Frozen shoulder is a common condition that causes thickening and inflammation of your shoulder joint’s lining (capsule). This results in pain and stiffness.
Patients often report a gradual onset of pain. This is usually a deep ache, exacerbated by movement, felt deep within, or at the front of your shoulder. The pain can be very severe and it often causes difficulty sleeping. There is then a pattern of increasing stiffness in all shoulder movements.
Frozen shoulder usually has three phases, which generally progress over a two-year period:
Normally 35-65 year olds, slightly more common in women. The incidence is more common in diabetics and those with thyroid disease. Some chemotherapy regimens carry a risk of developing frozen shoulder. While for most patients there is no identifiable cause, sometimes a frozen shoulder follows an injury or a surgery to the shoulder. This is called a 'secondary frozen shoulder'.
Rest, activity modification, painkillers and anti-inflammatories are obvious first-line treatments.
Physiotherapy doesn’t work well on its ownin frozen shoulder and aggressive physiotherapy in early stages makes it worse. Physio is however essential to maximise therapeutic gains AFTER treatment
Steroid Injection (Cortisone)
Sometimes done by GP before referral to surgeon. However, it is very hard to get the needle into exactly the right place without image guidance in frozen shoulder as the capsular volume is so small. It is therefore normally done under X-ray or Ultrasound guidance.
Hydrodistension (also called hydrodilation)
This is an awake, X-ray or Ultrasound-guided outpatient procedure (15 min). It is moderately uncomfortable, but generally well tolerated. A fine needle is guided into your shoulder. Cortisone and local anaesthetic are injected into your joint. Saline solution is then injected until your capsule ruptures, or no further distension is achieved (average 35ml total injected). This stretches out the contracted capsule. Hydrodistension is effective in over 70% of patients and often avoids the need for surgery altogether. It improves pain and range of motion. Beneficial effects are often rapidly felt (sometimes immediately) and endure. Risk of harm is very low, but up to 10% may find the procedure too uncomfortable to tolerate.
X-ray image of hydrodistension. The x-ray dye is providing a sillhouette of the joint space and dye can be seen escaping where the capsule has ruptured - blue arrow.
Surgery is Indicated if less invasive measures have failed to improve your pain or stiffness to a degree that works for you.
Arthroscopic Capsular Release is a keyhole operation performed under general anaesthesia and regional nerve block. Your thickened and inflamed capsule at the front of your shoulder is carefully excised before your shoulder is manipulated to restore range of motion. A steroid injection is normally performed at the same time.
Overall very good; indeed fFrozen shoulder was initially thought to be a wholly self-limiting condition. However, about 40% of patients who receive no treatment will have on-going stiffness and/or pain even after 2 years, although they have normally got used to it. Frozen shoulder often happens in opposite shoulder at a later date, but rarely recurs in same shoulder. Hydrodistension and, if necessary, arthroscopic capsular release are both effective at improving the pain and stiffness of frozen shoulder. Sometimes, the improved motion after treatment can unmask a separate shoulder problem, such as impingement or rotator cuff disease.
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
Spire Thames Valley hospital
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