Frozen Shoulder, also known as adhesive capsulitis, is an inflammatory condition affecting the shoulder joint capsule. It occurs in about 5% of the population and is more common in females between 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 injections for frozen shoulder to reduce severe pain and improve movement. What is a frozen shoulder injection, and when should you use it?
What are the typical findings of frozen shoulder?
A frozen shoulder usually presents with pain and stiffness in the shoulder. Initially, people report increasing pain, 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 essential to rule out other causes of shoulder pain and stiffness, such as arthritis or tendon calcification. This situation is where further investigations such as X-rays are crucial. 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 beyond two years and even ten 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 integral 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 for frozen shoulder can help.
More about frozen shoulder injection
Generally, injections for frozen shoulder 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. A frozen shoulder hydrodistension injection, a procedure using a high volume of water combined with cortisone is effective in some cases. However, we are unsure whether a frozen shoulder hydrodilatation injection is better than simple cortisone injection. In general, we suggest a simple cortisone injection for the early stages and hydrodilatation 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 more significant reduction in pain and improved movement. 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 surgery outcomes for frozen shoulder 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
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, frozen shoulder hydrodistension injection is helpful. Most cases settle without the need for surgery. The most important part of the treatment is to ensure that the diagnosis is correct. Therefore, you should always see a doctor who has expertise in shoulders and performs injections under ultrasound.
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