Frozen Shoulder — Understanding, Management, and Tailored Care at Joint Injections

 

Introduction

Frozen shoulder, medically known as adhesive capsulitis, is a condition that can significantly affect day-to-day activities. It involves stiffness, discomfort, and a gradual reduction in the shoulder’s range of motion. The journey of frozen shoulder can be lengthy, often evolving over months or even years, making early understanding and targeted management essential.

At Joint Injections, our approach is centred on detailed assessment, imaging guidance, and personalised treatment strategies — including ultrasound-guided steroid injections and ultrasound-guided hydrodistension injections — delivered by experienced clinicians.

Anatomy of the Shoulder Joint

The shoulder is one of the most mobile joints in the human body. Structurally, it is a ball-and-socket joint formed where the head of the humerus (upper arm bone) fits into the glenoid cavity of the scapula (shoulder blade). Surrounding this joint is a capsule — a soft tissue envelope that stabilises and supports the joint while allowing mobility.

Key components of the shoulder joint include:

  • Bones — humerus, scapula, and clavicle
  • Joint capsule — fibrous tissue that encloses the joint
  • Synovial fluid — lubricates and nourishes joint surfaces
  • Ligaments and tendons — provide structural stability
  • Muscles — particularly the rotator cuff muscles, which enable motion and support

In frozen shoulder, the capsule thickens, tightens, and may develop adhesions, reducing both space and fluidity in the joint.

Pathophysiology — What Happens in Frozen Shoulder?

Frozen shoulder is characterised by inflammation and fibrosis (thickening) of the joint capsule. This process limits joint space, restricting movement. Although the exact cause in many cases is not fully understood, the cascade usually involves:

  1. Initial inflammation — irritation and swelling within the capsule
  2. Fibrotic changes — gradual thickening and stiffening of the capsule
  3. Adhesion formation — fibrous bands develop, further limiting mobility

The condition can be primary (idiopathic, with no clear cause) or secondary (associated with trauma, surgery, systemic conditions, or prolonged immobility).

Phases of Frozen Shoulder

Frozen shoulder typically follows three clinical phases:

1. Freezing Phase

  • Duration: Weeks to several months
  • Symptoms: Progressive stiffness, increasing discomfort, and reduced range of motion
  • Common feature: Pain is often worse at night

2. Frozen Phase

  • Duration: Several months
  • Symptoms: Stiffness remains, but discomfort may ease
  • Main challenge: Functional limitations in lifting, reaching, or rotating the arm

3. Thawing Phase

  • Duration: Months to years
  • Symptoms: Gradual return of movement and function
  • Not always complete: Some individuals may experience residual stiffness

Common Symptoms

  • Persistent stiffness and difficulty moving the shoulder
  • Dull, aching discomfort, especially with certain movements
  • Increased discomfort at night or when lying on the affected side
  • Difficulty performing overhead or behind-the-back activities

Potential Causes and Risk Factors

Although frozen shoulder can develop without an obvious trigger, several factors may increase the likelihood:

  • Shoulder injury or surgery leading to prolonged immobility
  • Systemic conditions such as diabetes or thyroid disorders
  • Age — most common in individuals aged 40–60 years
  • Gender — slightly more frequent in women
  • Prolonged sling use following arm injury

Diagnosis

A diagnosis of frozen shoulder is made through clinical assessment and imaging when required. At Joint Injections, our clinicians take a detailed history and perform a focused examination, often supported by ultrasound imaging.

The key aspects of diagnosis include:

  • History-taking — onset, duration, functional impact
  • Physical examination — assessment of both active and passive movement
  • Ultrasound scanning — helps visualise soft tissue changes and exclude other shoulder pathologies

Management Options

Managing frozen shoulder focuses on relieving discomfort, improving movement, and preventing further stiffness. The exact approach depends on the phase and severity of symptoms.

Lifestyle and Self-Management Approaches

  • Gentle stretching and range-of-motion exercises
  • Heat therapy to relax the joint before movement
  • Activity pacing to prevent flare-ups

Clinical Interventions at Joint Injections

Ultrasound-Guided Steroid Injection

This involves delivering corticosteroid medication directly into the shoulder joint using ultrasound guidance for precision. The aim is to reduce inflammation in the joint capsule, potentially easing discomfort and allowing better participation in physiotherapy and movement exercises.

Ultrasound-Guided Hydrodistension Injection

Also known as hydrodilatation, this technique uses a sterile solution (often with corticosteroid and local anaesthetic) to gently stretch the joint capsule. Performed under ultrasound guidance, hydrodistension can help increase joint space and improve mobility in some individuals.

