What is frozen shoulder? (Frozen shoulder is also known as adhesive capsulitis)
We are not sure what causes frozen shoulder, but it is often a very painful and debilitating condition. Frozen shoulder often wakes people at night and basic daily activities can be very painful.
Is a steroid injection effective for frozen shoulder?
Frozen shoulder often has three distinct stages. The duration of each of these stages can vary from person to person. Stage one is known as the ‘painful stage’, stage two is known as the ‘stiff’ stage and stage three is known as the ‘unfreezing or thawing stage’.
Steroid injections have been shown to be the most effective treatment for frozen shoulder in stage one, the ‘painful stage’. During this stage patients find it very difficult to gain any pain relief and even small movements aggravate the pain. Often once pain is aggravated it takes several hours, even days for the pain to settle again.
If the patient is in significant pain, particularly pain that is waking them several times a night, then an ultrasound guided steroid injection is the treatment of choice. This is well supported in the medical literature.
What injection is effective for frozen shoulder?
There are two different injections we carry out for frozen shoulders depending on the patient’s presentation.
The two types of steroid injections for frozen shoulder are:
1. Ultrasound-guided steroid Injection (with local anaesthetic)
During the first stage the priority is to administer local anaesthetic and steroid into the shoulder joint. Steroid is a very effective anti-inflammatory drug and by using ultrasound guidance to carry out the injection the steroid is put directly into the joint, to ensure maximal pain relief.
Steroid injections are very effective at reducing the pain in the shoulder, particularly night pain. As a result of the reduction in pain we normally observe an increase in the range of movement as well. However, the main role of steroid is to reduce the pain and inflammation. Once the pain is under control patients can engage in a physiotherapy program. This is very important to ensure the patient makes a full recovery with full range of movement and function in the shoulder.
2. Hydrodistension Injection (local anaesthetic, steroid and saline)
A hydrodistension (also known as hydrodilatation or high volume injection) involves administering the local anaesthetic and steroid (as type 1 above) but also adding approximately 20 to 30 millilitres of saline solution (essentially salty water). The goal of this injection is to provide pain relief but also to stretch the capsule to improve the range of movement. This can be used in stage 1 but also on occasions in stage 2 of frozen shoulder to try and restore more movement in the joint.
It is essential to have physiotherapy following this injection to restore full range of movement and the strength in the shoulder.
How many steroid injections can you have for frozen shoulder?
Approximately 80% of our patients with frozen shoulder only receive one injection. It depends how you respond to the first injection and the levels of pain and stiffness that you are still experiencing.
We always try and limit the number of injections we carry out on our patients. However on occasion, in the case of frozen shoulder, having more than one injection is sometimes required.