Frozen Shoulder: FAQ's -Answers
Transcription:
My name is Gavin Jennings. I’m a Consultant Orthopaedic Surgeon who specialises in shoulder problems.
Many of the questions I get asked by patients about shoulder conditions come up again and again. In this short video I would like to share some of the answers to the common questions I get about frozen shoulder.
What is frozen shoulder?
Frozen shoulder is a condition where the shoulder becomes increasingly painful and more stiff over time. There are other causes of stiffness and pain in the shoulder but frozen shoulder is a specific disease. Frozen shoulder can occur in most age groups but is most common in patients in their 40s and 50s and is slightly more common in women. Certain groups such as diabetic patients are very prone to getting it.
What are the symptoms of frozen shoulder?
Frozen shoulder symptoms can come on fairly gradually. The sufferer often starts by noticing an aching around the outer and sometimes front part of the upper arm. Over time the person will notice the shoulder is stiffening up. Activities such as reaching behind and reaching out suddenly become painful. If the shoulder is jolted or thrust out rapidly the patient may notice excruciating pain which may last for a few minutes or even hours. The symptoms are often troublesome at night and can often disturb the sleep. Occasionally the sufferer may notice nerve type symptoms such as tingling and shooting pains down the arm.
Why does frozen shoulder happen?
Frozen shoulder occurs when the lining of the ball and socket joint and the shoulder becomes inflamed. Abnormal cells then formed in the capsule around the joint. These behaves like a mixture between scar forming cells and muscle cells. They lay down scar and then to add insult to injury they contract-like muscle cells. These changes account for the pain and stiffness in the shoulder. Although we know what happens in frozen shoulder no one really knows exactly why. Frozen shoulder can come out of the blue which is known as primary frozen shoulder. Alternatively frozen shoulder can come on after any other shoulder problems and this is known as secondary frozen shoulder. There are certain other conditions such as diabetes and thyroid problems which have an association with developing frozen shoulder and even some medications can increase the risk of getting one
How long does frozen shoulder last and will it go away?
The standard answer to this is about 1-3 years without treatment. However symptoms can last significantly longer and there is good evidence that in about 10% of people the symptoms of stiffness at least may last for ever. There is also evidence that in the majority of cases frozen shoulder will improve over time but if untreated, there will almost always be some residual lack of movement in the shoulder.
How is frozen shoulder treated?
There a number of treatments that have been used for frozen shoulder, some more effective than others. Physical therapy can help some of the symptoms but there is not a great deal of evidence that when used alone it can change the natural course of the problem. Steroid injections into the ball and socket joint have been shown to be of benefit and combining steroid injections and physical therapy has been shown to be even better still. If these conservative measures do not sort the problem then surgery can be considered. The modern approach for this is to perform a keyhole release of the tight structures in the shoulder. There a number of other treatments some of which have conflicting evidence as as to whether they work and some of which are just not worth bothering with at all!
Who should I see about my frozen shoulder?
There is some evidence that the earlier a steroid injection is given into the shoulder the better and I usually therefore say to people that they are best off initially seeing someone who is able to provide such an injection. If a steroid injection and physical therapy have not led to significant improvement and you have not already involved a orthopaedic shoulder specialist in your care then that is probably time to do so.
Do I need a scan for my frozen shoulder?
The short answer to this is “no”
An experienced clinician will have no trouble at all in diagnosing frozen shoulder and an MRI scan is rarely needed. If however there were thought to be other potential problems in the shoulder (as in the case of secondary frozen shoulder) then a scan may be suggested. There are some changes that can be seen on an MRI scan which are suggestive of a frozen shoulder but the patient's symptoms and examination are normally more than enough to make the diagnosis.
Will frozen shoulder come back?
The short answer to this again is “no”.
The evidence suggests that if someone has had a genuine frozen shoulder which has fully resolved they are unlikely to get the same condition again in the same shoulder. Not infrequently, I see patients who present with a frozen shoulder and they have been told they have had it before some time ago. Closer questioning, however, often reveals that the initial diagnosis some years back was probably incorrect. There is no doubt, however, that if you have had a frozen shoulder you can subsequently get the same problem in the other shoulder. This more often occurs as two separate events but occasionally both shoulders can become frozen at the same time. It is likely that if you have had one frozen shoulder you are at slightly higher risk of developing another frozen shoulder on the other side when compared to the general population as a whole.
What has frozen shoulder got to do with diabetes?
There is absolutely no doubt that people with diabetes have a significantly increased risk of developing a frozen shoulder compared to the general population. It is likely also that the symptoms may be longer lasting and somewhat harder to treat than those in the non-diabetic population. There are a number of theories as to why the problem may be more common in diabetics including those based on abnormalities with collagen or scar formation and formation of new blood vessels which we know occur in the diabetic patient. But don’t worry, I won’t bother you with with the details of this right now.
What would you do if you had frozen shoulder?
This is in my view an excellent question to ask the person treating you no matter what the condition.
Fortunately (or unfortunately for me) I have had frozen shoulder affecting both sides and I can therefore give you a genuinely accurate answer to this question. I would, and indeed did have steroid injections into both of my shoulders. Fortunately for me the injections improved my symptoms significantly. I have been left a little bit stiff in both shoulders but I have no pain and although my days as a trapeze artist are over, this slight stiffness does not cause me any other problems or restrictions. Had I continued to have pain and stiffness however I almost certainly would have gone down the line of a keyhole frozen shoulder release operation.
I hope you’ve found these answers to some of the common questions I am asked about frozen shoulder helpful but please do not hesitate to contact me if you need any further information. If you’ve liked this video, then please give it a thumbs up and feel free to leave any comments.
This video provides answers to the Top Ten questions asked by patients on Frozen Shoulder