Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

What do you think about surgical manipulation for a frozen shoulder? Will it help me or not?

Answer:

Shoulder manipulation (moving the shoulder through its full range of motion while the patient is asleep with an anesthetic) can be helpful for some shoulder problems. But it is not usually the first choice in treatment for a frozen shoulder. Before determining the appropriate treatment, an accurate diagnosis is required. For example, the physician must sort out whether the patient has a true "frozen shoulder" or something else referred to as adhesive capsulitis. For many years, the terms adhesive capsulitis and frozen shoulder were used to describe the same condition. Patients experience shoulder pain and loss of shoulder motion. The problem comes on slowly over a period of time and seems to affect women more often than men (especially women between the ages of 40 and 60). But experts recognize now that there are many different shoulder conditions that can present with these (or similar) symptoms. So the old term "frozen shoulder", once used to describe any painful, stiff shoulder is now more refined. The term "adhesive capsulitis" may be a more accurate description for some patients. As the name suggests, adhesive capsulitis affects the fibrous ligaments that surround the shoulder forming the joint capsule. This condition is referred to as primary adhesive capsulitis to differentiate it from "frozen shoulder" (secondary adhesive capsulitis). Primary adhesive capsulitis is formed by inflammation, fibrosis, and contraction of the capsule with tiny adhesions holding the capsule to the bone. The normally loose parts of the joint capsule stick together. The result is pain and loss of motion from a mechanical (tissue) problem (adhesions causing tightness). The condition referred to as a frozen shoulder usually doesn't involve the capsule. Secondary adhesive capsulitis (or true frozen shoulder) might have some joint capsule changes but the shoulder stiffness is really coming from something outside the joint. Often, the short rotator muscles around the shoulder spasm. Sometimes, adhesions form inside the joint itself (rather than in the capsule). Some of the conditions associated with secondary adhesive capsulitis (true frozen shoulder) include rotator cuff tears, biceps tendinitis, and arthritis. Any of these problems can seriously limit the shoulder's ability to move, and causes the shoulder to "freeze." Risk factors for adhesive capsulitis include: diabetes, thyroid problems, Dupuytren contracture, treatment for breast cancer, autoimmune diseases, and previous heart attack or stroke. Arthroscopic release is considered "best practice" for shoulder motion limited by capsular tightness. This procedure has replaced manipulation under anesthesia (MUA) as the treatment of choice. Studies show that patients who have arthroscopic release have better (and more long lasting) pain relief and improved shoulder range of motion with arthroscopic treatment compared with MUA. And as mentioned, preliminary testing is recommended to make sure the pain and loss of motion is really coming from the joint capsule and not from inside the joint. Once the diagnosis has been made, then treatment can be prescribed. Physical therapy is the first line-of-treatment. It takes time to calm the pain signals and gain motion back, so a period of conservative care over several months is necessary. During this time, nonsteroidal antiinflammatory medications are often recommended for their short-term effects of providing pain relief. Steroid injections into the joint also provide a temporary decrease in pain and may aid in reducing inflammation in the early stages of the condition. When conservative care fails to bring about the desired results, treatment may be expanded to include nerve blocks, hydrodilation (injecting a saline solution into the joint to expand/rupture the capsule), or manipulation under anesthesia (surgeon moves arm through full motion while patient is asleep). When all else fails, surgery may be the last step. Of course, arthroscopy (looking inside the joint) is the final step in confirming the diagnosis. Arthroscopy is used to see inside the joint and release adhesions, scar tissue, and/or the capsule itself. Physical therapy after manipulation is required in order to maintain shoulder motion after manipulation or surgery. T. Sean Lynch, and Sara L. Edwards, MD. Adhesive Capsulitis: Current Concepts in Diagnosis and Treatment. In Current Orthopaedic Practice. July/August 2013. Vol. 24. No. 4. Pp. 365-369.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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