Frozen shoulder is a painful condition of the shoulder, which commonly affects individuals in the 5th or 6th decades of life.  The condition, which is also known as “adhesive capsulitis” or “shoulder contracture”, usually commences with an insidious onset of pain in the shoulder.  Occasionally the pain may follow an injury to the shoulder.  In the early phase of the disease, pain is experienced with movements of the shoulder and is often present day and night.  Some time after the onset of pain, patients will start experiencing stiffness in the shoulder.  

Natural History

The condition of Frozen shoulder often follows a protracted course.  Pain, which is often severe and constant in the early phase of the disease, tends to diminish in intensity with time leaving the shoulder stiff.  The course of the disease is variable with some patients recovering quickly, some slowly and some very slowly. A number of studies have demonstrated that, left untreated, more than 50% of patients will have residual symptoms upto 5 years after the onset of symptoms.

Why does a Frozen Shoulder develop?

Frozen shoulder is a condition, which affects the capsule (or sleeve) of the joint.  The capsule becomes inflamed and subsequently thickened and scarred leading to restriction of movements.  In most cases there is no specific cause but the condition may be associated with diseases such as diabetes, heart disease and some neurological disorders.  In some instances frozen shoulder may develop following an injury or after surgery.

How is a Frozen shoulder diagnosed?

A diagnosis of frozen shoulder is made based on the history of a painful, stiff shoulder and difficulty reaching sideways, up or behind the back. Examination shows significant limitation of movements of the shoulder in all directions. An X-ray can be helpful to exclude other pathology and is usually normal. An ultrasound scan may be performed to check the state of the rotator cuff. Special imaging with MRI or CT scans is rarely necessary.

How is Frozen shoulder treated?

Steroid injections: In the early phase of the disease pain may be difficult to control with tablets alone.  Steroid injections, placed accurately into the joint, have been shown to be very effective in relieving pain in the early phase of the disease and may be repeated on 2 or 3 occasions until the pain has subsided. 

Hydrodilatation: This involves injecting a mixture of local anaesthetic, steroid and saline into the joint under x-ray or ultrasound guidance. It may be effective in alleviating pain and enabling patients to have physiotherapy to regain movements. 

Physiotherapy: When the constant pain has resolved, stiffness may be overcome to some extent by supervised physiotherapy directed at progressive stretching of the capsule.  Stretching exercises should be performed in all directions to achieve maximum benefit.

Surgery: In some instances when the stiffness is severe or if it should fail to respond to physiotherapy then it may be appropriate to undertake surgical treatment.  This consists of arthroscopic or “key-hole” surgery to circumferentially release and remove parts of the capsule to restore movements.  If there is associated pathology such as impingement then this can be treated at the same time. This is then followed up with physiotherapy to maintain the improvement in the range of movements that has been achieved at surgery.  For further information on surgical treatment, please refer to the section on “Arthroscopic capsular release”.