Frozen shoulder

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Frozen shoulder – also known as adhesive capsulitis – causes pain and stiffness in your shoulder joint. The condition may come on gradually and continue to worsen for several months before starting to improve. A frozen shoulder can last for 18 months or longer, in some cases. Sometimes the condition may require surgery.

There are three distinct phases to a frozen shoulder:

  • Freezing stage – during this phase the shoulder’s range of motion becomes limited and any movement causes pain which can be severe and may be worse at night.
  • Frozen stage – during this phase, the pain starts to lessen but the shoulder remains stiff.
  • Thawing stage – during this phase, the range of movement in your shoulder begins to improve.

Causes of frozen shoulder

A frozen shoulder is caused by thickening and contraction of the joint capsule which surrounds the shoulder joint, restricting movement. Why a frozen shoulder develops is not fully understood. Most commonly there is no known cause or reason why a frozen shoulder has occurred. Certain conditions have an increased risk of developing a frozen shoulder. These include:

  • Diabetes, hypothyroidism, Parkinson’s.
  • Recent or ongoing neck pain, stroke, cardiovascular disease
  • Recent injury to the arm

Women have a slightly higher risk than men of developing a frozen shoulder and it most commonly occurs in the middle age.

Symptoms of frozen shoulder

Symptoms include pain and stiffness of the shoulder, which may worsen over time and can be particularly bad at night, causing disturbed sleep.

Diagnosis of frozen shoulder

A frozen shoulder is normally diagnosed using a physical examination and an X-ray. Your doctor may ask you to make certain movements to ascertain how much movement you have in your shoulder.

The doctor may also gently move your arm to assess for stiffness. A frozen shoulder causes pain linked to both active movements (when you move your arm) and passive movements (when someone else moves your arm).

An X-ray is important to rule out arthritis and on occasions an MRI scan if there has been a recent injury to rule out other possible causes of your symptoms.

Treatment of frozen shoulder

There is a range of possible treatments depending on the level of pain and stiffness you are experiencing. Although frozen shoulder will often get better with time, the severe pain and limitation may require active treatment to speed up recovery or if it is not improving as expected.

Painkillers and anti-inflammatories can help to relieve pain and reduce inflammation. A physiotherapist may be able to recommend exercises to improve mobility in your shoulder and reduce stiffness, although overstretching in the freezing phase can flare the condition up.

If this fails to provide adequate relief you may be offered:

  • Injection of corticosteroids into the shoulder to improve mobility and relieve pain.
  • Arthroscopic surgery – this is minimally-invasive surgery using an arthroscope (a thin, tube-like instrument that is inserted through a small incision in the skin). The arthroscope contains a camera which enables the surgeon to see inside your joint. Tiny surgical instruments are used to release the thickened joint capsule freeing up the shoulder.
  • Other treatments can include hydrodilatation (stretching of the capsule with injection under X-ray) or manipulation. These are now less common, with the best evidence suggesting arthroscopic surgery as the most effective surgical treatment.


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