Frozen Shoulder is a common cause of shoulder pain, particularly within middle-aged patients. Indeed, in Chinese medicine, Frozen Shoulder is known as ’50-year-old shoulder syndrome’. It is also known as ‘Adhesive Capsulitis’ meaning a ‘Sticky Capsule’ and more recently is coined a ‘Contracted Frozen Shoulder’. It is slightly more common among females than males and is more likely to occur following an injury to the shoulder and is more commonly seen in patients with certain medical conditions such as diabetes. Often there is no cause or explanation for why a Frozen Shoulder occurs.
Typically, Frozen Shoulder often starts slowly, with quite severe pain, often in the upper arm, which then develops into pain with severe stiffness and loss of range of motion at the shoulder region. Patients more often complain that they are having difficulty sleeping due to the pain. The loss of movement most often associated with a frozen shoulder affects the ability for patients to externally rotate their shoulder (turn their shoulder outwards) and therefore patients see a severe restriction of certain movements such as washing their hair or reaching their arm into their coat sleeve.
Stages of a Frozen Shoulder
There are two stages in a Frozen Shoulder – firstly when the pain is greater than the stiffness, and secondly when the shoulder is very stiff but less painful. To diagnose a Frozen Shoulder there should be an equal restriction in both active and passive range of movement in external rotation of the shoulder (gleno-humeral) joint. Investigations such as X-ray and MRI scan are generally normal aside from age related wear and tear but are sometimes requested by patients GP to help confirm patients diagnosis and rule out significant arthritis. As with all conditions specific symptoms and presentation will vary slightly from patient to patient.
It was felt in the past that in most cases of frozen shoulder the symptoms were self-limiting and would eventually get better without treatment. It has now been shown that this is not the case and 50% of people continue to have pain at 7 years, with the average duration being 30 months.
You may be prescribed anti-inflammatories such as Naproxen or Ibuprofen. Cortico-steroid injections may help the pain in the early stages. Other injections, such as Hydrodistension (High Volume) to stretch the capsule have also been shown to be beneficial.
Physiotherapy and Acupuncture can help with the pain and movement of a Frozen Shoulder. Treatment would consist of mobilisations of the shoulder, neck and thoracic spine. Massage, acupuncture, stretches and exercises and can all be beneficial.
Shoulder pain can be extremely debilitating and patients often present at clinic exhausted through lack of sleep and frustrated at all the jobs and activities that they are being unable to do. It is therefore really important that we are able to offer patient’s quick relief.
We assess each patient individually and treat using our findings to create a tailor-made treatment and exercises programme.If there is no improvement in symptoms after 6 months and they are severe, surgery may be an option, though surgery is not often necessary.