What is frozen shoulder?

A frozen shoulder is an inflammatory condition, which mostly occurs spontaneously, and is characterised by stiffness and pain in the shoulder joint.  It is more common in females in the middle aged group, and also more common in certain medical conditions, such as diabetes and thyroid disease.

If one thinks of the shoulder as an “onion” with multiple layers, the disease starts in the deepest layer (synovium).  It then gradually spreads to the capsule and leads to stiffness, which eventually resolves and the condition clears up.  Fortunately, this is a self-limiting condition, and very rarely needs surgery.  If one waits long enough it will clear up, but we try and help patients by speeding up the progress of the condition.

Our management of frozen shoulder is usually conservative.  I have found over the years that the following treatment is successful in the majority of patients.

It is very seldom that we need to do an arthroscopic capsulotomy for this condition.

During the first consultation I give an intra-articular injection of Celestone Soluspan under ultrasound control, to ensure that the injected material is accurately deposited.  I then add a suprascapular nerve block, also ultrasound guided, which adds in the pain modulation.

We then follow this up with two more injections into the glenohumeral joint, at monthly intervals.

We have found that by giving cortisone injections into the joint, the duration can be shortened.  The injection has to be given under ultrasound control to make it accurate.  In most cases if we give three injections at monthly intervals – most patients improve to a degree that they do not require any further management.

Only in exceptional cases do we need to do a surgical procedure, where we go and loosen the shoulder (arthroscopic capsulotomy)