| Frozen Shoulder |
What is frozen shoulder?
This is a very common condition in which the shoulder joint becomes stiff and painful.
What causes it?
Although there is always a trigger which sets it off, this can be so minor that it often doesn't register and many people have the impression that it came on 'out of the blue'. It also occurs after accidents, injuries, fractures or operations to the shoulder or even to the wrist or hand.
What happens to the shoulder?
The shoulder is made up of layers of different tissues. The most important are the muscles and their tendons (the rotator cuff) which hold the ball in the socket of the joint and help to move it. But right in the inside of the joint is a very thin and very flexible layer called the 'capsule' and it is this which is affected in frozen shoulder. The trigger changes it from being thin and flexible to thick and rigid and so it prevents movement. All the other layers of the shoulder are unaffected.
How do I know if I've got it?
When it first starts, frozen shoulder mimics rotator cuff tendonitis and it can be very difficult to tell them apart. The joint is a little tight with the arm right up in the air and will be painful in some positions. However, whereas tendonitis can usually be cured with physiotherapy and steroid injections, these treatments really do not have any significant effect on the progression of frozen shoulder.
As it develops so the movement of the shoulder decreases and eventually you may only be able to lift the arm to shoulder level in front of you and not be able to turn the arm out sideways at all. It can be incredibly painful, especially if you shoot the hand out to grab something, or someone pulls your arm or you jar it. You must have an x-ray before the diagnosis can be made. This is because there are some other conditions which result in a stiff shoulder; such as arthritis.
This is a very common condition in which the shoulder joint becomes stiff and painful.
What causes it?
Although there is always a trigger which sets it off, this can be so minor that it often doesn't register and many people have the impression that it came on 'out of the blue'. It also occurs after accidents, injuries, fractures or operations to the shoulder or even to the wrist or hand.
What happens to the shoulder?
The shoulder is made up of layers of different tissues. The most important are the muscles and their tendons (the rotator cuff) which hold the ball in the socket of the joint and help to move it. But right in the inside of the joint is a very thin and very flexible layer called the 'capsule' and it is this which is affected in frozen shoulder. The trigger changes it from being thin and flexible to thick and rigid and so it prevents movement. All the other layers of the shoulder are unaffected.
How do I know if I've got it?
When it first starts, frozen shoulder mimics rotator cuff tendonitis and it can be very difficult to tell them apart. The joint is a little tight with the arm right up in the air and will be painful in some positions. However, whereas tendonitis can usually be cured with physiotherapy and steroid injections, these treatments really do not have any significant effect on the progression of frozen shoulder.
As it develops so the movement of the shoulder decreases and eventually you may only be able to lift the arm to shoulder level in front of you and not be able to turn the arm out sideways at all. It can be incredibly painful, especially if you shoot the hand out to grab something, or someone pulls your arm or you jar it. You must have an x-ray before the diagnosis can be made. This is because there are some other conditions which result in a stiff shoulder; such as arthritis.
Will it get better?
Frozen shoulder is termed a 'self-limiting condition' which means that it will get better by itself. However that does take, on average, 18 months! Some of my patients are happy to wait it out but many want their shoulder back as soon as possible.
Frozen shoulder is termed a 'self-limiting condition' which means that it will get better by itself. However that does take, on average, 18 months! Some of my patients are happy to wait it out but many want their shoulder back as soon as possible.
What other options are there?
My views on frozen shoulder are a little controversial but are now becoming more generally accepted. So, I don't encourage physiotherapy during the frozen phase of frozen shoulder. Many people are delighted to be told they can stop physio because it hurts so much! And that can be quite a good indicator that a shoulder is freezing rather than having tendonitis because good, hands-on physiotherapy will often cure, or at least improve, tendonitis.
If you do not want to have a procedure to get the shoulder moving again (see below) then my view is to let the body do what it is trying to do - freeze up! I suggest you stop trying to keep it moving and don't try and force it to move. But I also tell you not to worry as the movement gets more and more limited. Because once it has frozen up then it will start to thaw out and the movements will come back.
