Sport Surgeon

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Frozen Shoulder (Adhesive Capsulitis) - Shoulder Injury

This condition is often over diagnosed. In my experience it is often confused with tendonitis or bursitis often used as a blanket term for any painful shoulder.

It presents in a very predictable pattern. There may have been a minor incident such as a jolt to the shoulder and then you will notice discomfort initially. It can be spontaneous and is sometimes associated with diabetes. The initial painful period continues and increases and then stiffness begins. The early phases are more difficult to diagnose as stiffness is not present. As time progresses the pain subsides slowly and stiffness increases. Eventually the pain disappears followed by the stiffness.

The condition is self-limiting in that it will almost always disappear in time. It’s frustrating and disabling when it is active. Treatment is aimed at limiting these symptoms whilst it resolves itself. The whole process of resolution can take a number of years but during this time we have many options available to treat and limit the disability that you are suffering.

The mainstay of initial treatment is physiotherapy. The aim is to keep a working range of movement which in turns limits the irritation to the joint lining which becomes inflamed and cause the pain. If this fails then we can undertake further treatment but you will need to be seen in clinic.

When you are reviewed the movements in your shoulder will determine the best course of action to take. We usually recommend a scan to exclude other pathology such as a rotator cuff tear as this can have significant bearing on the type of treatment recommended.

The next treatment is to try an injection in outpatients. This can be very effective in the early stages of a frozen shoulder reducing pain and allowing the physiotherapist to keep the shoulder moving. This is usually reserved for patients who retain a reasonable amount of rotational movement but are struggling with pain. When you are reviewed I will show you how to monitor your own progress using a simple test of rotational movement.

If the movement is significantly restricted, we can consider hydrodilatation. This requires a radiologist to find the main joint using an ultrasound they will inject a high volume of local anaesthetic in the joint to break down the adhesions in the joint and improve the joint movement allowing the physiotherapist to progress with your rehabilitation. This cannot be undertake if there is a rotator cuff tear or other pathologies.

The traditional mainstay to treat a frozen shoulder that is not settling is a manipulation under anaesthetic. This is effective in that the range of movement is usually obtained quickly. This does require a short hospital stay and you will be put to sleep, albeit briefly. This works in about 80% of patients and carries only small risks. Whilst more modern key-hole techniques are often recommended they are invasive and this simple technique is very effective and low risk.

If the frozen shoulder persists you can consider a release through key-hole surgery. We sometimes need to do this as the first intervention due to other pathology on the scan. In my opinion this should be reserved for persisting severe frozen shoulders which are often associated with diabetes. If all else fails this can help during the final phases when the pain is settling and the stiffness persists.

Overall there are many studies that show a frozen shoulder will almost always get better. As surgeons we are here to help reduce the symptoms so you and your therapist can keep you going with day to day activities.

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