Frozen shoulder (Adhesive capsulitis)

Relieving your shoulder pain and restoring motion

Cleaning windows, combing hair or opening bottles – when your shoulder hurts, every movement can feel like agony.

Frozen shoulder is also called adhesive capsulitis. It is a very specific condition which is common and is characterised by pain, stiffness and restricted motion in the shoulder.

Our shoulder experts at Schoen Clinic specialise in the treatment of a frozen shoulder. Together with you, we will discuss all available treatment options to relieve your pain and get you back to enjoying life again.

What is a frozen shoulder?

A frozen shoulder (adhesive capsulitis) is an increasing limitation of movement in the shoulder joint. Patients between 40 and 60 years of age are mostly affected. In thirty percent of patients, both shoulders are affected, but generally not at the same time. Frozen shoulder is ultimately a self-limiting condition. That means it can also heal without medical treatment. A frozen shoulder develops gradually, gets worse and generally heals over the course of one to three years. Ten to twenty percent of those affected, however, retain permanent restrictions.

Symptoms of frozen shoulder

Patients typically experience a dull ache that may increase to a sharper pain with certain movements or activities. Pain tends to be focused deep in the shoulder however, it may occasionally be experienced in the upper arm, upper back and neck and you may also experience stiffness in each of these regions.

Patients also typically experience stiffness and significantly reduced range of movement of the shoulder, particularly with motions required for grooming, performing overhead activities, dressing, and reaching behind the back or for the seatbelt. You may also experience pain at night or upon waking in the morning.

As the condition progresses, it often presents three distinct phases. They are the inflammatory phase (freezing phase), stiffness phase (or frozen phase), then a resolution or 'thawing' phase. Each phase may last for months and studies have shown complete resolution can take 8-40 months.

Causes of frozen shoulder

Whilst the exact cause of a frozen shoulder is unknown, the joint capsule often becomes inflamed and symptoms associated with this condition then usually develop gradually over time. It can, however, also develop following a recent history of minor or serious shoulder injury, surgery or period of immobilisation.

It usually occurs from middle age onwards and is very common in people with diabetes and in women. Often both shoulders are affected, separated by a short period of time. Although the underlying cause is unknown the abnormalities noted are a profound inflammation of the lining of the shoulder joint and subsequent scarring and tightening of the ligaments and capsule surrounding the shoulder joint. The inflammation results in pain and the scarring reduces movement.

Diagnostics: How to recognise a frozen shoulder

The diagnosis of frozen shoulder is largely a clinical diagnosis. The onset of pain and symptoms often follows a characteristic pattern. Clinical examination is also extremely valuable. During the physical exam, your doctor may ask you to move in certain ways to check for pain and evaluate your active range of motion. Your doctor might then ask you to relax your muscles while he or she moves your arm (passive range of motion). Frozen shoulder affects both your active and passive range of motion as there is a significant restriction in the shoulder’s range of motion created by a contracture in the shoulder capsule itself. Often the patient notices this as a loss of motion in rotational movements.

Although the diagnosis is largely clinical, your doctor may suggest some tests like X-ray, ultrasound or MRI to rule out other problems.

Treatment options to restore your shoulder mobility

Most frozen shoulder treatment involves controlling shoulder pain and preserving as much range of motion in the shoulder as possible. Although many frozen shoulders get better on their own within 12 to 18 months, the sufferer can have very significant pain and sleep disturbance. For persistent symptoms, your consultant specialist may suggest other non-surgical procedures such as steroid injections and joint distensions. However, if none of the above has relieved your shoulder pain, your consultant may recommend surgery. 

Medications

Over-the-counter pain relievers, such as aspirin and ibuprofen, can help reduce the pain and inflammation associated with frozen shoulder. In some cases, you may be prescribed stronger pain-relieving and anti-inflammatory drugs. Although these may well help your symptoms, they may not in isolation limit the length of this syndrome.

Therapy

A physical therapist can teach you range-of-motion exercises to help you recover as much mobility in your shoulder as possible. Your commitment to doing these exercises is important to optimise recovery of your mobility. However, in some instances these may not be possible or indeed be counter-productive, particularly in the initial phases of this condition where pain is a significant feature. Physical therapy is extremely helpful in conjunction with other treatment modalities to maximise and maintain the effect of regaining range of motion.

Steroid injections

Injecting corticosteroids into your shoulder joint may help decrease pain and improve shoulder mobility, especially in the early stages of the process.

Joint distension

Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint. Often this is combined with a steroid injection.

Frozen shoulder surgery – When nothing else has helped

Surgery for frozen shoulder is rare, but if nothing else has helped, your consultant may recommend surgery to remove scar tissue and adhesions from inside your shoulder joint. This is usually extremely effective in helping resolve pain and regain range of motion. This procedure is performed arthroscopically (keyhole surgery).

Aftercare & recovery

Following treatment with any of the described treatment options, physical therapy is essential to maintain the gains and maximise the range of motion you have achieved. Patients are encouraged to follow a self-directed rehabilitation programme, initially aimed at increasing range of motion and preventing further capsular constriction. This will be helped by supervision of a physical therapy practitioner.

Frozen shoulder: Our specialists

With specialists in all aspects of upper limb and shoulder conditions, Schoen Clinic has a highly experienced multidisciplinary team to help treat your frozen shoulder.

Dr Roger Wolman

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant - Rheumatology

Consultant - Sports & Exercise Medicine

Consultant Rheumatology and Sport & Exercise Medicine
MD (Res) FRCP FFSEM
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Mr Ian Bacarese-Hamilton

Schoen Clinic Orthopaedic and Spinal Hospital London

Head of Department - International

Head of Department - Leg Lengthening

Consultant Orthopaedic Surgeon & Trauma Surgeon
FRCS(Orth)
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Mr Adrian Carlos

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Hand & Wrist

Consultant Orthopaedic Surgeon - Shoulder & Elbow

Consultant Orthopaedic Surgeon
MB ChB MSc(SurgSci) PgD(Orth) FRCS(Tr&Orth)
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Mr Livio Di Mascio

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Hand & Wrist

Consultant Orthopaedic Surgeon - Shoulder & Elbow

Consultant Orthopaedic Surgeon
MBBS FRCS Ed (Tr&Orth)
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Mr Dimitrios Karadaglis

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Hand & Wrist

Consultant Orthopaedic Surgeon - Shoulder & Elbow

Consultant Orthopaedic Surgeon
MRCS, MSc, Dip Orth, FRCS(Tr&Orth)
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Mr Ioannis Polyzois

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Hand & Wrist

Consultant Orthopaedic Surgeon - Shoulder & Elbow

Consultant Orthopaedic Surgeon
MB ChB MRCS CCSTOrth(Hons) FEBOT
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Mr Giuseppe Sforza

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Hand & Wrist

Consultant Orthopaedic Surgeon - Shoulder & Elbow

Consultant Orthopaedic Surgeon
MD MCh(Orth)
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Frozen shoulder: Our specialised hospital

From the moment you begin your patient journey at Schoen Clinic, you are treated as a partner in your care. With expert advice and treatment options available at your disposal, we will help you improve your quality of life as quickly and effectively as possible. 

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Authors, 09.06.2020