“This information is meant only as a guide to help you understand and your treatment options. It is not a substitute for a consultation with a specialist Orthopaedic Shoulder Surgeon. We strongly recommend a thorough discussion with your surgeon about the most appropriate treatment about your problem.” 

Frozen / Stiff Shoulder

Frozen / Stiff Shoulder

In frozen shoulder (also commonly, but incorrectly, referred to as “Periarthritis”), the joint capsule thickens and becomes tight. Stiff bands of tissue —called adhesions — develop. These restrict movements of the shoulder and cause pain. The hallmark of this condition is stiffness and restriction of shoulder movements.

It is also usually associated with pain – especially during overhead activities like combing or washing your hair, and clothing yourself. In severe cases, sleep is also disturbed due to pain. Click here to know more about Shoulder Anatomy

Frozen Shoulder Symptoms

There are two main complaints with frozen shoulder: pain and stiffness.

  1. Pain: is Pain from frozen shoulder is usually dull or aching. It is typically worse early in the course of the disease and when you move your arm. The pain is usually located over the outer shoulder area and sometimes the upper arm. In severe cases there is pain at rest also, particularly when you sleep on the affected side.

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Frozen Shoulder Causes

The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk for developing frozen shoulder.

Diabetes. Frozen shoulder occurs much more often in people with diabetes. The reason for this is not clearly known. Keeping your blood sugar levels in check is important in the treatment of  frozen shoulder.

Immobilization. Frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, a stroke with paralysis, or other injury. Having patients move their shoulders soon after injury or surgery is one measure prescribed to prevent frozen shoulder.

Other Diseases. Some other conditions associated with frozen shoulder include hypothyroidism, Parkinson’s disease, and cardiac disease.

Frozen Shoulder Diagnosis

Some tests that may help your doctor rule out other causes of stiffness and pain include:

X-rays. Dense structures, such as bone, show up clearly on x-rays. They help rule out arthritis and other diseases which mimic a frozen shoulder. X-rays will not detect problems of soft tissues of your shoulder, and is usually normal in frozen shoulder.

Magnetic resonance imaging (MRI) and ultrasound. These studies can create better images of problems with soft tissues, such as a torn rotator cuff, or labrum. They are usually not needed in routine diagnosis of frozen shoulder.

Frozen Shoulder Treatment

Frozen shoulder generally is usually self-limiting, and gets better over time, although it may take anywhere from 6 months to 4 years.

The goal of treatment is to control pain and restore motion and strength. 

Nonsurgical Treatment

Majority of patients improve with relatively simple treatments to control pain and restore motion. 

Non-steroidal anti-inflammatory medicines. Drugs like ibuprofen, aceclofenac and paracetamol reduce pain and inflammation. 

Physiotherapy. Specific exercises will help restore motion. These are usually done under the supervision of a physiotherapist initially, and later on via a home program. Therapy includes stretching or range of motion exercises for the shoulder. Sometimes heat is used to help loosen the shoulder up before the stretching exercises. 

Ultrasound guided steroid injections and Hydrodistention. Occasionally, your doctor might suggest injections into the shoulder joint to control the pain when it is severe. Steroid and local anaesthetic is injected directly into your shoulder joint. Ultrasound guidance helps accurate positioning of the needle into the joint, where it will act on the inflamed capsule. Ultrasound guidance also helps in assessment of the soft tissues covering your shoulder, and rules out tears of the rotator cuff or impingement.

Surgical Treatment

If your symptoms are not relieved by therapy, medicines and injections, you and your shoulder surgeon may discuss surgery. It is important to talk with your surgeon about your potential for recovery continuing with simple treatments, and the benefits and risks involved with surgery.

The goal of surgery for frozen shoulder is to release and stretch the stiffened joint capsule.

Manipulation under anesthesia. This is a historical procedure, but is not in favour nowadays. It could potentially end up damaging important tendons and cartilage. 

Shoulder arthroscopy and capsular release. In this procedure, your hand will be made numb by anaesthesia. Then your surgeon will release the tight portions of the joint capsule through key-hole surgery. This is done using pencil-sized instruments inserted through small cuts around your shoulder. Most patients have good outcomes with these procedures.

Recovery.  After surgery, physiotherapy is necessary to maintain the motion that was achieved with surgery. Recovery times vary, from 6 weeks to three months. Although it is a slow process, your commitment to therapy is the most important factor in returning to all the activities you enjoy.

Long-term outcomes after surgery are generally good, with most patients having reduced or no pain and improved range of motion. In some cases, however, even after several years, the motion does not return completely and a small amount of stiffness remains.

Although uncommon, frozen shoulder can recur, especially if a contributing factor like diabetes is still present.

Looking to learn more about Sports Injury, Shoulder Fractures, Shoulder Arthritis, Shoulder Dislocations, Subacromial Impingement, Rotator Cuff Tears . Take a look at our Patient education guide

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