Shoulder

Frozen Shoulder

What is it?

Frozen shoulder or in medical terms “adhesive capsulitis” is a very common condition. It normally occurs in people aged 40-60 and is more common in women than in men. The exact cause is unknown, however it can occur after an injury or surgery and is more common in patients who have diabetes. It occurs when the flexible tissue around the joint referred to as the shoulder joint capsule, becomes inflamed, thickened and stiff. This causes great restriction in shoulder movements and a lot of pain.

Pain is generally worse at night and lots of normal activities become very difficult due to the loss of movement for example; putting on your coat and combing or washing your hair.

Stages of frozen shoulder

Stage 1- Freezing – This stage can last from 2-9 months. During this stage pain is the main issue and the movements of the shoulder are gradually getting worse. Pain is generally worse at night and can affect your sleep.
Stage 2- Frozen – This stage can last from 4-12months. Pain starts to decrease but the movements of the shoulder are very restricted even ‘Frozen’.
Stage 3- Thawing – This stage can last anything from 5 months to 4 years and at this stage the movement is gradually returning to the arm and pain may no longer be an issue.

A prompt assessment by a physiotherapist or shoulder specialist is vital.

How can physiotherapy help?

Physiotherapists are able to diagnose the condition and commence early treatment. Recovery can be slow from a frozen shoulder. Physiotherapy helps by starting to get the shoulder moving. Massage helps loosen the muscles around the joint. Capsular stretches can help try to release the stiff/thickened joint capsule. Electrotherapy and home exercise can further improve the movement.

Treatments

Ultrasound guided injection
In the early stages ultrasound scanning and injection therapy around the inflamed joint may allow initial pain relief to allow further stretching exercises to be performed.

Hydrodilatation injection
The main problem with frozen shoulder is scarring of the front of the shoulder joint (the joint capsule). This can often respond to a special injection into the shoulder which aims to stretch the tissue and allow an increase in movement. This injection is performed under xray guidance to ensure accurate placing of the needle. Water and local anaesthetic is then injected into the joint to stretch the capsule. Patients are awake for this procedure and many notice an immediate improvement. It is vital that further exercises and physiotherapy commence as soon as possible after this injection to maximise any benefits achieved.

Manipulation under Anaesthetic
Range of motion of the shoulder may be improved by stretching exercise. However this can be painful. Occasionally, although this is becoming less common, a manipulation under general anaesthesia may be offered. During this procedure controlled stretches are performed to attempt to increase the range of movement. The manipulation carries the risk of causing a fracture of the arm bone (humerus) and this risk would be discussed fully with the patient prior to the surgery. Following the surgery the patient will require further physiotherapy to maximise any benefits achieved.

Arthroscopic capsular release
Capsular release surgery allows careful division of the tight bands of scar tissue while minimising the risks of fracture of the arm bone (humerus). This is performed under general anaesthesia and often considerable improvement in range of motion can be achieved. This is usually daycase surgery, and is followed by intensive physiotherapy to maximise the benefit achieved and reduce the chance of recurrence. The wounds are small with this surgery, and post operative analgesia will be required for several days or weeks.

Orthoderm clinic is able to provide initial assessment by a shoulder surgeon and physiotherapy by Room One Physiotherapy. Ultrasound scanning, injection therapy and Hydrodilatation therapy are all available in the Orthoderm Clinic, please contact us for an appointment.

 

Consultants

• 
  Mr Michael Eames MD FRCS (Tr and Orth) Consultant Orthopaedic Surgeon