For five months my wife, 71, has had a frozen shoulder. She has tried physiotherapy and acupuncture to no great effect, and has had a few injections and been prescribed painkillers and sleeping pills. Can she do anything else?
Name and address withheld

Many people suffer from "frozen shoulder", or adhesive capsulitis, resulting from thickening and contraction of the capsule around the shoulder joint. Surprisingly, the non-dominant shoulder is affected more commonly than the dominant one. Frozen shoulder occurs mostly between the ages of 40 and 70, is more common in women, and results in stiffness, loss of motion and often substantial pain.

The causes of frozen shoulder are unknown, but it sometimes appears to be associated with metabolic disorders, including thyroid conditions and diabetes, although some patients may have injured the affected shoulder. Initially, a "freezing" phase occurs. This is followed by a "frozen phase", and is completed by a "thawing phase". While it is rare for frozen shoulder to last longer than 24 months, it may cause stiffness and discomfort for three years. Luckily, it is very rare for the disorder to recur.

Patients who are first seen in the "freezing" or in the "frozen" stages are very resistant to management, which includes physical therapy, injections, and painkillers. Unfortunately, most patients do not experience much improvement, and some may need to have the shoulder moved in all directions under general anaesthesia. Even in this instance, there is not much scientific evidence to show that the natural course of the condition is accelerated.

Recently, arthroscopy has been advocated. In this procedure, the affected shoulder is inspected with a small endoscope, and the joint is distended with physiological solution to break the adhesions. This treatment can be performed under regional anaesthesia in a day-case setting, and is becoming popular, particularly in the US. The results are encouraging, and most patients experience immediate resolution of pain and return to lasting near-normal function very fast. Long-term results are not available yet, but it may well be the solution of choice for patients who do not want to, or cannot, wait for the condition to run its course. All procedures are, theoretically, available on the NHS, but only a few surgeons perform arthroscopy. I, for example, do not.

· Professor Maffulli is a consultant orthopaedic and sports injury surgeon at Keele University medical school. If you have a question for him, email fitness@theguardian.com