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Commonly asked questions about Frozen Shoulder

Q:

What is Frozen shoulder?

A:

Frozen shoulder is essentially a chronic fibrosing condition in which the fibroblast cells become overactive and lay down abnormally thick layers of collagen causing a marked thickening of the shoulder joint capsule. This capsular lining of the joint subsequently contracts and leads to shoulder stiffness and pain

Q:

What are the medical terms for this condition?

A:

Various terms such as adhesive capsulitis, scapulohumeral periarthritis and checkrein shoulder have been used to describe this poorly understood disorder of the glenohumeral joint

Q:

What are the features of frozen shoulder?

A:

The classical features of frozen shoulder were described by Codman in 1934 who described a condition characterised by a slow onset of pain, felt near the insertion of the deltoid, with inability to sleep on the affected side and restriction in both active and passive elevation and external rotation, yet with a normal radiographic appearance. Although this description was made more than 70 years ago, it is probably still the most accurate and comprehensive account

Q:

What is primary and secondary frozen shoulder?

A:

Primary frozen shoulder occurs without any known precipitating cause. Secondary frozen shoulder arises as a result of an underlying problem such as fracture, tendon injury, labral tear or a systemic condition

Q:

What systemic conditions are commonly associated with frozen shoulder?

A:

These include diabetes, dupuytrens contracture, thyroid disorders, hyperlipidaemia, heart and chest disease such as bronchitis. The incidence of frozen shoulder in diabetic patients is as high as 36%

Q:

Who gets frozen shoulder typically?

A:

Frozen shoulder occurs more commonly in women than men and has its highest incidence in the age group 35-60. About 15-20% of people get it on both sides

Q:

How do you diagnose frozen shoulder?

A:

The diagnosis of frozen shoulder is made during the clinical examination. An isolated loss of external rotation is the key to diagnosis. There are no specific blood tests or radiographic examinations needed to make the diagnosis. Ultrasound or MRI scans are not necessary to make the diagnosis but may help to exclude structural problem within the shoulder such as a torn tendon

Q:

What treatment options are available?

A:

The treatment options include:

  • Non steroidal anti-inflammatory drugs
  • Ice packs
  • Physiotherapy
  • Steroid Injection
  • Surgery – arthroscopic contracture release

Q:

What does surgery involve?

A:

Surgery involves a gentle manipulation under anaesthetic, followed by key hole surgery in which two to three little stab incisions (about 0.5 to 1cm each in size) are made around the shoulder. Through these arthroscopic portals, the camera as well as a variety of surgical instruments is inserted into the shoulder and the layers of thickened scar tissue inside the shoulder are divided under direct magnified vision

Q:

What is the recovery like after surgery?

A:

The operation can be carried out as a day case procedure with no need to stay overnight in hospital. There is no need to wear a sling afterwards and there is no restriction on activity. Physiotherapy can start as soon as possible

Q:

What is the natural history of frozen shoulder?

A:

Frozen shoulder is typically said to progresses through 3 stages over a period of about 2-3 years. The first stage is the Painful stage (1-8 months) characterised by severe pain on any movement of the shoulder, worse particularly at night. Simple daily tasks such as combing the hair, reaching to the back trousers pocket or scratching the back from behind becomes progressively more difficult. The second stage is the Frozen stage (9-16 months) in which pain starts to decrease in intensity but the shoulder is becoming stiff and the range of movements is noticeably less. The third and final stage is the Thawing stage (12-40 months) in which the range of movement starts to improve

Q:

Do all frozen shoulders get better on their own?

A:

Traditionally, it was believed that frozen shoulder is a self limiting condition which resolves spontaneously after a period of 2 to 3 years. Recent studies have shown that up to 50% of patients have an incomplete recovery with persistent pain and stiffness even after a period of 7 years. (B Shaffer Journal of Bone and Joint Surgery)

Q:

When is surgery indicated?

A:

Most people would agree that if you have tried and not responded to anti-inflammatory drugs, corticosteroid injections as well as physiotherapy, then surgery can be considered. It must be noted that surgery is not a ‘quick fix’ but it can reduce the intensity of the pain and expedite the recovery process

Arthroscopic view of the severe inflammation and synovitis seen in frozen shoulder




In frozen shoulder, the inside of the joint is heavily inflamed, red and tender.
Note the tightness of the joint due to capsular contracture

Further reading:

Accessory features of frozen shoulder
F Lam, DH Bhatia, M Crowther, K van Rooyen, J de Beer.
British Elbow and Shoulder Society 18th Annual Scientific Meeting 2007 in Telford
Click her for futher reading


The information on this website does not replace medical advice. If you have a medical problem please see your doctor or consultant.