Frozen Shoulder

Frozen shoulder is a painful condition where the shoulder becomes stiff due to inflammation and thickening of the ligaments that stabilise the shoulder. Stiff bands of tissue called adhesions may develop. This usually occurs spontaneously and gradually with no obvious cause but there are associations with underlying health conditions such as diabetes and thyroid abnormalities. It is more common in adults aged between 40 and 60 years and is more common in women than men.

The main symptoms of frozen shoulder are pain and stiffness. Symptoms usually progress in three phases:

Freezing – pain at rest is the predominant feature. The pain is often described as a constant dull ache in the shoulder, with sharp pain when trying to move the shoulder more than it wants to go. Patients commonly have ‘pins and needles’ in their arm and hand with shooting pains down the whole arm. Patients often notice they are unable to lie on the affected shoulder due to pain. Stiffness is often mild in the very early stages.

Frozen – pain at rest improves but stiffness now predominates and usually limits work or recreational activity. Sharp pain is experienced when trying to move the shoulder beyond its limits.

Thawing – pain improves considerably, and movement slowly increases as the stiffness resolves.

Frozen shoulder will often settle spontaneously, however this cycle may take 2-3 years. If you have diabetes, the recovery may not be complete.

Frozen shoulder is usually a clinical diagnosis which a specialist makes after taking a history and performing a clinical examination. Usually the only test needed for a diagnosis of frozen shoulder is an x-ray of the shoulder to rule out arthritis or other causes of shoulder stiffness. Mr Wijeratna often sees patients who have been given a diagnosis of shoulder impingement or rotator cuff tear when in fact they have a frozen shoulder.

Frozen shoulder is a self-limiting condition that usually gets better with time. However it usually takes 18 months to 2 years. Pain often improves but stiffness can last much longer and some patients never regain their previous range of motion.

Do keep an upright posture and your shoulders gently back.

Do move your shoulder – keeping it still will make the pain worse.

Do try heat or cold packs on your shoulder.

Don’t make up your own strenuous exercises – for example, gym equipment can make the pain worse.

Don’t slouch when sitting – do not roll your shoulders and bring your neck forward.

The treatment varies according to the stage of frozen shoulder.

Freezing – Simple over-the-counter pain relief. Anti-inflammatory steroid injections are very effective in reducing pain and the symptoms of ‘pins and needles’. Simple home-stretching exercises are often enough to help maintain some range of motion as formal physiotherapy can often make the shoulder more painful.

Frozen/ Thawing – Prescribed physiotherapy exercises can improve range of motion but for patients where this isn’t working, Mr Wijeratna recommends an arthroscopic capsular release. This is keyhole (arthroscopic) surgery to release the thickened ligaments to immediately improve the motion of the shoulder. Physiotherapy is then needed to maintain and improve the gains made by surgery.
Mr Wijeratna is the only surgeon in Nottingham who offers hydrodilatation for patients with a frozen shoulder. This is a good option for patients who don’t want surgery but also don’t want to live with their symptoms and wait for things to get better on their own. Mr Wijeratna can discuss whether this procedure is suitable for you at your consultation.

Arthroscopic capsular release is a day-case procedure performed under a regional anaesthetic nerve block which numbs the whole arm. The patient is awake for the duration of the procedure which enables them to go home sooner after surgery. The arm will be in a sling for up to 24 hours whilst the nerve block is working and then removed to allow exercises to start. Painkillers will be prescribed for when the nerve block wears off. Physiotherapy exercises should be started as soon as possible to maintain and improve the gains made by surgery. The patient visits their GP 10 days after surgery for removal of stitches if this is necessary and regular physiotherapy visits are booked. Mr Wijeratna sees patients in clinic 3 months after surgery and discharges the majority of patients at that point.