A frozen shoulder – also called adhesive capsulitis – is a condition that causes the shoulder joint to become increasingly stiff and painful. The symptoms include loss of movement and worsening pain, which can be particularly bad at night.
Normally the symptoms begin gradually and worsen over time, before starting to resolve themselves. There are three distinct phases to a frozen shoulder, each of which may last several months:
- Freezing stage – this is where your shoulder’s range of movement starts to lessen and moving your shoulder begins to cause pain.
- Frozen stage – during this phase your shoulder becomes stiffer, although the pain may start to lessen.
- Thawing stage – this is when movement gradually starts to return to your shoulder.
Causes of frozen shoulder
It is not completely understood what causes frozen shoulder, which often lasts around two years and sometimes longer.
The shoulder joint is made up of bones, ligaments and tendons encased in a capsule of connective tissue. It is this tissue that becomes inflamed when you have a frozen shoulder, causing it to thicken and tighten and restricting movement. Sometimes the condition is linked to injury or surgery that prevents you from moving your arm fully, such as a fractured arm, stroke or rotator cuff injury.
Diabetes can also increase the risk of frozen shoulder, although doctors are unclear why, so it is important to have regular check-ups if you are diabetic. Other diseases that may heighten your risk include Parkinson’s, cardiovascular disease and thyroid conditions. If you are risk of developing a frozen shoulder you may be able to do exercises to maintain a full range of movement in your joint.
Treatments for frozen shoulder
There are a number of treatments for a frozen shoulder, depending on how severe the pain is and how long it has lasted. Among the common treatments for frozen shoulder are:
- Painkillers and anti-inflammatories to help ease some of the symptoms.
- Heat or a cold compress applied to the affected area.
- Injections of corticosteroids into the joint to provide increased pain relief and bring down swelling.
- Exercises recommended by a physiotherapist to help get movement back into your shoulder. These might include gentle stretches and exercises to strengthen the shoulder. You might also need advice on how to manage the pain, as a frozen shoulder can be very painful, and support to develop a good posture as keeping upright with your shoulders back can help to relieve pain.
Hydrodilatation procedure as treatment for frozen shoulder
Unlike other conventional treatments, which simply aim to control the symptoms of frozen shoulder, hydrodilatation is a procedure that aims to improve the range of movement in the shoulder joint.
It involves injecting a mixture of sterile saline, local anaesthetic and steroid into the affected shoulder and then stretching the capsule that surrounds the joint.
How it works
A radiologist carries out the procedure, using X-ray or ultrasound to guide the injection into precisely the right part of the joint. A local anaesthetic is used to numb the area before a fine needle is carefully inserted into the shoulder joint and a small amount of dye is injected to check the position of the injection. Once it is correctly located, saline, local anaesthetic and steroid is injected to stretch the joint capsule.
You should not feel any pain but you may experience a pushing sensation or pressure in your shoulder. You will not be able to drive yourself afterwards, however you should be able to resume your normal activities within 24 hours. Following the procedure you will need to do exercises recommended by a physiotherapist to maximise the improved range of movement in your shoulder.
Is it for me?
Hydrodilatation is a safe and effective procedure with very few risks. There is a slight risk of infection in the injected joint, but no different to the injection of other joints. This can be managed with antibiotics or joint washouts if it occurs.
Around 70% of people experience increased movement in the shoulder and 90% report a decrease in pain following the procedure.
In some cases, the improvements are experienced immediately while for other people it can take a few weeks for the full effects to be felt. It is important to do exercises recommended by a physiotherapist to maximise the benefits of hydrodilatation.
It is important to get a proper diagnosis if you suspect a frozen shoulder so you can get the correct treatment advice. The condition varies from person to person so not all treatments will be appropriate for everyone. A radiologist will be able to explain more about how hydrodilatation might help you, if it is an option you are considering.