What is the treatment for a 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.
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A frozen shoulder is a shoulder that has significant 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 normal capsule of the shoulder joint. Any injury to the shoulder, no matter how insignificant, can lead to a frozen shoulder.
These can include tendinitis/tendinopathy, bursitis, as well as rotator cuff injuries. Frozen shoulder occurs more often in patients with conditions such as diabetes, thyroid conditions, and chronic inflammatory arthritis of the shoulder. It is also more common 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.
On history, the patient will complain of severe pain that is aggravated by motion. There is significant night pain. The pain is intense. 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 evaluated with history, physical, laboratory testing, and x-ray/ magnetic resonance imaging.
Sometimes an arthrogram is done. This is a test where x-ray contrast dye is injected into the shoulder joint to demonstrate the 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.
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.
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. There is 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 obtain optimal mobility and function. Frozen shoulder can recur.
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