Many people who have had a shoulder problem will tell you they had frozen shoulder. In the community, all types of shoulder pain are often interpreted as this but adhesive capsulitis (frozen shoulder) itself is a distinct entity.
Although very common, capsulitis is probably one of the most painful conditions that we see. It is typically characterised by gradual onset of pain with increasing severity, gradual stiffening of the joint with restriction in function and eventual lessening of pain with gradual return to motion, albeit sometimes with some long-term stiffness.
While there may be a minor or even significant injury preceding the onset of frozen shoulder, in up to 40% of cases there does not appear to be any precipitating event. The time involved for the process to complete is often significant (sometimes 2-3 years!) and so to reduce the severity and allow earlier range of motion, treatment is often required.
In frozen shoulder, the joint lining (capsule) becomes thick and stiff and this limits the patient’s range. For example, reaching out to take a ticket to enter a car park is typically painful at end of range. It is more common and more severe in patients with diabetes. In this group, the number of people coming to surgical release is much higher than the general population. Thankfully however, the vast majority of patients can be managed without surgery with anti-inflammatories, steroid injections, sometimes a higher volume injection known as a hydro dilatation, and physiotherapy.
In cases where pain and restricted range remains a problem, surgical release may be necessary. This is usually performed as a day procedure under general anaesthetic. The timing of this is dependent on the inflammatory phase having largely waned as operating too early on a shoulder with capsulitis can make matters worse.
The procedure is an arthroscopic (keyhole) procedure where the segments of the capsule that are diseased are released under direct vision. In addition, the arthroscopy allows diagnostic accuracy as to where the problem may have started or if there are any structural defects involved.
It is important to remember that shoulder surgery itself can kick off this process although the management in that instance may be slightly different depending on your surgeon’s preferences. While still practiced by some surgeons, blind manipulation under anaesthesia is no longer commonly performed as the risk profile for this is significant.
Following release, good rehabilitation is key to maximising your range and function post operatively. It is important that you engage with your physio in the post-operative phase. A sling is recommended only for comfort but early motion to maximise the effect of the release is key. I can discuss this with you at your consultation and post operatively. In addition, your physiotherapist can give you guidance.
Physios: see our therapy guidelines for post-operative care