Frozen Shoulder (adhesive capsulitis) is a painful disorder which results in complete or partial loss of movement. The causes are not fully understood but are often idiopathic or can be related to mild trauma,or pre existing inflammation. There is a strong association with diabetes and thyroid disorder. The capsule of the shoulder joint at first becomes inflammed, then thickens with fibrosis and contracts. The symptoms develop slowly and can be categorized into three stages:
Frozen Shoulder will generally tend to improve in due course, however this takes time, typically 2 – 3 years.Ten year follow up studies have however demonstrated that a high proportion of patients ( %) never regain full movement with conservative treatment, and a significant proportion (%) remain with symptomatic stiffness and limitation of function. However this takes time – usually two to three years. Conservative treatment combines pain relief and exercises and physiotherapy at the appropriate stage. Hydrocortizone injection into the joint cavity is an effective treatment to relieve pain and reduce stiffness. Physiotherapy should only commence once the pain has settled.
Surgical options include manipulation under anaesthetic which involves manipulating or forcing the joint to move in a controlled sequence. This process causes the capsule to stretch or tear.
The second surgical option is to release the capsule with shoulder arthroscopy . Two small incisions ( 5mm)are made and the tight fibrotic joint capsule is selectively released (commonly with radio-frequency ‘ Co- Ablation’ probe) in a very controlled manner. After surgery, physiotherapy is important to maintain the motion that has been achieved during surgery and strengthen the rotator cuff muscles.