• Diagnosis
  • Treatment
  • Rehabilitation

Frozen Shoulder

Also known as: Adhesive capsulitis, Shoulder periarthritis

Frozen shoulder is a condition where the capsule becomes inflamed and forms scar tissue. It causes stiffness and pain in the shoulder.

It can occur at any age but is most common in middle-aged people, affecting twice as many women as men. It is also more common in patients with underlying conditions such as diabetes or thyroid disease.

It can develop spontaneously with no obvious cause or can be brought on as a result of injury. Sometimes it occurs in association with other shoulder problems such as rotator cuff disease

Symptoms

Frozen shoulder is characterised by progressive shoulder pain and stiffness. Movement becomes limited and it can become difficult to do everyday tasks like brushing hair or getting dressed. It can be particularly painful at night.

Investigations

An x-ray will exclude arthritis, the other main cause of pain and stiffness, and dislocation of the shoulder. An MRI scan often helps confirm the diagnosis and excludes serious rotator cuff disease.

Frozen Shoulder

The natural progression of frozen shoulder is self-limiting. It progresses through severe pain, through painful stiffness to end in painless stiffness which eventually eases. The time period can vary but two years is the average.

For many patients, treatment with anti-inflammatories (e.g. Ibuprofen) and painkillers (e.g. Paracetamol) may suffice. There is usually no benefit from physiotherapy.

If tablets fail to help and night pain is severe, a well-placed steroid (cortisone) injection (often placed under X-ray control) can be successful in terminating the pain. The residual stiffness gradually improves by itself with 90% of normal movement returning within a couple of years after the condition’s onset.

A process known as hydrodilatation can be performed under local anaesthetic to relieve pain and help with function.

For resistant and severe cases, keyhole surgery to release the shoulder joint can be effective. This is normally performed under a combination of general anaesthetic and nerve block for post-operative pain relief.

Frozen Shoulder

Frozen shoulder can be treated conservatively or with surgery. Conservative management can involve physiotherapy although some cases do not respond. If the condition is caught very early on then physiotherapy can be effective. This involves soft tissue mobilisation by means of manual therapy (hands on stretches) by an expert physiotherapist as well as postural exercises to stabilise the scapula in a better position. Sometimes taping and stretches are used to stretch the capsule of the shoulder joint. Advanced frozen shoulders mainly do not respond to physiotherapy alone.

Post operative frozen shoulders require soft tissue stretches by manual therapy as well as intensive strengthening and range of movement exercises. These will be progressed to regain full movement and power in the shoulder.