Adhesive Capsulitis (frozen shoulder)

What is it?

Adhesive capsulitis or frozen shoulder is a condition where the shoulder is exquisitely painful and very stiff. Pain is constant and at rest.

It is a poorly understood condition; it often starts suddenly and without warning and may be triggered by mild trauma or even surgery. It is the capsule of the joint that is affected. It becomes inflamed and then contracts.

capsule of the shoulder joint

It is well documented that there is an association with diabetes mellitus, hypercholesterolaemia, hear disease or a condition known as Dupuytren’s disease

There are typically three stages:

  • Increasing pain, gradual loss of movement and pain at night
  • Pain settles but shoulder remains very stiff
  • Resolution and restoration of movement

The natural history of the condition is that it normally resolves spontaneously but this can be between 12 and 48 months after onset.

Will I need any tests/scans?

It is likely that X-rays and an Ultrasound scan will be requested for adhesive capsulitis to make the diagnosis. MRI maybe requested if any concomitant intra-articular pathology is suspected. Please see the section Surgery FAQs to see if you will need any other tests e.g. blood tests before your surgery.

How is it treated?

Physiotherapy and good analgesia forms the mainstay of non-operative treatment. In addition, cortisone injections may be used.

Hydrodilatation of the shoulder, often incorporating cortisone is a treatment that is administered via an injection into the shoulder under X-ray control. Mr Patel carries this out under regional or general anaeathesia and as a day case procedure. A large volume of fluid (saline) is injected into the shoulder to distend the contracted capsule, thus aiming to relieve pain and improve movement. Although a successful treatment strategy, the relief has been reported to be temporary in some studies.

Surgery involves shoulder arthroscopy and releasing of the tight capsule using a special radio-frequency probe: arthroscopic capsular release. It is a very accurate way of releasing the contracted capsule and can be very successful, provided physiotherapy is implemented soon after the procedure and adhered to.

With both the above procedures, a manipulation under anaesthetic can also be carried out to improve the stiffness.

Can I go home the same day?

More often than not, as with most arthroscopic surgery, this is a day case procedure. Occasionally an overnight stay is advised depending on post-operative comfort levels, medical co-morbidity and time of day of the surgery.

What about after the operation?

With this condition, early movemnet and as much as possible is desireable. You will see a physiotherapist before discharge to be instructed on simple exercises to carry out. You should aim to exercise the shoulder 3-4 times a day; although the shoulder will be sore to start, there should be no lasting pain or pain that is not alleviated by the analgesia prescribed to take home. Sleeping with a pillow under the shoulder is recommended. It will be painful to sleep on the side of the operated arm for several weeks.

There are no restrictions of movement. It is recommended that you have out-patient physiotherapy set up prior to the procedure so that it can start immediately after surgery (including hydrodilatation).

You will be prescribed analgesia to take home and Mr Patel strongly advocates its use to keep pain to a minimum; it should be noted that pain is more difficult to control if allowed to establish itself. Mr Patel recommends the regular application of ice as an adjunct to relieve pain and swelling in the acute post-operative period.

You will see Mr Patel two weeks after surgery for a wound check (and stitch removal) and a physiotherapy program will ensue thereafter which is paramount to the success of the operation.

For this procedure, Mr Patel recommends return to work and activity, including driving, when you feel able.

What are the potential complications?

All surgery carries a risk. Specific risks to arthroscopic capsular release are:

Infection – this can be either superficial (portals) or within the joint. You will be given antibiotics to reduce this risk.

Stiffness – It is very important that some mobility of the shoulder is maintained after surgery. The physiotherapist will advise on simple exercises that can be carried out at home. Mr Patel also recommends that you take regular analgesia and use ice (see Surgery FAQs) to help minimise post-operative discomfort and facilitate early movements.

Bleeding – this may require a return to the operating room for removal of blood clots and to stop the bleeding.

Neurological – patients often describe a patch of numbness or a heavy feeling around the shoulder in the early post-operative phase. This is commonly swelling related and resolves as swelling reduces and full shoulder mobility is recovered.