Our clinicians carefully assess suitability for each procedure, ensuring the treatment is tailored to individual needs.

Role of Ultrasound Guidance

Using ultrasound ensures accurate placement of the injection, allowing the medication to be delivered directly to the intended target within the shoulder joint. This can enhance procedural precision, minimise risk to surrounding tissues, and allow real-time visual confirmation for both the clinician and patient.

When to Consider Injection-Based Interventions

While some cases of frozen shoulder improve with conservative measures, individuals with persistent stiffness, significant functional limitation, or slow progress may be considered for an ultrasound-guided injection procedure at Joint Injections.

Why Choose Joint Injections

  • Specialist clinicians experienced in musculoskeletal conditions
  • State-of-the-art ultrasound imaging for guided precision
  • Tailored treatment approach suited to each stage of frozen shoulder
  • Comfort-focused care in a clinical setting designed for patient reassurance

Recovery and Outlook

Frozen shoulder recovery varies. For some, the condition resolves over months; for others, stiffness may persist longer. Early assessment, accurate diagnosis, and a well-structured management plan can help individuals maintain function and daily activity.

Conclusion

Frozen shoulder can be a challenging and restrictive condition, but with careful assessment, targeted intervention, and ongoing support, individuals can work towards regaining shoulder function.

At Joint Injections, we combine clinical expertise, precision imaging, and patient-centred care to provide ultrasound-guided steroid and hydrodistension injections as part of a comprehensive management pathway for frozen shoulder.

Comments

Post a Comment

Popular posts from this blog

Ultrasound-Guided Cortisone Injections for Baxter’s Nerve Entrapment

Image
  Introduction Baxter’s Nerve Entrapment , also known as inferior calcaneal nerve entrapment, is a condition that can contribute to chronic heel pain. It is often misdiagnosed as plantar fasciitis due to the overlap in symptoms. The condition arises when the first branch of the lateral plantar nerve, known as Baxter’s nerve, becomes compressed or irritated. Anatomy of Baxter’s Nerve Baxter’s nerve is a branch of the lateral plantar nerve, which originates from the tibial nerve. This small but significant nerve travels along the medial aspect of the heel and innervates the abductor digiti minimi muscle of the foot. Due to its anatomical course, Baxter’s nerve is prone to compression between the deep fascia of the abductor hallucis muscle and the medial calcaneal tuberosity. Pathology and Causes of Entrapment Baxter’s nerve entrapment  occurs when the nerve is compressed or irritated due to various factors, including: Repetitive stress and overuse  — Activities such as prol...
Read more

Ultrasound-Guided Cortisone Injections for Achilles Tendinopathy

Image
  Achilles tendinopathy   is a common condition affecting the Achilles tendon, which connects the calf muscles to the heel bone. This condition is characterised by pain, stiffness, and reduced function in the tendon, often developing due to repetitive strain or overuse. While it is prevalent among athletes, particularly runners, it can also affect individuals who engage in activities that place excessive stress on the tendon. Management options for  Achilles tendinopathy  vary depending on the severity and chronicity of the condition. Among the available treatment modalities, ultrasound-guided cortisone injections have gained attention as a potential intervention for managing tendon-related pain and inflammation. This blog will provide a comprehensive overview of Achilles tendinopathy, including its anatomy, pathology, risk factors, symptoms, diagnosis, and various management approaches. It will also explore the role of ultrasound-guided cortisone injections in manag...
Read more

Ultrasound-Guided Cortisone Injections for Heel Bursitis

Image
  Introduction Heel bursitis  is a condition that affects the bursae, which are small fluid-filled sacs that cushion and reduce friction between bones, tendons, and muscles. Inflammation of these bursae in the heel region can result in significant pain and discomfort, impacting daily activities such as walking, running, and standing for extended periods. Heel bursitis  can occur due to repetitive stress, excessive pressure, or biomechanical abnormalities. While various treatment options exist,  ultrasound-guided cortisone injections  have been used to target inflammation with precision. Anatomy of the Heel The  heel  is a complex structure composed of bones, soft tissues, and bursae. Key anatomical components include: Calcaneus (heel bone)  — The largest bone in the foot, responsible for weight-bearing. Achilles tendon  — Connects the calf muscles to the heel bone and plays a crucial role in movement. Retrocalcaneal bursa  — Located betw...
Read more