Is It Really Frozen Shoulder?
What is Frozen Shoulder?
How common is it?
- The first is the 'freezing' phase - pain is the main symptom. As pain worsens, the shoulder loses motion. This may last from six weeks to nine months.
- The second phase is the 'frozen' phase - with time pain becomes less and stiffness becomes a more prominent feature. This generally lasts four months to nine months.
- The third phase is the 'thawing' phase - resolution of symptoms (both pain and stiffness). This may last five months to two years.
How to make the diagnosis?
Symmetrical external rotation in normal shoulders
"The cardinal sign of frozen shoulder is loss of external rotation."
Does MRI help?
"Frozen shoulder generally gets better on its own, but it can take years!"
What are the differential diagnoses?
2. rotator cuff tear
In the initial phase, the treatment is anti-inflammatory medication and physiotherapy for shoulder stretching exercises. The stretching exercises should be gentle.
If there is no significant improvement, the next step is steroid injection. This is very safe, as the steroid stays in the shoulder. It reduces the inflammation inside the joint and relieves pain, so that stretching exercises can be more effective.
If problems continue, the next step is arthroscopic capsular release. This is 'keyhole surgery'. The capsule is cut with a tiny pair of scissors allowing the shoulder to move normally again. Vigorous post-operative physiotherapy keeps the shoulder movement gained at operation. Most patients have a very quick recovery after arthroscopic release [1-3]. This is a modern version of ‘manipulation under anaesthesia’ where the surgeon moves the shoulder to tear the capsule - it works, but it is pretty sore afterwards, whereas when the capsule is cut instead of torn it is not especially sore.
Inflamed joint lining in frozen shoulder looks like soft coral (Arrow)
"Most patients have a very quick recovery after arthroscopic release"
1. Baums MH, Spahn G, Nozaki M, Steckel H, Schultz W, 1. Klinger HM. Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis. Knee Surg Sports Traumatol Arthrosc. 2007 May;15(5):638-44.
2. Warner JJ, Allen A, Marks PH, Wong P. Arthroscopic Release for Chronic, Refractory Adhesive Capsulitis of the Shoulder. J Bone Joint Surg Am 1996 78: 1808-16.
3. Hannafin JA, Chiaia TA. Adhesive capsulitis. A treatment approach. Clin Orthop Relat Res. 2000 Mar;(372):95-109.
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