Frozen Shoulder

FROZEN SHOULDER

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:
  1. Rapid onset of pain which can be quite severe. Limitation of movement ensues.Pain is often worse at night.  This usually lasts between two to nine months.
  2. Pain begins to reduce, stiffness remains or increases.  This stage generally lasts four to nine months.
  3. The condition begins to resolve with slow restoration of movement.The condition is more common in women between the ages of 40 – 70 years and there is a higher incidence in the diabetic population. Other medical conditions associated with Adhesive Capsulitis include Hypo or Hyper thyroidism, Parkinsons Disease, Cardiac Disease or recent cardiac surgery and Dupuytrens Contracture.

    On examination there is usually no muscle wasting apart from the deltoid from under use.  Active and passive movements are markedly restricted with passive external rotation frequently being LESS THAN 50% OF THE UNAFFECTED SIDE.  This reduction in external rotation is the pathognomonic sign of  frozen shoulder.  There are only two other conditions that present with gross limitation of external rotation.  Osteoarthritis and locked posterior dislocation.

 

 

Treatment Options

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.