Frozen Shoulder

The term “Frozen Shoulder” is often used to describe any painful condition in the shoulder. More correctly, it should be confined to describe the condition “capsulitis”. This condition is caused by inflammation of the capsule, a ligament-like structure which surrounds the shoulder joint. The cause of capsulitis is not clearly understood but it appears to be commoner in females, particularly above the age of 40 years and is also commoner in people with diabetes.

A capsulitis usually develops out of the blue, literally wakening with pain in the shoulder. It can also be caused by a minor injury to the shoulder, such as lifting something that was too heavy, or over-stretching with the arm. A nagging pain becomes more persistent and noticeable to the extent that it will disturb sleep and interfere with everyday activities. The pain is often felt around the shoulder, extending down the upper arm to the elbow. There are sometimes other symptoms, such as a sense of numbness and tingling in the whole arm. Gradually, the shoulder becomes stiff, making it difficult to lift the arm above shoulder level or to reach behind the back. Sudden movements which jerk the arm can cause severe pain.

The diagnosis of capsulitis is usually made on the history and examination of the shoulder. Characteristically, there is a loss of rotational movement, the movement that is required to reach behind the back of the neck or small of the back. X-rays of the shoulder are usually normal.

Treatment involves providing adequate pain relief and applying heat and ice around the shoulder. An X-ray examination of the shoulder, called a “distension arthrogram”, in which local anaesthetic and steroid (cortisone) is injected into the shoulder joint can be very effective. This examination stretches the tight capsule of the shoulder joint, and the steroid will also reduce the inflammation of the capsule. In most cases (approximately 80%) it will produce very rapid reduction in pain and an improvement in the range of movement of the shoulder. Physiotherapy treatment however, is also required. If this treatment does not work, keyhole surgery may be used to release the tight capsule of the shoulder joint and manipulate the shoulder. This will re-establish full movement under anaesthetic, which then can be maintained by further physiotherapy treatment.

If capsulitis is untreated, symptoms will go on for over a year. The range of shoulder movement often does not return to normal. With early treatment, pain is controlled and the range of shoulder movement should recovery and return to normal.

Capsulitis rarely affects the same shoulder for a second time but there is an increased risk of developing capsulitis of the opposite shoulder.