Mr. Richard Dallalana
MBBS FRACS FAOrthA

Background

Frozen shoulder is also called adhesive capsulitis. It is a common condition which is characterized by pain and restricted motion in the shoulder. The exact cause of the condition is unknown however it usually starts spontaneously. At other times there may be an initiating event such as an injury or surgery to the shoulder.

It usually occurs from middle age and onward and is very common in people with diabetes and in women. Often both shoulders are affected, separated by a short period of time.

Although the underlying cause is unknown the abnormalities noted are of a profound inflammation of the lining of the shoulder joint and subsequent scarring and tightening of the ligaments and capsule surrounding the shoulder joint. The inflammation results in pain, and the scarring reduces movement.

Prognosis

The natural course of this condition is for it to dissipate by itself after 18-24 months. During this period of time it classically follows the following process:-

  1. approximately 6 months of pain and restricted motion;
  2. a further 6 months of predominantly restricted motion with less pain;
  3. 6 months of a gradual ìthawingî where pain resolves and movement improves.

At the end of this period of time most people have recovered fully however a small percentage has a permanent small restriction in motion. It is rarely of functional significance.


Fig.1 Frozen shoulder
Fig.2 Normal shoulder

Treatment

The first stage in treatment is to ensure that the diagnosis is correct. There are conditions which can mimic this condition such as arthritis and these need to be ruled out to start with.

Analgesics and anti inflammatories can be helpful to control the symptoms. The arm can be used for most activities within the limits of pain and the available movement.

Many forms of therapy have been tried however very few things are actually able to influence the natural course of this condition. Physiotherapy focusing on stretching exercises helps to maintain strength and function but will not speed up recovery from the condition.

The two recommended forms of treatment are as follows:-

Hydrodilatation

Hydrodilatation is an injection administered by radiologists whereby fluid under pressure is injected directly in to the joint. This fluid pressure helps to break down some scarring and contraction of the capsule. Cortisone in the fluid suppresses the inflammation of the lining and contributes to the effect.

The injection has a high success rate at alleviating at least some of the pain and stiffness. It is often painful to have it administered however only momentarily so. If it is somewhat effective however the symptoms return then it can be repeated. If performed early in the disease process it can shorten the time frame to natural resolution of the condition.

Surgery

Should the condition be unacceptable to tolerate and hydrodilatation fails then a relatively minor surgical procedure can be performed which also is shown to help improve movement, reduce pain and shorten the natural course of the condition. Surgery is performed under general anaesthetic and it involves a forceful manipulation or stretch of the shoulder joint to stretch out the capsule and break down some of the scar tissue followed by an arthroscopy of the shoulder to remove the blood which results from the stretching procedure, to remove some of the inflamed lining of the joint, and to divide any scarring or tight areas of capsule which could not be alleviated through the stretch alone.

The procedure is performed as either a day case or with an overnight stay in hospital. Following this a physiotherapy led exercise program will be commenced so that the gains in range of motion can be maintained. A sling is not required after the surgery and the arm may be used normally within comfort levels.

Complications of this procedure include infection, persistent stiffness, anaesthetic related issues or rarely damage to nerves or blood vessels passing by the shoulder. When considering this surgery these all need to be weighed up in light of the potential benefit in the knowledge that the condition in most circumstances will resolve by itself with time.

Non-urgent matters should be listed for discussion at the next review with Mr. Dallalana or alternatively queries can be directed via e-mail at dallar@parkclinic.com.au or by calling the rooms.
Certificates can be obtained at review or by your GP at other times.

Rooms at71/166 Gipps St. East Melbourne 3002
and Suite 54, Cabrini Medical centre, Isabella St. Malvern

Phone(03) 8415 1907
(03) 9928 6555 (Mercy Private Hospital)
(03) 9508 1222 (Cabrini Hospital)

Emaildallar@parkclinic.com.au