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Frozen Shoulder

Adhesive Capsulitis

Shoulder joint Whilst the incidence of Frozen Shoulder is more common than you might imagine, affecting nearly 1 in 20 people during their lifetime, the exact causes are still largely unknown. We do know that certain people are more at risk – women for instance or people with certain health conditions such as diabetes. It is also known that certain events can trigger an episode, such as a car accident or a protracted stay in hospital. Recovery can be very slow and usually follows a common pattern of pain and stiffness often lasting several years. Most people will regain full movement eventually, but there is usually very little that can be done to speed up the recovery process, so treatments tend to focus on relieving pain and trying to keep the shoulder as mobile as possible to encourage healing and make everyday tasks more manageable.

Causes

Frozen shoulder, or Adhesive Capsulitis, to give it it’s medical term, is commonly associated with a thickening or inflammation of the fibrous tissues surrounding the shoulder joint (the “capsule”), making the shoulder very stiff and painful to move. Typically someone with “true” Frozen Shoulder would find it virtually impossible to raise their arm to shoulder height and in some cases there is virtually no movement at all, hence the term “frozen”.

Some groups do have an increased risk of developing frozen shoulder:-

More women experience this condition than men and it generally affects people in middle age, between 40 and 60. It is very rare that the condition affects younger people.
People who have had a shoulder injury or have undergone shoulder surgery. A school of thought believes that there may well be a link between the condition and prolonged periods of immobility of the shoulder that are a consequence of an injury or recovery from surgery. The same could well be a factor in people who have been immobile or confined to bed, as with a hospital admission for instance
People with diabetes, bronchitis, angina or those who have suffered a stroke. Parkinson’s disease, lung disease and heart disease sufferers are also known to have an increased risk.

Common Stages of Frozen Shoulder

Frozen Shoulder typically goes through three identifiable stages:-

First Stage

Often referred to as the “freezing” stage, where pain and stiffness gradually increase over a period of time lasting anything up to 9 months. It is not uncommon for the pain to be worse at nights making sleeping difficult, particularly on the affected shoulder.

Second Stage

The “frozen” or “adhesive” stage. Pain usually reduces during this stage (lasting up to year) but typically movement is still restricted or can get worse. Inability to move the shoulder properly may well cause some muscle wasting during this phase.

Third Stage

Referred to as the “thawing” stage as movement gradually returns to normal. This can take a few months or quite commonly a few years before full movement returns.

Treatments

Treatment will largely depend on where you are in the cycle of the condition. During the early stages (stage 1 into stage 2) where pain is commonly the biggest issue, then treatment is generally focused on pain relief. In later stages (stage 2 into 3) then treatment will be geared towards increasing your mobility and muscle strength.

Early Stages

Your GP may prescribe you painkillers and/or anti-inflammatory drugs, depending on the severity of the pain and your suitability to the medicines. In severe cases, your GP may recommend a steroid injection directly into your shoulder to give you some temporary relief.

Later Stages

Physiotherapy can be particular useful. Prescribed shoulder exercises can help improve range of movement and counteract any muscle wasting that may have occurred. Furthermore, physiotherapists can offer additional pain relief options including TENS (Transcutaneous electrical nerve stimulation),acupuncture and massage therapy.

In severe cases where recovery is proving very slow, you may be offered shoulder manipulation or surgery. Manipulation involves the shoulder being manually moved and stretched under a general anaesthetic. Arthroscopic Capsular Release is a keyhole surgical procedure using a special probe to remove the scar tissue within and surrounding the capsule to improve the capsule movement. Both procedures would typically require some physiotherapy afterwards to maintain the improved function.

How do I know if I have a Frozen Shoulder?

If your shoulder is becoming increasingly stiff and painful and shows no signs of getting better, then you should see your GP. Your GP will assess your symptoms and physically examine you, looking for any obvious signs of bruising, swelling or muscle wasting around the shoulder. Your GP will want to rule out any other potential causes of your pain (such as infection or tumour) as well as identifying any potential health factors that may be contributing to your symptoms. For these reasons they may ask you for a blood sample. Where diagnosis is proving difficult to confirm, you may be referred for an X-ray or MRI scan.