Dr Graeme MacDougal

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SYDNEY ORTHOPAEDIC SHOULDER AND ELBOW SURGEON

SYDNEY ORTHOPAEDIC SHOULDER AND ELBOW SURGEON

Frozen Shoulder (Adhesive Capsulitis)

Adhesive capsulitis is a condition which involves the glenohumeral (ball and socket joint) of the shoulder, and in particular causes a contracture of the joint capsule.

Its incidence may be as high as 5% of the normal population but the incidence is increased in those who have a tendency toward diabetes, hypercholesterolemia and underactive thyroid disease. It is usually limited to one shoulder at a time, but occasionally occurs in both shoulders simultaneously.

The cause of frozen shoulder is unknown, although many patients attribute its origin to minor traumatic episodes. It should be differentiated from shoulder stiffness, which occurs after severe trauma of the shoulder, such as fractures and dislocations or following surgery of the shoulder which are better termed ‘post-traumatic stiff shoulders’. This differentiation is important because the natural history of adhesive capsulitis (without history of trauma or surgery) is towards spontaneous resolution over a period of nine months to two years. Post-traumatic stiff shoulders tend to follow a variable course and should not be considered a true idiopathic frozen shoulder.

Symptoms of frozen shoulder are those of pain and restricted range of motion, for example the pain is particularly strong at night and at the end range of motion when reaching or attempting to reach overhead. The diagnostic clinical finding is a global restriction of range of motion, both active and passive movements, with a normal appearing X-ray (no arthritis of the joint) and a progressive loss of range of motion.

Note that the symptoms related to rotator cuff disease and impingement may be similar to frozen shoulder symptoms in the early phase of the capsulitic process.

TREATMENT OF FROZEN SHOULDER


The natural history is towards spontaneous resolution with no treatment at all, but one should tailor the treatment options to the individual patient’s needs.

The capsulitic shoulder responds well to application of heat for temporary pain relief and hydrotherapy can work to relieve symptoms. These two measures do not change the natural history of the condition or reduce the loss of range of motion.
Physiotherapy and other forms of manipulative therapy are unlikely to improve frozen shoulder in the early phase of this condition and may actually aggravate the problem.

Corticosteroid injection given into the glenohumeral joint and sometimes combined with a saline hydrodilation may relieve symptoms of pain and also increase range of motion, but the response to these injections is variable. These injections are usually done by the radiologist at the request of the treating specialist.

Prior to arthroscopy, manipulation under anaesthetic was a common treatment of frozen shoulder but this essentially induced tearing of the contracted capsule, and potentially other structures.

With the advent of arthroscopic procedures, a selective arthroscopic circumferential capsular release by electrocautery can restore range of motion, and when combined with synovectomy, marked pain reduction is achieved.

For best results this arthroscopic surgical procedure needs to be combined with a motivated and compliant patient, with excellent physiotherapy and hydrotherapy postoperatively.

SUMMARY


The cause of frozen shoulder is unknown. Its natural history is toward spontaneous resolution over nine months to a two year period if no treatment is given at all.

Treatment is available as described above, and most patients settle with non-operative management once an explanation of the pathology has occurred.

Heat and corticosteroid injections may give temporary relief and if a more definitive or accelerated recovery from the condition is required because of severe symptoms, arthroscopy capsular release is available to be performed.

SUMMARY


The cause of frozen shoulder is unknown. Its natural history is toward spontaneous resolution over nine months to a two year period if no treatment is given at all.

Treatment is available as described above, and most patients settle with non-operative management once an explanation of the pathology has occurred.

Heat and corticosteroid injections may give temporary relief and if a more definitive or accelerated recovery from the condition is required because of severe symptoms, arthroscopy capsular release is available to be performed.
  Any surgical or invasive procedure carries risks. Should you wish to discuss your frozen shoulder treatment options with Dr MacDougal, please make an appointment to do so in order that your individual treatment needs can be prescribed for your particular situation.

Graeme MacDougal Shoulder and Elbow Surgeon

North Sydney Sports Medicine Centre
60 Pacific Highway
St Leonards NSW 2065