Frozen shoulder

A frozen shoulder (sometimes referred to as shoulder capsulitis) describes a condition in which the soft tissue which encapsulates the joint (joint capsule) becomes painful and inflamed. The process leads to scar tissue developing which renders the movements of the shoulder increasingly stiff (frozen). Fortunately, in most cases, a frozen shoulder resolves spontaneously over 2-3 years.

A frozen shoulder can occur after trauma to the shoulder but more commonly occurs gradually with no underlying cause. Some individuals are at greater risk of developing a frozen shoulder:

• Female
• Age range: 40-60
• Diabetic individuals

Stage 1 (‘Freezing’ phase) – Typically 6-9 months

Inflammation to the joint capsule develops and progresses. The active inflammation often means that the pain is constant rather than movement related and pain levels can be severe and worse through the night. Stiffness to the shoulder movements gradually increases throughout this phase.

Stage 2 (‘Frozen’ phase) – Typically 4-12 months<’/h3>

Inflammation levels reduce and as such, pain levels become less severe, less constant, and more related to movement. Stiffness to the shoulder movement remains.

Stage 3 (‘Thawing’ phase) – Typically 12-24

As the scar tissue within the joint capsule gradually normalises, shoulder flexibility gradually improves as does the pain on shoulder movements. To maximise improvement, it is important to work on exercising the shoulder to regain range of movement and strength during this phase.

The main feature on examination is increasing restriction of movement at the shoulder. This gradually progresses to involve all movements over a few months (the freezing phase).

X-rays and scans are not routinely required.

A frozen shoulder will self-resolve in most cases. Treatment will depend on the stage of the condition and the levels of pain experienced. Initial management will focus on maintaining range of movement and strength.

Exercises

Exercises to help regain flexibility to the affected shoulder joint:

[shoulder ER supine stick mobilisation in 0 video] 5×30 second holds, 2x per day

[shoulder active assisted walking up wall flexions video] 3×10 repetitions 3-4x per week [shoulder HBB stretch] 5×30 second holds, 2x per day

These are suggested exercises only. If you are at all concerned about whether these exercises are suitable for you or if you experience any pain while doing them, please seek appropriate clinical advice from your GP or physiotherapist.

Using painkillers when needed

Over-the-counter analgesia is available through pharmacies when needed. Paracetamol is most commonly prescribed. Anti-inflammatories, such as Ibuprofen, are also used, but as there is little or no inflammation involved in osteoarthritis these are best avoided without discussing with your GP. Side effects are even more common than with paracetamol so please ensure to take appropriate medical advice. There is a good booklet on the Arthritis Research UK website with information about the various drug options.

Corticosteroid injection therapy

The severe pain which can be a feature of frozen shoulder in stage 1 will often settle with no treatment. However, some individuals experience significant sleep disturbance and limited function. In these circumstances, a corticosteroid injection into the shoulder joint is an effective option to settle pain and expedite recovery. You can read more about local corticosteroid injections here.

• Hydrodilatation procedure – Involves injecting the shoulder joint with a large volume of fluid (containing saline, steroid and local anaesthetic) to “stretch” the shoulder capsule.
• Capsular release surgery: This is a keyhole surgery which releases the stiff areas of the shoulder joint capsule.
• Manipulation under anaesthetic (MUA) surgery: This is the manual manipulation of the shoulder joint with the patient asleep.

The two surgical procedures above carry small risks and would be considered only when other treatment options have been exhausted.