Frozen shoulder and therapy
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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A frozen shoulder is a shoulder that has loss of range of motion in all directions.
The range of motion is limited with both active (when the patient attempts motion), as well as passive (when the doctor attempts to move the joint) maneuvers. Another term for frozen shoulder is adhesive capsulitis.
Frozen shoulder is due to inflammation, scarring, thickening and shrinkage of the shoulder capsule that lies within the shoulder joint. There are several causes of frozen shoulder. These can include any type of trauma, tendinitis, bursitis, as well as rotator cuff injuries. Frozen shoulder occurs more often in patients with conditions such as diabetes and chronic inflammatory arthritis of the shoulder. Patients with prior chest or breast surgery also are at risk. Prolonged immobility of the shoulder joint can lead to frozen shoulder.
On examination, the shoulder range of motion is limited with both active and passive attempts at movement. Conditions affecting the shoulder can be diagnosed with a careful history, physical, laboratory testing, and magnetic resonance imaging (MRI) examination of the shoulder.
Inflammatory arthritis can cause swelling, pain, or stiffness of the joint that can mimic a frozen shoulder. Treatment
Injury to the rotator cuff tendons around the shoulder can also limit shoulder joint range of motion, but usually not in all directions. During the examination of a shoulder with tendon injury (tendinitis or tendon tear), passive range of motion is maintained better than active range of motion.
This requires a combination of anti-inflammatory medication, glucocorticoid injections, and physical therapy. Without aggressive treatment, a frozen shoulder will not improve.
Physical therapy is important and includes ultrasound, electric stimulation, range of motion exercise maneuvers, ice packs, and strengthening exercises. Physical therapy can take weeks to months for recovery, depending on the severity of the scarring of the tissues around the shoulder joint.
Patients should avoid sudden, jerking motions or heavy lifting with the affected shoulder.
Occasionally, frozen shoulder is resistant to conservative treatment. Patients with resistant frozen shoulder can undergo either release of the scar tissue by arthroscopic surgery or manipulation of the shoulder under anesthesia.
The latter procedure is performed to physically break up the scar tissue of the joint capsule. It carries a risk of fracturing the humerus (arm bone). It is important for patients that undergo manipulation to get involved in an active exercise program for the shoulder after the procedure. Exercise of the shoulder after the procedure is mandatory to secure optimal mobility and function.
A better option and much less invasive is a new procedure called percutaneous needle tenotomy with autologous tissue grafting. With this procedure, a patient has the shoulder capsule freed up by using a small needle that is introduced under local anesthesia using ultrasound guidance to break up the adhesions.
Platelet rich plasma obtained from the patient's whole blood is then injected. Platelets contain multiple growth factors that aid in the healing process.The patient is then free to go home. Physical therapy is usually initiated one-two weeks after the procedure.
For more information regarding shoulder tendonitis problems, visit our new site:
Tendonitis and PRP
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