Frozen shoulder, also known as adhesive capsulitis is a condition characterised by stiffness and pain in the shoulder joint experienced for months, sometimes years. Signs and symptoms generally begin gradually, worsen and then resolve, usually within 1 – 3 years.
Your risk of developing frozen shoulder increases if you are between the ages of 40 and 60 or recovering from a medical condition, or a procedure that prevents you from moving your arm, such as a stroke.
Treatment for this condition involves physical therapy exercises, corticosteroids or numbing medication injected into the joint capsule. In some cases, arthroscopic surgery may be carried out to loosen the joint capsule to help it move more freely.
It is uncommon for frozen shoulder to reappear in the same shoulder; however, some people can develop it in the opposite shoulder.
Symptoms of Frozen Shoulder
The shoulder is made up of three bones (the humerus, scapula and clavicle) that form a ball-and-socket joint. Tissue surrounds the shoulder joint to keep everything in place. When the tissue around your shoulder joint become thicker and tighter, scar tissue starts to develop, causing your shoulder to not have enough room to rotate.
Frozen shoulder typically develops in three stages over time. Each stage can last a number of months.
Freezing Stage
You will have a limited range of motion and any movement of your shoulder causes pain.
Frozen Stage
Your shoulder becomes stiffer, and using it becomes harder; however, pain may lessen.
Thawing Stage
The range of motion in your shoulder increases. For some people, the pain worsens at night, in some cases disrupting sleep.
It is unusual for frozen shoulder to recur in the same shoulder, but some people can develop it in the opposite shoulder.
The main symptoms of a frozen shoulder are:
- Pain
- Stiffness
- Swelling
You will usually feel a dull ache or pain in one shoulder, and sometimes in the muscles at the top of your arm. You become aware of a frozen shoulder when it starts to cause pain, triggering you to limit your movement. Less movement in your shoulder increases stiffness and eventually you can no longer move your arm as much as you could. When frozen shoulder is severe, you might not be able to carry out everyday tasks that involve shoulder movement such as reaching for things, cooking or dressing.
Causes of Frozen Shoulder
The ligaments, bones and tendons that form your shoulder joint are wrapped in a capsule of connective tissue. Frozen shoulder develops when this capsule gets thicker and tighter around the shoulder joint, restricting its movement. It is often not clear why the condition develops in some people, although there are certain factors that increase your risk of developing it, such as:
A hormone imbalance
Systemic diseases such as diabetes, overactive thyroid, underactive thyroid and Parkinson’s disease
Weakened immune system
A long period of inactivity following an injury, surgery or illness
Age and sex
Women over the age of 40 are more likely to develop frozen shoulder
Immobility following a shoulder injury, broken arm or stroke is one of the most common causes of frozen shoulder. If you have sustained an injury that makes it hard to move your shoulder, talk to your doctor about exercises to help you maintain the range of motion in your shoulder joint.
Diagnosis
If you feel pain and stiffness in your shoulder, consult with your doctor. To diagnose frozen shoulder, your doctor will carry out a physical examination and discuss your symptoms and range of motion. During the physical examination, your doctor may ask you to move your shoulder in certain ways to check for pain and evaluate the level of movement (active range of motion). They may then ask you to relax your muscles while they move your arm (passive range of motion) and note the differences.
Your doctor may decide that you need an anaesthetic injection in your shoulder. This will numb the pain so that they can have a better understanding of your active and passive range of motion.
Frozen shoulder can generally be diagnosed based on signs and symptoms alone. However, your doctor may suggest imaging tests such as an X-ray or MRI scan to rule out other issues such as a rotator cuff tear or arthritis.
Treatment of Frozen Shoulder
The condition can be left untreated, but the pain and stiffness can last for up to three years. Over the counter nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen can help relieve the pain and inflammation in your shoulder. If they do not alleviate the pain, your doctor may prescribe you a stronger medication. If your symptoms are severe or do not improve over time, your doctor may recommend other kinds of treatments, including:
- Physical therapy
- Medication
- Corticosteroid injections
- Home care
Surgery
Capsular release surgery will be suggested if other conservative methods fail to relieve the pain and stiffness. During surgery, options are to manipulate the shoulder by putting it through a full range of motion under general anaesthetic to break any adhesions, or arthroscopic surgery. This form of surgery involves making a small incision in the shoulder and removing scar tissue to release it, allowing the shoulder to recover its lost movement. If your condition has been caused by an injury, surgery is usually more successful if it is carried out within a few weeks of the injury.
Capsular release surgery is usually carried out on a day case basis and is normally followed up with post-operative physiotherapy. The majority of patients typically resume full range of motion within three months.
Outlook
Although most people recover within two years without treatment, early treatment can help keep the condition from getting worse. Physical therapy and pain medication can also help speed up this progress. If you suffer from diabetes, appropriately managing your condition can reduce your risk of developing frozen shoulder. If you undergo surgery, it is important to utilise the prescribed exercises following the procedure to stop the condition returning.
Need Help?
If you are suffering from frozen shoulder, you can be seen by a Consultant Orthopaedic Shoulder Surgeon at One Ashford Hospital, usually within 48 hours. One Ashford Hospital is well placed to see patients with knee injuries from Ashford, Maidstone, Canterbury, Folkestone, Dover and all surrounding villages.
To book an appointment, call the hospital direct on 01233 364 022 or email here
One Ashford
One Hatfield