Also known as: adhesive capsulitis
What is it
Frozen Shoulder is an extremely painful condition in which the shoulder is completely or partially unmovable. The cause of frozen shoulder is largely a mystery. One theory is that it may be caused by an autoimmune reaction. In an autoimmune reaction, the body’s defense system, which normally protects it from infection, mistakenly begins to attack the tissues of the body. This causes an intense inflammatory reaction in the tissue that is under attack. Frozen shoulder often starts out of the blue, but may be triggered by a mild injury to the shoulder. The condition usually goes through three phases, starting with pain, then stiffness and finally a stage of resolution as the pain eases and most of the movement returns. This process may take a long time, sometimes as long as two or more years.
Be careful when talking to people as some people describe any shoulder problem as a frozen shoulder and they probably do not have it. It is important to make an accurate diagnosis and have the shoulder checked for other conditions like arthritis and rotator cuff disease.
Frozen shoulder may be associated with diabetes, high cholesterol, heart disease and is also seen in patients with scar tissue in their hands, a condition called Dupuytren’s contracture. It may follow an injury to the shoulder or surgery.
The lining of the shoulder joint, known as the capsule, is normally a very flexible elastic structure. Its looseness and elasticity allows the huge range of motion that the shoulder has. With a frozen shoulder this capsule (and its ligaments) becomes inflamed, swollen and contracted. The normal elasticity is lost and pain and stiffness set in.
Three stages of development:
Typical frozen shoulder develops slowly, and in three stages.
Stage One: Pain increases with movement and is often worse at night. There is a progressive loss of motion with increasing pain. This stage lasts approximately 2 to 9 months.
Stage Two: Pain begins to diminish, however, the range of motion is now much more limited, as much as 50 percent less than in the other arm. This stage may last 4 to 12 months.
Stage Three: The condition may begin to resolve. Most patients experience a gradual restoration of motion over the next 12 to 42 months
Surgery may be required to restore motion for some patients, as most people never regain full shoulder motion.
Physiotherapy – to prevent any further stiffness and regain range of motion. Physio will not reduce the time it takes to recover. It is probably of little value to do exercises and you need to let the condition improve itself with time. You can try physio but there is little point in continuing if there is no sign of any improvement.
Painkillers and anti-inflammatories – may help the pain in the early stages. There are no specific ones that are any better than another. You may find that certain ones work best for you.
Injections – can reduce inflammation and provide pain relief but they do not always work. They are quite safe and may be worthwhile trying. They probably will make no difference to the stiffness.
Surgery – Surgery has been shown to be of benefit in both the early and later stages of a Frozen Shoulder. It is excellent for both pain relief and restoring movement, although intensive physiotherapy is essential after the surgery. This involves a manipulation of the shoulder under anaesthetic for most cases. Some people may require surgical release of the tight shoulder capsule done with keyhole (arthroscopic surgery). Unfortunately a significant number of people will become stiff again after surgery. It is important to use the first hours and days after surgery to get back as much movement as possible before any stiffness sets in again.
The good news is that your shoulder is very likely to improve itself without any treatment at all. You could give it 1 year to see will it free out. Once the pain goes the stiffness will improve even if you do nothing about it. Then between 1 and 2 years after it started you can decide if you want to try and speed the healing up with surgery.