Shoulder
Frozen Shoulder
Frozen shoulder (adhesive capsulitis, to give it its medical name) is the capsule around the shoulder joint thickening and tightening for no obvious reason. The shoulder does not just hurt; it loses movement in every direction. It runs its own long course whatever is done, so treatment is about making that course shorter and easier to live with. There is nothing broken to fix.
By appointment only, at Kharar (Mohali) or Solan. Your confirmation says which.
What tends to cause it
Most cases have no clear trigger. When there is one, it is usually a spell of using the shoulder less than normal: after an injury, a fracture elsewhere in the arm, or a stroke. It is more common in people with diabetes, and in them the shoulder is usually stiffer and slower to recover.
It usually affects one shoulder, between the ages of forty and sixty, and women more often than men. It goes through three overlapping phases. First it becomes more and more painful and starts to stiffen. Then the pain settles and the stiffness takes over. Then it slowly loosens. The whole course commonly runs eighteen months to three years. Most people expect far less.
When it needs seeing sooner
Frozen shoulder is not an emergency. Some stiff, painful shoulders are something else, though, and need seeing sooner:
- The shoulder is hot and swollen and you feel unwell or feverish, which can mean an infected joint
- Weakness, more than stiffness, is the main problem, particularly after a fall or a specific injury
- Numbness or weakness spreading down the arm, which points to the neck or a nerve instead of the shoulder
- Unexplained weight loss, night sweats, or a history of cancer alongside the pain
Short of those, book a routine consultation. Ordinary frozen shoulder does not get worse for waiting a few weeks for an appointment.
How it gets assessed
The diagnosis rests on one finding: movement is lost in every direction, even when someone else moves the arm for you. A rotator cuff problem can feel much the same, but that shoulder usually still moves freely when someone else does the moving. The two are set side by side in frozen shoulder or rotator cuff tear: how to tell them apart.
External rotation, turning the arm outwards from the elbow, is usually the most restricted movement and the most useful single test.
X-rays are often taken and are usually normal. Their job is to rule out arthritis; frozen shoulder itself is diagnosed by examination. An ultrasound or MRI is not routinely needed. It is used when the pattern does not fit and a cuff tear has to be ruled out.
What treatment usually looks like
The large majority of frozen shoulders are treated without surgery. The aim is to get you through the painful phase with less pain, and to keep as much movement as possible while the capsule is tight.
- A stretching and mobility programme, gentle and regular, never aggressive, particularly through the painful phase
- A corticosteroid injection into the joint, often most useful early on, while pain is a bigger problem than stiffness
- Anti-inflammatory medication for a defined period
- Time. Most frozen shoulders eventually loosen even without treatment, and treatment shortens the wait and makes it easier to bear
A minority are still very stiff after a proper trial of all this, usually six to twelve months. For them, an arthroscopic release of the tight capsule, or manipulation of the shoulder under anaesthesia, can move things on when nothing else has.
Common questions
Can I just wait it out without any treatment?
Often, yes. Most frozen shoulders do loosen on their own in the end. What treatment changes is how painful and limiting those eighteen months to three years are, and there is little reason to spend them in more discomfort than you need to.
Will physiotherapy make it more painful?
Done properly, no. It should stay within what the shoulder will tolerate, particularly in the painful phase, and should not force movement against resistance. If the shoulder is consistently worse after each session, it is being pushed too hard. Tell whoever is treating you.
Does it always come back to full movement?
Most people get back close to full movement. Some are left with a degree of permanent restriction, most often in the last few degrees of external rotation, and it is usually mild enough not to affect daily life.
I have diabetes. Does controlling it better help?
It is good for your overall health and may lower the risk of the other shoulder developing it, but it will not make the frozen shoulder you already have get better any faster. Diabetes plays a part in the condition developing. Once it is there, the treatment is the same.
Related procedures
Where an operation does turn out to be the right answer, these are the ones this problem most often leads to.
Not sure what is causing it?
Finding out is what a consultation is for. Bring any imaging you already have, and any plan you have been given elsewhere. He sees patients by appointment only, in Kharar, Mohali, and on set days each month in Solan.