Frozen Shoulder

A true frozen shoulder is a very painful condition which results in a gross reduction in movement of the shoulder in all directions. The other common shoulder condition, rotator cuff tendinopathy or impingement syndrome, is often characterized by a loss of elevation, but rarely rotation. Osteoarthritis rarely affects the shoulder joint.

The cause of a frozen shoulder is a bit of a mystery. It is a rare condition generally, but tends to affect mostly women at the menopausal age. A traumatic shoulder injury or surgery may precipitate its onset, but it may simply arise for no specific reason. It then tends to run through 3 stages, and recovery can take more than one year at times.

The initial stage is characterised by severe pain. Often there is disturbed sleep at night. This stage can last 3-8 months. The second stage is the “stiffness” stage. The shoulder can get stiffer in this stage, but the night pain will usually subside. The third “thawing” stage is when the shoulder starts to regain its mobility.

Treatment is difficult in the first stage due to the pain. The aim is to maintain as much movement as possible. I have found anecdotally that intra-articular cortisone injections to be of some benefit. Mobilisation can be more aggressively performed in the second stage, once the initial pain subsides. Physiotherapy is usually adequate to manage this condition, but surgical options are available if the condition is recalcitrant. This may include manipulation under anaesthesia or arthroscopic (keyhole) surgery to release the adhesions.

Progress can be frustratingly slow, but it is encouraging to know that it is a self-limiting condition and things will eventually get better. It is very unlikely that the condition will re-occur or affect the other shoulder.