What is a frozen shoulder?
Frozen shoulder is a condition that causes gradual stiffness and pain in the shoulder joint, it is also known as adhesive capsulitis. The shoulder joint normally has a loose bag (capsule) which allows for large degrees of movement. In adhesive capsulitis, or frozen shoulder, the bag becomes inflamed and shrinks which causes the stiffness and pain.
It commonly affects people in their 40’s to 60’s and is more common in women and some medical conditions such as diabetes and thyroid issues. This type of injury is often confused with rotator cuff tears, shoulder impingement, and sub acromial bursitis, all of which tend to cause similar symptoms.
There are two types of frozen shoulder, primary and secondary. In primary frozen shoulder there is no obvious cause for developing the symptoms. In secondary frozen shoulder it occurs following an identifiable cause such as an injury, accident or surgery where the shoulder is kept still for a period of time.
Frozen shoulder is typically a slow-onset condition with a range of common symptoms that present across three stages. In the first stage, freezing, you may experience a gradual limitation of motion and pain during shoulder movements. Patients commonly describe night pain and difficulty sleeping on that side. Then, in what is commonly referred to as the “frozen stage”, you may notice increased stiffness in the shoulder and difficulty reaching behind your head or back. Finally, in the thawing stage, motion will begin to return to normal.
In order to diagnose a frozen shoulder, Dr Cheriachan will perform a physical examination, observing the movement of your shoulder and manipulating the joints for you, a typical feature of frozen shoulder is sharp pain at the limits of your movement. While this process is often enough to determine the condition of your shoulder, Dr Cheriachan may also request an X-ray, ultrasound, or MRI scan. These tests will provide a clearer picture of the joint and assist with diagnosing potential causes or ruling out co-existing conditions.
The majority of patients with frozen shoulder will resolve spontaneously however it can take 12-24 months to fully recover. The initial treatment is non operative with anti-inflammatory medications or a steroid injection in the early phase to relive pain followed by physiotherapy exercises to stretch the tight capsule. Hydrodilatation can also be useful which involves injection a volume of sterile fluid into the joint to stretch the capsule. In patients who are not making any improvements after 6-12 months or have significant residual stiffness, surgical treatment may be required. This involves arthroscopic or “key hole” surgery to release the joint capsule in conjunction with a manipulation to maximise your motion.
Frozen shoulders often get better on their own. This process can take between 12 and 24 months; however, results vary, and there are several factors that impact upon the speed of your recovery, including the severity of your injury, the type of treatment you opt for and your commitment to therapy. By closely following the advice of your doctor or physiotherapist, you can greatly increase the effectiveness of your treatment and the speed of your recovery.
Whilst the majority of people who undergo shoulder surgery do well and are very happy with their function and result, there are risks which are specific to shoulder surgery in addition to the general risks of surgery as listed in the FAQ section of the website. The specific risks of frozen shoulder surgical release is damage to the axillary nerve which runs close to the capsule at the bottom of the joint, which is rare, and recurrence of stiffness as the shoulder can stiffen up again following surgery due to scarring. Dr Cheriachan will discuss these risks with you in detail and what measures he takes to reduce their occurrence.
The rehabilitation from frozen shoulder typically takes 12-24 months, and depends on how severe your frozen shoulder was to begin with. Typically most patients will have some return of function after 6 months and be able to do most daily activities such as driving, cleaning and dressing. After any shoulder injury, it’s important that you move your shoulder regularly to rebuild strength and movement. That’s why the rehabilitation process for frozen shoulder typically involves extensive physiotherapy and pain medication. Dr Cheriachan or your physiotherapist may manipulate your shoulder help improve range of motion, or simply monitor you as you do your own exercises. In any case, this process will help you to regain full use of your shoulder.
Additional information can be found here.
Preparing for your visit
Your first visit will be used to carefully assess your condition as well as gathering all related health information. It is important that you bring all relevant documents including scans and x-rays. We also ask that you wear clothing that allows freedom of movement as your visit will include a physical examination.