Severe pain and limitation of shoulder movements (especially external rotation) can occur as a result of thickening of the shoulder joint capsule, a condition called Frozen Shoulder. This is more severe in patients who have diabetes and it may take years until movement is restored.
What causes frozen shoulder?
It’s not clear why people get a frozen shoulder but is often caused by inflammation of the capsule. The capsule is a membrane that envelops the shoulder joint and normally is very thin and elastic. In frozen shoulder the anterior part of this capsule called rotator interval as it is not covered by rotator cuff muscles, thickens and restricts normal movement especially external rotation. This can happen after an injury, after surgery or following long immobilisation.
What are the symptoms?
Pain and restriction of movement especially rotating outwards are the main symptoms of frozen shoulder. Pain can be severe and wake you up at night. Gradually all arm movements can get restricted.
What is the treatment of a frozen shoulder?
We do not know how to cure frozen shoulder however there are ways to improve pain and movement. Physiotherapy is important and in combination with pain relief medication can be the main treatment. If exercising is difficult a steroid injection into the gleno-humeral joint may ease the pain.
Hydrodilatation involves stretching the capsule of the joint by injecting a mixture of sterile saline, local anaesthetic and steroid. This is done with local anaesthesia under image control either x-ray or ultrasound. Position of the tip of the needle inside the joint is usually confirmed by injecting radio -opaque dye into the joint. The capsule is then stretched (dilated) by injecting saline under pressure followed by local anaesthetic and a cortison. The success rate of hydrodilatation is around 70% , There are small risks involved mainly infection and failure to improve symptoms.
Arthroscopic capsular release is a surgical procedure done under general anaesthesia. This is indicated if conservative treatment failed to improve symptoms. A camera (arthroscope) is inserted through a puncture wound into the shoulder joint and instruments are used to release the adhesions. The arm is manipulated to make sure a full range of movements is achieved. Most patients begin physical therapy the same day of the manipulation or the following day.