Frozen Shoulder, also known as adhesive capsulitis, is a common condition that causes pain and stiffness of the shoulder joint but with no clear precipitating event. Characteristically there is a constant low background ache but sudden jerky movements are agonising. Night pain is often a feature. It is due to an aggressive inflammation of the lining of the shoulder joint (synovitis) which causes pain, and also thickening and tightening of the joint capsule which causes stiffness. The exact cause and trigger are unknown but it is more common in women than men and typically effects people in the middle years. There is a recognised association between frozen shoulder and diabetes or other hormonal conditions, and with Dupytren’s contracture.
It is a very peculiar condition because it usually starts for no apparent reason and almost inevitably disappears again, even without any treatment, although this can take up to 2 years.
If you have had a frozen shoulder it never recurs on the same side but there is a 1 in 5 chance it will occur on the other side.
The diagnosis is based on the typical clinical history and the examination findings of a stiff but strong shoulder.
A simple xray is helpful to rule out other problems such as arthritis. There are no entirely characteristic features of frozen shoulder on MRI so it is seldom helpful unless to exclude other causes of the symptoms.
On this page you will find videos and information about the condition and how it can be managed. There are 3 common ways that Harry treats this condition. See at the end for Harry’s opinion on capsular distension or hydrodilatation.
- Wait for natural healing – about 18 months
- A cortisone injection to relieve pain but not improve movement
- An operation to improve pain and movement. There are two operations which can be considered; manipulation under anaesthetic (MUA) and arthroscopic capsular release.
In 2020 an important study was published in the Lancet (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31965-6/fulltext) comparing the results of physiotherapy, MUA and arthroscopic capsular release as different treatments for frozen shoulder. This study showed that by 12 months most people were almost completely better which really confirmed this condition as a one which gets better anyway over the course of a year or so. It also showed that arthroscopic capsular release was associated with a higher complication rate and that the MUA was the most cost effective of the 3 treatments.
Since 2003 Harry has performed over 1000 operations for frozen shoulder.
Harry Brownlow talks more about Frozen Shoulder in this video
This audio pod-cast answers common questions about Frozen Shoulder
You may prefer to read our information leaflet about this condition which you can do here.
Frozen Shoulder Treatment
Wait for natural healing
To help manage the pain while the symptoms of a frozen shoulder resolve over time you can try the following:
- simple analgesia such as paracetamol and ibuprofen
- gentle exercises within your limits of pain to maintain movement
- avoid movements that make the pain worse
I don’t find physiotherapy to help during the painful phase. Stretching exercises at this stage of the disease often seems to cause more pain and it does not improve movement. Once the disease process has moved to the painless but stiff stage then a stretching programme can be helpful.
You are allowed to do anything you feel ready to try, there are no restrictions. If you do something and it hurts then it is a reminder that there is still a problem but it unlikely to be doing you harm.
Cortisone Injections
If pain is the main problem, and especially if it is regularly disturbing your nights, then you might consider having a glenohumeral cortisone injection. This is done in the clinic using ultrasound to guide the injection. It can make the pain worse for a few days (a flare) but after a week or so you should notice a good improvement in pain. It is important to know that this injection will not improve the movement. Other side effects to consider are a depression of the immune system for a week or so, and one should avoid having any vaccinations within 2 weeks of the cortisone injection.
You can watch a video of Harry performing an ultrasound guided cortisone injection for frozen shoulder in clinic here
Harry discuss the general issues about cortisone injections here.
Operations
Some people either need their frozen shoulder just to go away as quickly as possible or they are having a particular problem with the lack of movement (stiffness). This is typically seen when the frozen shoulder is effecting the dominant arm of someone who needs good movement for their work or sport. The only way to reliably recover movement is to have an operation. Usually this would be in the form of a manipulation under anaesthetic.
Manipulation Under Anaesthetic
This is a quick, safe and effective treatment for the stiffness of frozen shoulder. It is performed under general anaesthetic as a daycase procedure. There is no cutting involved in the surgery so no scars. An injection will be given into the shoulder at the same time. However, it is important to understand that the recovery from this operation is painful and hard work! You will be expected to be performing exercises several times a day and to be having regular physiotherapy in order to maintain your newly recovered movement. You will be fighting hard against your frozen shoulder which wants to tighten back up again. Knowing this we will give you plenty of strong painkillers to take home after the operation. Usually, after several weeks, the disease gives up at which stage the pain settles and the movement remains very much improved. Any residual stiffness or discomfort slowly fades away over the following weeks.
Harry Brownlow demonstrates an MUA of the shoulder
Arthroscopic Capsular Release
However there are occasions when a manipulation might be considered unsafe in which case Harry prefers to perform an arthroscopic capsular release. This might be if you have recently had an injury, rotator cuff repair or stabilisation, or because you are known to have fragile bones (osteoporosis), or if your shoulder is especially tight (as can happen in some diabetics).
Harry Brownlow discusses the indications for and expected recovery after an arthroscopic capsular release.
Postoperative Physiotherapy Protocol
If you have had an operation for frozen shoulder then it is vital that you engage with early physiotherapy in order to maintain your newly recovered movement. Click here to see our postoperative physiotherapy protocol.
Arthrographic Capsular Distension or Hydrodilatation
This is a technique which involves injecting a combination of cortisone, local anaesthetic and saline into the shoulder joint, under ultrasound control, until the capsule ruptures. This can be a useful adjunct in the treatment for frozen shoulder.
Many shoulder surgeons advocate this technique for their patients. Harry tried it for a while but stopped offering it routinely because it hurt! Most patients found it to be a very uncomfortable experience and also it quite frequently had to be repeated.
Therefore Harry prefers other, less painful, options. However there are times when this might still be useful and he would be happy to discuss this with you.
Testimonial
“A note to say massive thank you to you and your team for ‘giving me my life back’! After almost 9 months of finding myself sleep deprived and exhausted, attributed the constant pain of a frozen shoulder, the visit to you and on your recommendation undergoing the manipulation under anaesthetic (MUA) has given me relief and restful nights back. Thank you” – Manipulation Under Anaesthetic