A frozen shoulder is a painful and debilitating condition that can last for several years. The causes are not always fully understood but the condition – also caused adhesive capsulitis – is the result of thickening of the capsule of connective tissue that surrounds the shoulder joint. As it thickens it becomes tight which restricts movement of the shoulder joint, causing pain, loss of mobility and stiffness.
You can find out more about the risk factors of frozen shoulder in our blog ‘Frozen Shoulder: Am I at Risk?’
Treatments for frozen shoulder
Treating a frozen shoulder depends on the severity of the condition and how long you have had it. Most frozen shoulders will resolve themselves over a prolonged period of time so you may choose simply to wait for the symptoms to subside. Anti-inflammatories and shoulder exercises can speed the recovery process and improve the range of motion in your shoulder.
In more severe or long-lasting cases, treatment may be necessary. We offer several different treatments for a frozen shoulder.
Hydrodilatation: If your shoulder has become very stiff then we may recommend a procedure called hydrodilatation. This involves injecting the tight, scarred lining of the shoulder joint with saline mixed with steroid, local anaesthetic and a contrast dye. Imaging equipment is used to assist with accurate positioning of the injection.
The European Federation of National Associations of Orthopaedics and Traumatology (EFORT) Open Reviews published a study in November 2017 into the benefits of hydrodilatation as a first-line treatment for frozen shoulder. Researchers concluded that for patients who do not recover in a timely way or for whom it is not practical to allow the condition to resolve by itself, hydrodilatation can be an effective treatment approach. It may also be helpful in patients who make an incomplete recovery from a frozen shoulder but researchers warn that people who are diabetic may not experience such good outcomes as those who are not. It is unclear why this is.
Other treatment options for the condition include:
Steroid injections: In the early stages of a frozen shoulder, before severe stiffness develops, an injection of corticosteroids mixed with local anaesthetic may help to relieve the pain of frozen shoulder and, when combined with physiotherapy, can improve mobility and movement in the shoulder. Ultrasound is used to guide the needle to ensure accuracy. It can take a few days for the injection to take effect although the local anaesthetic will provide immediate pain relief lasting a few hours. The benefits of steroid injections normally last for several months, which may be enough time to work with a physiotherapist to prevent stiffness developing.
Arthroscopic surgery: Arthroscopy is a surgical technique used to diagnose and treat joint problems. It may be used in severe cases of frozen shoulder. It involves making a small incision above the shoulder joint and then inserting the arthroscope, which is roughly the size of a pencil, into the joint. The arthroscope contains a miniature camera that allows the surgeon to see the structures inside your shoulder which are transmitted to a monitor. A pump is used to push water through the joint to help identify areas of damage that are preventing you from moving your shoulder properly. We then use tiny surgical instruments to relax and release the shoulder lining (capsular) which has become tight and stiff. Arthroscopy is normally carried out under general anaesthetic and takes an hour or less. You should be able to go home the same day although you will need someone to drive you and remain with you for 24 hours after the anaesthetic. Your shoulder may feel stiff and sore afterwards but should recover within a few weeks. A physiotherapist will recommend exercises to help you regain full use of your shoulder joint.
Manipulation under anaesthesia: This is a more traditional procedure where the shoulder is forcibly manipulated to break the capsule of the shoulder joint. It is a very effective and quick procedure that does not require any incisions in the skin. However it carries a small, perhaps unacceptable, risk of fracture or dislocation. Also, no information is obtained about the other structures in the shoulder that may be the underlying cause of the frozen shoulder, as a camera has not been inserted inside.
If you have a frozen shoulder, we can provide a diagnosis and discuss the most suitable treatment options.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).
Telephone: 020 376 15987
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