Frozen shoulder (adhesive capsulitis)

WHAT IS IT?

Adhesive capsulitis and frozen shoulder are synonymous terms used to describe a stiff and painful shoulder .The capsule (watertight lining of the joint) of the shoulder joint becomes inflamed, thickened and scarred, causing pain and stiffness. It occurs in about 2% of the population, most commonly in those aged 40 to 60 years old, and more often in women than men.

WHAT PART OF THE SHOULDER IS AFFTECTED?

The joint capsule is a sac that encloses the joint and holds the fluid that bathes and lubricates it. The walls of the joint capsule are made up of ligaments that attach bones to bones. The joint capsule normally allows a large amount of slack tissue so the shoulder is unrestricted as it moves through its large range of movement. Capsulitis (inflammation of the capsule) considerably limits the shoulder's ability to move and causes the shoulder to ‘freeze’.

WHAT CAUSES IT?

The exact cause of frozen shoulder is not fully understood. Often an injury or accident may precipitate it or it may develop after surgery, but often no particular reason for it can be found. It occurs much more commonly in diabetics and those with thyroid problems but it is not known why. One theory is that it is an overreaction to injury whereby the tissue ‘over-repairs’ itself.

WHAT ARE THE SYMPTOMS?

The symptoms change as the problem develops, usually through three phases:

Freezing: with possibly no apparent precipitating event, the shoulder becomes progressively more painful. The pain is usually aching in nature and felt vaguely over the shoulder, over the back and down the arm. Trying to move the shoulder aggravates the pain. The pain can be very severe and cause difficulty sleeping. The shoulder also becomes gradually more stiff, losing its range of motion. This phase typically lasts between 6 weeks and several months.

Frozen: during this phase the joint become more and more stiff but the patient may experience some improvement in their pain. This phase typically lasts for approximately 6 months.

Thawing: the stiffness slowly improves. Complete recovery back to normal, or near normal, strength and range of motion takes, on average, 2 years.

WHAT IS THE TREATMENT?

This is a self-limiting condition which means it should get better on its own. The trouble is, it often takes longer than most patients find acceptable. The aim of any treatment is to fast-forward the patient along the disease pathway to relieve the pain and restore the range of motion sooner than it would come anyway.

NON-SURGICAL TREATMENT:

Treatment of adhesive capsulitis can be frustratingly slow. Most cases eventually improve, but the process can take many months. The goal of your initial treatment is to decrease inflammation and maintain existing movement of the shoulder. Your GP will probably recommend anti-inflammatory medications, such as ibuprofen.

During the early stage, your doctor may recommend an injection of cortisone and a long-acting anaesthetic to reduce inflammation. Cortisone is a steroid that is very effective at reducing inflammation. Controlling the inflammation relieves some pain and allows the stretching program to be more effective.

Physiotherapy can be helpful in maintaining the range of motion and is often a critical part of helping you regain the motion and function of your shoulder. You will often be given exercises and stretches to do as part of a home program. However, during the painful phase it may not be at all comfortable or effective.

SURGICAL TREATMENT:

Manipulation Under Anaesthesia (MUA): If progress is slow, your surgeon may recommend manipulation under anaesthesia. This means you are put to sleep with a general anaesthetic. The surgeon stretches your shoulder joint beyond what would be possible with you awake. The heavy action of the manipulation stretches the shoulder joint capsule and breaks the scar tissue. This may improve motion in the joint faster than allowing nature to take its course. You may need this procedure more than once. This procedure has risks. There is a very slight chance the stretching can injure the nerves of the brachial plexus, the network of nerves running to your arm. There is also a risk of fracturing the humerus (the bone of the upper arm), especially in people who have osteoporosis (fragile bones). I would tend to offer manipulation only if the shoulder stiffens up after an arthroscopic capsular release (see next section).

Arthroscopic Capsular Release: When it becomes clear that non-surgical treatment has failed, arthroscopic release may be needed. This procedure done under general anaesthetic, together with a nerve block to numb the arm. The surgeon uses an arthroscope (camera – see section on shoulder arthroscopy ) to see inside the shoulder. During this procedure, the surgeon can accurately cut and remove the thickened scar tissue and improve movement.

Spire Elland Hospital

Elland Lane
Elland
HX5 9EBT

For an appointment, telephone:
Outpatient Bookings on 01422 324069
Self pay enquiries on 01422 229 597
Main Hospital number is 01422 229 632

BMI The Huddersfield Hospital

Birkby Hall Road
Huddersfield
West Yorkshire
HD2 2BL

Reception: 01484 533 131

Department of Orthopaedics & Trauma

Calderdale and Huddersfield NHS Foundation Trust
Huddersfield Royal Infirmary
Acre Street
Lindley
Huddersfield
HD3 3EA

NHS Secretary:
Mrs Margaret Thomas
Tel 01484 342 343

NHS Clinics

Trauma:
Calderdale Royal infirmary, Halifax
Huddersfield Royal Infirmary

Elective Shoulder and Elbow problems:
Friday morning at Calderdale Royal Hospital, Halifax

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