by Dave Baker (Clinical Director, Complete Physio)
Frozen shoulder is a common cause of shoulder pain particularly within middle-aged patient’s. Indeed, in Chinese medicine frozen shoulder is known as ’50-year-old shoulder syndrome’. Its slightly more common among females than males and is more likely to occur following an injury to the shoulder and is more commonly seen in patients with certain medical conditions such as diabetes.
Typically frozen shoulder starts with quite severe pain which then develops into pain with severe stiffness and loss of range of motion at the shoulder region. Patient’s more often complain that they are having difficulty sleeping due to the pain. The loss of movement most often associated with a frozen shoulder affects the ability for patients to externally rotate their shoulder (turn their shoulder outwards) and therefore patients see a severe restriction of certain movements such as washing their hair or reaching their arm into their coat sleeve. Investigations such as x-ray and even MRI scan are generally normal aside from age related wear and tear but are sometimes requested by patients GP to help confirm patients diagnosis. As with all conditions specific symptoms and presentation may vary slightly from patient to patient.
Treatments which normally help other shoulder problems such as stretching and exercise can be very painful and in many cases can be of limited benefit with a frozen shoulder. Increasingly the evidence for treatment of this condition has shown pain relieving injections such as steroid and a special injection used to stretch the shoulder joint to help with movement known as ‘Hydro distension‘ or ‘High Volume’ injections can be most effective and also allow the exercise and stretches to begin to take affect. Shoulder pain can be extremely debilitating and patient’s often present at clinic exhausted through lack of sleep and frustrated at all the jobs and activities that they are being unable to do. It is therefore really important that we are able to offer patient’s quick relief
Mrs J 53 years old and booked an appointment for severe pain in her right shoulder, her dominant arm, which started 4 weeks earlier and it seemed to be getting worse. She reported sleep was been disrupted every night due to pain and that despite taking a range of over-the-counter and prescribed medications nothing was having much impact upon her pain. She had tried some stretches and exercises which had helped for a previous shoulder problem but on this occasion her pain was so severe after performing the exercises that she had had to stop.
This lady had been to her GP twice already and she had considered also attending her local A&E department as the pain was so bad. Her GP had referred her for an x-ray which had apparently been normal and advised her to take painkillers and that the pain should resolve in a week or 2. This lady had no significant past medical history and worked full time in the office job but had to take the last 2 weeks off work due to the pain.
On examination this lady had greatly restricted movement which is typical of a frozen shoulder (adhesive capsulitis) with severe pain and stiffness on all movements but especially trying to turn the shoulder outwards or put arm behind her back. Ultrasound scan of the shoulder performed in clinic that day was essentially normal.
Having discussed our diagnosis and treatment options and this lady decided to proceed with a pain killing injection which is also used to stretch the shoulder joint (hydro distension injection). The injection was performed under ultrasound guidance to ensure accuracy.
A followup review session was booked for 1 week later, when this lady reported an overall reduction in her pain of 60% and was delighted to report that she was sleeping much better. From here treatment was able to progress using exercise and rehabilitation and over the coming months this lady was able to gain full pain relief and full range of movement of her shoulder.
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