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What is Frozen Shoulder?

Frozen shoulder is a term often used for any painful condition of the shoulder. In reality, it is a very definite and specific condition about which we know a great deal, but there are still many mysteries. The cause of frozen shoulder is unknown, but it is associated with several conditions such as diabetes, thyroid and heart disease. Being female also increases the chances of developing the condition.

This niggling and painful problem often has a mind of its own and doesn’t seem to obey the rules…Conventional approaches and traditional treatments for the aches and pains, unfortunately, can often make it worse and last longer. Unlike degenerative conditions, it is not progressive and has the ability to completely repair itself. When planning treatment and considering options of intervention this must always be taken into consideration. Frozen shoulder is normally easy to diagnose, but at other times can be tricky as it presents as other ailments.

It is little wonder the diagnosis is often delayed when investigations can point you in the completely the wrong direction. Frozen shoulder can’t be seen on an Xray, Ultrasound, MRI scan or CT scan. It requires careful examination the purpose of investigative scans is to exclude other conditions that may cause similar symptoms.

The essential problem of frozen shoulder is a stiffening in the capsule, or lining, of the shoulder joint. As the capsule starts stiffening, a painful ache persists, which worsens as the stiffness becomes severe and starts limiting movement. After some months, the ache gives way to painful restrictions of activity. The shoulder needs to lose a large amount of free movement before it becomes noticeable, but normal everyday movements such as shaving, applying deodorant or putting on a jacket become difficult to perform.

Luckily there are many ways to treat this condition. However, active treatment is usually only considered if day to day life is being affected, work/sport are being disrupted, and sleep is drastically disturbed. Unfortunately, there is no quick fix, pill or injection that will fix frozen shoulder – so don’t believe anyone claiming an instant miracle cure.

The traditional methods of treatment generally include pain control (drugs, acupuncture or injections), modifying activity and sleep positions, and addressing anxiety and misconceptions. If this is not successful at controlling the impact of the condition, then more interventional measures are available to consider. However, these all come with measurable risk, pain and inconvenience, which all must be considered before moving forward.

There are three main interventions for frozen shoulder including, Hydrodilatation, Manipulation under anaesthesia, and Arthroscopic capsular release. Hydrodilatation is a series of high-pressure injections of steroid and saline into the joint with two to three-month intervals. This has the advantage of not involving surgery, but is often very painful, and can take a long time to work. The two surgical options are manipulation or arthroscopic (keyhole) surgery. These have the advantage of a ‘short cut’ to relive the condition, but require a hospital stay and then a recovery period.

At the end of the day, it will be a discussion between you and your consultant as to what course of treatment will be the most appropriate.

Mr Dan Rossouw

Mr Rossouw has a keen interest in shoulder surgery and the management of shoulder conditions, including rotator cuff injuries, shoulder instability and shoulder dislocations. He has undertaken extensive research on rotator cuff repair and shoulder arthroscopy. He is an enthusiastic and highly regarded trainer amongst his colleagues. Mr Rossouw is a Consultant Orthopaedic Surgeon for Barnet and Chase Farm Hospital and has joined the Orthopaedic faculty of the Royal Free London NHS Foundation Trust.

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