Frozen shoulder

Frozen shoulder, what is it? 

It is a common condition that is estimated to affect 2%-5of the population (Hand, 2008). It is often a condition that develops gradually and its main feature is that of stiffness and pain. The joint that is affected is the glenohumeral joint (from Greek glene which means eyeball, and –oid, refers to ” the form or shape “) i.e. shape of an eyeball. Looking at the image of the skeleton you can clearly see that shape and form wise the name makes sense! This is the joint between the humerus (your upper arm bone) and the scapula (shoulder blade). 


Wat are the 
symptoms of frozen shoulder? 

Patients often experience a deep-seated ache in the shoulder usually at the back of the joint. The pain often radiates down the shoulder in the upper arm. Movements are restricted usually outward rotation of the shoulder is most affected. Any overhead movements are also restricted. This means that normal day to day activities such as getting dressed and combing hair are often affected. Pain at night is another common feature of this condition. 

Commonly 3 different stages of frozen shoulder are identified:  

The freezing stage which is dominated by pain and thought to be the inflammatory phase, is then followed by the frozen stage which is the stage that is dominated by stiffness, and eventually the thawing stage when pain is not so much of a feature but they is still significant stiffness whilst gradually range of motion returns. 


What causes frozen shoulder?
 

Frozen shoulder is most commonly seen in those between the ages of 40 years of age and 60 years of age.  

Thyroid problems, diabetes, cancer and kidney disease appear to increase the risk of developing frozen shoulder. Parkinsons disease and Dupuytren’s disease are also associated with a higher risk of developing frozen shoulder. 

Recent injury to the shoulder which could have been trivial, can also increase the risk of development of frozen shoulder. 

 

How long does frozen shoulder last for? 

Vastamäki (2012) retrospectively reviewed patients diagnosed with frozen shoulder over a period of 27 years. 51 patients had been observed onlwithout treatment94% of these patients recovered to normal levels of function and motion without treatment in a period of on average 15 months (range 4-36 months). 

 

How is frozen shoulder diagnosed? 

Frozen shoulder is predominantly diagnosed clinically (that means by means of a physcial examination). This does need to be done by an expert in musculoskeletal examination. Our Sonoscope clinic offers assessment by experts with in excess of 20 years of experience in diagnosing and treating people with frozen shoulder.  

An x-ray is a useful examination to identify bony causes of stiffness in the shoulder such as osteoarthritis and also to rule out more uncommon bone pathologies. Whilst x-ray is very good at evaluating bone it does only provide very limited information on soft tissues (muscles, tendons, ligaments etc).  

Ultrasound is very helpful here. Ultrasound can evaluate rotator cuff tendons for tears. It can also evaluate the joint margins for signs of osteophytes which are very common in osteoarthritis. This is very helpful in combination with the clinical examination.  

The ultrasound helps to confirm this diagnosis by ruling out any other conditions such as: rotator cuff tear, subacromial bursitis, osteoarthritiscalcific tendinopathy and other conditions that can mimic frozen shoulder. Once this is done an injection to treat the condition can be performed usually within the same session. 


Frozen shoulder, how do we treat it
? 

According to a British Medical Journal practice review paper by Rangan (2016) there is limited evidence to suggest that physiotherapy might be helpful to treat frozen shoulder. As exercise does not have known harmful effects it is a good option to start with in addition to watch full waiting. 

Thonly substantial evidence for effective treatment of frozen shoulder is for intraarticular steroid injection and for intra articular hydro dilatation (or hydrodistension) injection and the degree of evidence is classed as moderate. 


What treatments does the Sonoscope clinic offer for frozen shoulder?
 

Here at the Sonoscope Injection clinic we offer both steroid injections as well hydro dilatation or hydrodistension injections. In both cases steroid is injected in the joint but in hydrodistension injections  a significant amount of salty water is also injected with the aim to stretch the joint and reduce the tightness which benefits the flexibility of the joint. 

 

 References:

Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. 2008;17:231–6. 

Rangan, A., Hanchard, N. and McDaid, C., 2016. What is the most effective treatment for frozen shoulder?. Bmj354, p.i4162. 

Robinson, C.M., Seah, K.M., Chee, Y.H., Hindle, P. and Murray, I.R., 2012. Frozen shoulder. The Journal of Bone and Joint Surgery. British volume94(1), pp.1-9. 

Shah N, Lewis M. Shoulder adhesive capsulitis: systematic review of randomised trials using multiple corticosteroid injections. Br J Gen Pract 2007;57:662–667. 

Vastamäki, H., Kettunen, J. and Vastamäki, M., 2012. The natural history of idiopathic frozen shoulder: a 2-to 27-year followup study. Clinical Orthopaedics and Related Research®470(4), pp.1133-1143. 

 

shoulder skeleton