Frozen Shoulder

by Mr. David Shields

Frozen shoulder, also known as adhesive capsulitis, is a condition that causes pain and stiffness in your shoulder joint. It can make everyday tasks difficult and affect your sleep. The condition develops when the tissue around your shoulder joint becomes inflamed, then gets tighter and shrinks. This is more common in people aged 40 to 60, and women are more likely to be affected than men.

What are the symptoms of frozen shoulder?
  • Pain in your shoulder that can be worse at night and disrupt sleep.
  • Stiffness in your shoulder, making it difficult to move.

These symptoms usually develop slowly and get worse over time. The condition is called “frozen” shoulder because the more pain you feel, the less likely you’ll use your shoulder, which causes the capsule to thicken and become tight.

Frozen shoulder symptoms are typically divided into three stages:

  • The “freezing” stage: Shoulder becomes stiff and painful to move, with pain slowly increasing, sometimes worsening at night. This stage lasts from six weeks to nine months.
  • The “frozen” stage: Pain may lessen, but the shoulder remains stiff, making daily tasks difficult. This stage lasts for two to six months.
  • The “thawing” (recovery) stage: Pain lessens, and the ability to move the shoulder slowly improves.
    This can last from six months to two years.
Frozen Shoulder_2
What causes frozen shoulder?

The exact cause isn’t always clear. However, some things can increase your risk:

  • Injury or surgery that stops you moving your arm normally.
  • Diabetes: 10-20% of people with diabetes develop frozen shoulder.
  • Other health conditions: such as thyroid problems, stroke, Parkinson’s disease, and heart disease.
  • Immobility: keeping your shoulder still for a long time.
  • Spontaneous:also known as idiopathic, (perhaps the most common) when there is no identified cause, it’s just bad luck that it happens.

It is important to have regular check-ups for diabetes and to move your shoulder after injury or surgery to help prevent frozen shoulder.

How is frozen shoulder diagnosed?

A healthcare professional will assess your shoulder by discussing your symptoms, your medical history, and conducting a physical examination. This may include:

  • Moving your shoulder in different directions to check your range of motion.
  • Comparing your active range of motion (when you move your arm yourself) with your passive range of motion (when someone else moves your arm).
  • You may also have x-rays to rule out other problems such as arthritis.
How can you ease the pain yourself?

Here are some things you can do to help ease pain:

  • Follow any exercises given to you by your GP or physiotherapist.
  • Keep your shoulder moving, as keeping it still will make the pain worse.
  • Take pain relieving medications regularly, up to the recommended daily dose.
  • Use heat or cold packs to reduce pain and swelling.
  • Avoid strenuous exercises or gym equipment, as this can make the pain worse.
  • Support your arm with pillows while sleeping or sitting to prevent rolling onto the affected side.
Frozen Shoulder
What are the treatment options?

Treatment for frozen shoulder typically focuses on relieving pain and restoring movement:

1. Pain Relief:
  • Stronger painkillers: your GP may prescribe stronger painkillers for more severe pain.
  • Avoid movements that cause pain, and only move your shoulder gently.
2. Getting Movement Back:
  • Physiotherapy: This is a key part of treatment, and involves stretching and strengthening exercises. A physiotherapist will assess your movement and develop a plan of exercises.
  • Home exercises: You can do exercises at home to help improve range of motion.
  • Corticosteroid injections: These injections can reduce inflammation and pain, though they do not cure the condition.
3. Other treatment options

(if other treatments are not effective):

  • Hydrodilatation: This procedure involves injecting sterile fluid into the shoulder joint to stretch the capsule. This is most effective in the thawing phase, and less effective in diabetics or those with frozen shoulder after an injury.
  • Manipulation under anesthesia: Your shoulder is moved to stretch or tear the tight tissue.
  • Shoulder arthroscopy: This keyhole surgery to target and release the tight parts of the joint capsule. Usually reserved for shoulders which don’t respond to the above treatments
What exercises can help?

Physiotherapists can show you exercises to do at home to help reduce pain and improve movement. Examples include:

  • Pendulum exercises: let your arm hang down and gently swing it back and forth or in circles.
  • Wall slides: glide your hand up and down a wall.
  • External rotation stretches: using a stick or doorway to gently rotate your arm.
  • Forward flexion: Use your unaffected arm to lift your affected arm overhead.
  • Crossover arm stretches: gently pull one arm across your chest. It is important to do the exercises gently and avoid pain.
FAQs About Frozen Shoulder
What is the main cause of frozen shoulder?

The exact cause isn’t always clear, but it occurs when the shoulder joint capsule thickens and tightens. It can be caused by a previous injury, surgery, or other health conditions such as diabetes or thyroid problems.

How long does frozen shoulder last?

Frozen shoulder usually improves over time but it can take months or years. Full recovery can take up to 3 years. However, most people see significant improvement within 12 to 18 months with treatment.

Can frozen shoulder be cured?

There isn’t a cure for frozen shoulder, but treatments can relieve pain and improve movement. Many people recover fully with treatment.

Is it safe to exercise with frozen shoulder?

Yes, it’s important to keep your shoulder moving, but follow the advice of a healthcare professional and do not do strenuous exercises. Gentle exercises and stretches will help.

Can I prevent frozen shoulder?

You may be able to reduce the risk of secondary frozen shoulder by keeping your shoulder mobile after injury or surgery, and managing health conditions like diabetes.

Is surgery always needed for frozen shoulder?

Surgery is not usually needed as most cases improve with non-surgical treatments. Surgery may be an option if other treatments aren’t effective.

What is the best way to sleep with frozen shoulder?

Try sleeping on your back or your unaffected side, and use pillows to support your arm to help prevent you rolling onto the affected side.

FAQs About The Upper Limb Clinic
What services does The Upper Limb Clinic offer?

The Upper Limb Clinic offers expert assessment, diagnosis, and treatment for a range of shoulder conditions including frozen shoulder, rotator cuff injuries, and arthritis. We provide both surgical and non- surgical options, tailored to each patient’s needs.

Who will I see at The Upper Limb Clinic?

You’ll be seen by Mr. David Shields, a highly experienced orthopaedic surgeon in Glasgow. He has extensive expertise in diagnosing and treating frozen shoulder.

What kind of surgical options are offered at The Upper Limb Clinic?

If needed, we provide advanced surgical procedures such as manipulation under anaesthesia and shoulder arthroscopy. These options are only recommended if non-surgical approaches aren’t effective.

Does The Upper Limb Clinic accept private health insurance?

Yes, The Upper Limb Clinic accepts most major private health insurance policies.

Why choose The Upper Limb Clinic?

The Upper Limb Clinic is dedicated to providing you with the highest standard of care, combining clinical expertise with a patient-centred approach. Our goal is to help you recover from frozen shoulder and get back to your normal activities.