Symptoms

Pain is the main symptom experienced with frozen shoulder and is usually dull or aching. It is typically worse early in the course of the disease and on movement of the arm. Pain is located over the outer shoulder area and sometimes the upper arm. People also decreased movement and stiffness in the shoulder.

Causes

Frozen shoulder can occur in anyone, however there are certain patient characteristics that can put people at more risk of suffering from frozen shoulder. It affects 2% to 5% of the population.

Causes include:

• Patients who recently had to immobilise their shoulder for long period
• Recent trauma (after surgery or an arm fracture)
• Diabetes, thyroid disease
• Prior history of adhesive capsulitis: it’s unusual for frozen shoulder to recur in the same shoulder, but a portion of people with frozen shoulder will be affected in the opposite shoulder

Diagnosis

Diagnosing frozen shoulder can be made by medical consultation and examination, taking the patient's past medical history. Further imaging is not always necessary to confirm the diagnosis, however investigations such as MRI, X-ray and Ultrasound can be used to exclude other causes for shoulder stiffness and pain.

Treatment Options

Treatment of frozen shoulder requires an individualised approach, tailored to the individual needs of the patient. Frozen shoulder generally gets better over time, although it may take up to 3 years. The focus of treatment is to control pain and restore motion and strength through physical therapy.

Non Operative Treatment

In the initial stages pain can be a predominant feature, therefore treatment is aimed at relieving pain. Simple pain relief such as paracetamol and anti-inflammatories can be useful, and at times patients will require stronger pain relievers. Injections of local anaesthetic and cortisone to the shoulder joint, delivered under image guidance, can be useful in relieving pain particularly in the earlier stages of the condition when pain is a problem.

Physiotherapy and manual therapies can be useful, however this may be difficult to undertake in the early stages when pain is a big feature. Once the pain subsides, physiotherapy to help improve range of movement can be useful.

Hydrodilatation is a technique where the shoulder joint capsule is distended with saline and corticosteroid under pressure to attempt to stretch the joint capsule.

Surgery

If symptoms are not relieved by therapy or other conservative methods, surgery may be required where the goal is to stretch and release the stiffened joint capsule. The most common methods include:

• Manipulation under anaesthesia. Where shoulder is forced to move causing the capsule and scar tissue to stretch and tear releasing the tightening and increasing range of motion
• Shoulder Arthroscopy. Where tight portions of the joint capsule are cut and released to allow more range of movement.

        Find out more about Shoulder Arthroscopy.