Frozen shoulderA frozen shoulder is a shoulder that has significant loss of range of motion in all directions. Cause Frozen shoulder is due to inflammation, scarring, thickening and shrinkage of the normal capsule that lies inside the shoulder joint. Any injury to the shoulder, no matter how trivial, can lead to frozen shoulder. These can include 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. Its incidence is also increased in patients who have had chest or breast surgery. Prolonged immobility of the shoulder joint can put persons at increased risk for developing a frozen shoulder. Diagnosis On history, the patient will complain bitterly of severe pain that is aggravated by motion. Even at rest, though, the shoulder will hurt. There is significant night pain. On examination, the shoulder range of motion is significantly limited, with both active and passive attempts at movement. Underlying diseases affecting the shoulder can be diagnosed with history, physical, laboratory testing, and x-ray/ magnetic resonance imaging examination of the shoulder. Sometimes an arthrogram is done. This is a test where x-ray contrast dye is injected into the shoulder joint to demonstrate the characteristic shrunken shoulder capsule of a frozen shoulder. As mentioned above, the shoulder can also be evaluated with an MRI scan. Inflammatory arthritis can cause swelling, pain, or stiffness of the joint that can mimic a frozen shoulder. 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. Treatment This requires an aggressive combination of anti-inflammatory medication, glucocorticoid injections, and physical therapy. Glucocorticoid injections may need to be repeated. Without aggressive treatment, a frozen shoulder will not improve. Physical therapy is often key and can include 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. It is important for persons with frozen shoulder to avoid re-injury to the shoulder tissues during the rehabilitation period. 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 scarred 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. Continued 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.
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