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frozen shoulder
2 Dec 2019
2 Dec 2019
by Dr Krishant Naidu

Frozen Shoulder

What is it and who can it affect?

Frozen shoulder (also known as adhesive capsulitis) is a condition characterised by progressive pain and stiffness. It is more common in 40-60-year-olds and females are more commonly affected. It can affect both shoulders in 15% of patients.

 

What happens?

The shoulder joint capsule is normally a loose covering around the shoulder joint. In capsulitis, the capsule becomes inflamed and scarred. Nerve sensitization also occurs.

 

Why does it occur?

It can occur after minor trauma and is seen in 5-10% of patients after shoulder surgery. Often, no particular injury or incident is identified. It is more commonly seen in patients with diabetes and thyroid disorders. We still don’t completely understand why it occurs.

 

What is the natural history?

Frozen shoulder usually presents with worsening pain and restriction of movement. Rotation and overhead movements are particularly affected. There is sleep disturbance and aggravation with movement and activity. Over time, the pain slowly settles, followed by an improving range of movement. This resolution can take 1-2 years. About 30% of patients will have some longterm restriction of range of movement and function.

 

Could it be anything else?

Osteoarthritis is the other common shoulder condition that causes pain and restriction of movement. Concurrent pathology affecting the rotator cuff can often co-exist. Frozen shoulder is often mistaken for impingement or bursitis. Investigations (Xrays, Ultrasound, and MRI) can exclude other pathology and confirm the diagnosis.

  • Xrays: absence of arthritis and sinister bone lesions.
  • Ultrasound: rotator cuff assessment, secondary bursitis from impingement.
  • MRI: capsular thickening, oedema
 

 

What treatments are available?

  • Simple analgesia (Paracetamol) and Non-steroidal Anti-inflammatories can provide short term relief.
  • Soft tissue therapy – address periscapular, thoracic and cervical spine range of movement, muscle tightness.
  • Neuropathic pain medication (eg. Amitriptyline)
  • Injection therapy
    • Hydrodilation
      • Stretching the capsule
      • Mixture of Cortisone, Local Anaesthetic and Sterile Saline
      • Ultrasound guided (no radiation)- as effective as CT or Xray guided.
    • Suprascapular Nerve Injection
      • Relief of pain
      • Ultrasound guided
  • Surgery
 

 

Could it get worse?

Avoiding aggravating activity is important. Aggressive manipulation can exacerbate. It’s important to be guided by pain and use the shoulder in a pain free range.


To make a priority appointment at Sportsmed Biologic, call 1300 858 860.



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