Common Conditions of the Shoulder: Frozen Shoulder (Adhesive Capsulitis)

This is a condition in which there is a global reduction in the range of motion of the shoulder (stiffness). The condition may arise for no apparent reason or may follow an injury or surgery to the shoulder. It is more ommon in women and diabetics.

What are the signs and symptoms?

The first thing that most people notice is that the shoulder becomes painful. This is a severe pain, which causes them to wake at night. The pain is "within the shoulder" and usually cannot be localized any more precisely. The shoulder is painful to move particularly in internal rotation (reaching behind the back) and external rotation (turning the palm away from the body). Most people complain that they have difficulty putting on a shirt. As the condition progresses the resting pain subsides (this may take 6 months) but the stiffness continues. The stiffness may be so severe that the shoulder has virtually no mevement. The stiffness usually subsides 18 months to 2 years after symptoms first started. Full movement may not be regained.

What is the initial treatment?

The initial treatment is painkillers and anti-inflammatories. The purpose of this is to settle the pain and allow for physiotherapy to be started. The aim is to maintain as much movement as possible whilst the condition runs it's course and eventually settles. In many cases this is all that is needed.

If initial treatment doesn't work, what's next?

In a small number of cases the stiffness and pain fail to respond to painkillers and physiotherapy. Many treatments have been suggested and there is little evidence that many of them work. If the stiffness is becoming worse there are three options

Hydrodilatation:

This procedure is carried out by the specialists in the X-ray department. Using ultrasound or X-ray a needle is guided into the joint and fluid (local anaesthetic and steroid) is injected to stretch out the inside of the joint. You can go home the same day and physiotherapy is arranged to start the next day.

Manipulation under anaesthetic:

In this procedure a light anaesthetic is given and the shoulder joint is moved through all of its range to try to stretch the shoulder capsule and break down any scar tissue that has formed. This is followed the same day by physiotherapy to maintain the movement which has been achieved.

Arthroscopic capsular release:

In this procedure arthroscopy of the shoulder joint is performed under general anaesthetic and the tight capsular tissue is cut allowing for increased movement. Again physiotherapy after the surgery is essential or the shoulder will become stiff again.

Please click this link for further information on Arthroscopic Capsular Release Surgery

How can further stiffness be prevented?

Most shoulders do not become stiff again once the condition has settled. Adherence to the physiotherapy program, which will include exercises to be done at home, is essential. A small number of patients will relapse despite all of the intervention. In these cases the manipulation or arthroscopy may be repeated.