Steroid Injections For Frozen Shoulder (Adhesive capsulitis)
Adhesive capsulitis, often referred to as frozen shoulder, is a condition which causes pain and stiffness in the shoulder joint due to the capsule that encloses the shoulder joint becoming thicker, contracted and tighter than it should be.
It can start insidiously or after you have had trauma to the shoulder like a fracture or after surgery.
Symptoms of Frozen Shoulder
- A dull or aching pain in your shoulder, which tends to be worse at night or when you move your shoulder joint.
- Stiffness around your shoulder joint that may stop you from moving your shoulder normally. This can make it difficult to do everyday tasks such as driving or dressing yourself.
The 3 stages of a frozen shoulder
1. Freezing Phase
Gradual onset of shoulder pain at rest with sharp pain at extremes of motion, and pain at night with sleep interruption.
Can last from 2 – 9 months
2. Frozen Phase
Pain starts to subside and progressive loss of shoulder range of movement. Pain only with extremes of movement.
Can last for about 12 months
3. Thawing Phase
Spontaneous, progressive improvement in range of movement.
May last up to 3 years
What causes it?
Onset of this pathology is usually idiopathic (comes on for no particular reason), however there are certain conditions and factors which have been linked to increased occurrence of frozen shoulder.
- Female population
- Aged over 40
- Underactive or overactive thyroid
- Metabolic Syndrome
- Post shoulder surgery or injury
The shoulder is a ball and socket joint made up of the humerus (upper arm bone) and the scapular (shoulder blade). The socket on the scapula, know as the glenoid fossa, is not very big or deep which then requires additional support to prevent the shoulder becoming unstable. This anatomy however allows for a greater degree of motion that we utilise compared to other joints. To improve joint stability there is a thickening of the capsule that surrounds the joint which encapsulates the joint fluid. These thickenings are the ligaments of the shoulder joint. This is a also a group of 4 muscles that provide stability to keep ball in the socket known as the rotator cuff.
Frozen Shoulder Treatment
Although the majority of the time frozen shoulder will eventually resolve by itself, the current research found that effective treatments which shorten the duration of the symptoms have a significant impact on reducing long term problems.
The latest evidence has found that the most effective treatment for frozen shoulder is the combination of physiotherapy and steroid (cortisone) injection. The cortisone injection is used to reduce inflammation and pain in the shoulder, which is particularly beneficial in the early stages where pain is a greater issue than stiffness. This can also be performed as a “hydrodistension injection”- where the shoulder joint is also injected with a high volume of saline to stretch the tight joint capsule from the inside and allow movement. Having a course of intense physiotherapy shortly afterwards will then maximise recovery and improve the range of movement of the shoulder. Physiotherapy treatment will involve manual therapy including mobilisation of the joint and an independent exercise program to assist a speedy recovery.