Halting the agony of a frozen shoulder – in just 15 minutes

ASIMPLE i njection i s saving patients the agony of a ‘frozen’ shoulder. The 15-minute procedure brings instant relief and could spare thousands from invasive surgery.

While steroid injections have long been given to lessen pain and improve movement in the shoulder, the new technique also stretches tissue in the joint out again, loosening it.

Up to five per cent of adults develop a frozen shoulder at some point, for reasons not fully understood. Most commonly, cases appear after a small injury which results from stretching or over-reaching.

The part of the shoulder affected is the capsule. This contains ligaments that are elastic, allowing the shoulder to move freely.

But with frozen shoulder, the capsule and ligaments become inflamed, swollen and tight, causing pain and stiffness as scar tissue forms inside the joint. Patients may develop such limited mobility that they struggle to reach a back pocket or fasten a bra.

Without treatment, most frozen shoulders take up to four years to improve as the condition goes through a cycle of inflammation, scarring and then healing. However, up to 15 per cent of patients are left with a permanent inability to raise their arm fully.

Until now, surgical procedures to either tear or release the capsule have been offered. But this often means a general anaesthetic, and recovery can be slow and painful. In contrast, the new technique, known as hydrodilatation, is done under local anaesthetic as an outpatient procedure.

It involves an injection containing a steroid to reduce inflammation and pain, and also saline to expand the over-tight capsule, stretching out scar t i ssue and l oosening the shoulder.

A new study, to be published in the Journal Of Orthopaedics, involving 350 patients who had the injection, found that 99 per cent went back to their previous job, and 85 per cent returned to their previous level of exercise within six weeks.

‘ Patients with frozen shoulder often cannot sleep or cope with the pain, and painkillers generally do little to help,’ says Professor Lennard Funk, consultant orthopaedic surgeon at Wrightington Hospital in Lancashire and one of the authors of the study.

‘Now they can be offered a simple injection to improve their range of movement as well as relieving the pain. It also works immediately, sparing them from invasive surgery.’ First, a local anaesthetic is injected into the back of the shoulder. Then a mixture of saline and steroid is inserted directly into the joint using ultrasound images to guide the clinician – usually a radiologist or surgeon. Depending on the size of the joint, around four tablespoons of the solution are used.

THE fluid expands the capsule, and the patient may feel pressure in their shoulder. The clinician continues i njecti ng f l ui d until the capsule is full and they hear a popping sound. Afterwards, the patient does physiotherapy exercises to keep the joint mobile. Many people in this trial had recovered fully within three months.

Farmer Linda Clancy, 57, from Cheshire, started feeling pain in her right shoulder last year. ‘ At first I thought I’d pulled a muscle in the gym, but over the next few weeks it got worse,’ she says.

‘ When I was handling sheep, they’d jump and wrench my shoulder – and the pain was so bad at night I couldn’t sleep properly.’

After physiotherapy failed to ease the problem, Linda sought the help of Prof Funk. ‘I felt the pressure in my shoulder building, and suddenly it released, she says. ‘The pain went instantly and I could raise my arm again, whereas before I could only lift it as high as my waist,’ she says. ‘The difference is amazing.’

The technique is widely available both on the NHS and privately and costs between £150 and £300, compared to up £6,000 for surgery.