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What is ‘frozen shoulder’?

By on September 1, 2011

The Japanese have a good name for it: go-juu kata, 50 [year old] shoulder.

This is a common and distressing condition which comes on for no known reason, typically in people in their 50s. One shoulder gradually becomes stiff and painful over some weeks or months, with the pain spreading down the arm, sometimes as far as the wrist; it can disturb sleep and make it impossible to lie on the affected side at night. To start with the pain is felt only on movement, but then can be felt even with the arm at rest. After about six months it becomes stable but pain and loss of movement can continue for a year or 18 months. Recovery then slowly takes place over about the next six months. Sometimes the other shoulder is affected but further episodes are unusual.

The diagnosis is entirely ‘clinical’, that is to say, it is made by a doctor on the basis of the history of how the symptoms start and progress, and the findings on a detailed physical examination. Blood tests, X-rays and scans are of no help and only need to be done if there is suspicion of a more serious disorder being present.

The usual treatment offered is pain killers and anti-inflammatory drugs of various sorts, sometimes with physiotherapy (physical therapy). This can reduce the pain to some extent but does nothing to alter the underlying condition, which is inflammation of the shoulder joint. In medical jargon it is called ‘adhesive capsulitis’.

There is, however, a simple treatment which can have a dramatic effect on the pain by aborting the inflammation: an injection of cortisone (steroid) into the joint. This is an entirely orthodox procedure which should be within the scope of any interested doctor after suitable training.

I find there is a great deal of misunderstanding, even fear, over the use of cortisone. It needs to be understood that cortisone for injection into a joint is quite different from the form given by mouth which is used to treat various serious diseases. Like any other treatment, if the joint injection is given for the right reason, into the right place, and in the right way, it can produce marked improvement with minimal risk of unwanted effects. In the case of frozen shoulder, the injection needs to be repeated a number of times at gradually increasing intervals until the condition settles. In my experience this is a safe treatment, side effects are rare, and rapid resolution of pain and with early recovery of movement are gratifying to both the patient and doctor.

 

About Dr. Gabriel Symonds

Dr. Gabriel Symonds was the director of the Tokyo British Clinic. The clinic closed down in May 2014 after serving the expatriate community for 20+ years. Dr. Symonds has retired and the Tokyo British Clinic is now closed. Dr Symonds will continue to live in Tokyo and may be contacted by e-mail over any questions concerning medical records or related matters: symonds@tokyobritishclinic.com He will be available from another address for: smoking cessation psychotherapy/counselling circumcision information Tel: (03) 5458-6099 www.tokyobritishclinic.com