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Dear doctor, I have an extremely painful 'frozen shoulder'. What are my treatment options?

16 January 2018

Q: I have an extremely painful “frozen shoulder” which is really affecting my everyday life. What is it and what can I do about it?

A: A frozen shoulder, also known as ‘adhesive capsulitis’ is a commonly diagnosed condition often used to refer to a range of shoulder conditions, though is actually very specific. Common symptoms include an increasingly painful stiff shoulder and loss of movement including difficulty to get the arm behind your back. 

The cause of a frozen shoulder is unknown and is typically more severe in diabetic patients. The actual problem is with the “capsule”, or lining of the shoulder joint which becomes very inflamed causing pain at the front of the shoulder, later spreading down the arm with bolts of pain including occasional tingling and numbness. It can also cause severe sleep deprivation due to the persistent pain and discomfort.

It is important to make an accurate diagnosis of frozen shoulder, which can be done so by a clinical examination, a good history, exclusion of other causes and an x-ray. 

The condition can be self-limiting and resolve over time, with mild cases known to resolve within six to nine months, though it can take another six to nine months for the movement to return - with about 80-90% of people regaining all their shoulder movement. For these mild cases a regular course of anti-inflammatories are required. Physiotherapy at the very early stages of frozen shoulder can sometimes make the symptoms worse, it is however helpful in the later stages.

For the more severe frozen shoulder, an injection into the shoulder joint can often relieve pain in the early stages. More resistant cases can be treated by manipulation and injection under sedation or a light general anaesthetic can help with movement, pain reduction and decrease recovery time. For the really stiff and resistant cases, “keyhole” surgical release of the shoulder may be required. 

If you are concerned about frozen shoulder it is important to be assessed by your Doctor or Physiotherapist, who can arrange investigation for you appropriately.

Mr Gareth Harper is a Consultant Orthopaedic Surgeon practising at Spire Portsmouth Hospital.

 

The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.

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