What is frozen shoulder?
Frozen shoulder is more properly termed Adhesive Capsulitis of the shoulder. The capsule - the bag of tissue that holds the joint together - becomes inflamed. The inflammation causes the capsule to shrink and stick to the bones and cartilage inside the joint. This results in the joint becoming very stiff and painful and can cause considerable disability.
What causes it?
There are a few recognized triggers for frozen shoulder. It can start after an injury to the shoulder - particularly if the injury causes a tear in the "rotator cuff" muscles - the muscles which give the joint its stability. Sometimes a relatively minor sprain injury of the joint can trigger the inflammation which starts the adhesive process.
Frozen shoulder is especially common in diabetics and in patients with high cholesterol levels although doctors have not yet worked out why this happens.
In a large number of patients no obvious cause can be determined. These cases are called "idiopathic." Idiopathic frozen shoulder seems most common in women in their 40's, 50's or 60's but men and people of other age groups can also be affected.
Sometimes the same pattern of limited motion and pain is seen in patients with rheumatoid arthritis or osteoarthritis in their shoulder. Your doctor may organize tests to check for these possibilities although they are not common.
What are the symptoms of frozen shoulder?
Pain and stiffness are the two symptoms of adhesive capsulitis. The pain often comes first with stiffness developing later.
Most people feel their pain over the upper arm but it can spread down the arm to the elbow or below. The more inflamed the shoulder is, the further the pain seems to spread. Using the arm above the head or behind the back is very difficult and many people find it unpleasant to lie on the affected side when asleep at night.
Dressing and undressing can be very difficult - more so for women who rely on the ability to get the hand behind their back to fasten or unfasten their bra.
In many cases the pain starts slowly and gets steadily worse for several months - accompanied by increasing stiffness. Things then seem to stabilize and a few more months may pass with neither worsening or improvement in the situation. Gradually, the pain gets less and movement returns but the process from onset to recovery can take several years if no treatment is given.
Do you need frozen shoulder investigations?
Most people don't need investigations - the diagnosis is usually made by the doctor recognizing the pattern of events and finding a loss of motion in the joint.
If there is a suspicion that other joints are also inflamed then tests to look for rheumatoid arthritis might be arranged or an X-ray taken to check for osteoarthritis.
Significant trauma at the start of the symptoms could indicate that the muscles of the rotator cuff have been torn and in this case an ultrasound image, an MRI scan or an arthrogram (injection of dye into the joint) might help to make a plan for management.
What treatment can you have?
Physiotherapy will help restore the range of motion by showing you how to stretch the tight joint. This can be very painful in the early stages and patients need to be careful not to stretch too hard too soon. Overdoing it too early in the course of the illness can prolong the time taken to recover.
Stick with simple painkillers - they will help just as much as anti-inflammatory drugs - and are much less likely to cause side effects in your system.
An injection of steroid and local anaesthetic can give very good pain relief but the joint often stays stiff.
In very resistant cases it is possible to do an injection very deeply into the joint using an X-ray machine to guide the needle and - if things still don't improve - surgery can be undertaken to release the capsule. Other treatments designed to free up movement include manipulation under general anaesthetic.
Most sufferers simply need adequate pain relief, physiotherapy and reassurance - with perhaps an injection in the early stages to relieve the worst of the pain.
The textbooks say that recovery takes place without any treatment over a period of 18 to 24 months. In my experience it can sometimes take longer than this. Nearly every patient has fully recovered within three years of onset.
Treatment can shorten the time to recovery dramatically. Injections lessen or abolish the pain and well planned physiotherapy will improve the movement range. Many people are simply glad of the reassurance that they don't have arthritis or some other serious condition. Adhesive capsulitis - although very frustrating - always recovers eventually.