What is it?
A frozen shoulder (“adhesive capsulitis”) is a painful, disabling condition of the shoulder characterised by increasing stiffness of the joint. It typically goes through three stages.
An initial, very painful, inflammatory phase (approximately 12 weeks), followed by a less painful but stiff frozen phase (12-36 weeks) followed by a thawing phase (36-52 weeks) during which movement is recovered. The whole process can last up to two years, although occasionally it can be longer, especially in patients who suffer from Diabetes Mellitus
What causes frozen shoulder?
Frozen shoulder usually comes on “out of the blue” but occasionally it can follow a minor injury of the joint. It is more common in diabetics and patients with other endocrine problems such as thyroid disease.
It is not known what triggers a frozen shoulder but the capsule (the lining) of the joint becomes very inflamed and then gradually scars leading to a contracture.
It is the inflammation that causes the intense pain, particularly at night, and the contracture of the capsule that causes the restriction of movement.
How is it diagnosed?
The diagnosis is confirmed by taking a careful history, particularly around the onset of the symptoms and the sorts of activities which cause the pain. A thorough examination is very important assessing the range of movement of the joint. One of the classic features of a frozen shoulder is that the passive range of motion is equal to the active range of motion.
Typically in frozen shoulder the range of movement of the joint is significantly reduced compared to the normal shoulder whilst the strength of the muscles
/ tendons is preserved. An x-ray is essential to exclude underlying arthritis, which can also cause pain and restricted movements of the shoulder.
What are the treatment options?
Frozen shoulder is usually a “self-limiting” condition. This means it will generally get better by itself.
The whole process, however, from onset of pain to recovery of function and resolution of pain can take up to two years. If you are managing with the level of discomfort and restricted movement then, once the diagnosis is made, you can continue with gentle exercises to keep the joint mobile. It is important not to overstretch the joint as this can aggravate the pain.
It is recommended to avoid physiotherapy in the early stages for this reason. Once you are in the ‘frozen’ phase then gentle physiotherapy can be helpful. If you are experiencing a lot of pain than an injection into the shoulder joint can be very helpful at reducing the pain.
What injections can be given and how?
It is critical to put any injections into the right place and as such we strongly recommend a guided injection into the glenohumeral joint using the mi-eye device. This allows us to be sure we have the injection in the right place as well as allowing us to also perform a “hydrodilatation” procedure in selected cases
What is a hydrodilatation procedure?
Hydrodilatation is a procedure that aims to improve the movement of the shoulder joint and decrease pain in the shoulder. It involves stretching the capsule of the joint and reducing the inflammation within it by injecting a mixture of sterile saline, local anaesthetic and steroid.
Who will be doing the procedure?
Our consultant shoulder surgeon Mr Yewlett who currently performs more shoulder mi-eye procedures than any other UK surgeon will perform the procedure in the clinic setting to ensure the injection is accurately placed.
What can I expect to feel during and after the procedure?
The initial injection numbing the skin will feel like a sharp scratch. Once the area is numb you should feel very little. There may be a sensation of pushing and pressure.
Is it safe?
The risks of this procedure are very small as it is a very safe procedure.
There is a very small risk of infection, as with any joint infection. If your shoulder becomes swollen, painful and reddened, or you feel unwell and feverish, then you must attend your nearest hospital Emergency Department to ensure you have not developed an infection.
A recently published multicentre study showed that there had been no infections reported in a cohort of >1350 patients treated with the Mi eye for shoulder or knees. Mr Yewlett’s personal series of 20 Mi eye cases has had no reported infections or complications at 1 year follow up.
What can I do if an injection doesn’t solve the problem?
If your shoulder does not respond to an injection and remains stiff and painful then the choice is between conservative treatment and waiting for it improve or a key hole release of the contracture.
What does surgery involve?
The operation for a frozen shoulder is called an arthroscopic release followed by a gentle manipulation of the joint to stretch up the released tissue.
The operation is ‘key hole’ and involves release of the contracted capsule circumferentially around the ball and socket. This reduces the risk of damage to important structures when the shoulder is then manipulated.