The Stiff Shoulder

Two conditions can make the shoulder markedly stiff. These are frozen shoulder (adhesive capsulitis) and advanced arthritis of the shoulder. it is relatively easy to tell the two apart and usually just requires an X-ray. In frozen shoulder the X-ray is usually completely normal and in arthritis the X-ray is very abnormal. Usually a patient with advanced osteoarthritis in the shoulder has had symptoms for several years though the disease can often deteriorate quite quickly as the damage increases. If you recognise this steady deterioration in pain and movement it is possible you have arthritis of the shoulder. The commonest age range to develop this disease is between 60 and 70 years. If you suspect this diagnosis then follow the link to arthritic problems.  

In frozen shoulder the history often is of severe shoulder pain followed by a rapid loss of range of motion. it is classically described as occurring in 4 stages. These are painful stage; painful frozen stage; frozen painless stage and resolution stage. It is likely that most frozen shoulder will resolve without treatment but this can take 3 to 4 years. Treatment is aimed at shortening this time. Initially physiotherapy can be helpful in stretching out the shoulder but often pain is too severe to allow any effective exercises. In this circumstance a steroid injection can help the pain and allow effective physiotherapy. 

Some patients with frozen shoulder do not respond to exercises and injections. In these we normally recommend an arthroscopic procedure to release the thickened and contracted tissues found in these stiffened shoulders. This can be very effective in accelerating recovery. Post operative physiotherapy is very important in maintaining the recovered range of movement. Some patients can have very resistant stiffness requiring multiple surgeries to obtain a cure. This is particularly the case in diabetic patients who can develop very severe and stubborn shoulder stiffness.


© Peter James Hughes 2015