WHAT IS A FROZEN SHOULDER?
My Weekly’s favourite GP from TV and radio writes for you
Your shoulders can move more, in more directions, than any other joint in your body – hardly surprising that occasionally something goes wrong.
Like your hip, your shoulder is a “ball and socket” joint. The ball is at the head of your humerus (the bone in your upper arm) and it sits in a cup formed from bone at the end of your shoulder blade. The end of your collarbone also forms part of the joint, and a “cuff” of muscles called the rotator cuff pull it in all directions. To stabilise the joint, there’s a capsule of tough connective tissue around it. This arrangement allows maximum movement with minimum risk of the shoulder dislocating – although shoulders dislocate more often than other joints because the “cup” is shallow.
Frozen shoulder is most common in your 40s to mid 60s, and affects up to 1 in 20 people. You’re more likely to suffer with it if you’re a woman or have other conditions like diabetes, heart disease, stroke or overactive thyroid. It’s not the same as arthritis, and although it can happen after a shoulder injury, it usually starts for no apparent reason.
Frozen shoulder is sometimes called “adhesive capsulitis” – in other words, the shoulder capsule gets inflamed (the medical term for inflammation is “-itis”) and scar tissue forms that sticks the joint together. Most often, it affects the shoulder you don’t write with. If this happens, you’ll find your shoulder is stiff and you can’t move it as far as you could. It’s often very painful, especially when you move but also when you lie on it at
ALTHOUGH FROZEN SHOULDER USUALLY CAN’T BE “CURED” QUICKLY, MOST PEOPLE WILL RECOVER NATURALLY WITHIN ABOUT 2 YEARS IN TOTAL
night or even when resting.
The first “freezing” phase is usually most painful, and typically lasts 2-9 months. During this time, stiffness and reduced movement gradually worsen until they peak as the pain wears off. This “frozen” phase typically lasts 4-12 months in which you may find rotating your shoulder is a particular problem. Finally in the “thawing” phase, your shoulder gradually gets back to normal over 1-3 years.
Almost every arm movement involves the shoulder, so frozen shoulder can interfere with everything from driving to brushing your hair. Pain relief is important in the first few months. Your doctor may offer paracetamol, anti-inflammatory tablets like naproxen or ibuprofen and codeine-containing tablets (or patches that release a steady dose of strong pain relief). Steroid injections into the joint are an option if the pain is severe, although you’ll need to wait several weeks between injections and can only have 3 due to the risk of damage to your joint.
Physiotherapy can make a huge difference to pain and range of movement. Your physio may use a combination of stretching exercises, massage and hot/cold packs and advise on exercises to do at home. There’s little or no evidence that treatments like TENS machines (which deliver tiny electrical impulses) and acupuncture help, so they are not recommended in guidelines. If you’re still suffering severely there are surgical options, all done by an orthopaedic surgeon under anaesthetic. These include manipulating your shoulder to stretch and break down scar tissue in the capsule, or inserting a tiny telescope into the joint and using radio waves to break down the scar tissue. You’ll go home the same day but will need physiotherapy. Next week: Sepsis awareness
COLD COMFORT – IT’S HIGHLY UNLIKELY THAT YOU’LL EVER GET FROZEN SHOULDER AGAIN IN THE SAME SHOULDER IF YOU’VE HAD IT ONCE
PHYSIO CAN MAKE A BIG DIFFERENCE TO PAIN AS WELL AS STIFFNESS AND RANGE OF MOVEMENT’’