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Frozen Shoulder

(Adhesive Capsulitis)



Frozen shoulder is the common term for ' adhesive capsulitis' which is a condition characterised by stiffness and pain of your shoulder joint. Over time the shoulder becomes very difficult to move.

The shoulder joint like most the joints in the body contains synovial fluid to' lubricate' the joint surface. To contains this fluid joints have a lining or sac called the 'capsule'. If this capsule becomes inflamed and 'stuck down' then you end up with stiffness and pain i.e. a frozen shoulder. 

Frozen shoulder has three stages ; the first phase is inflammation or 'painful' stage which may last upto 4 months, the second phase is the 'freezing' phase where your shoulder progressively gets stiffer which may last from 4-12 months, the final third phase is the resolution phase 'thawing' which can last from 12 months to 3 years.


In most cases there s no clear reason for developing a frozen shoulder and this is termed 'idiopathic'. The most common risk factors to develop a frozen shoulder is diabetes, trauma, or surgery. It typically occurs in the fifth and sixth decade of life.


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A frozen shoulder is diagnosed clinically (by asking you about your symptoms and examining your shoulder) either by your GP, an experienced Physiotherapist or your Shoulder surgeon.  

The main features of a frozen shoulder in pain with any movements and increasing stiffness.

A frozen shoulder especially if you don't have any risk factors (Diabetes/ Trauma) is generally self-resolving.


Early treatment includes, pain killers, anti-inflammatory medication and physiotherapy particularly for stretching.  

If your pain is not settling particularly at night and your shoulder remains stiff then a steroid injection into your joint should be considered.  This is also known as a 'hydro-distension' procedure.

What is a hydro-distension?

A hydrodistension is  usually performed under ultra-sound guidance where a cortisone mixed with a large volume of  Local Anaesthetic is  injected into your shoulder joint. The aim is to reduce the inflammation around the joint lining and 'stretch' the thickened tissues. 

Physiotherapy must start within 72 hours to give you the best chance of improving. The reported success rate is around 70-80%. Having a hydro-distension may reduce the natural resolution time of the disease. 

It may take 18 months to 3 years for a frozen shoulder to resolve but 41% of patients report on-going mild symptoms.

If your symptoms are persistent and do not significantly improve over 6-12 weeks after a hydro-distention you should consider an Arthroscopic (Key hole)  Capsular Release (ACR). This surgical procedure in simple terms cuts the scar tissue in your shoulder under direct vision using a camera to improve the range of motion and pain in your shoulder. 

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Useful external patient info links:


The decision to undergo an Arthroscopic Capsular release (ACR) is your and my duty as your surgeon is to help guide your decision. My general guidance is that surgery should only be considered if both a hydro-distension and physiotherapy have failed to improve your pain and range of motion. Generally a reasonable time frame is 4-6 months of non-operative treatment.

The outcome of an arthroscopic capsular release is very good with 85-90% chance of improving your shoulder movement and pain. Generally a frozen shoulder is more stubborn if you have diabetes or have injured your shoulder. 

 An ACR is performed whilst you under a general anaesthetic which will be performed a Consultant anesthetist. You will also be offered a intrascalene nerve block to help with pain. In some circumstances the surgery can be performed whilst you are awake under a nerve block.

General anaesthesia is very safe but still carries a small risk  (<1%) of Heart Attack, Stroke, Deep Vein Thrombosis, Pulmonary embolism. It is important to have all details of your medications and past medical history so you can be optimised for surgery and these risks can be assessed individually. 

It is important that you understand the risk of surgery which are outlines below:


  • Infection (<1%)

  • Nerve & Vessel damage (<1%)

  • Persistent pain/ stiffness (5%)

What are the alternatives?  

A  Manipulation Under Anaesthesia (MUA) where your shoulder is forcefully stretched to tear the scarred down capsule. This procedure has a 3% fracture risk.

Do I need physiotherapy after the procedure?


Physiotherapy should start within 72 hours after the procedure  to give you the best outcome.


How long do I wear a polysling after my operation?

You should wean your self off the polysling after 48 hours. Pendular exercised will be shown to you and these should start as soon as pain allows.

Is it normal for my shoulder to be swollen & wound to leak fluid?

You will notice that after surgery that your shoulder has a bulky padded dressing. This is designed to absorb excess fluid from the arthroscopy (Saline is pumped into your shoulder to allow visualisation) for 24 hours and then can be taken off. Your shoulder will appear swollen which is very normal and this will reduce over a few days. Leaking fluid from your key hole wounds will be blood tinged but not frank blood or foul smelling discharge. 

Can I get my dressings wet?

For the first 7 days you must keep your dressings/ wounds dry. 

When Can I start driving?

It  is  illegal  to drive while wearing  a sling.  You may  start  to drive once  the sling  has  been discarded  but  not  until  you can safely  control  the vehicle.  This  is  normally  between 1- 2  weeks  after  the operation.  It  is  advisable to start  with short  journeys.

When can I go back to work?

This  will  depend on the  type of  work  you do  and the  extent  of  the surgery.  If  you have a non-manual job and do not need to drive you may  be  able  to return within 1-2 weeks.  If  you have a heavy  lifting  job or  one with sustained  overhead arm  movement  you may  require  6 or more weeks off.  

How am I Likely to progress?

It is important to recognise that improvement is slow and that this is not a quick fix operation. By 3 weeks after operation you should be able to raise your arm below shoulder height more comfortably. Getting your hand up your back usually takes a little longer. By 3 months after the operation most people have noticed 80% improvement in their symptoms and have achieved almost full range of motion. Everything continues to improve slowly and by 9 to 12 months after the operation your shoulder should be back to normal / feeling like the other shoulder. 

When can I resume recreational activities?

 Timings for returning to functional activities are approximate and will differ depending upon the individual. However, the earliest that these activities may commence are:

  • Driving:  1-2 weeks or when safe.

  • Lifting:   As able.

  • Swimming:  Breast stroke at 2 - 3 weeks, freestyle when able.

  • Return to work:

        Light work (no lifting) 7-14 days. 

        Medium work (light lifting below shoulder level) from 4-6weeks

        Heavy work (above shoulder height)  3  months.

  • Golf: 6 weeks (but not driving range).

  • Racquet sports: When comfortable

British Elbow & Shoulder Society (BESS) Frozen Shoulder patient exercise video

RBH Post operative Physiotherapy protocol for ACR

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