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Frozen Shoulder

April 14, 2020

The view of the shoulder joint capsule. A health version on the left. A capsule covered in scar tissue (red areas) that limit the joints movement and cause pain.

Frozen shoulder, or adhesive capsulitis in as it is known as in the medical world, is a condition that affects the shoulder joint causing pain, stiffness, weakness and difficulty with simple tasks such as turning on a light switch, combing your hair or getting dressed. The cause of adhesive capsulitis is unknown, but it is known to occur mainly in people aged between 40 and 60 years of age. It has a tendency to effect women more than men as well. People who suffer from diabetes have been found to be more susceptible to experiencing frozen shoulder.

Adhesive capsulitis usually begins with a gradually growing pain and stiffness in the shoulder that becomes more unbearable and restrictive. Most people don’t remember any single incident that starts the freezing process. Most people seek treatment for adhesive capsulitis after 6-12 weeks of restricted movement of the arm.

Inside the shoulder joint, the capsule - an envelope that holds fluid inside the joint - starts to thicken and swell. This causes pain and limits the movement as scar tissue increases within the capsule and ligaments. This thickening of the capsule can last for up to a year. During this time the shoulder will become stiff and more painful.

The stages of frozen shoulder can be divided into three stages: Freezing, Frozen and Thawing. As the names suggest, the shoulder gets tighter initially, then remains stiff and finally starts to loosen up. Each of these stages roughly mimic each other in term of duration, and the total time a frozen shoulder can last is generally 1-3 years.

To treat a frozen shoulder it is important to get the right treatment at each stage. The most common treatment choices are pain killers and physiotherapy to help manage the pain, increase movement and strength and restore everyday functioning of the arm.

In extreme circumstance where the shoulder does not respond to physiotherapy and medication surgery can be performed. The most common surgeries for adhesive capsulitis are arthroscopic debridement or manipulation under anaesthetic. In the arthroscopic surgery the surgeon will use keyhole surgery to remove any scar tissue that is restricting the joints movement. In a manipulation under anaesthetic the shoulder joint is stretched out while the patient is unconscious to allow for the muscles to relax and to minimise any pain. These surgeries are generally last choice.