Frozen Shoulder (Adhesive Capsulitis) is a painful condition that tends to affect women more than men, and is most often seen between the ages of 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 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 have a subtle residual restriction of movement.
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 also be helpful with the diagnosis and to rule out other potential issues.
Treatment initially focuses on rehabilitation, working on regaining the lost range of movement through a stretching program. Sometimes pain interferes with this process and can have a massive impact on daily activities and cause difficulty with sleep. 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 and steroid, with the patient lying on their side and the injection targeted to the back of the shoulder. This injection is used as a strong anti-inflammatory and for pain relief, and is used 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 joint 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.