Frozen shoulder

Frozen shoulder is a difficult and mysterious condition which is often assumed when a middle-aged person gets a painful and stiff shoulder.

However there is a lot of confusion about the exact diagnosis, how long it lasts and what the best treatments are.

Over the last few years research has identified much more closely what the diagnosis means and how this problem should be managed.

The definition of frozen shoulder

It is important to be clear exactly what frozen shoulder is.

1. Symptoms (what the person complains of)

• True shoulder pain. Pain in the neck, shoulder and arm can have many different causes. True shoulder pain is usually indicated by the sufferer by placing their palm across the shoulder joint and just below on the upper arm.

• Gradual onset of night pain. There is no sudden onset of pain, no injury or event to explain it, it just gradually appears and steadily increases.

2. Signs (what the examiner finds)

• Restriction in the movements of the shoulder, both active (the person doing them themselves) and passive (the joint being moved by someone else).Upward motion is usually less than 100 degreees (ie not far above shoulder level) and the arm cannot be turned outward more than 30 degrees.

• Other causes of shoulder problems should be excluded before frozen shoulder is diagnosed.

3.Investigations

• Plain xrays are normal in appearance

• An arthrogram, an investigation where dye is injected into the joint, shows a tight and contracted joint space

The natural history of frozen shoulder

Frozen shoulder is typically thought to have three phases, with the whole course of the condition lasting up to seven years.

1. Painful phase. This phase can last 10-36 months. The pain can be severe and unrelenting, leading to severe problems sleeping. Sufferers often appear unhappy, and may have lost some of their sense of humour due to the pain lasting so long.

2. Stiffening phase. This lasts 4-12 months, leading to a gradual loss of movement of the shoulder. The end result can be a very stiff joint at some point.

3. Recovery period. This lasts from 12-24 months. The shortest time for this condition to resolve is over two years, the longest up to seven years. Recovery is often not complete, with mild pain and stiffness a common long term problem, without however any significant functional disablility.

Frozen Shoulder treatment options

There are a number of options for treatment of frozen shoulder including exercises, steroid injections, manipulation under anaesthetic and open or arthroscopic surgery.

Frozen Shoulder FAQs

• What are the conditions associated with frozen shoulder?
• What is the incidence of frozen shoulder?
• What are the most common investigations for frozen shoulder?
• What is the pathology of frozen shoulder?