Treatment - How can I help

Frozen Shoulder

Other popular names

Who does it affect?

Anyone, however is more prevalent in diabetic patients, particularly insulin dependant diabetics. An episode of minor injury may trigger the start of the frozen shoulder process.

Why does it happen?

Frozen shoulder often starts without apparent cause, but may be triggered by injury to the shoulder.  The condition generally goes through three phases, starting with pain (often referred to as the ‘freezing phase’, then stiffness (often referred to as the ‘frozen phase’) and finally a stage of resolution (often referred to as the ‘thawing phase’) as the pain eases and most of the movement returns. This process may take a long time, sometimes as long as two or more years.

Frozen shoulder may be associated with diabetes, high cholesterol, heart disease and is also seen in patients with scar tissue in their hands, a condition called Dupuytrens contracture.

Symptoms

Frozen Shoulder is an extremely painful condition in which the shoulder is completely or partially unmovable (‘frozen’). It is one of the most painful conditions of the shoulder.

The lining of the shoulder joint, known as the 'capsule', is normally a very flexible elastic structure, giving the normal large range of movement normally associated with the shoulder.  With a frozen shoulder this capsule (and its ligaments) becomes inflamed, swollen, red and contracted.  The normal elasticity is lost and pain and stiffness set in.

Diagnosis

Usually none as the condition is well known and easily identifiable.  Occasionally an x-ray may be taken.

Non-surgical treatment

If nothing is done most frozen shoulders improve significantly over 2-4 years.  However the pain and limitations caused by the stiff shoulder generally require some form of intervention.  This depends on the severity of the pain and stiffness.  There are two options that may be used prior to surgical intervention:

Physiotherapy to prevent any further stiffness and attempt to restore a wider range of movement

Therapeutic steroid injections may be used to reduce inflammation and provide pain relief.  These are only performed once or twice. 

Pain-killers and anti-inflammatory drugs will also be offered.  Often stiffness and pain are not averted and you will be offered surgery at this point.

Surgical treatment

Surgery is carried out as a day case procedure usually under general anaesthetic and takes about 30 minutes.

The surgery is performed arthroscopically (key-hole surgery) for a capsular release (Arthrolysis) as well as a technique called Manipulation Under Anaesthetic (MUA).

Post-surgery rehabilitation

You can go home soon after the operation. The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off.  The dressing will be removed soon after your operation.  The wound is cleaned and redressed with a simple dressing. 

You will need physiotherapy after your operation to help you maintain the movement in your shoulder. You should notice an improvement in symptoms within a few weeks but the final result may take some 3-6 months. Patients with diabetes may find recovery is a little more prolonged.

Return to normal routine

Keep the wound dry until 12 days.

Return to driving:

You are advised to avoid driving for at least 7 days.

Return to work:

Everyone has different work environments.  Returning to heavy manual labour should be prevented for approximately 4 - 6 weeks. You will be given advice on your own particular situation.

Risks

Overall over 97% are happy with the result. However complications can occur.

General risks (less than 1% each):

Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any upper limb surgery from a minor procedure to a complex reconstruction).

Specific risks:

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