Frozen

 What is a Frozen Shoulder ?

A frozen shoulder literally means a stiff shoulder. This is caused by tightening of the lining of the shoulder joint (capsule). The capsule is attached to both sides of the shoulder joint, the socket (Glenoid) & the ball (head of Humerus). Tightening of the capsule prevents the ball form moving across the socket of the shoulder joint, which becomes stiff as a result.

What causes a frozen shoulder ?

Most of the time, a shoulder that is called frozen is in reality a shoulder that is stiff due to another shoulder problem. In particular, Impingement, rotator cuff tears and arthritis are commonly mistaken for a frozen shoulder.

A frozen shoulder is a condition with an unknown cause where the capsule (lining) of the shoulder joint becomes inflamed and contracts as a result of that inflammation. This condition is also, sometimes, called adhesive capsulitis. A frozen shoulder is common in people who have diabetes.

Occasionally, a frozen shoulder develops as a result of another condition, such as a heart attack, a stroke, disc prolapse in the neck or breast surgery.

What does a frozen shoulder feel like ?

Initially, a frozen shoulder starts with severe pain that keeps you awake at night. The pain is a sign of the inflammation in the capsule. Over a period of weeks or a few months the pain gradually settles and stiffness starts. The stiffness is the result of the contraction of the capsule caused by the inflammation. At that time, the shoulder is only painful when you try to stretch it too far.

Does a frozen shoulder get better ?

After a period of stiffness lasting for up to three years, or even longer if you are diabetic, the shoulder starts to loosen and some or even all of the movement comes back. Most of the time, some slight restriction in the movement remains.

What can I do to make my frozen shoulder better ?

During the early painful period, anti-inflammatory medication is helpful but does not normally control the pain completely. A shoulder injection containing a steroid during that time controls the inflammation and the pain better. Once the painful period has passed, gentle stretching exercises help to regain the movement of the shoulder. Aggressive physiotherapy tends to aggravate the pain and is not recommended.

How can I find out if my shoulder problem is a frozen shoulder ?

Your doctor will examine you and exclude the possibility of you having other shoulder problems such as impingement, rotator cuff tear and arthritis by organising an X-ray and an MRI or an Ultrasound scan. All these tests are normal in a frozen shoulder.

How can my frozen shoulder get better quicker ?

As mentioned above, a steroid injection in the painful phase and gentle stretching in the stiff phase are the first lines of treatment for this condition, which tends to resolve on its own over a two to three year period.

No other treatment is helpful in the painful period. If gentle stretching exercises are not helpful over a three months period or the demands of your job or life style mean that you need the movement of the shoulder restored quicker, surgery may be an option.

What type of surgery is available for the frozen shoulder ?

Two types of surgery are available. A manipulation under anaesthesia, which means mobilizing the shoulder by moving it under a general anaesthetic. This releases the capsule (lining) of the shoulder joint allowing the shoulder to move.

The same effect can be achieved by an arthroscopic release of the shoulder. This again requires a general anaesthetic, involves two or three keyhole puncture wounds to allow looking inside the shoulder and cut through the capsule of the shoulder joint. This operation has the advantage over the manipulation under anaesthetic of being able to exclude other causes of shoulder pain and stiffness by looking inside the shoulder and allows better control the process of release of the capsule. It may also be the only option if manipulation alone does not allow the shoulder joint to move.

After either of these operations, immediate physiotherapy to maintain the movement gained under anaesthetic is crucial. Otherwise, the shoulder tends to stiffen again. This is more difficult than it sounds, as the operation tends to increase the pain in the shoulder for 2-3 weeks, which makes physiotherapy uncomfortable during that time.

The amount of movement regained following surgery may not be complete, but almost always allows good shoulder function. Once function is regained, the condition never reoccurs. Return to all normal activities is only restricted by pain but is normally possible within 2-3 weeks.

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