Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder, or adhesive capsulitis, is a condition that makes the shoulder joint stiff, painful, and hard to move. This article explains what frozen shoulder is, what causes it, how it is treated, and the role of steroid injections.

What is Frozen Shoulder?

Frozen shoulder occurs when the connective tissue surrounding the shoulder joint (the shoulder capsule) becomes inflamed, thickened, and contracted. This leads to pain, stiffness, and a reduced range of motion. The condition typically progresses through three stages:

1. Freezing Stage: Pain develops gradually, and the shoulder’s range of motion starts to decrease.

2. Frozen Stage: Pain may diminish, but stiffness becomes more pronounced, limiting mobility.

3. Thawing Stage: The shoulder’s range of motion slowly improves, often over several months or years.

Causes and Risk Factors

The exact cause of frozen shoulder is not always clear, but certain factors increase the risk:

• Age and Gender: Most common in individuals aged 40 to 60, with women being more frequently affected.

• Diabetes: Individuals with diabetes have a significantly higher risk of developing frozen shoulder.

• Immobilisation: Extended periods of shoulder immobility due to injury, surgery, or other conditions can contribute to its development.

• Other Medical Conditions: Thyroid disorders, cardiovascular disease, and Parkinson’s disease are also associated with a higher risk.

Treatment Options

Managing frozen shoulder requires a multifaceted approach aimed at reducing pain and restoring mobility. Common treatments include:

• Physiotherapy:

  • Stretching and strengthening exercises tailored to improve shoulder mobility and reduce stiffness.

  • Manual therapy techniques performed by a physiotherapist to enhance joint mobility.

• Pain Management: Over-the-counter medications like paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs).

• Steroid Joint Injections: Corticosteroid injections into the shoulder joint can reduce inflammation and alleviate pain, especially in the early stages of frozen shoulder.

• Hydrodilatation: A procedure in which saline and steroid solutions are injected into the joint to stretch the capsule and improve movement.

• Surgical Intervention: In severe cases, procedures such as manipulation under anaesthesia or arthroscopic capsular release may be necessary.

The Role of Steroid Joint Injections

Steroid injections are a widely used treatment option for frozen shoulder, and particularly beneficial if given in the early 'freezing' stage. The benefits of steroid injections include:

• Rapid Pain Relief: Corticosteroids reduce inflammation quickly, helping to alleviate pain within days to weeks and facilitate participation in physical therapy.

• Improved Mobility: By reducing inflammation, steroid injections can decrease stiffness, allowing for improved joint function.

• Excellent adjunct to physiotherapy: When combined with a structured physiotherapy program, steroid injections can enhance overall outcomes.

Considerations for Steroid Injections

Shoulder steroid injections are effective, but they are not without risks. A good summary of potential risks can be found in our FAQs, here.

Conclusion

Frozen shoulder requires a comprehensive treatment approach. Steroid joint injections can make it easier for patients to engage in physiotherapy and regain mobility.

If you’re struggling with frozen shoulder, you can contact us to discuss your needs, or book in directly for a consultation.

References

1. Dias, R., Cutts, S., & Massoud, S. (2005). Frozen shoulder. BMJ, 331(7530), 1453-1456.

2. Neviaser, A. S., & Hannafin, J. A. (2010). Adhesive capsulitis: A review of current treatment. American Journal of Sports Medicine, 38(11), 2346-2356.

3. Diercks, R. L., & Stevens, M. (2004). Gentle thawing of the frozen shoulder: A prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years. Journal of Shoulder and Elbow Surgery, 13(5), 499-502.

4. Buchbinder, R., Green, S., & Youd, J. M. (2003). Corticosteroid injections for shoulder pain. Cochrane Database of Systematic Reviews, 2003(1), CD004016.

5. Uppal, H. S., Evans, J. P., & Smith, C. (2015). Frozen shoulder: A systematic review of therapeutic options. World Journal of Orthopedics, 6(2), 263-268.

6. Griesser, M. J., Harris, J. D., Campbell, J. E., & Jones, G. L. (2011). Adhesive capsulitis of the shoulder: A systematic review of the effectiveness of intra-articular corticosteroid injections. Journal of Bone and Joint Surgery, 93(18), 1727-1733.