Do I have to have treatment?
Pain and stiffness can improve over time and as long as you are prepared to wait so you do not have to have treatment.
For Pain :
- Modify activity and sport to avoid the pain. It is quite safe to continue with any activities or sport if it does not cause you too much pain. Jarring movements such as hitting a divot playing golf will be very uncomfortable but gentle swimming or aerobics will be fine.
- Take painkillers such as Paracetamol and Codeine as well as anti-inflammatories such as Ibuprofen can be bought over the counter and may be taken.
- Have a cortisone (steroid) injection which is injected into the joint to calm down the inflammation. It often helps with the pain of a frozen shoulder but does not speed up the time it takes for the stiffness to get better. The injection is uncomfortable and can make the pain worse for a few days. The pain may even come back again later although further injections can be given if found to be useful. Cortisone injections are useful for controlling the pain and for those people who do not wish to have surgery.
- Ultrasound guided hydrodilatation may be administered by the radiologist in the x-ray department where a large volume of saline and cortisone are injected and this may be repeated a week later.
- Arthroscopic capsular release may be required. This is key hole surgery where 360o release of the capsule of the shoulder joint is cut to allow movement and results are very good
For Stiffness :
- Regular and gentle shoulder exercises may be useful to try and improve the stiffness in the shoulder, but they are only useful once pain is no longer a major issue.
- Physiotherapy may stretch the shoulder although once again only when the pain is no longer an issue. Ice, heat and ultrasound therapy can also be used as can other allied specialities as acupuncture and osteopathy.
- Arthroscopic capsular release as described above.
What tests will my doctor do?
A shoulder x-ray is useful. It should look normal but is useful to rule out arthritis (wear and tear) If your doctor suspects other diseases such as a tear in the tendons around the shoulder, then an ultrasound or MRI scan be also be suggested.
Why have surgery?
If your symptoms persist despite trying the solutions above then surgery is usually the next step. Surgery is performed to try to increase the range of movement in the shoulder by cutting or tearing the tight capsule that restricts movement.
What operation/procedures are available?
Arthroscopic capsular release involves keyhole surgery to carefully divide scar tissue from the inside joint. Two or three small incisions (5mm) will be made around the shoulder.
Surgery is carried out under (full) anaesthetic (you will be asleep) and surgery is performed as a day case (you go home the same day).
What are the risks?
All operations involve an element of risk such as infection, nerve injury, bleeding and failure to improve symptoms. We do not wish to over-emphasise them but feel that you should be aware of them before and after your operation. Please make sure you discuss any concerns with Mr Al-Sabti at the consultation. However, most patients return to a normal range of pain free movement following surgery for a frozen shoulder.