Introduction
Frozen Shoulder is also known as Adhesive Capsulitis. It is a painful condition causing shoulder stiffness and pain.
In this condition, the capsule surrounding the shoulder joint shrinks, becomes thicker and inflamed. As a result of this, shoulder movement is restricted and painful.
Frozen shoulder affects 2-3% of the population. It most commonly affects people in 40-60 years age group. Diabetics are more commonly affected with 10-20% being affected at some stage.
Causes
No Known Cause
In most cases, there is no known cause for frozen shoulder and the onset is spontaneous.
Diabetes
Diabetics are at increased risk.
Shoulder Trauma
Traumatic injuries such as falls, accidents and work injuries can cause frozen shoulder.
Shoulder Surgery
Can occur following an operation.
Symptoms and Signs
Diagnosis is based on patient symptoms, examination findings and scans.
Pain
This is usually the first symptom. The pain in shoulder is often dull and may radiate down the arm or up to the neck.
Stiffness
This may follow pain by months. There will be restricted movement in the shoulder. This usually This may cause problems with certain activities such as:
- Overhead activity e.g. hanging clothes.
- Brushing teeth.
- Dressing oneself.
- Washing Hair.
Phases of Frozen Shoulder
Classically frozen shoulder has three phases. It may take 3 years for all symptoms to resolve.
- Freezing – Pain is the predominant feature. It may last up to 9 months.
- Frozen – The shoulder is very stiff but less painful in this phase. This phase may last 12 months.
- Thawing – Stiffness gradually resolves. May last 24 months.
Weakness
Shoulder muscle weakness can be secondary to pain.
Tests
X-ray
This is used to exclude other causes of shoulder pain and stiffness.
MRI
This will demonstrate thickening and shrinkage of the shoulder capsule.
It can be used to exclude tears of the rotator cuff tendons.
Non-surgical Treatment
Frozen shoulder often resolves by itself without any intervention. It may take 3 years to resolve. Treatment can help with pain and stiffness.
Pain Killers / Anti-Inflammatory Medications
These assist with pain only. This includes medications such as Panadol, Nurofen and Mobic.
Steroid (Cortisone) Injection
This is performed by radiologist. Steroid injection is used to reduce inflammation in the joint capsule and therefore help with pain and movement.
Hydrodilation
This is performed by a radiologist. Saline and Cortisone is injected into the capsule to stretch it and break down scar tissue. Physiotherapy and stretching exercises are required after this.
Physiotherapy
The aim of physiotherapy is to preserve and improve range of movement.