Frozen shoulder (or adhesive capsulitis) is a common shoulder condition typically affecting patients in their fourth or fifth decade of life. It is characterised by pain and progressive loss of motion and can occur spontaneously or secondary to an injury or even shoulder surgery.
Classically frozen shoulder has three distinct phases: freezing, frozen and then thawing. The freezing stage is characterised primarily by pain, often described as a deep aching pain and worse at night. The frozen phase involves progressive loss of motion of the shoulder, particularly the ability to turn the arm away from the body (external rotation). The thawing phase is heralded by the gradual resolution of symptoms and return of motion and shoulder function.
The good news is that this condition resolves spontaneously in 80-90% of cases. The bad news is that it can take 12-24 months for the condition to run its course and can certainly be quite disabling during this time.
In most cases frozen shoulder is a clinical diagnosis – that is, your doctor will be able to make the diagnosis after taking a history and performing a physical examination. That said it is often prudent to perform at least plain x-rays to exclude other diagnoses such as shoulder arthritis, which can also cause pain and loss of motion. In more unusual cases, sometimes even an MRI can be useful to clarify the diagnosis.
Management of Frozen Shoulder
One of the main components of management is ensuring patients are well educated regarding the course of the disease and what to expect.
Even though this condition is common, there is no treatment that has been shown to change the final outcome or duration of frozen shoulder. There are, however, treatments that can relieve symptoms (especially pain) as the condition progresses.
One of the most effective measures is an ultrasound-guided injection of steroid and local anaesthetic into the shoulder joint. This has been shown to give significant pain relief (particularly during the freezing phase) for up to 6-12 weeks. It has also been shown to be just as effective as a more invasive procedure known as hydrodilatation.
Although the vast majority of cases will resolve on their own, in certain cases where stiffness does not improve over the expected timeframe, surgery can be considered. This would usually only be considered after at least 12 months of symptoms and involves arthroscopic (keyhole) surgery to release the scar tissue within the joint and joint capsule to ‘free up’ motion of the shoulder joint. Dr Alexander will discuss the risks and benefits of this procedure for your specific situation.