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Frozen Shoulder (Adhesive Capsulitus)
What is frozen shoulder?
This is a condition in which there is a global reduction in the range of movement of the shoulder (i.e. stiffness). The condition may arise following an injury or surgery to the shoulder or for no apparent reason at all. It is more common in women and diabetics.
What are the signs and symptoms?
The first thing which most people notice is that the shoulder becomes painful, particularly at night, which causes them to awaken. The precise location of the pain cannot be identified, but is described as 'pain within the shoulder'. The shoulder is painful to move and many describe difficulties in putting a shirt on. The resting pain subsides, usually after about 6 months from onset of symptoms, but the stiffness continues. The stiffness may be so severe that the shoulder has virtually no movement. This usually subsides after around 18-24 months from the initial discomfort. Full range of movement may never be regained.
What is the initial treatment?
Initially, painkillers and anti-inflammatories will be prescribed in order to settle the pain and allow for physiotherapy to be started. The aim of the treatment is to maintain as much movement as possible and allow the condition to run its course until it settles down. In many cases, this is all that is needed.
If initial treatment does not work, what next?
In a very small number of cases, the initial treatment of painkillers and physiotherapy does not treat the pain and stiffness. Many treatments have been hypothesised, but with little evidence that they work. Manipulation under anaesthetic is one procedure that can be done. This is a procedure in which the shoulder joint is moved through all ranges of movement to stretch the shoulder capsule and break down any scar tissue that has formed, under a light anaesthetic. This is then followed the same day by physiotherapy to maintain the movement that has been achieved. An alternative procedure is an arthroscopic capsular release, during which arthroscopy of the shoulder joint is performed and the tight capsular tissue cut to allow increased movement. Physiotherapy then follows surgery to prevent the shoulder becoming stiff again.
Preventing further stiffness.
Once the shoulder has settled, stiffness does not usually reoccur. However, adherence to the physiotherapy programme, including exercises to be done at home, is essential. In the small number of cases where relapses do occur despite carrying out all of the prescribed therapies, then manipulation or arthroscopy may be repeated.
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