Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder is a very painful condition characterised by severe pain in the shoulder progressing to significant stiffness.    The shoulder joint capsule becomes severely inflamed, which then thickens and contracts preventing the shoulder from moving.

There is normally no obvious trigger to the start of a frozen shoulder.  Frozen shoulder is considered a cycle that does return, in most affected patients, to normal shoulder function eventually.  Unfortunately that can take 2-3 years to happen.  

What are the causes?

Frozen shoulder is more common and also much harder to treat in patients with diabetes.  It can occur after an injury to the shoulder and many will relate the start of their symptoms to a trivial injury.  

What are the symptoms?

Frozen shoulder has 3 phases that patients go through:

Freezing – Patients experience severe pain, particularly at night.  Painkillers only offer minor relief but the shoulder remains relatively mobile.  This phase can last up to 9 months.

Frozen – As the pain starts to reduce the shoulder becomes more stiff.  Patients find it particularly hard to get their arm behind their back.  This phase can last for 6-12 months.

Thawing – The shoulder gradually becomes easier to move with a return to normal shoulder function.  This phase can take up to 12-24 months.

How is it diagnosed?

Your surgeon can usually make the diagnosis by asking about the symptoms you have and examining your shoulder.  X-rays are useful at ruling out arthritis as the cause of your stiffness.    

How is it treated?

Frozen shoulder will usually get better, but this can take many years and so is unlikely to be an acceptable solution for many patients.  

In the freezing phase, simple painkillers and physiotherapy can help.  An injection into the shoulder may also reduce inflammation and pain.

A procedure called hydrodilatation can be used during the frozen stage.  This involves an injection into the shoulder joint in which the joint capsule is ballooned using fluid or air.  This works well at improving symptoms and avoids the need of surgery.  

Surgery, in the form of an arthroscopic capsular release and manipulation under anaesthetic is also very successful at treating both the pain and stiffness caused by frozen shoulder.