Aggressive physiotherapy leaves the shoulder hovering between getting better by physio (which should be quickly if it's tendonitis) and getting better naturally (which we know takes a long time). So, leave off the physiotherapy until the joint starts to get moving again and then it is useful.
My views on frozen shoulder are a little controversial but are now becoming more generally accepted. So, I don't encourage physiotherapy during the frozen phase of frozen shoulder. Many people are delighted to be told they can stop physio because it hurts so much! And that can be quite a good indicator that a shoulder is freezing rather than having tendonitis because good, hands-on physiotherapy will often cure, or at least improve, tendonitis.
If you do not want to have a procedure to get the shoulder moving again (see below) then my view is to let the body do what it is trying to do - freeze up! I suggest you stop trying to keep it moving and don't try and force it to move. But I also tell you not to worry as the movement gets more and more limited. Because once it has frozen up then it will start to thaw out and the movements will come back.
Aggressive physiotherapy leaves the shoulder hovering between getting better by physio (which should be quickly if it's tendonitis) and getting better naturally (which we know takes a long time). So, leave off the physiotherapy until the joint starts to get moving again and then it is useful.
I had a frozen shoulder a few years ago and my GP cured it with a steroid injection so why won't you inject mine this time?
Because you don't have frozen shoulder now and you didn't have it last time either. Frozen shoulder is misdiagnosed three times out of four with a huge number of people being told they have it when they don't and vice versa. So, many people have had their tendonitis cured while believing they had frozen shoulder.
Sometimes, in the very early stages of the condition and when I'm not yet sure which condition you have, then I may do a steroid injection. If that cures you then you had tendonitis and if it doesn't then you have a frozen shoulder.
Because you don't have frozen shoulder now and you didn't have it last time either. Frozen shoulder is misdiagnosed three times out of four with a huge number of people being told they have it when they don't and vice versa. So, many people have had their tendonitis cured while believing they had frozen shoulder.
Sometimes, in the very early stages of the condition and when I'm not yet sure which condition you have, then I may do a steroid injection. If that cures you then you had tendonitis and if it doesn't then you have a frozen shoulder.
Frozen Shoulder
... and you want to get it moving quickly then I do have a means of doing that surgically.
Under a combination of an interscalene block (see anaesthesia for shoulder surgery) and a general anaesthetic, I carry out an ‘arthroscopic capsular release’. This is a key-hole operation in which I cut the thickened capsule that is limiting your movement from the inside. It is done through two 1 cm incisions (one at the back of the shoulder and one at the front) with a special arthroscope (digital camera linked to a television screen) inserted through the back and a cutting instrument through the front. As I cut the thickened ‘curtain’, the shoulder starts to move more and more until the full range has been restored.
... and you want to get it moving quickly then I do have a means of doing that surgically.
Under a combination of an interscalene block (see anaesthesia for shoulder surgery) and a general anaesthetic, I carry out an ‘arthroscopic capsular release’. This is a key-hole operation in which I cut the thickened capsule that is limiting your movement from the inside. It is done through two 1 cm incisions (one at the back of the shoulder and one at the front) with a special arthroscope (digital camera linked to a television screen) inserted through the back and a cutting instrument through the front. As I cut the thickened ‘curtain’, the shoulder starts to move more and more until the full range has been restored.
Classic changes of frozen shoulder with thickened and inflammed anterior capsule
The tear in the inferior capsule after manipulation
Post-operatively you go back to the ward with your arm up over your head in a sling in a position it hasn’t been able to reach in months. You shouldn’t have any pain nor will you be able to move your arm thanks to the interscalene block. The important thing is to keep your newly ‘defrosted’ shoulder moving so you will be doing exercises every 15 minutes using your good arm to move your bad one.
You will see the physiotherapist during your hospital stay and they will demonstrate further exercises for you to do at home. I encourage you to try and get into a swimming pool every day (if possible) and regular physiotherapy is essential to iron out all the bad habits and
weakness that will have built up whilst your shoulder was frozen.
The stitches come out after 10 days and during that period they just need to be kept clean and dry using water-proof plasters during baths, showers and swimming and breathable plasters the rest of the time.
The shoulder can be left to defrost by itself or I can do an arthroscopic release to speed up that recovery process.