Frozen Shoulder (Adhesive Capsulitis)
My shoulder hurts and barely moves
If you encounter these symptoms you might have developed Frozen Shoulder (Adhesive Capsulitis).
What is Frozen Shoulder (Adhesive Capsulitis)?
The medical term for frozen shoulder is adhesive capsulitis. It is an inflammatory condition affection the capsule (enclosure) of the shoulder joint. It leads to tissue thickening and in turn limitation of range of motion.
What are the signs of Frozen Shoulder (Adhesive Capsulitis)?
Sudden onset of pain with increasing shoulder stiffness are the hallmark signs. Frozen shoulder runs through three stages:
- Stage 1 - Freezing Stage: The shoulder becomes acutely very painful and gradually stiffer. The duration varies between 4 and 12 weeks
- Stage 2 - Frozen Stage: In this stage the pain settles but severe stiffness persists. This stage is the longest of the three and can run for many months, even years.
- Stage 3 - Thawing Stage: In this short stage of only a few weeks the shoulder becomes mobile again.
Who gets Frozen Shoulder (Adhesive Capsulitis)?
In most cases the condition has no identifiable event. There is an increased tendency for the development of frozen shoulder in middle aged female patients who sugar from type 2 diabetes mellitus. However frozen shoulder can happen following trauma, surgery or radiotherapy.
Treatment for Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder is a self limiting condition and always resolves once it has run through the three stages described above. Particular the very painful first stage requires strong pain medication as antiinflammatories often don’t suffice. Further treatment is dependent on the actual stage of the condition. If pain and developing stiffness are debilitating in stage one, a ‘hydrodilatation’ or ‘arthrographic distension’ is an option. During this non-operative procedure the joint is injected with cortisone, local anaesthetic and saline under image guidance. Aim of the hydrodilatation is to distend the enclosure of the joint and to release adhesions (inflammation scars). If the procedure is done under sedation, which is my preferred way of performing it, a 'manipulation under anaesthesia’ can be added to restore full range of motion.
Whilst physiotherapy has no role in any of the stages, after hydrodilatation it is required in order to maintain the best possible motion. Once the condition has entered stage two, hydrodilatation will not be successful and the procedure of choice is keyhole surgery.
Surgery for Frozen Shoulder (Adhesive Capsulitis)
In stage two of frozen shoulder the stiffness has progressed in a way that barely any motion can be carried out in the shoulder joint itself. The arm function is maintained mainly by motion between the shoulder blade (scapula) and the chest as well as elbow and wrist joint. To restore shoulder motion, ‘capsulotomy’ is performed via keyhole surgery (arthroscopy). This usually requires two or three 5mm incisions to the joint. The capsule, which is the enclosure of the shoulder joint, is then circumferentially divided around the socket, this is followed by 'manipulation under anaesthesia’, which will restore full range of motion.
Preparing for Frozen Shoulder (Adhesive Capsulitis) Surgery
Prior to the procedure, we will arrange for one preconditioning physiotherapy session where we fit a shoulder immobiliser, explain some simple exercises and give you an ice bladder with icing instructions. If required we will also arrange for a bulk billed pre-admission clinic at the hospital. This is run by a specialist anaesthetist who will gather information and request investigations that are required for safe anaesthesia. Our reception staff will advise of costs, hospital and admission details.
Recovery after Surgery for Frozen Shoulder (Adhesive Capsulitis)
For comfort the arm will be placed in a shoulder immobiliser. Often the procedure can be carried out as day surgery. Icing will commence immediately and should be continued for several days. Physiotherapy will begin within 48 hours after the procedure. Whilst the actual condition of frozen shoulder will continue to run through its cycle, after capsulotomy the shoulder is more mobile as compared to an untreated shoulder suffering from the condition.