The pathology of this is not yet completely understood, but it involves inflammation of the capsule (covering of the joint) which leads to contractures in the ligaments (thickenings within the capsule) and lack in movement.
Frozen shoulder can be idiopathic (unknown cause), associated with diabetes or secondary to other shoulder conditions, such as trauma or surgery. Diabetic frozen shoulder tends to be highly resistant to treatment. Once a patient has frozen shoulder on one side, there is an increased chance of it developing on the other side.
The natural progression will be in 3 stages. At first, the patient will suffer from intractable pain. The next step is the frozen stage where the pain eases off and the stiffness becomes the main problem. Finally, the stiffness decreases and there is a gradual increase in movement. The average time period for this whole process is about 18 months.
The diagnosis is usually clinical. Investigations like MRI are carried out to rule out other pathologies.
Treatment of the first stage is targeted at pain relief. Oral analgesia is recommended with physiotherapy. If this not help the other options are hydrodilatation with a steroid injection followed by physiotherapy. There is a good success rate with this less invasive modality of treatment and does not involve any general anaesthesia. Surgery can be considered for recalcitrant cases or if patients choose to have it as a part of shared decision making. I tend to offer to do this as a wide-awake procedure without any general anaesthesia where patient can actually see the procedure if they like! If they are not comfortable, they always have the option of having a full general anaesthetic along with a shoulder block. Mr Mohan has pioneered the concept of fully awake shoulder surgery in his practice in the NHS and in the private sector.