New jab that thaws out a frozen shoulder could bring relief to millions

By
Alice Smellie

Last updated at 10:42 PM on 11th February 2012


Those with diabetes, lung and heart disease are at higher risk

Those with diabetes, lung and heart disease are at higher risk

Karl Grieves was putting on a sweater one morning when he felt a sharp, wrenching pain in his left shoulder.

‘It was as though I had pulled a muscle,’ says Karl, 48. ‘I didn’t think twice about it, but over the next couple of weeks the pain got worse and worse. Even picking up the phone was impossible.’

He had not – as you may be thinking – broken or dislocated his arm. Instead, Karl was suffering with a common problem that can happen at any time: a frozen shoulder.

The shoulder joint is a
ball-and-socket joint. The ball is at the top of the humerus (upper arm
bone) and the socket is a shallow cup on the edge of the scapula
(shoulder blade).

Surrounding
the shoulder joint is a joint capsule, a watertight sac that encloses
both the joint and the fluids that lubricate it.

The
walls of this capsule are made up of ligaments and connective tissues.
When the arm is raised over the head this capsule is fully stretched,
and when the arm is lowered to the side the tissue hangs down in a small
sack.

Frozen shoulder –
also called adhesive capsulitis – occurs when this capsule of tissue
becomes inflamed and stiff. This causes both chronic pain and restricts
movement.

The shoulder is
literally frozen, or stuck. It is also highly frustrating. Pain can be
worse at night and even minor activities such as dressing or lifting a
kettle can become difficult.

‘There
are three main stages to a frozen shoulder,’ says consultant
orthopaedic surgeon Simon Moyes, who is based at the Wellington Hospital
in Central London. ‘First of all you feel pain, then pain and
stiffness, and finally just stiffness. It usually takes between 18 and
24 months to recover from but it can take longer.’

Experts do not know the exact causes but the condition has links to rheumatic disease and can occur after shoulder surgery.

Those
with diabetes, and lung and heart disease, are at a higher risk of
developing it and sporting injuries are another factor. Frozen shoulder
can also happen spontaneously, yet it rarely afflicts people aged under
40.

How the injection works to relieve the pain

How the injection works to relieve the pain

Treatments so far have
been limited – ice or heat may give pain relief, as can
anti-inflammatories. Physiotherapy can help to restore movement to the
joint. Sometimes steroids are used to reduce the inflammation and
occasionally arthroscopic surgery may be an option to release the
adhesions.

But in the past
few months, a new option in the form of one or two simple injections has
been revolutionising the medical approach to the condition. Called
hydrostatic distension, it costs from £300 when administered privately
but the treatment is also available on the NHS.

Moyes
is one of the first consultants to offer the procedure. He says: ‘It
was developed by radiologists. The shoulder is first given an assessment
by an orthopedic consultant to ascertain the exact situation. An MRI
scan is usually performed.

‘Then
a radiologist injects a mixture of local anaesthetic, saline and a
small amount of steroid – via a 2.5in needle – into the ball and socket.

‘If
you imagine that the ball and socket are like a deflated balloon, we
are literally reinflating it and breaking down the adhesions – the bits
of lining that have become glued together.’

Treatments so far have
been limited – ice or heat may give pain relief, as can
anti-inflammatories 

Patients
usually require two injections, two weeks apart, and after a month 80
per cent of them are pain-free. Karl, a managing director at an
insurance company who lives in London, was one such satisfied patient
after he had the injection last autumn.

‘I was surprised to have somehow wrenched my shoulder by simply putting on a sweater,’ he recalls.

Karl travels a lot for work and found that he could not reach overhead lockers on planes without doubling up in agony.

He
was recommended physiotherapy but this did not help, so he went to see
Moyes privately. An MRI scan confirmed the problem as a frozen shoulder
and he immediately agreed to the injections.

‘The
thought of 18 months in this sort of pain was unbearable,’ he says of
his decision. By this point he was taking ibuprofen several times a day.

Karl
was warned that he might feel pain during the procedure, but was
surprised. ‘There was some discomfort but no more than having an
anaesthetic at the dentist,’ he says.

As
he lay on his side for access, a local anaesthetic was administered
into the shoulder. ‘Within half an hour I had the whole range of
movement back in my shoulder,’ he says.

Karl was able to go straight back to work and needed only one more injection.

‘I went back after two weeks for a check-up and was absolutely fine,’ he says.

Moyes
adds: ‘This is still a specialised area but more and more consultant
musculo-skeletal radiologists are being trained to do it as we see
incredible results.’

 

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