Frozen shoulder, which is technically termed ‘adhesive capsulitis’, is condition in which the shoulder capsule – which is the connective tissue around the glenohymeral joint of the shoulder, becomes inflamed and stiff which causes both chronic pain and difficulty in moving. This is a painful condition which can be disabling and prevent patients from continuing with their usual activities due.
There is generally slow recovery and during the problem the movement is severely restricted. Pain tends to worsen at night and when the weather is poor, while bumps and jogs can cause sudden surges of pain lasting several minutes. Other side effects of the problem can include difficulty sleeping and this can lead to low energy and depression. Compensation from the rest of the body can also result in neck and back pain. The problem is generally self limiting and tends to subside after five months to three years.
While in some cases the problem is caused by injury or trauma to the affected area, there is often no identifiable cause. Some theories suggest that the problem is caused by autoimmune problems where the immune system begins to attack the healthy tissue in the capsule. Lack of fluid in the area is often responsible for the difficulty in moving. However the precise mechanism and causes are not fully understood. Certain risk factors also include: diabetes, stroke, lung disease, connective tissue disorders and heart disease. It generally only affects those over forty.
As it is difficult to identify a specific cause of the problem treatment can be painful and taxing and will not always provide relief. The aims of treatment are normally to improve mobility and to reduce discomfort and this will normally involve physical therapy – the manual manipulation of the joint along with exercises to be performed at home. Other therapies and treatments include:
Hydrodilation (also known as hydraulic arthrographic capsular distension), is a treatment specifically for frozen shoulders. Here the aim is to tease apart the adhesions in the shoulder that prevent movement and cause pain. The treatment is applied by a radiologist with a radiographer and involves the injection of a local anesthetic and cortisone injection into the joint, before the injection of 40ml of sterile saline solution. According to one study, there is no statistical support for the effectiveness of hydrodilation, however many people report it as being effective. The process in full only lasts 10 minutes.
Medication can be used to reduce the swelling and treat the pain and this will normally consist of analgesics and NSAIDs.
Manipulation Under Anesthesia
In severe cases a doctor might perform manipulation while the patient is under anesthesia. Here they will then forcefully break up the adhesion and the scar tissue inside the joint to restore the range of movement.
In the majority of cases surgery is not necessary, but in some cases it will be used to repair the joint.
In most cases the condition is self limited and patients tend to regain 90% of their shoulder motion over time – though this can take up to two years.