What causes a frozen shoulder?

Often, a frozen shoulder can develop with no obvious cause (primary frozen shoulder). People with diabetes and thyroid problems are at higher risk of developing this type of frozen shoulder.

In other cases it can be related to an accident, fall or for any reason that the shoulder has been less mobile. It is also more common after surgery (shoulder, breast etc), a stroke or heart attack. In these cases it is known as a secondary frozen shoulder.

Why do I have pain and stiffness?

The shoulder is a very mobile ball and socket joint. It is surrounded by a capsule which helps keep the shoulder in joint and also contains fluid which lubricates its smooth movement.

In a frozen shoulder, this capsule becomes intensely inflamed and it is this inflammation that causes the severe pain. The capsule also contracts or tightens leading to the stiffness and limitation of movement.

What are the symptoms and signs?

A frozen shoulder occurs in 3 continuous phases

Freezing Phase (lasts 3 to 9 months) – this is the intensely painful inflammatory phase. The pain is localised to the front or side of your shoulder and upper arm. Your shoulder movement becomes progressively stiffer during this stage. In more severe cases, overhead and twisting activities can become difficult if not impossible. Your sleep is likely to be disturbed especially when laying on the affected side.

Frozen Phase (lasts 6 to 12 months) – in this stage your pain starts to diminish but your movement remains reduced and restricted.

Thawing Phase (lasts 12 to 24 months) – shoulder movement starts to gradually return during this final phase.

Many patients will make a full recovery over the course of time however there remains a small group of patients who can have difficulties in the long term.

What treatments are available?

There are many different treatments options available. The effectiveness of these treatments varies and their timing is important.

Pain killers – these are an excellent way to reduce your symptoms during the painful freezing stage. Paracetamol and anti-inflammatory medications are the best first line and your doctor or pharmacist will be able to advise which are safe for you to take.

Injections – steroid injections into the shoulder joint can be effective in the short term at improving pain. These can be administered by your general practitioner or when seen in the outpatient clinic. This type of injection does not have any effect on the range of movement in the shoulder

Physiotherapy – this is an essential adjunct to treatments such as hydrodilatation and surgery. In the early freezing phase, it is important to avoid any painful stretches.

Hydrodilatation – this involves an injection of local anaesthetic, sterile saline and steroid into the shoulder. It is performed by specialist musculoskeletal radiology consultants under x-ray guidance. The fluid injected causes a distension or stretching of the tight capsule to allow a return of movement to the shoulder. The steroid component of the injection gives a good pain relief. This has been very successful for the treatment for frozen shoulders in combination with physiotherapy.

Surgery – this final option is keyhole surgery to the shoulder. This is performed under general anaesthesia (with you asleep) during which the tight contracted capsule is released. This frees up the movement in the shoulder and at the same time we can examine the rest of the shoulder joint and tendons. Physiotherapy is an essential part of the recovery process after surgery.