Case Study: Frozen Shoulder in Both Shoulders

This case at a glance

Diagnostic Findings

On examination, both shoulders were stiff. She could not raise either arm above shoulder height. She could not reach behind her back. Moving her shoulders brought on the pain, and lying on them made it worse. No scan is recorded for this case.

I asked about her symptoms and examined both shoulders. The pattern fitted frozen shoulder. Its medical name is adhesive capsulitis.

The shoulder joint sits inside a soft bag of tissue called the capsule. In frozen shoulder, this capsule becomes inflamed. Over time, it thickens, tightens and forms scar tissue.

The shoulder normally moves further than any other joint in the body. When the capsule tightens, movement is lost in every direction. This is why she could not raise her arms or reach behind her.

Frozen shoulder is mainly diagnosed by examination. A scan is often used only to rule out other problems, such as a torn tendon. I explained all this to her before we agreed a plan. My first aim was to ease the pain, so that she could start moving her shoulders again.

Treatment Approach

Here is how I treated her:

1. On the same day, I gave her local anaesthetic injections around both shoulder joints. There were five in total: three on one side and two on the other. These injections block the nerves that carry pain from the joint. This is called a nerve block.
2. I then arranged three physiotherapy sessions. Her physiotherapist helped her slowly get back the movement in both shoulders.
3. I prescribed two types of medicine. One eased stiffness in the soft tissues. The other was an anti-inflammatory painkiller. She took them for just over a month.
4. I gave her a home exercise plan. This included stretches and weight-bearing exercises to build strength around the shoulders. I suggested swimming as one helpful option.
5. I explained that regular exercise matters. Without it, the stiffness of frozen shoulder can come back.

 

Outcome

In this case, she reported that her shoulders began to loosen soon after the injections. At follow-up, she could raise both arms. She reported that shoulder pain no longer woke her at night.

Her movement kept improving with physiotherapy. She stopped her medicines after just over a month.

More than two years later, she reported no return of her shoulder symptoms. She continues to exercise her shoulders regularly.

This outcome reflects one individual case. Treatment suitability and results depend on each patient’s specific diagnosis and clinical assessment.

Ask the Doctor

Q: How is frozen shoulder treated, and can exercise help?

A: Frozen shoulder is usually treated with a few methods that work together. I often start by easing the pain, for example with a nerve block or a steroid injection, so the shoulder can be moved without fear of pain. Physiotherapy then helps bring back movement, and regular exercise afterwards may lower the chance of the stiffness coming back. Not all shoulder pain is frozen shoulder, though: a torn tendon from a fall, heavy lifting or a sudden hard movement can feel similar. Pushing through that kind of pain with exercise can make it worse, so I check with a scan first if I suspect a tear.

— Dr Bernard Lee Mun Kam, Pain Specialist