Symptomatology: Painful Stiff Shoulder

If your shoulder is very painful and stiff, it may fall into one of the following condition:

1.  Frozen shoulder / Adhesive Capsulitis
2. Arthritis of the shoulder joint itself
3.  Stiffness from previous injury or surgery to the shoulder

Frozen Shoulder / Adhesive Capsulitis:

Frozen shoulder can develop spontaneously or from minor injury. There is also a risk of developing this condition following any sort of surgery to the shoulder. Frozen shoulder is a self-resolving condition and will go through three phases as below:>

Phase 1 – the inflammatory phase – this is the worst part of the condition when the shoulder is extremely painful, simple movements or even catching the elbow on a table can be extremely painful. Treatment of this phase is really confined to adequate analgesia and steroid injection for pain relief. This phase can go on for up to six months.

Phase 2 – the frozen phase – as the inflammatory phase resolves the pain should improve to the point where the patient does not require analgesia. At this point the shoulder will still remain quite stiff but there should be a lot less pain. It is at this stage that physiotherapy and possibly surgical intervention may be of benefit.

Phase 3 – the thawing phase – this is where movements will return very slowly and gradually over time. Recovery of all three phases can take anywhere between 12 and 24 months to resolve and generally there is often a loss of 10% global range of movement permanently regardless of whether surgery is performed or not.

Surgery – in order to try and accelerate your recovery, arthroscopic surgery and manipulation of the shoulder may be considered in the frozen phase. This will be carried out as a day case under general anaesthetic and regional anaesthetic to the arm. Three holes are created, the inflammatory tissue is removed and the shoulder gently manipulated. There can be vast improvement in elevation and reaching of the shoulder and on external rotation. Internal rotation (getting the arm around the back to the bra strap for example) is often minimally improved but should improve with time. There is a small risk of fracture with manipulation of any shoulder which is to be expected and the other risks associated with arthroscopy.

Further Reading