The term frozen shoulder is by definition a stiff shoulder but is loosely used to describe a shoulder that has a restricted range of movements. A shoulder may be stiff due to a number of causes, including osteoarthritis, after surgery or following trauma.
The term ‘frozen shoulder’ or ‘adhesive capsulitis’ is a less common cause of a stiff shoulder, where the ligaments and capsule surrounding the shoulder joint become thickened and inflamed, causing pain and limitation of movement.
When viewed with a camera or arthroscope, the inside of a frozen shoulder appears red, inflamed and very tight.
The cause may be unknown (idiopathic) or may be be related to a minor or obvious injury triggering the condition. Diabetics and patients who are hypothyroid are more prone to developing this problem.
Symptoms of worsening pain and stiffness often interfere with everyday tasks, such as driving, dressing or sleeping. Even scratching your back, or putting your hand in a rear pocket, may become impossible. Work may be affected in some cases.
By definition, the X-ray of the shoulder needs to be completely normal for the condition to be a true frozen shoulder.
The condition is present in five per cent of the population, mostly women and of middle age
The condition is present in five per cent of the population, mostly women and of middle age.
The good news is that most true frozen shoulders actually resolve in time. However, this may take up to two years. In the interim, the shoulder passes through three phases.
These are the freezing stage, lasting around two months, where the shoulder is acutely inflamed and painful; the frozen stage, lasting around six months, where the shoulder is both painful and stiff; and, finally, the thawing stage, lasting around one year, where the stiffness slowly resolves and movements are regained.
Obviously, most patients are unwilling to wait this period of time for the shoulder symptoms to be resolved and, therefore, intervention is normally required.
In the early stages, anti-inflammatories and gentle exercises, or physiotherapy and, possibly, steroid injections may help ease the symptoms. However, when the frozen stage is reached, surgical intervention is typically required if physiotherapy and stretching have not helped.
Capsular distension or hydrodilatation, where saline solution is forced into the shoulder joint under pressure, may also be indicated at this stage, but steroid injection normally has little benefit, especially when stiffness has set in.
Traditionally, a MUA (manipulation under anaesthesia) of the shoulder used to be performed to break the fibrous tissue and regain movement. This is now considered an obsolete procedure, with risks of fractures and cuff tendon injuries.
An arthroscopic release of the shoulder using keyhole surgery is a more controlled and effective surgical procedure and the tight tissues can be cut and released under direct vision.
Several sessions of physiotherapy are required after this procedure, but the success rate is between 95 to 98 per cent.
Alistair Melvyn Pace, Consultant orthopaedic surgeon