Frozen Shoulder

Frozen shoulder is a common, under-diagnosed condition, causing a very painful and stiff shoulder. Without treatment, it can be disabling for years. Prompt treatment, often involving keyhole surgery, results in a much quicker and more complete recovery.

Who does this affect? It is usually seen in middle years, and is more common in women. For example, In Japan, it is known as 50 year olds' shoulder.

Symptoms In most people, the exact cause is not known, although there is a genetic link. It is common in diabetics and those with Dupuytren's contracture. The lining of the shoulder joint (capsule) is normally very thin and elastic to allow the shoulder to have its excellent range of movement. Frozen shoulder results in the capsule becoming thickened and inflamed (Capsulitis). This scarring leads to contracture, and painful shoulder stiffness. Some people have a mild form whilst others have it more severely. Without treatment, it can take several years to improve.

Investigations A careful examination and X-ray, in order to rule out other causes, is usually all that is necessary.

Non-surgical Treatment Initially, patients will receive a steroid injection and physiotherapy.

Surgical Treatment If non-surgical treatment is unsuccessful, manipulation under anaesthesia may be tried, but increasingly, surgery to release the thickened lining is recommended. This is done under a general anaesthetic, often as a day case. After surgery, patients undergo a course of physiotherapy. 80% improvement by 3 months is typical, but 1 in 10 patients relapse.

Picture -frozen shoulder appearance through the arthroscope (keyhole camera). Note the red, inflamed lining(capsule) of the shoulder joint
 

Picture -  frozen shoulder after release. The capsule has been cut through back to muscle.