Frozen shoulder



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.

Click here: Second Opinion Arthritis Treatment Kit


A frozen shoulder is characterized by significant loss of range of motion in all directions.

While it most often affects one shoulder, it is not uncommon for the condition to affect the other as well, although usually not at the same time.

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.”

Cause

Frozen shoulder is due to inflammation, scarring, thickening and shrinkage of the shoulder capsule inside the shoulder joint. Many conditions 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, chronic inflammatory arthritis of the shoulder, and those who have had chest or breast surgery. Prolonged immobility of the shoulder joint also can lead to a frozen shoulder.

Diagnosis

On history, the patient will complain of severe pain that is aggravated by motion. The shoulder will hurt at rest. There is terrible night pain. The shoulder range of motion is significantly limited, with both active and passive movement.

Some conditions can mimic frozen shoulder. For example, inflammatory arthritis can cause swelling, pain, or stiffness of the joint that can resemble a frozen shoulder.

Injury to the rotator cuff tendons can also limit shoulder joint range of motion, but usually not in all directions. A shoulder with tendon injury (tendinitis or tendon tear) shows that passive range of motion is maintained better than active range of motion.



Treatment

This requires a combination of anti-inflammatory medication, glucocorticoid injections, and physical therapy.

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 shoulder problem. I had frozen shoulder and the therapy was painful, long term (several weeks), but successful.

Frozen shoulder can be 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. This latter procedure carries a risk of fracturing the humerus (arm bone). It is important for patients that undergo manipulation to start an active exercise program for the shoulder after the procedure.

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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