What is a frozen shoulder?
A frozen shoulder is the result of the formation of scar tissue in the capsule of the shoulder joint.
In most cases there is no clear cause. Other causes include a fall onto the shoulder, types of paralysis whereby the shoulder joint cannot be used for a long time, diabetes, and operations on the shoulder.
Signs and symptoms
The first symptoms are usually pain and severe stiffness of the shoulder. Movement can cause sudden and severe pain to occur and the shoulder cannot be moved any further. Pain typically occurs on raising the arm above the head or putting it behind the back. Sleeping on the affected shoulder may also be very painful. Frozen shoulder often has three stages:
- Phase 1 (2-9 months): This is the most painful stage, movement makes the pain worsen and the pain is less at night. The shoulder cannot be moved as far as previously.
- Phase 2 (4-12 months): During this phase the overriding problem is restriction of movement. The pain eases up.
- Phase 3 (12-24 months): Slow improvement of the limitations of movement and the pain.
How is frozen shoulder diagnosed?
The diagnosis is made on the patient's pattern of symptoms. When carrying out physical examination for shoulder problems, there are three useful shoulder tests: raising the arm out to the side, holding the arm along the body and turning it outwards, and bringing the arm over to the unaffected shoulder horizontally. In addition a neurological examination has to be done to exclude a disc prolaps of the neck.
Do I need additional examinations?
- Diagnostic examination for other non-physical factors important for your pain, have already been done by yourself trough filling out your pain questionnaires.
- Blood investigations if a systemic disease such as rheumatism are suspected.
- If shoulder symptoms persist for a long time: X rays, ultrasound and an MRI scan
- A bone scan if a tumour is suspected.
What are my treatment options?
Depending on the cause of your pain, your pain specialist will decide whether or not to start physical treatment. Based on the results of the completed pain questionnaire, additional examinations can/may be carried out, and apart from physical treatment other methods of treatment will be suggested.
If the results of your pain questionnaire are abnormal, your pain specialist will offer you one of the non-physical treatments listed below:
Interventional pain treatment
- Local injection into the shoulder joint
- Local infiltration of the supra-scapular nerve
- PRF treatment of the supra-scapular nerve