Frozen shoulder: the symptoms and solutions

It is estimated that one in 20 adults in the UK will suffer a painful shoulder condition at some point in their lifetime. One problem that people can develop is frozen shoulder, which is medically known as adhesive capsulitis. The condition can be confused with arthritis or other shoulder problems such as bursitis. Below, you’ll discover how to spot the signs of frozen shoulder and what solutions are available.

What is frozen shoulder?

Frozen shoulder occurs when the articular shoulder capsule — the lining that surrounds the shoulder joint — shrinks and stiffens. It’s a very painful condition that can affect sleep, reduces mobility and makes everyday tasks extremely difficult such as reaching for something or even just getting dressed. It usually affects just one shoulder at a time, but in some cases, both shoulder joints can be affected. If one shoulder does develop the problem, then there is a 20% chance that at some time point the other shoulder will develop the same problem.

The good news is that for most patients the condition is self-limiting and it will get better. The bad news is that it can take 18 to 24 months to completely resolve, and, in some cases, it can persist for even longer.

The exact nature of the problem is till under investigation.

Who is at risk of developing frozen shoulder?

Frozen shoulder most commonly affects those between the ages of 40 and 60 and women are more likely to suffer than men. Whilst in many cases there is no obvious cause, some people are more susceptible to the condition, such as those with diabetes, Dupytrens disease, Parkinson’s or possibly thyroid problems. Additionally, patients who have had a stroke or immobility caused by an injury or previous surgery can be at increased risk.

Studies suggest frozen shoulder in diabetics is brought on by collagen glycosylation in the shoulder joint caused by high blood sugar. Those who are insulin dependent have also shown to be six times more likely to develop shoulder issues than others.

What are the signs of frozen shoulder?

Most cases of frozen shoulder follow a pattern, with symptoms worsening and then resolving within an 18 to 24 month period. Typically, the stages of frozen shoulder are classified as freezing, frozen and thawing.

Stage 1: Freezing

This is the painful stage and the sufferer starts to notice discomfort and the shoulder gradually tightening, limiting mobility. This can occur over a period of weeks but the pain is such that there will be significant night pain causing sleep disturbance. Discomfort and pain may also be experienced simply at rest. When the limits of movement are reached, again the shoulder is very painful. This period can last for six months or more.

Stage 2: Frozen

In this stage, whilst there is still some pain, this generally improves. However, the shoulder remains very stiff. making it difficult to carry out everyday tasks. Again this period can last for over six months.

Stage 3: Thawing

In this final stage, the movement in the shoulder gradually returns and any residual pain dissipates. It is unusual but not impossible to develop the same problem again in the same shoulder.

How is frozen shoulder diagnosed?

London Shoulder Specialists diagnose frozen shoulder by assessing the level of pain experienced and the range of motion present within the joint. An X-ray is likely to be requested to check whether there are any other issues in the shoulder which could be causing the pain and stiffness. Occasionally we may carry out an MRI to establish the full extent of the damage caused to the soft tissue surrounding the joint. An alternative might be to perform an Ultrasound scan.

What are the treatment options for frozen shoulder?

Once diagnosed with frozen shoulder, there are numerous treatment options available aimed at relieving pain and increasing or preserving mobility and flexibility in the shoulder. A recent web survey carried out in the Netherlands and Belgium, revealed shoulder specialists most commonly opt for non-steroid anti-inflammatory drugs along with intra-articular corticosteroid injections to treat the first stage of the condition. This can be very helpful in reducing the significantly debilitating pain symptoms, particularly those experienced at night. Usually, injections are limited to 1–2 episodes and sometimes the cortisone is combined with water (saline) to try to expand the capsule (hydrodilatation).

If the pain persists or if stiffness remains significant following injection, then an arthroscopy (keyhole surgery) can be considered, whereby a camera is put into the shoulder and the tight, thickened capsule is released. This technique has largely superseded manipulation of the shoulder under a general anaesthetic.

The role of physiotherapy in the first stage of the condition is slightly controversial, but there seems to be no question that it is beneficial in the second and third stages of the disease.

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