Frozen shoulders is an inflammatory condition that causes inflammation on the inside of
the joint lining shoulder and eventually leads to thickening and scarring of the shoulder capsule.
We describe frozen shoulder as going through three stages. The first stage is predominated
by pain and that's usually because of the inflammation inside the shoulder. It then
progresses on to the second phase; where there's pain and stiffness and the stiffness is caused
by the scarring and thickening of the joint capsule as well as by muscle spasm from the
pain. Eventually, the pain goes away and the stiffness takes a longer time to settle and
improve and we have said to patients in the past that these phases can be completed and
frozen shoulder would resolve within two years, but we now know in studies that up to seven
years patients can notice a difference in their shoulder when they're affected by frozen shoulder.
Most of the time, frozen shoulder doesn't have a specific cause. So, it's not usually
affected by an injury or certain sports or types of work. Frozen shoulder most commonly
affects people in middle age: from about 40 to the age of 65, and women are affected more
than men. While diabetics get a more aggressive form of disease, most of my patients with
frozen shoulder are actually not diabetic.
While there are no specific exercises to prevent frozen shoulder, it's important when you do
have a frozen shoulder to keep the shoulder moving. I usually recommend that patients
try to do all their activities of daily living and not to favour the affected arm. If the
shoulder's getting stiffer, then you can use things like warm compresses or the shower
and you can try to walk the arm along the wall out to the side or up in the air to try
to help to keep movement. But often if patients are losing movement rapidly, I'd refer them
to a physiotherapist to try to prevent them losing further range of motion.
How we manage frozen shoulder depends on the phase that the patient's in. If it's in the
very early phase where pain is predominating but they have full movement, over-the-counter
drugs like anti-inflammatory drugs can try to help with some of the inflammatory symptoms
and pain. If over-the-counter medication don't help with the pain, then an intra-articular
steroid injection can help relieve symptoms in at least half of patients and that would
be all they need to help them start to recover from this. If the patient's present late,
where the main problem is stiffness and that stiffness is preventing them from doing work
or normal sporting or recreational activities or if they haven't responded to a steroid
injection and are still in pain, then keyhole surgery to release the scar tissue in the
joint and take away as much of the inflammatory tissue as possible is sometimes necessary
and this is a common day-case operation that we do with the patient often awake under regional
anaesthesia that offers good reliable recovery for patients.
Surgery isn't always necessary for frozen shoulder. If the disease is caught early enough,
then a simple steroid injection maybe all the patient needs. The steroid injection must
be done into the joint. If patients don't respond well to a steroid injection or if
they present later with the disease where the main problem is stiffness, then surgery
is often needed and this is usually done as a keyhole day-case procedure, often awake
under regional anaesthesia. And the goal of surgery is to take away as much of the inflammation
and scar tissue as possible to free up the joint and this is followed by aggressive physiotherapy
afterwards to maintain the movement that surgery has achieved.