How to tell if you have frozen shoulder

By Omar Haddo, consultant orthopaedic shoulder surgeon at The Wellington Hospital, part of HCA Healthcare UK.

Having a frozen shoulder, also known as adhesive capsulitis, can be a frustrating experience. Not only is it a painful condition but it also limits the movement of your arm. Most of the time, it is not known why it develops but if left untreated, it means your arm can have restricted functional movement for over a year. Frozen shoulder can make simple daily activities such as reaching into a cupboard and putting on a shirt extremely difficult and painful.

There are three main phases of having a frozen shoulder and it is important to diagnose it correctly so as to target treatment appropriately.

1st phase - freezing

Pain from a frozen shoulder can often develop from nowhere so it is important to see a consultant if you are experiencing severe pain which is not a result from an injury. It is more common to develop a primary frozen shoulder, which starts inexplicably, but you can develop a secondary frozen shoulder which is caused by an injury. The pain may last up to three months without showing signs of improvement from over the counter painkillers before the shoulder becomes "frozen". Frozen shoulders are more common in women aged between 40 and 60 years old, those who have pre-existing heart and thyroid problems, and in diabetics. If you fall under those categories and notice inexplicable shoulder pain, it is important to get checked out immediately.

2nd phase - frozen

A frozen shoulder is a painful shoulder with loss of movement in all directions. The shoulder will not move even when physically moved by your other arm or by a consultant. If you are in this phase, you may notice some easing in the pain but will struggle with daily activities, especially reaching to shelves or your hair. You could experience restrictive movement for around 12 months however there are treatments that can help this.

3rd phase - the thawing

By the time you are in this phase, you will notice slow but progressive improvement in both the pain and in the range of movement. This phase can take up to six months.

A consultant will be able to diagnose a frozen shoulder based on your symptoms and on the examination, which should show restriction in shoulder movement. An X-ray will look normal but is needed to rule out arthritis or injury.

A non-surgical treatment option for a frozen shoulder is to simply wait and see. While the condition can be self-limiting, this will take a long time and the shoulder may not return to complete normality.

However, minimally invasive treatment can be hydrodilatation. Hydrodilatation is an injection made up of a sterile saline, local anaesthetic and steroid, and blows up the shoulder ligaments to help regain movement. This is usually carried out with local anaesthetic, under ultrasound or X-ray guidance. Sometimes this procedure may need to be carried out more than once and it can be used if you are in the first or second phases.

More invasive treatments for a frozen shoulder include manipulation under anaesthetic and arthroscopic release. Both of these require a general anaesthetic. The manipulation involves forcing the shoulder to move in all directions, causing tearing of the tight capsule inside. The arthroscopic release is keyhole surgery which enables your surgeon to look inside your shoulder joint and use special instruments to cut through tight parts of the capsule. These are usually done if the hydrodilatation fails and if you are in the second phase.

It is important to see a physiotherapist and start the correct exercises as soon as you are advised after your procedures. The key to a quicker recovery is to keep the joint active by practising the right exercises.

If you are in the third phase, then intervention is not recommended, but physiotherapy can help.

Primary frozen shoulder remains somewhat of a mystery to medics as there seems to be no distinct cause. Once you have frozen shoulder it is unlikely you will get it again in the same shoulder, but there is a small chance that you will in the other one. If you start noticing any of the signs or symptoms of a frozen shoulder, ensure you see a consultant promptly to discuss your treatment options.

To book an appointment with Mr Omar Haddo at The Wellington Hospital or Elstree Waterfront Outpatients Centre call 020 7404 6343