Frozen shoulder, or adhesive capsulitis, is a disabling condition capable of causing pain and reduced range of motion in the shoulder joint. It is caused by tissue adhesions forming inside the shoulder joint, which adhere your shoulder capsule to bone and restricts movement. According to Robert Manske in the 2008 “Current Reviews in Musculoskeletal Medicine”, frozen shoulder incidence is 3 to 5 percent in the general population, but increases to 20 percent in people who have diabetes. Since your shoulder is a complex joint used in many daily activities, decreased mobility of this joint is clinically serious. If proper diagnosis and treatment is not provided, pain and stiffness will increase until total immobility develops.
Frozen Shoulder Stages
Frozen shoulder usually occurs in three stages. The stage at which your shoulder is progressing determines the treatment protocol. Stage one is the freezing and painful stage, which lasts about 3 to 9 months. The pain comes from inflammation of the synovium, the lining surrounding your shoulder joint. You may progress to the second stage without increased pain, which lasts 4 to 12 months. At this transitional stage, shoulder movement becomes frozen. During the third stage, your range of motion should begin to improve. This last stage is called the thawing stage and can last 12 to 14 months.
Early Stage Treatment
- Anti-inflammatory Medications & Physical Therapy
Many physicians treat only the inflammatory condition present at the first stage of frozen shoulder symptoms, when early physical therapy or exercise may be able to prevent tissue adhesions from forming. Pain and inflammation can be treated with over-the-counter or prescription anti-inflammatory medications such as aspirin, ibuprofen, ketoprofen and meloxicam, while prescribed exercises and physical therapy can keep tendons and ligaments mobile enough to prevent adhesion formation. Also, prescribed muscle relaxants may reduce muscle spasm pain associated with this disease as well as heat and cold treatments.
- Corticosteroid Injection
If pain continues to limit your physical therapy, intra-joint corticosteroid injections may be indicated to reduce the inflammation in a frozen shoulder. Corticosteroid injections should be performed by medical personnel under ultrasound guidance for accurate placement. Up to 60 percent of blind injections may be inaccurate. If done properly, a corticosteroid injection should reduce your pain enough to allow you an increased range of motion during exercise for your frozen shoulder.
Later Stages Treatment
- Joint Distension
Frozen shoulder diagnosis in later stages can be difficult to manage. Anti-inflammatory medications, muscle relaxants, physical therapy and corticosteroid injections may not be successful. Joint distension, shoulder manipulation and surgery may be optional treatments for later stages of a frozen shoulder. For joint distension, a maximum amount of sterile water or anesthetic is injected into your joint under local anesthetic. As the solution is forced into your joint, stretching may cause adhesions to release and allow you increased mobility.
- Shoulder Manipulation
Shoulder manipulation or shoulder arthroscopic surgery for a frozen shoulder must be performed under general anesthetic, which means you will be unconscious during the procedure. Frozen shoulder manipulation under anesthesia will allow your physician to force your shoulder into positions that cannot be obtained during regular physical therapy. The manipulations will likely release the adhesions in your shoulder joint, thus increasing its mobility. Immediate physical therapy is important after this procedure, although increased pain may slow recovery.
- Arthroscopic Surgery
Often, shoulder manipulation and arthroscopic surgery can be combined for excellent results if no other treatment has provided you with frozen shoulder relief. Arthroscopic surgery is performed under general anesthesia by inserting surgical instruments into small incisions around your frozen shoulder and cutting tissues that will allow increased shoulder mobility. Also, the surgeon can view your joint during this surgery, and determine if any abnormalities may be present that contributed to the development of your frozen shoulder. Physical therapy is immediately after these treatments. Ice and corticosteroid injects may assist physical therapy.
