What is a frozen shoulder?

This refers to a painful shoulder of insidious onset associated with loss of movement and difficulty sleeping on the affected side. The cause is shrinkage of the capsule (lining of the shoulder joint), which becomes tight and causes pain and restriction of movement.

What causes a frozen shoulder?

In most cases there is no identifiable cause, however, certain diseases are known to increase the risk of frozen shoulder such as diabetes, raised cholesterol and thyroid problems. A frozen shoulder can also occur as a result of an injury to the shoulder or as a consequence of shoulder surgery.

Will I need any further investigations?

An x-ray of the shoulder is necessary to rule out other causes of a stiff and painful shoulder such as arthritis. More specialist tests are not usually required if the diagnosis is clear.

What are the symptoms of frozen shoulder?

Frozen shoulder is often described as having three distinct phases:

1. Freezing phase – there is rapid and progressive shoulder pain, which may be very severe. Pain is often worse at night.
2. Frozen phase – there is gradual loss of movement, particularly moving the hand out to the side with the elbow tucked into the side (external rotation) and raising the arm high up in front of the body (elevation).
3. Thawing phase – pain and stiffness gradually subside.

Frozen shoulder has the potential to resolve over time but this can however take 2-3 years.

What can be done to treat a frozen shoulder?

Treatments can be divided into those involving surgery and those not involving surgery:

Non-surgical treatment:

Physiotherapy

Although it is possible that physiotherapy may improve stiffness associated with a frozen shoulder, very often pain makes it very difficult for the patient to carry out the recommended exercises. Physiotherapy is more successful after there has been a treatment initiated to improve pain.

Painkillers

Painkilling tablets, especially anti-inflammatory medication, often improve pain around the shoulder.

Injections

Injections of cortisone into the shoulder joint may provide short-term improvement in pain and reduce the inflammation allowing physiotherapy to gradually stretch the tightened tissues and improve the range of motion.

Surgical treatment:

Arthroscopic capsular release and manipulation under anaesthetic

Under a general anaesthetic (with or without a nerve block) through a series of keyholes the tight shoulder joint lining is cut with a diathermy probe (electrical knife). This technique also allows visual inspection of the inside of the shoulder joint to identify problems in addition to a frozen shoulder. A manipulation is then performed to ensure a full and free range of motion of the shoulder.

What is the recovery after surgery?

You will have a sling to wear for comfort after the surgery that is usually discarded as soon as possible, certainly within 2-3 days. You can safely use the shoulder within your comfort zone. Physiotherapy is essential after the operation, to encourage good movement, rehabilitate the muscles back to normal function and ensure you are making good progress.

You will see a therapist prior to discharge from the hospital. You will be given painkillers to take home after surgery. The use of an ice pack on the shoulder may also be helpful for the first few days after surgery. You will be seen in clinic two weeks after surgery to check the wounds and assess your progress. There are no sutures to be removed. The pain will gradually settle and you will regain the movement in the shoulder over the next few weeks although it can take several months before you fully recover from the surgery.