Adhesive Capsulitis (frozen shoulder)

Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder. Frozen shoulder is a common condition in which the articular shoulder capsule (a sac of ligaments surrounding the joint) swells and stiffens, restricting its mobility. It typically affects only one shoulder, but one in five cases affect both.


Causes

The capsule of the shoulder joint has ligaments that hold the shoulder bones to each other. When the capsule becomes inflamed, the shoulder bones are unable to move freely in the joint.
Most of the time there is no cause for frozen shoulder. Risk factors include:

Symptoms

The main symptoms are:

Frozen shoulder without any known cause starts with pain. This pain prevents you from moving your arm. Lacks of movement leads to stiffness and then even less motion. Over time, you become unable to do movements such as reaching over your head or behind you.


Treatments -

The aim of treatment is to ease pain and stiffness; also, to keep the range of shoulder movement as good as possible whilst waiting for the condition to clear. One or more of the following may be advised to help ease and prevent symptoms:


Painkillers

Paracetamol may be advised first to try to control the pain. Codeine is a stronger painkiller which may be used as an alternative to, or in addition to, paracetamol.
Anti-inflammatory painkillers - Anti-inflammatory painkillers includes ibuprofen, diclofenac and naproxen. These drugs work by helping to ease pain and also by reducing any swelling (inflammation) in your shoulder.


Shoulder exercises

These are commonly advised. The aim is to keep the shoulder from 'stiffening up' and to keep movement as full as possible. For most benefit, it is important to do the exercises regularly, as instructed by a doctor or physiotherapist.


Physiotherapy

Many people are referred to a physiotherapist who can give expert advice on the best exercises to use. Also, they may try other pain-relieving techniques such as warm or cold temperature packs and transcutaneous electrical nerve stimulation (TENS) machines.


A steroid injection

An injection into, or near to, the shoulder joint brings good relief of symptoms for several weeks in some cases. Steroids reduce inflammation. It is not a cure, as symptoms tend to gradually return. However, many people welcome the relief that a steroid injection can bring.


Surgery

An operation is sometimes considered if other treatments do not help. Techniques that are used include:
Manipulation - This is a procedure where the shoulder is moved around by the surgeon while you are under anaesthetic.
Arthroscopic capsular release - This is a relatively small operation done as 'keyhole' surgery. It is often done as a day-case procedure. In this procedure, the tight capsule of the joint is released with a special probe.