Frozen Shoulder

Introduction

The term "frozen shoulder" refers to a condition that causes inflammation and scar tissue to form in the lining of the shoulder joint (the "joint capsule").

People at risk

In 90% of cases there is no known cause.5% of cases are associated with diabetes and 5% occur after a minor injury. Symptoms classically start 2 weeks after an injury. Strictly speaking,shoulder stiffness after an operation is not really classical frozen shoulder.

Warning signs

Any athlete who complains of pain when lifting the arm more than 2 weeks after injuring his shoulder should consult his GP or physio and if necessary be referred to a Shoulder Specialist.

Incidence

Most common between the ages of 40 and 55 and slightly more common in females.

Symptoms

Severe pain in the early stages, followed by stiffness in the later stages. Pain with sudden movements is extremely characteristic of frozen shoulder. Stiffness usually presents with patients not being able to do their bra up, tuck their shirt in at the back and washing their hair.

Stages

There are 4 stages of the disease:

Stage 1 – Pain only. This lasts 3 months. Capsule inflamed.

Stage 2 – Pain and stiffness. From 3 – 9 months. 80% of patients present in this stage.

Stage 3 – Stiffness only. From 9 -15 months. Capsule scarred.

Stage 4 – Resolution. Usually complete at 24 months.

Treatment

3 reliable treatment options exist

Anti-inflammatories in the early stages(where pain is the main symptom).

Physiotherapy in the later stages, where gentle capsular stretching exercises can be done. A combination of 1) and 2) can be done in stage 2.

Injection into the shoulder joint. Works very well in the first 2 stages and can significantly shorten the duration of the disease.

Arthroscopic capsular release. This is done under general anaesthetic through “keyhole” surgery. The capsule is released, allowing the shoulder to move fully again. This procedure need only be done in less than 10% of cases, and is reserved for self-employed people who do overhead work with the affected shoulder.

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