Frozen shoulder

What is frozen shoulder?

Frozen shoulder is when tissue and ligaments around your shoulder joint become inflamed, painful and stiff. It's also called adhesive capsulitis.

The condition typically develops in three stages:
• Stage 1 - your shoulder becomes inflamed and very painful – these are the first signs of frozen shoulder and some movement may be lost (freezing)
• Stage 2 – the shoulder pain may ease, but movement becomes increasingly difficult (frozen)
• Stage 3 – the shoulder pain continues to ease and mobility returns (thaws) - this may take a number of months and, in some cases, several years.

Frozen shoulder usually affects one shoulder, but in about 20% people it’s both. It can sometimes be confused with arthritis, however is very different.

What causes the condition?

In some people, it’s not clear exactly what has caused their frozen shoulder, although it can result from an injury or operation. However, you’re more likely to be affected if you:

• Are aged between 40 and 60, with women more likely to be affected than men
• Have diabetes (more than twice as likely)
• Have either an overactive or underactive thyroid condition
• Have had a stroke
• Have heart disease
• Have other shoulder problems such as a rotator cuff injury or tendonitis

What are the typical signs?

Symptoms vary from person to person. You may still have flexibility in your shoulder. However, in some cases, your shoulder may be so stiff that movement is practically impossible.

Symptoms of frozen shoulder include:

• Limited movement in your shoulder and arm, making it harder to carry out everyday activities
• Shoulder pain and stiffness that doesn’t go away

How is it diagnosed and treated?

Diagnosis

Your consultant will discuss your symptoms with you and perform a medical examination, which may be followed by an X-ray, MRI or ultrasound scan to rule out arthritis or a tendon injury.

Treatment

Non-surgical treatment: Physiotherapy and simple painkillers, such as ibuprofen. In some cases, your consultant may advise you to have a joint injection with steroids to reduce the inflammation and improve your symptoms. Hydrodilatation is commonly offered which involves an injection into the joint under x-ray control. A large volume of fluid is injected, the aim being to stretch the lining of the joint and improve range of movement.

Surgery: Keyhole (arthroscopic) surgery to release the scarring of the lining of the shoulder joint is very effective to resolve pain and improve shoulder movement. This is carried out under general anaesthetic as a day-case operation (you come into hospital and return home on the same day).

Recovery

This depends on the type of treatment you’ve had, but can take from between 6 and 12 weeks depending on whether you’ve had surgery. Your consultant will be able to advise you on this.

When can I return to normal activities?

• Work - this depends on your individual employment and lifestyle, however if your job mainly involves sitting then an approximate guide is around two to three weeks post-surgery. If you have a more active role, your consultant will be able to advise you on a suitable period of time, however it could take up to four months
• Driving – On average takes about two to three weeks.
• Exercise – As pain allows, from two to three weeks onwards.

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