The first thing that most people notice is that the shoulder becomes painful. This is a severe pain, which causes them to wake at night. The pain is “within the shoulder” and usually cannot be localized any more precisely. The shoulder is painful to move particularly in internal rotation (reaching behind the back) and external rotation (turning the palm away from the body). Most people complain that they have difficulty putting on a shirt. As the condition progresses the resting pain subsides (this may take 6 months) but the stiffness continues. The stiffness may be so severe that the shoulder has virtually no movement. The stiffness usually subsides 18 months to 2 years after the symptoms first started. Full movement may not be regained.

The initial treatment is painkillers and anti-inflammatories. The purpose of this is to settle the pain and allow for physiotherapy to be commenced. The aim is to maintain as much movement as possible whist the condition runs its course and eventually settles. In many cases this is all that is needed.

In a small number of cases, the stiffness and pain fail to respond to painkillers and physiotherapy. Many treatments have been suggested and there is little evidence that many of them work. If the stiffness is becoming worse then there are various options:

• Hydrodilatation: This procedure is carried out by the specialists in the Radiology Department. Using ultrasound or x-ray, a needle is guided into the joint and fluid (local anaesthetic and steroid) is injected to stretch out the inside of the joint. You can go home the same day and physiotherapy is arranged to start the next day.
• MUA (Manipulation Under Anaesthetic): In this procedure, a light anaesthetic is given and the shoulder joint is moved through all of its range to try to stretch the shoulder capsule and break down any scar tissue that has been formed. This is followed the same day by physiotherapy to maintain the movement, which has been achieved.
• Arthroscopic Capsular Release: In this procedure arthroscopy of the shoulder joint is performed under general anaesthetic and the tight capsular tissue is cut, allowing for increased movement. Again physiotherapy after the surgery is essential or the shoulder will become stiff again.