In the last few months, we have seen a significant rise in the number of patients coming to see us with frozen shoulder symptoms. The precise reasons for this are unclear.
We do not fully understand the causes of frozen shoulders although a study as far back as the 1970s (Personality In Frozen Shoulder, A. Fleming, Sally Dodman, T.C. Beer and S. Crown) suggested that psychological factors may play a part. In this study, researchers compared the personality profiles of 56 patients with frozen shoulder using data from Middlesex Hospital. They concluded that female patients showed more evidence of “somatic anxiety”, which is a measure of increased tendency to focus anxiety symptoms within bodily structures and functions.
Although increased anxiety due to the pandemic may or may not be playing a role in the increases we are seeing, there may be other factors, too, such as increased immobility due to lockdown, or it may simply be a coincidence.
This blog covers the symptoms of frozen shoulder, some of the common causes and the possible treatment options.
What is frozen shoulder?
Frozen shoulder – also known as adhesive capsulitis – is characterised by pain and stiffness in the shoulder joint. It normally develops slowly and tends to follow a three-stage pattern:
- Stage one is the freezing stage. Movement of your shoulder starts to become restricted and any movement causes pain, which can be severe.
- Stage two is the frozen stage. During this phase the pain may start to lessen however the shoulder normally becomes stiffer, making any kind of movement difficult.
- Stage three is the thawing stage. Gradually the range of movement in your shoulder begins to improve during this phase.
The whole process may take between one and three years. A frozen shoulder does not normally recur in the same shoulder, although it can sometimes develop in the opposite shoulder.
What is happening when you develop a frozen shoulder is that the capsule of connective tissue that surrounds the bones, tendons and ligaments in your shoulder joint are becoming thicker and tighter. This restricts movement of the joint and causes pain.
Causes of frozen shoulder
As we’ve said, experts are not completely certain what causes a frozen shoulder. However, there are certain factors that increase your risk of developing the condition. These include:
- Age – being over the age of 40 makes you more likely to develop a frozen shoulder.
- Sex – the condition is more common in women than in men.
- Certain chronic diseases – studies have shown that the condition occurs more frequently in people with certain systemic diseases such as diabetes, Parkinson’s, tuberculosis and cardiovascular disease.
- Reduced mobility or immobility due to a fracture, rotator cuff injury, surgery or stroke also increases the chances of developing a frozen shoulder.
Symptoms of frozen shoulder
The symptoms of frozen shoulder are pain – which can be severe – and loss of movement in the shoulder. The condition typically follows the three-stage process outlined above. Knowing that you are at increased risk of frozen shoulder, for example if you have recently undergone shoulder surgery, means you may want to take steps to reduce your chances of developing the condition. An orthopaedic surgeon or physiotherapist may be able to suggest some exercises to keep your shoulder mobile while it is healing. In many cases, however, it may not be possible to prevent the condition.
Treatments for frozen shoulder
A doctor will use a physical examination to diagnose a frozen shoulder. You may also be sent for imaging tests, such as an X-ray or MRI scan, to rule out other possible causes of your symptoms.
Most frozen shoulders get better on their own so, other than taking painkilling medication, using a TENS machine or doing exercises recommended by a physiotherapist to improve movement in your shoulder, you may not require treatment.
However, for more persistent symptoms you may be offered different types of treatment including:
- Injections of corticosteroids into the joint to decrease pain and improve mobility.
- Injections of sterile water into the joint capsule (joint distension) to stretch the tissue and improve movement.
- Shoulder manipulation under general anaesthetic to loosen the tightened capsule.
- Surgery to remove adhesions and scar tissue from the inside of your shoulder joint. This is normally performed arthroscopically (using keyhole surgery).
If you are experiencing symptoms of frozen shoulder and require a diagnosis or if you have received a diagnosis and are wondering about your treatment options, contact us for a discussion about possible next steps. This is particularly important if your symptoms are severe or have persisted for a long time as you are likely to require treatment.
Pain in your shoulder that lasts beyond a few days needs to be investigated by a doctor to ensure that it is appropriately treated and to avoid the risk of long-term damage.
Castle Orthopaedics is here to help
Castle Orthopaedics is open for virtual and face to face appointments at both Spire Nottingham Hospital and BMI The Park Hospital. Surgery is now also being scheduled once again, which means that injuries requiring surgery can be treated.
Our orthopaedic consultants each specialise in a particular area of orthopaedics, giving you added peace of mind that you are receiving expert medical advice and highly tailored treatment.
BMI The Park Hospital
Sherwood Lodge Drive Burntstump Country Park, Arnold NG5 8RX
Spire Nottingham Hospital
Tollerton Ln, Tollerton, Nottingham NG12 4GA