Frozen shoulder

The orthopaedic experts at HCA UK can provide you with frozen shoulder treatments that help relieve pain and restore movement.

• Appointments with specialist shoulder and elbow consultants are confirmed within 24 hours
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What is frozen shoulder?

Also known as adhesive capsulitis, frozen shoulder is a condition that limits the mobility of your shoulder and makes it painful to move.

The shoulder joint consists of a ball (humeral head) and socket (glenoid), connected by soft tissue that ‘contains’ the shoulder joint. It's usually one of the most mobile joints in the body. 

With frozen shoulder, the tissue thickens and tightens and the ligaments shorten. This leaves less room for the ball to move in the socket, restricting mobility and causing pain in the joint. 

What are the symptoms of frozen shoulder?

Overall, stiffness and pain are the main symptoms of frozen shoulder and can occur over a period of around two years or longer. The symptoms tend to appear in three stages:

• Stage 1: The condition begins with the ‘freezing’ stage which present with sharp pain when you try to move your shoulder. This is usually worse at night and lasts from six to nine months.
• Stage 2: Next is the ‘frozen’ stage, in which your shoulder becomes increasingly stiff but less painful. This stage typically lasts from four months to one year.
• Stage 3: Last of all is the ‘thawing’ stage, when your shoulder slowly returns to normal. This usually takes six months to two years, but can take longer in extreme cases.

What causes frozen shoulder?

Frozen shoulder is an inflammatory process that has no clear single cause and can appear unexpectedly. Two-thirds of people can identify an event such as a fall or wrenching injury. In the remaining third, frozen shoulder starts more slowly, without an obvious trigger. It can also start after any condition that prevents you from moving your shoulder as usual, as lack of use causes the shoulder capsule to become tight and the soft tissues to thicken. 

However, certain factors put you at greater risk for developing frozen shoulder. 

What does frozen shoulder diagnosis involve?

Your consultant will begin by taking your medical history and discussing your symptoms with you. Then they'll conduct a physical exam of your shoulder, which will involve testing its active and passive range of motion. This might cause you some pain or discomfort, but rest assured that your consultant will only do this as much as they need to get a better understanding of your condition.

They may also refer you for an X-ray or MRI scan to rule out other conditions that could be causing shoulder pain and stiffness, such as a rotator cuff tear, shoulder arthritis or calcific tendonitis, before arriving at a frozen shoulder diagnosis. This will also allow them to confirm the presence of thickened tissue in the axillary pouch, excess fluid in the biceps groove, and other important indicators of frozen shoulder. 

What are the treatment options for frozen shoulder?

All adhesive capsulitis treatments will aim to reduce your inflammation, relieve pain and improve your shoulder's range of motion. The most effective treatment will depend on your exact symptoms and their severity.

Non-surgical frozen shoulder treatments

Your consultant will suggest the following non-surgical treatments for your frozen shoulder in the first instance, only recommending surgery if those do not prove successful. These treatments will be more effective with an earlier frozen shoulder diagnosis.

Frozen shoulder physiotherapy

Physiotherapy is a crucial part of any frozen shoulder treatment as it's ultimately what will restore the range of motion you've lost. You'll attend appointments with a specialist musculoskeletal physiotherapist who'll create a rehabilitation plan for you that's tailored to your particular needs.

Your physiotherapist will begin by assessing your shoulder before providing you with treatment sessions. You'll also receive a programme of physio exercises and gentle stretches for frozen shoulder that you can do at home, as well as advice on how to improve your posture.

Anti-inflammatory medication

Anti-inflammatory medications such as Naproxen will help reduce your pain and inflammation. The consultant might prescribe stronger medication for you to use after physiotherapy sessions or to help you sleep at night.

Steroid injections

Your consultant might recommend corticosteroid injections into your shoulder joint, done under ultrasound guidance to ensure precision. This treatment could help decrease your pain and improve your shoulder mobility by decreasing inflammation, especially if administered soon after you develop frozen shoulder. It also helps make it more comfortable to do physio for your frozen shoulder, further aiding your recovery.

Hydrodilatation for frozen shoulder

Hydrodilatation involves injecting a mixture of sterile saline, local anaesthetic and steroid into the shoulder joint capsule. This stretches the tight tissue, reduces inflammation and improves your shoulder mobility. This procedure is performed by a radiologist using X-ray or ultrasound guidance to ensure the injection is placed precisely.

Hydrodilatation is typically only recommended for people who have reached the second stage of frozen shoulder. Pain following the procedure can last up to two weeks, but your consultant will prescribe painkillers to help you manage it.

Frozen shoulder surgery

Most people recover from adhesive capsulitis without the need for shoulder surgery. Yet if non-surgical treatments aren't effective or your symptoms are particularly severe, your consultant may recommend you have one of the following procedures.

Shoulder manipulation

Also called closed manipulation, this treatment involves a surgeon moving your shoulder joint through its full range of motion. This breaks up the tightened and scarred tissue, improving shoulder mobility. 

It's a non-invasive procedure, meaning it doesn't involve any incisions. You'll be put under general or regional anaesthetic, so you won't feel any pain until it wears off. The shoulder will be sore following the procedure and pain should last for the first few weeks, though your consultant will prescribe painkillers to help you manage the pain. Most patients recover from the procedure within 4-6 weeks.

Capsular release shoulder surgery

Capsular release of the shoulder is usually performed as an arthroscopic procedure, also called a keyhole surgery. It's typically performed for people who are in the second or third stage of frozen shoulder. 

Small, camera-guided instruments are inserted into the shoulder joint through a small incision and used to create space. This involves directly removing the scar tissue inside the capsule and sometimes part of the inflamed capsule itself. 

You will likely have some pain, bruising and swelling to your arm following the surgery. Your consultant will prescribe you painkillers to help you manage the pain after the procedure. You should be comfortable by six weeks after the surgery, but it can take from six months to a year to fully recover.