Having a painful shoulder can be a really miserable experience.

Because shoulder pain is mostly positional or movement dependent, it can be doubly cruel. Just when we’re feeling comfy, we’ll re-awaken that sickening deep ‘yowch’ as we forget that yanking a heavy door open or reaching for a seat belt isn’t the best idea. Equally frustrating is the impact shoulder pain has on basic tasks we take for granted. From personal shoulder injury experience, I can tell you that a husband who is already late for work, doesn’t make the most patient coiffure.

Having seen three shoulder sufferers in clinic today, I was reminded of the following:

Lack of a good night’s sleep + Non-blow-dried hair + smudged mascara + twisted bra strap is the typical female frozen shoulder ‘user experience’.

Why are we so slow to help patients with a frozen shoulder? I suspect there are three main reasons:

1) Confusion around examination, diagnosis, and co-existent pathologies
2) We’re not ‘quite there yet’ in terms of really robust clinical trials, and we still think about ‘supervised neglect’
3) Lack of dissemination of knowledge about hydrodilatation or access to it.

Here’s my take on it. I’m quite long in the tooth, and a couple of decades ago, my understanding as a Doctor was that most cases of true frozen shoulder (capsulitis) occurred in persons of certain age who had diabetes.I recall sitting across from the patient and saying in my most concerned and caring vocal tone that it was ‘likely to take a good two years to get better’.We’d discuss ‘painful’ and ‘thawing’ phases, and possibly recommendations for a shorter, more manageable haircut.

The reality is that the majority of my patients who have a capsulitis have it secondary to a soft tissue ‘event’.This might be a lateral fall onto the shoulder on a ski-slope or cycle lane, and not infrequently MRI imaging picks up some co-existent labral tear or rotator cuff insult.I regularly see it occurring in city workers who play a mean game of tennis, and hypermobile active mums who’ve been nursing heavy twins.

All of them have a really naff time.

Even though there needs to be better quality research, I am convinced that we need to get ‘interventional’ early. For me that means a thorough examination, confirmed with proper imaging (and yep, that ideally an MRI in my book – or at the very least ruling out glenohumeral OA with an X-ray), followed by early image-controlled hydrodilatation and very swift rehab.

I think the time for ‘let’s first see how you go with a few weeks of physio’ is well and truly over.

A well thought out, well administered image-guided hydrodilatation injection + rehab is the kindest way to help your frozen shoulder patients.
Please refer them early for help as soon as you spot it. You’ll save many a patient from a sleepless night. Or bad hair day.