First an apology: frozen shoulder isn’t really caused by the weather. (I know – it seemed like a good headline at the time…) Winter-related puns aside, though, I felt it would be worth exploring the condition in a bit more detail. Why? Because it’s really very common. In fact frozen shoulders account for around 20% of my shoulder impingement patients (an impingement is where tissue ‘catches’ on neighbouring bone or tissue in the shoulder). So if you have been struck down with it, you’re not alone. And the good news is that there’s plenty we can do to fix it.
What is frozen shoulder?
Frozen shoulder is a term that gets rather bandied around by the general public. But it does have quite specific criteria for diagnosis. Also known as adhesive capsulitis or shoulder contracture, it’s essentially a stiffness of the ‘capsule’ – the ball-and-socket joint at the centre of your shoulder. Ordinarily, the tissue surrounding the capsule is soft and flexible. When frozen shoulder sets in, however, it becomes thick and inflamed. The tissue tightens around the joint, like shrink wrap.
What causes it?
We aren’t entirely sure. One possibility is trauma. An accident may cause a person to stop moving their arm; frozen shoulder sets in afterwards. Another possibility is that it’s a bodily protective mechanism, perhaps in response to trauma. But sometimes it just seems to arrive out of the blue. One thing we can say is that frozen shoulder is more common in patients with diabetes, and in people suffering from Dupuytren’s disease, a condition in which thickened tissue forms in the hands and fingers.
What does it feel like?
The first thing you will feel is a diffuse pain, deep down in the shoulder. Soon after that, the joint will stiffen and you will lose external rotation of the arm. So movement becomes restricted, and not just because it’s too painful to move the shoulder: you will physically struggle to move the joint at all. This can continue even after the initial pain and inflammation has passed, because the capsule tissue has become thickened, fibrotic and shrunken.
What can I do about it?
There are a number of ways to treat frozen shoulder. One of the key things is to keep the joint moving. In the early stages, it’s tempting to put the arm in a sling and rest – but that’s not recommended. This is one of those conditions where you need to ‘tell your shoulder who’s boss’. Small, frequent movements are better than once-a-day heroic movements. And physiotherapy can help tremendously; we will happily recommend you one, if needed. Anti-inflammatory pain relief and steroid injections can also free up joint movement.
Is surgery an option?
Time is often the greatest healer with frozen shoulders, and many patients find that the condition passes over the coming months, even without treatment. But in more severe cases, when pain relief, steroids and physio aren’t working, we can recommend surgery as an alternative. One common option is a manipulation under anaesthetic – literally pushing the shoulder through a range of movements to get it moving again. Another option is an arthroscopic release, where a tiny probe is used to remove the restrictive capsule tissue. Whatever the outcome, we can explore all the options in detail if you come for an appointment.