Frozen Shoulder also known as adhesive capsulitis is an inflammatory condition affecting the capsule of the shoulder joint.  It occurs in about 5% of the population and is more common in females between the ages of 40 and 60.  Most cases occur without a cause. However, some cases start after a fall onto the shoulder.  Other triggers include recent surgery and medical conditions such as diabetes and thyroid disease. Often, we perform a frozen shoulder injection to reduce severe pain and improve movement. What is a frozen shoulder injection and when should you use it?

What are the common findings of frozen shoulder?  

frozen shoulder

Frozen shoulder usually presents with pain and stiffness in the shoulder. Initially, people report increasing pain quickly followed by shoulder stiffness or restriction of movement. Often, people find that simple movement such as brushing hair or removing a bra becomes difficult. Sleep also becomes a problem because of pain.

How do we diagnose frozen shoulder?

Generally, a painful and stiff shoulder is the usual presentation. However, it is important to rule out other causes of shoulder pain and stiffness such as arthritis or tendon calcification.  This is where other investigations such as X-rays are important. For more complex cases, imaging such as ultrasound or MRI may be needed.

Will this frozen shoulder get better on its own?

Usually, most cases get better after 18-24 months. However, recent studies suggest that some people can have symptoms that persist beyond 2 years and even up to 10 years.

What are the best treatment options? 

In general, there is a lack of agreement on the best treatments. Firstly, there is no evidence that tablets such as steroids or anti-inflammatories are effective.  Secondly, physiotherapy such as stretching and strengthening is an important part of treatment and effective in milder cases.  However, there is no agreement on the best type of physiotherapy. In serve cases, a cortisone injection can help.

More about frozen shoulder injection

shoulder joint injection under ultrasound

Generally, frozen shoulder injections are effective in the early stages to reduce pain. A recent high-level study found frozen shoulder injections improve pain for up to 4 months. Shoulder joint hydrodistension, a type of injection using a high volume of water combined with cortisone is effective in some cases. However, we are not sure whether distension is any better than a simple cortisone injection for frozen shoulder. In general, we suggest a simple cortisone injection for the early stages and distension for the latter stages. Moreover, we think that frozen shoulder injections should always be done with ultrasound to improve accuracy.

More recently, platelet-rich plasma or PRP injections are used for various musculoskeletal conditions. In a study comparing PRP to cortisone injections in frozen shoulder, PRP showed a greater reduction in pain and improved movement. Obviously, we need more studies to determine whether PRP is more effective than cortisone in frozen shoulder. However, the early results are promising and suggest that we could use PRP as a replacement for cortisone.

Is surgery a good option for a Frozen shoulder?

Surgery also called a capsular release, is only useful for persistent cases. You must remember that surgery has risks and is not always successful. A recent study suggests that outcomes of surgery are equal to physiotherapy but have serious adverse effects of 4-5%. Overall, your decision regarding surgery should not be taken lightly.

Final word from Sportdoctorlondon

In general, a combination of treatments for Frozen Shoulder exists, depending on the stage. In the early phases, we prefer an ultrasound-guided Frozen Shoulder injection followed by gentle stretching and strengthening of the shoulder.  For later stages, shoulder hydrodistension is useful.  Most cases settle without the need for surgery.  The most important part of the treatment is to ensure that the diagnosis is correct. You should always see a doctor who has expertise in shoulders and performs injections under ultrasound.

Other common shoulder conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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