Frozen Shoulder

Frozen shoulder is a common cause of shoulder pain particularly within middle-aged patients. It is slightly more common among females than males and is more likely to occur following an injury to the shoulder and is more commonly seen in patients with certain medical conditions such as diabetes.  Frozen shoulder can also be referred to as adhesive capsulitis or Frozen Shoulder Contracture Syndrome. 

Normally frozen shoulder starts with quite severe pain, often for no apparent reason, which then develops into pain with severe stiffness and loss of range of motion at the shoulder. Commonly patients will experience pain while lying in bed making it difficult to sleep.  One of the key movements that is restricted in frozen shoulder is external rotation (turning the hand outwards with the elbow by your side), however this can develop into loss of ability to elevate the arm upwards, to the side and difficulty placing the hand behind your back.  This can result in severe loss of function making it difficult to dress or reach into cupboards. Investigations such as x-ray and even MRI scans are generally normal but this can be useful to rule out other issues thereby assisting in the diagnosis.  There is some emerging evidence that ultrasound scanning could be of assistance in detecting frozen shoulder alongside a good clinical examination. 

Many other shoulder problems respond well to exercise-based rehabilitation but in frozen shoulder they can be extremely painful and often of limited benefit.  Increasingly the evidence for treatment of this condition has shown pain relieving injections such as steroids can be most effective and also allow the exercise and stretches to begin to take effect. The effectiveness of the injections is improved if administered as early as possible thus preventing the conditioning from advancing and the shoulder from becoming maximally stiff.  It often surprises patients how limiting this condition can be and often become very frustrated with the condition.  It is therefore important that we can offer a quick intervention to assist people in their recovery.  

If the condition becomes well-established and there is very extreme limitation of movement then a special injection procedure known as a hydrodistension (or hydrodilitation) can be a very good option. This process involved combining a steroid injection with injecting a high volume of saline fluid into the shoulder joint which will stretch the contracted capsule of the shoulder affected by the condition. The Ultrasound Scan & Injection Clinic at Life Fit offers quick access to an expert clinical examination, diagnostic ultrasound scan and injections (steroid and hydrodistension) for frozen shoulder as indicated. Injections are performed under ultrasound guidance to ensure maximal accuracy. The ‘one-stop’ nature of the clinic being integrated within the physiotherapy service allows appropriate exercises to be prescribed following injection to improve recovery.