work for everyone and occasionally keyhole surgery or manipulation under general anaesthetic may be required.

The key to frozen shoulder is getting it diagnosed as soon as possible so that the correct treatment can be started. So don’t rely on friends to make the diagnosis, it can be quite a difficult one to make!