Frozen Shoulder - Symptoms, Causes, Solutions
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Topics
1. What is Frozen Shoulder? 2. What are the risk factors? 2. What are the symptoms? 3. How is this condition diagnosed? 4. How is Frozen Shoulder treated? 5. What is Hydrodilatation? What is Frozen Shoulder?The Shoulder Joint is formed by the articulation between two bones, the Scapula & the Humerus (See diagram). This joint is encased by a Joint Capsule and in the joint, there is a lubricant called synovial fluid which allows the shoulder joint to articulate smoothly and painlessly.
The cause of this disease is not entirely clear. However, it is thought to be both an inflammatory process as well as a fibrotic process. The fibrotic process results in a thickened joint capsule, which can cause pain and limitation in the range of motion of the shoulder. This condition often occurs without any inciting event. However, it sometimes occurs following trauma or a period of immobility (eg. use of an immobilization sling for a fracture). What are the Risk Factors?
The risk factors for developing Frozen Shoulder includes:
What are the Symptoms?Patients frequently experience a gradual onset of shoulder pain and stiffness. For some individuals, the pain worsens at night, making it difficult to lie down on the affected side, which can disrupt sleep. Alongside the pain, there's a noticeable restriction in the shoulder's range of motion in various directions, impacting everyday activities. This condition progresses through stages, although not all patients' experiences strictly adhere to these stages.
Stages of Frozen Shoulder:
How is this condition diagnosed?
Frozen Shoulder (Adhesive Capsulitis) is a clinical diagnosis. This means that it is diagnosed by a doctor using clues from clinical history and physical examination. Occasionally, if the diagnosis is unclear, additional imaging (MRI scans / Ultrasound) may be required. However, it should be noted that these scans are typically not required for the diagnosis of Frozen Shoulder. How is this condition treated?Frozen shoulder has a self-limiting course. However, resolution of the symptoms can be debilitating and may take up to 3 years to resolve. Additionally, the resolution of symptoms may not be complete. Treatment has been shown to speed up the recovery process. Furthermore, there is some evidence that patients who are treated may have better long term shoulder range of motion.
Fortunately, the mainstay of treatment of Frozen Shoulder is non-operative treatment. This treatment plan comprises of:
In a very small proportion of patients who do not get better despite conservative treatment, surgery may be an option. What is Shoulder Hydrodilatation?Hydrodilatation is a minimally invasive procedure used to treat this Frozen Shoulder. It's typically performed in a clinic setting using a needle, although in more challenging cases, it may be done in a Fluoroscopy suite, which is a treatment room with X-ray capability. This procedure can be performed at any stage of the disease and aims to expand the joint with fluids to reduce inflammation.
It's highly effective for this condition. Most patients experience a significant improvement in their range of motion after a single injection. This procedure not only improves range of motion but also relieves pain, which is crucial for successful treatment as pain can hinder joint capsule stretching. Recovery after hydrodilatation is typically quick, with minimal downtime. Patients can usually resume normal activities the same day and are encouraged to perform stretching exercises to aid recovery. This procedure is very safe when performed by experienced Pain Specialists. Nevertheless, it is important for you to discuss the benefits, risks and alternatives with your Pain Specialist before deciding if this procedure is suitable for you. Dr Christopher Liu is a Pain Specialist based in Singapore who sees patients with Frozen Shoulder. As Singapore General Hospital, he pioneered an Ultrasound MSK Injection Clinic for patients with Musculoskeletal Pain such as shoulder and hip pain. |
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