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How to treat a Frozen Shoulder

Frozen shoulder (also known as Adhesive Capsulitis) occurs when the soft tissues (capsule) around the shoulder joint become stiff and thickened. The tissues can further become scarred (adhesions), and this is the reason why the shoulder becomes painful and eventually loses its range of motion. One or both shoulders can be affected and although it can happen spontaneously (without any obvious cause), it is usually seen after an injury to the shoulder (fracture, dislocation or sprain) or if there is a period of reduced mobility (e.g after a stroke).



Who could get a Frozen Shoulder?

The short and simple answer is that anyone could get a Frozen Shoulder. However, it is rare for children to experience it. In addition to shoulder injury, some adults have a slightly increased risk of developing a Frozen Shoulder like women over the age of 40 and patients with Diabetes and Thyroid disease.


How is a Frozen Shoulder diagnosed?

The diagnosis is made after a clinician examines your shoulder and takes a detailed history. Usually, it’s quite evident with examination alone and further tests may not be required. The shoulder will typically be painful and tender to touch in the early stages of the condition, but typically stiff with an inability to externally rotate, especially in the later stages. Although not routine, blood tests and x-rays may be requested by your clinician if there is a doubt of any other underlying problems like Osteoarthritis or Rheumatoid Arthritis. Ultrasound has increasingly been shown to be helpful in diagnosing frozen shoulders, although not routinely performed. It can allow the clinician to exclude other causes of painful shoulders.


How is a Frozen Shoulder managed?

Physiotherapy and Time

Over 90% of patients who develop a spontaneous frozen shoulder show near normal improvement within two years without being offered any treatment. Relapses within the same shoulder are uncommon. In rare cases, symptoms can last beyond two years.

First line treatment is usually conservative. Oral painkillers can be very effective in providing pain relief and helping with getting through with your activities of daily living. This could be Paracetamol, Ibuprofen or other anti-inflammatory medications.

Early and effective movement is encouraged, and appropriate physiotherapy is key and is the main treatment option.



Shoulder injection

A steroid injection is a potential treatment option for pain arising from a Frozen Shoulder. This is usually mixed with a local anaesthetic which is given directly into the joint. It can take 24-72 hours for the anti-inflammatory effect of the steroid to start. The local anaesthetic in turn relieves pain from the injection itself and may provide short-term relief until the steroid starts to work. Clinical research suggests the use of both early physiotherapy alongside a steroid injection for effective treatment outcomes.



Shoulder Hydrodilatation

The hydrodilation procedure involves injecting a fluid (usually Normal Saline 0.9%) into the shoulder joint space which subsequently expands breaking up scar tissue and loosening the joint. Ultrasound Imaging helps guide the injection to increase accuracy.

The procedure involves sterilising the skin over the joint and local anaesthesia administration. Under image guidance using an ultrasound probe, a needle is inserted into the capsule of the shoulder joint and a fluid mixture consisting of saline, steroid and an anaesthetic is injected. This procedure takes about 10-15 minutes. You may experience some discomfort during and after the procedure which usually lasts no more than half an hour. Its strongly advised to avoid driving or lifting heavy objects for at least 6 hours after the procedure. You may experience early symptom relief but it usually takes up to 6 weeks for the treatment to take effect. Hydrodilatation is generally safe, there is a small risk of infection, bleeding and failure to relieve symptoms.



Keyhole Surgery (Shoulder Arthroscopic Capsular Release)

Surgical intervention involves manipulating the shoulder joint under general anaesthesthetic and releasing the scar using a camera inserted through a keyhole. This is performed as a day case procedure.




Is there anything that can be done at home to help with Frozen Shoulder?

After an accurate diagnosis, your clinician will provide you with a physiotherapy programme you can perform at home to help you with your recovery. These involve stretching the soft tissue (capsule) to the point of pain, daily. This overtime will allow an increase in the range of movement. Exercises should focus on achieving abduction, external rotation, and forward flexion. Once improvement is being noticed, you can incorporate the use of a band.


Summary

Frozen shoulder can be a debilitating condition resulting from an insidious onset of global shoulder stiffness and pain. Treatments are available and tailored to your individual circumstances and stage of condition. Research shows no significant clinical superiority between manipulation under anaesthesia, arthroscopic capsular release, and early physiotherapy combined with a corticosteroid injection for treatment of a frozen shoulder. This means that more than one treatment options may be considered to aim for an effective treatment. If you are experiencing symptoms of Frozen Shoulder of any shoulder pain get in touch and we at ACTIVATE will be more than happy to help


About the Author: Dr. Mustafa Alnaib MBChB, MRCS, MSc, FEBOT is an orthopaedic surgeon, musculoskeletal doctor and Clinic Director at ACTIVATE Musculoskeletal Clinic in Kent.

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