Frozen shoulder, also known as Adhesive Capsulitis is a very painful condition which results in stiffening of the shoulder joint.
• Severe pain in shoulder
• Marked Reduction in the range of motion
• Loss of sleep at night
• Inability to carry out normal daily activities
Stages of Disease
Frozen shoulder used to be described into 3 phases of the disease
1. Freezing – The shoulder is extremely painful and becomes progressively more painful
2. Frozen – The shoulder is less painful but is still very stiff
3. Thawing – the stiffness of the shoulder starts to ease off
More recently Frozen shoulder has been simplified into 2 stages
1. Pain predominant – you will be in a lot of pain whilst the shoulder steadily stiffens up. You will have difficulty in simple activities and sleep
will be disturbed
2. Stiffness predominant – the pain starts to settle but you generally continue to have a stiff shoulder and difficulty performing activities
The treatment for frozen shoulder varies with how long the condition has been affecting you. Treatment may involve a steroid injection, inflation of water into the joint or a surgical release of the shoulder. All treatments run in tandem with ongoing physiotherapy.
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Freezing / Pain Predominant Phase
Physiotherapy – gentle movements of the shoulder without causing lots of pain is vital to ensure that any potential movement is retained. Physio is important to run alongside any invasive intervention that is agreed.
Injection – a simple steroid injection into the shoulder joint can help with settling the pain down. It may not completely eliminate the pain and very occasionally you may require a second injection.
Frozen / Stiffness Predominant Phase
Hydrodilatation – You will be referred to a Consultant Radiologist for a 30- minute appointment. Under the guidance of x-ray local anaesthetic will be infiltrated into the front of the shoulder. A needle is then inserted into the shoulder and your shoulder is physically expanded by filling it water. A small amount of local anaesthetic and steroid is instilled into the shoulder to help with pain both during and following the procedure. Physiotherapy will follow the procedure.
Manipulation under Anaesthetic
You will be admitted for a day case procedure, which involves a very short general anaesthetic. Once anesthetised, your shoulder will be manipulated and moved around in a set manner to release the tight contracted tissue in the joint.
Arthroscopic Capsular Release
If a manipulation of the shoulder is not sufficient then you will require keyhole surgery to release the scar tissue. This involves a general anaesthetic and 3 small incisions around the shoulder. Through these incisions the scar tissue that causes the stiffness inside the joint are released. The incisions are sutured and the stitches require removal at 2 weeks. Once again physiotherapy is required in the weeks after the operation.
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Following the operation, you will normally have a bulky dressing covering your wound. This is then removed to reveal the sticky dressing at 48 hours until 14 days following your operation. The stitches will require removal at 14 days. You will require a wound check either at the hospital or your GP practice at 14 days.
Physiotherapy following treatment is crucial to the rehabilitation of the shoulder to ensure a successful outcome. On occasion it may not seem like you are making huge amounts of progress but it is vital to keep pushing on even with small gentle exercises.
Due to pain after surgery, patient may be reluctant to perform their exercises. If you do not gently rehabilitate your shoulder it can become stiff and you can re-develop a frozen shoulder.
Anaesthetic in the modern era are extremely safe however there are still minor risks associated with the different techniques which the anaesthetist will discuss with you before your surgery.
(1%) is a risk with all surgery. In the majority of cases these are infections around the wound and can be treated with a course of antibiotics. The more unusual deep-seated infections however can require admission to hospital and surgery to clean the wound out if necessary.
Is a potential but very rare risk with this surgery. Often the nerves at greatest risk are the tiny nerves supplying skin in the area of the wound and cutting through these may result in an area of numbness that is not often troublesome.