Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Frozen Shoulder

SYMPTOMS

There is sudden or gradual onset of localised pain and stiffness in the shoulder, often in a middle-aged athlete, with no preceding trauma.

AETIOLOGY

Frozen shoulder is a capsulitis of unknown origin that makes the shoulder freeze because of a gradually shrinking capsule. The onset can be dramatic; the patient wakes up with a stiff shoulder having had no previous problems. It is sometimes associated with general collagen disorders and diabetes.

CLINICAL FINDINGS

The shoulder is passively restricted in movements in all directions. The condition is very painful.

INVESTIGATIONS

This is a clinical diagnosis. X-rays should be taken in different planes to rule out bony pathology. MRI is usually not helpful since it is a static examination and the syndrome is a dynamic problem. Individual discussion with the radiologist is important.

TREATMENT

A frozen shoulder is often said to be incurable but can heal within two years. That is not true: physiotherapy and occasionally arthroscopic release can improve the condition dramatically. NSAID can help in the initial stages. Each case needs to be discussed individually. Secondary problems in the neck and upper back are almost inevitable and must be addressed.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) consultant orthopaedic surgeon to determine the diagnosis and for consideration of surgery. In almost all cases, a thorough rehabilitation programme, including specific treatment, thoraco-scapular control training, strength, flexibility and posture training is required but symptoms should be expected to last a long time.

EXERCISE PRESCRIPTION

Most sports and activities without an overarm action are possible but secondary symptoms due to compensatory movements are common. Running should be avoided since the shoulder will be sensitive to this type of impact and holding the arm still while running will cause secondary upper back and neck pain. Swimming is usually difficult but warm water can be helpful to release the shoulder. The specific rehabilitation should aim to achieve over time a full range of controlled motion, good posture and thoraco-scapular control.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs. Range of motion, strength, control and flexibility should be comparable with the other shoulder.

DIFFERENTIAL DIAGNOSES

Post-traumatic stiffness after surgery or immobilisation and external impingement syndrome can also cause these symptoms.

PROGNOSIS

Fair-Poor in true frozen shoulder.

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