Do you have a 'Frozen Shoulder'?
Do you have a frozen shoulder?
Shoulder joints are the most mobile joints in our bodies,[i] but we tend to take them for granted, until something goes wrong with them. It’s then that we realise how important shoulders are to every part of our lives, from getting a good night’s sleep to driving a car.
The symptoms of frozen shoulder can vary a lot from one person to another, so yours may not exactly match the descriptions you hear from other people.[ii] .
The symptoms are often divided into three stages.
As a general guide, stage one starts with an acheing shoulder, and you’ll find it painful to reach out to pick something up. In stage two your shoulder muscles may become very stiff, but the pain tends to stay much the same. In stage three you should find that you can move your shoulder more and your pain and stiffness decrease.[iii]
“It’s important to get the diagnosis right,” explains Mr. Per Anderburg, Consultant Orthopaedic Surgeon at Horder Healthcare. “First, you should have an X-Ray or MRI scan through your GP, to see if you need a referral to a surgeon to find out the cause of the pain.”
Seeing your GP first should help you get the right diagnosis, and the right treatment. And getting treatment quickly can speed up your recovery. People with frozen shoulder often leave it until they are in quite a lot of pain before they seek help.
Who has Frozen Shoulder?
It’s mostly people aged 40 to 60, and women are more likely to have this than men. If you’ve had an injury to your shoulder or arm, or even if you’ve had shoulder surgery, this can increase your risk of having frozen shoulder.
There are also health conditions that can increase your likelihood of having this condition. Top of this list is diabetes, but heart disease, stroke, lung disease and breast cancer, can increase your risk too. Being immobile, possibly because of an illness or injury, or being hospitalized, can also make you more likely to have frozen shoulder.[iv] This condition affects about three % of adults in the UK.[v]
What causes Frozen Shoulder?
It isn’t always easy to know why you’ve developed frozen shoulder. “Sometimes it comes on for no apparent reason,” explains physiotherapist Sammy Margo. “But when we start asking people about themselves we often find that they may not have been moving about as much recently. Or they may have had surgery, and have been holding themselves or sleeping differently, and so their shoulder started stiffening up. There’s always a story behind it.”
As a surgeon, Per Anderburg is most interested in secondary frozen shoulders. “This can happen when you have done something to injure your shoulder. We’re talking about very small things – actions most people don’t even remember doing. It could happen when you take your jumper off, or reach for something. These are very limited injuries that can create a little inflammation or even bleeding.”
“In some cases this can become chronic inflammation, which can go into the tendon, and can cause scar tissue between the tendon and the surrounding capsule,” explains Per Anderburg.
And this can be enough to trigger the problem.
What is Frozen Shoulder?
Known as Adhesive Capsulitis of the shoulder, frozen shoulder happens when the capsule of thin tissue that surrounds your shoulder, thickens and tightens up. This may be because scar tissue has formed in the tissue of the capsule.[vi] This tightening makes it difficult for your shoulder to move as much as it should, and leads to stiffness and pain.
Treating Frozen Shoulder
There are two main ways of treating frozen shoulder - through physiotherapy and/or surgery, although your GP may suggest painkillers like paracetamol or ibuprofen to begin with.[vii] Your doctor may also suggest you have steroid injections in your painful shoulder. These won’t cure the problem, but can ease your symptoms in the short term.[viii]
“Normally people with frozen shoulder come to us after the stiffness, once it starts being painful. We’d like to see them earlier because we can fix the problem more quickly then,” says Sammy Margo.
“Our treatment for frozen shoulder includes massage, stretching and acupuncture. We also do exercises to help mobilize the joint, strengthening, and a home exercise programme, which is important to recovery.”
“People start to feel less pain after about six to eight half-hour treatments – that’s the national average.” But achieving full – or almost full – recovery can be a long process. For some people it may involve a course of physiotherapy treatments, a corticosteroid injection, more physiotherapy, and possibly another steroid injection, and then surgery. “At that point, you may be six to nine months down the line,” explains Sammy Margo.
The recovery period for a quite severe frozen shoulder can be as long as 18 months to two years. “Sometimes people don’t see a surgeon for well over a year, and it’s not right that they should be in pain for that long, says Per Anderburg, “ I think they should see a surgeon within three to four months.”
During surgery for frozen shoulder, Per Anderburg adds a nerve block to the anaesthetic, to help with post-operative pain. “Then the first thing I do is gentle manipulation, to break loose the scar tissue formation in the capsule, and sometimes between the rotator cuff tendon and the capsule. “
“Next, I put my scope inside and look at the shoulder joint and the bursa (a small capsule of fluid that cushions the tendons). I remove any scar tissue, repair any tears in the tendons and create more space for them.” In most cases you can do all this with keyhole surgery.”
The first few weeks after surgery can be painful, warns Per Anderburg, but it does get better, and physiotherapy helps. In most cases you can go back to light work after two to three weeks, and should see the full effect of the operation after three to four months.
· [v] http://patient.info/doctor/adhesive-capsulitis-of-the-shoulder