Frozen shoulder

Frozen Shoulder(Adhesive Capsulitis)

Why does it occur?

Frozen shoulder is a condition that is not fully understood, the trigger for the condition to develop is not certain. Some cases may have a genetic predisposition.  The end result is that the capsule of the shoulder joint becomes contracted, thickened and appears inflamed when viewed arthroscopically. Most people will get better with time but this may take a very long time and up to 10% will not return to normal

What are the symptoms?

Pain is the predominant symptom, felt part way down the arm where the deltoid muscle inserts and often not helped by analgesics. Pain at night disturbs sleep. Shoulder movements are restricted, particularly rotational movements. Sudden movements of the arm can bring on severe pain.

Investigations

An x-ray of the shoulder is required to exclude other causes of a stiff shoulder, mainly arthritis or rarely a missed dislocation.  A typical history of symptoms and a normal x-ray confirms the diagnosis

Treatment options

  • Non-operative treatment

Some cases resolve quickly, Those that do not may have physiotherapy or injections which are unlikely to help a true frozen shoulder.

  • Operative treatment

Manipulation under anaesthetic has been the standard surgical treatment for many years and has given good results.

Arthroscopy and capsular release of the shoulder appears to have some benefits over manipulation alone and is a safe, day case procedure under general anaesthetic.

Most patients get a rapid improvement in pain and range of movement following arthroscopic release.

Complications

10% of patients do not improve with treatment. These tend to be those with a more severe predisposition to the condition and include diabetics, those with both shoulders involved and patients who also have signs of Dupytren's disease

Other complications are rarely reported, injury to the axillary nerve being the most significant.

Rehabilitation after surgery

A sling is provided for comfort and should be discarded as soon as possible. An immediate improvement is usually noticeable and further improvement occurs with time and physiotherapy.  There may always be a slight restriction in range of movement but this is not usually enough to affect function.

Frequently asked questions

Can the shoulder stiffen again? Yes some people get stiff within a few weeks and require a further procedure

When can I drive a car again?  You can drive again once you have enough comfort and function in the shoulder to be in control of your vehicle.