A frozen shoulder or adhesive capsulitis is a condition in the ball and socket of the shoulder joint. The capsule or lining of the joint becomes highly inflamed and thickened. This leads to loss of range of movement, stiffness and pain. It can be brought on by injury or may occur spontaneously. It is more common in patients with diabetes.
What are the symptoms of a frozen shoulder?
The main symptoms of this condition are pain and loss of movement or stiffness. The shoulder may also feel weak. As a result it can lead to difficulty in performing simple day to day tasks such as getting dressed, personal care and chores around the home. You may experience pain which is worse at night and wakes you from sleep.
Due to the reduced movements in the ball and socket joint, this places stress on the other joints around the shoulder and the space under the shoulder tip. This can lead to subacromial bursitis and inflammation of the acromioclavicular (AC) joint.
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How do you diagnose a frozen shoulder?
Diagnosis is usually made clinically, however is confirmed with plain XRs and an ultrasound scan or MRI scan, which are also used to rule out other conditions which can present in a similar manner.
How do you treat a frozen shoulder?
In the first instance I often recommend an ultrasound guided injection of steroid, anaesthetic and saline (Salt water). This is called a hydro dilatation. It is performed by a radiologist. They will ensure the rotator cuff tendons are intact before performing the procedure. In many cases pain and range of movement is improved rapidly, however a second injection may be required to resolve the situation. Engagement with a physiotherapist to help with some capsular stretches soon after the injection is often useful.
In some cases the pain and stiffness may not be resolved completely by the injection or it may return. In these circumstances you may be offered an operation to release the thickened tissue within the shoulder joint followed by a gentle manipulation. A subacromial decompression and excision of the AC joint may also be performed. This is done as an arthroscopic or keyhole procedure under a general anaesthetic. It is a day case procedure. (See Procedures and consent).