Frozen Shoulder

Frozen shoulder is a condition that leads to pain and stiffness of the shoulder. It's also known as adhesive capsulitis or shoulder contracture.

Most people who get frozen shoulder are between the ages of 40 and 60 and up to 1 in 20 people in the UK may be affected by frozen shoulder at some point in their life, with women being more commonly affected than men.

It's not fully understood what causes it but the following can increase your risk of developing a frozen shoulder:

· a previous shoulder injury or shoulder surgery

· diabetes

· Dupuytren's contracture

· Some other health conditions, such as heart disease and stroke

During the development of the condition, the capsule surrounding the joint becomes inflamed and thickened and this restricts the movement of the shoulder in all directions with or without pain.

A diagnosis of frozen shoulder can be apparent to the clinician but early on is easily misdiagnosed. Sometimes further testing is required to distinguish from other conditions, for example blood tests for diabetes, x-rays for arthritis and ultrasound or MRI for tendon and bursa problems.

As the pain and stiffness develops it typically goes through 3 phases:

• Stage 1 - Freezing - Very painful, painful on movement or being knocked and painful at night.

• Stage 2 - Frozen - The shoulder becomes stiffer and stiffer and typically less painful.

• Stage 3 - Thawing - The shoulder gradually recovers its flexibility.

My approach to the treatment of Frozen Shoulder.

I gauge the treatment plan according to the stage that the shoulder is at.

Early stage. The goal is pain relief, sleep at night and prevention of further stiffening of the shoulder. It’s important to keep it moving but little is gained by forcibly stretching it, therefore I will advise on appropriate exercises. It may be necessary to address painful, contracted muscles and trigger points using manual therapy or acupuncture.

Later stages. The goal is restoration of mobility and return to normal activities. As the pain subsides then the stiffness is dealt with by having it stretched in different directions in clinic and with a home exercise program. In some cases, remedial exercises are taught to rehabilitate weakened muscles.

Other approaches include

• Oral painkillers and anti-inflammatories

• Steroid injection into the joint

• Hydrodilatation - fluid injection into the joint to expand and stretch it

• Manipulation under anaesthetic to stretch the capsule of the joint

• Surgical release techniques

It is quite normal for a frozen shoulder to slowly resolve spontaneously but that can take 2 years or so, 18 months to 2 years is a typical estimate. It is important to treat this debilitating chronic condition to resolve each stage more quickly, more completely and to reduce the need for the more drastic procedures.