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About frozen shoulder

What is frozen shoulder?

Frozen shoulder typically has 3 overlapping phases:

Phase 1 (painful phase): Progressive and increasing pain on movement. Pain tends to be constant in this phase and worse at night affecting sleep. Movement begins to become restricted.
Phase 2 (stiffing and freezing phase): Reduction in pain but increasing stiffness and significant restriction in shoulder range of movement.
Phase 3 (resolution and thawing phase): Lasting gradually improving shoulder range of movement, stiffness, and function. Reduced pain.

What causes frozen shoulder?

It’s often not clear why people get a frozen shoulder.
There is emerging evidence that frozen shoulder is associated with other health conditions such as diabetes, heart disease, high cholesterol, Parkinson’s disease, stroke or Dupuytrens contracture (a condition causing scar tissue in the hands).
It may follow an injury to the shoulder (such as a rotator cuff tear or bone fracture) or surgery.

Facts on frozen shoulder

Usually affects individuals between 50 to 65 years of age
It affects about 3% of adults at some stage in their lives
About 10% will develop the condition in the other shoulder within 5 to 7 years
10 to 30% of patients with diabetes will develop frozen shoulder and is generally more severe
Approximately 70% of individuals with frozen shoulder are female

Treatments and management

There are various treatment options available for frozen shoulder. In the first phases of the condition managing pain is the main aim of treatment. In the second and third phases treatment is mainly targeted at improving shoulder range of movement and stiffness. Suspected frozen shoulders rarely need imaging tests such as x-rays, magnetic resonance images (MRIs), or ultrasounds. Still, health care providers do sometimes order them to make sure other problems are not causing the symptom.

Pain management

Paracetamol is a common painkiller which can be used to help treat your shoulder aches and pain. However, you should not take this with anything else that contains paracetamol.
Anti-inflammatory medication (NSAIDs): These include medications such as Ibuprufen, Diclofenac, and Naproxen which can help ease pain and reduce any inflammation in the shoulder. These are usually only recommended in short course with advice from your GP or pharmacist.
Steroid injection: Cortico steroid is a powerful anti-inflammatory drug that can be injected in the shoulder joint, it is most effective in phases 1 and 2 of the condition to reduced pain. It is important to know that this is not a cure for a frozen shoulder, however can give good pain relief to allow symptoms to be more manageable. It will not reduce the duration of the condition or increase movement of the joint.
Hydro-dilatation injection: This involves injecting the shoulder with cortico steroid and a large volume of saline, this technique is done with the use of ultrasound or Xray. The joint capsule is stretched which can be helpful to improve pain and function.

Exercise

Exercise is the main focus of treatment for a frozen shoulder with the aim to help improve pain, restore shoulder movement and improve strength and overall function.
It helps release chemicals called endorphins which reduce your perception of pain and trigger positive feelings.
Exercise also improves blood flow to the affected area, slows down stiffness and can prevent the shoulder getting weak.
Your physiotherapist will advise you on the appropriate exercises which generally include stretches and strengthening exercises as a home exercise program.
Your physiotherapist may also try some mobilization techniques alongside your exercises.

Surgical treatment

A patient with frozen shoulder rarely require any surgery and is only considered as a last resort if symptoms persist and are severe in spite of adequate previous non-surgical treatment. However there are two procedures available which can be offered, these are manipulation under anaesthetist (MUA) and capsular release.

Manipulation under anaesthetic (MUA) involves freeing the shoulder by manipulating it whilst under a general anaesthetic
Arthroscopic capsular release involves cutting and removing the thickened, swollen inflamed abnormal capsule.

Should referral for these procedures be required then your clinician will discuss this with you further. As with all types of surgery there is a potential risk of post-operative complications.