Frozen shoulder is a painful condition in which inflammation causes reduced motion of the shoulder, or stiffness. It is also called adhesive capsulitis. Symptoms typically start slowly, then they get worse. The condition is self-limiting, meaning it usually resolves on its own, but it may take 1-2 years.
Frozen shoulder develops when the strong connective tissue around the shoulder or joint capsule, that contains all the ligaments that hold the ball in the socket, becomes thick and inflamed. As a result, the shoulder gets stiff and becomes “frozen”, it cannot move anymore. Risk factors implicated in the development of frozen shoulder include:
• Age: most patients are in their 40s to 60s
• Gender: it is more common in women
• Diabetes: people with diabetes are more likely to develop frozen shoulder
• Post-traumatic: Having to keep a shoulder still for a long period increases the risk of developing frozen shoulder. This might happen after shoulder injury of after breaking you arm
• Medical conditions, such as thyroid diseases, heart disease, stroke and Parkinson’s, increase the risk of having frozen shoulder
Frozen typically manifests in 3 stages:
• Freezing stage: This stage takes 2-9 months. The shoulder becomes gradually more painful to move and movement starts to become limited.
• Frozen stage: This stage lasts 4-12 months. The shoulder is stiff, and its use is limited, but pain becomes less pronounced.
• Thawing stage: This is the recovery stage and may last 5 to 24 months. The shoulder begins to move again.
Diagnosis is based mainly on history and physical exam. Dr Panagopoulos will take a detailed history and perform a thorough physical exam. The doctor like act you to raise your arm on your own. This determines your “active range of motion”. Then the doctor will move your arm passively. This determines your “passive range of motion”. In frozen shoulder, passive and active range of motion are the same. An x-ray will be also ordered to rule out any other shoulder pathology, such as arthritis. Other imaging modalities, such as ultrasound or MRI are usually not needed, but may be ordered if the diagnosis is in question.
Conservative treatment for frozen shoulder includes:
• NSAIDS and over-the-counter medication for pain control
• Physical therapy/home exercise program
• Steroid injection(s) in the glenohumeral joint. Dr Panagopoulos can perform this injection under ultrasound guidance in the office.
• Hydrodilatation: in this method, 60ml of normal saline are injected under ultrasound guidance in the shoulder joint. This is usually performed in the operating room under local anaesthetic.
If those modalities fail to provide any improvement to pain and stiffness, surgical procedures may be tried next:
• Manipulation under anaesthetic: This procedure is done under general anaesthetic. While you are asleep, the doctor will force move your shoulder. This will stretch and tear the inflamed capsule, increasing the range of motion of your shoulder.
• Arthroscopic capsular release: Using 2 small 4mm incisions, the doctor will insert a small camera to inspect your shoulder, as well as a small radiofrequency probe to release the thick capsule. This will increase your range of motion.
The above 2 procedures are usually done together to get better results. It is imperative to start physiotherapy right away so as to get moving and maintain the good motion obtained with surgery. Otherwise your shoulder might get stuck again.
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