FROZEN SHOULDER / ADHESIVE CAPSULITIS
What is it?
This is a condition in which there is reduction in movement of the shoulder (stiffness and pain). Symptoms can range from mild to severe. The condition may arise for no apparent reason or may follow an injury or surgery to the shoulder. It is more common in women, diabetics and patients who have dupuytrens disease.
What are the signs and symptoms?
The first thing that most people notice is that the shoulder becomes painful. This is a severe pain, which causes them to wake at night. The pain is 'within the shoulder' and radiates down the arm. The shoulder is painful to move, particularly in internal rotation (reaching behind the back) and external rotation (turning the palm away from the body). Most people complain that they have difficulty putting on their clothes and learn abnormal movements to adapt.
The natural history of a frozen shoulder is that the symptoms usually resolve – however this can take between 2 and 5 years. On average patients have symptoms for 30 months.
What is the initial treatment?
The initial treatment is painkillers and anti-inflammatories. The purpose of this is to settle the pain and allow for physiotherapy to be started. The aim is to
maintain as much movement as possible whilst the condition runs its course and eventually settles. In many cases this is all that is needed.
If initial treatment doesn't work, what's next?
Many patients are happy just to wait and allow their symptoms to resolve. However in more severe cases patients would like improved movement and eduction in pain. The type of treatment depends on the severity of your symptoms. At shoulderelbowhand treatment is tailored to individual patient requirements.
The treatment options available are:
This is where saline, steroid and local anaesthetic are injected into the shoulder joint under X-Ray control. This is usually performed in theatre with the patient awake. Patients are advised not to drive for 24 hours or until they feel comfortable to do so. This is often a 1st line treatment for frozen shoulder. This procedure can be repeated if symptoms return.
In a small number of cases the stiffness and pain fail to respond to painkillers, physiotherapy or hydrodilatation. Arthroscopic release allows examination of the whole shoulder joint. The tight structures surrounding the shoulder are released to allow an almost full range of movement. A small amount of bone is shaved away to allow the tendons to move freely after release. The procedure is usually performed under general anaeasthic with interscalene nerve block After surgery patients are encouraged to move the shoulder to maintain the movement that has been achieved by the arthroscopic release.
Most patients notice the improved range of movement immediately after the operation. The post surgical pain usually improves after 4-6 weeks.