Frozen shoulder: a guide to management and diagnosis

Frozen Shoulder (Adhesive Capsulitis) is a painful condition that tends to affect women more commonly than men, and is most often seen in individuals aged between 40 and 60 years.

It can be triggered for a variety of different reasons, including following an injury or illness but it can also occur spontaneously.

It tends to occur in three phases.  The first phase starts with pain, the second with marked stiffness and restriction of movement (freezing phase) and the third phase eventual resolution of symptoms (thawing phase).  Each phase can take up to six months and in theory should be self-limiting, i.e. should settle by itself, although patients often describe incomplete resolution of restriction of movement and are often left with a subtle deficiency.

Patients often complain of difficulty in washing the back of their head, in reaching behind their back to fasten a bra and in reaching for a high shelf.  Sudden movements, for example reaching out for a falling piece of paper without thinking, can result in excruciating pain.

A diagnosis of frozen shoulder is often made based on history and examination findings but an ultrasound and/or MRI can demonstrate features such as fluid in the biceps tendon sheath or in the gleno-humeral joint (ball and socket joint), as well as inflammation in the joint capsule.

Treatment initially focuses on physiotherapy-based rehabilitation, working on trying to regain the lost range of movement through a stretching program.  Sometimes pain interferes with this process and can have a massive impact on daily activities such as working and in particular sleeping.  If this is the case then an injection can offer significant relief and can help improve the condition in the long run.

A standard ball and socket joint injection consists of local anaesthetic from the skin to the joint, followed by steroid and local anaesthetic to the joint, with the patient side lying and the injection targeted to the back of the shoulder.  This injection is used as a potent anti-inflammatory and for pain relief when restriction of movement is minimal.

A hydrodilatation (high volume) injection is used when an individual has severe restriction of movement.  This entails injection of steroid, local anaesthetic and 20-30mls water which is used to mechanically stretch and expand the tight, restricted capsule and can often result in a dramatic improvement in range of movement, pain and function.  This is then followed by further physiotherapy to optimise movement.

If you would like to book a rapid-access appointment at either our Golders Green or Chelsea clinic locations then please call 0208 0046659, visit or email [email protected] for further information.



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