• A frozen shoulder is a relatively common problem.
• It is usually a self-limiting condition but can take several years to resolve.
• Posttraumatic or postsurgical frozen shoulders are often more difficult to treat.
• There are non-surgical and surgical options for managing this condition

What is a frozen shoulder?

A frozen shoulder (also known as adhesive capsulitis) is often painful with a variable degree of restricted movement.

Why does a frozen shoulder occur?

The condition can be associated with a number of conditions including diabetes, immune disorders, trauma or surgery and in many cases the cause is unknown. The capsule of the shoulder, is usually a loose elastic structure, lining and surrounding the glenohumeral joint. In frozen shoulder, this capsule becomes inflamed, stiff and contracted.

How does it progress?

The condition usually passes through three phases, starting with pain, followed by stiffness and finally a stage of resolution as the pain eases and movement returns. This process may take some time and a full range of movement may not be restored.

Stage One: Pain increases with movement and is often worse at night. Progressive loss of motion with increasing pain.

Stage Two: Pain diminishes but the range of motion has become much more limited.

Stage Three: The condition may begin to resolve. Most patients experience a gradual restoration of motion.

How is a ‘Frozen Shoulder’ diagnosed?

Your surgeon will usually be able to diagnose this condition on the basis of your symptoms and an examination. This may need to be supplemented by an ultrasound or MRI scan in order to rule out damage to the rotator cuff tendons. An x-ray can be helpful in excluding conditions such as osteoarthritis.

What happens if nothing is done?

The condition is generally self limiting but can cause significant restriction of shoulder function in the short to medium term.

What treatment options are there?

Physiotherapy: To prevent any further stiffness and help to regain range of motion.
Medication: Painkillers and anti-inflammatories.
Injections: These can be done to reduce inflammation and provide pain relief. They also can used to perform a procedure called hydrodilatation. Which is used to expand the capsule like a balloon.
Surgery: This involves manipulation of the shoulder while the patient is under anaesthetic in most cases. It may be necessary to perform a surgical release of the tight shoulder capsule using arthroscopic ‘keyhole’ surgery. This can be of benefit in both the early and later stages of the condition. It can provide pain relief and help restore movement. Intensive physiotherapy is essential after surgery.

What are the risks of surgery?

Postoperative complications are rare but may occasionally be severe; the main risks of arthroscopic surgery include infection, wound healing problems, bleeding and nerve damage. Fracture of the humerus can occur. People with osteoporosis are at higher risk of fractures following manipulation for frozen shoulder.