By guest blogger Mr Richard Sinnerton, Consultant Orthopaedic Surgeon...
What is a frozen shoulder?
Many of you will know patients who have had had a frozen shoulder, and some of you will have had it yourselves. It isn’t just a painful shoulder and it isn’t just a shoulder that you can’t move. It is defined as a ‘global loss of passive movement with normal x-rays’. And that means that not only can the sufferer not move it, but a clinician will be unable to move it either.
How is it diagnosed?
An x-ray is absolutely essential and diagnosis cannot be made without one since, especially in the older patient, arthritis is another cause of a stiff shoulder.
What causes frozen shoulder?
The shoulder is a ball-and-socket joint surrounded by lots of layers that hold it together and move it around: skin, fat, muscles, ligaments and tendons. Those are all normal in a frozen shoulder; what isn’t normal though is the inside lining of the joint - the capsule. Normally this is thin and stretchy, but in a frozen shoulder something upsets it causing it to thicken and lose its elasticity. That is what causes the pain and loss of movement.
There is always a trigger that causes the shoulder to freeze. In some cases it may not be an obvious cause and may even occur weeks or even months before the patient realises there is something wrong. In other cases, the trigger may be more obvious, for example after surgery on the arm or chest, or after a fall.
The stages of frozen shoulder
Stage 1: Freezing
In its early stages, a frozen shoulder can be a difficult thing to diagnose because the symptoms can be identical to tendonitis – painful when moved, but still moving reasonably well. This stage is called ‘freezing’. As a consequence, frozen shoulder is misdiagnosed three times out of four, such that 75% of people who are told they don’t have a frozen shoulder actually do, and vice versa.
Stage 2: Frozen
Usually by the time the patient sees a specialist, the condition has progressed and they will be in stage two: ‘frozen’. This is where the shoulder simply doesn’t move. If a patient at this stage lies on the floor and stretches both arms overhead, the good hand will hit the carpet but the bad one won’t and if they bend their elbow, tuck it in to their side and try and move the hand out sideways – it won’t go all the way.
Stage 3: Defrosting
The final stage is ‘defrosting’ where the capsule slowly and steadily recovers and the movement returns to normal or nearly normal.
Left to their own devices most frozen shoulders get better; on average, this takes about 18 months.
If caught in the freezing-up stage, then injections of steroid and hydrodilatation to the ball and socket joint might help with the pain. Physiotherapy does not help and can make the condition last longer.
If patients don’t want to wait then they can opt for an operation to accelerate the process - details of the procedure and the recovery can be found here. Around half of my patients choose surgery and half opt to let nature take its course - that decision is up to each individual patient.
Frozen shoulder is a very common condition that is all too often misdiagnosed. It will resolve by itself, but if patients can’t cope with the loss of movement and function then a keyhole operation will get them better quicker.
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