Most of you will have heard of Frozen Shoulder; many of you will know someone who has had it and some of you will have had it yourselves. But what actually is a Frozen Shoulder?
It isn’t just a painful shoulder and it isn’t just a shoulder that you can’t move. It is defined as a global loss of passive movement with normal x-rays. And that means that not only can you not move it but your doctor can’t move it for you. The x-ray is absolutely essential and the diagnosis of Frozen Shoulder cannot be made without an x-ray because, especially in the older patient, arthritis is the other cause of a stiff shoulder.
The shoulder is a ball and socket joint surrounded by lots of layers: skin, fat, muscles, ligaments and tendons that hold it together and move it around.
Those are all normal in a Frozen Shoulder, but what isn’t normal is the inside lining of the joint called the capsule. Normally this is thin and stretchy – like Lycra – but in a Frozen Shoulder something upsets it causing it to thicken and lose its elasticity and that causes the pain and loss of movement.
Although not necessarily obvious, there is always a trigger that causes the shoulder to freeze. It doesn’t have to be anything dramatic and may occur weeks or even months before you realise there is something wrong.
The trigger can be more obvious: after surgery on the arm or chest or after a fall. In its early stages a Frozen Shoulder can be a difficult thing to diagnose because the symptoms can be identical to tendonitis – painful when you move it but still moving reasonably well – this is stage one: ‘freezing’. This means that Frozen Shoulder is misdiagnosed three times out of four such that 75% of people who are told they don’t have a Frozen Shoulder actually do and the other way round. Usually by the time you get to see me the condition has progressed and you will be in stage two: ‘frozen’. This is where the shoulder simply doesn’t move. If you lie on the floor and stretch both arms overhead the good hand will hit the carpet but the bad one won’t and if you bend your elbow, tuck it in to your side and try and move the hand out sideways – it won’t go all the way.
The final stage is ‘defrosting’ where the capsule slowly and steadily recovers and the movement returns to normal or nearly normal. Left to their own devices most Frozen Shoulders get better which, on average, takes about 18 months. Caught in the freezing-up stage then injections of steroid and hydro dilatation to the ball and socket joint might help with the pain. Physiotherapy does not help and can make the condition last longer. If you don’t want to wait then you can have an operation to accelerate the process and you can find details of the procedure and the recovery on my website. About half my patients choose surgery and half opt to let nature take its course – that decision is up to you. Frozen Shoulder is a very common condition which all too often, is misdiagnosed. It will get better by itself, but if you can’t cope with the loss of movement and function then a keyhole operation will get you better quicker.
Mr Richard Sinnerton, FRCS FRCS (Tr & Orth), Consultant Orthopaedic Surgeon