Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

I have a full-blown case of frozen shoulder. The PA who saw me gave me all kinds of options from doing nothing to having surgery. What do you recommend?

Answer:

Treatment ranges from conservative (nonoperative) care with doing nothing, physical therapy, or steroid injections to surgery to release the adhesions. Surgery can be done with a simple manipulation (shoulder is moved through full motion while patient is anesthetized), arthroscopic capsular release, or open incision release. A recent study of long-term outcomes after arthroscopic capsular release may have some helpful insights for you. A single surgeon from the Orthopaedic Research Institute in Australia followed a group of patients through surgery and the follow-up recovery time (including up to five years later). This was the first study to report such results more than two years after the first arthroscopic procedure. The surgeon performed a complete 360-degree release of the capsule (all the way around the shoulder joint). Then a gentle manipulation was performed by moving the arm through its full range-of-motion. The surgeon injected the joint with a numbing agent combined with a steroid (antiinflammatory) medication. The goal of the injection therapy was post-operative pain relief. Everyone treated with this approach went home on the day of surgery without a sling and with instructions from the physical therapist for the proper exercises to perform. Results were measured by comparing before and after surgery range-of-motion, pain intensity, activities and function. The ability to reach behind the head and back was measured. Ability to lie on the painful side and sleep at night were also reported and recorded. Current level of sports participation was rated from "none" to hobby, club, or professional play. All the patients reported immediate pain relief during activity and at night while sleeping. There was at least a 50 per cent improvement in range of motion early on. Functional skills like reaching overhead or behind the back improved steadily from postoperative week 6 through the end of the first year. By the end of the first year, the affected shoulder had motion equal to that of the unaffected shoulder. And there were no complications (e.g., infection, worse symptoms, nerve damage, joint instability). The author concluded that arthroscopic capsular release for idiopathic adhesive capsulitis is an acceptable, safe, and effective treatment technique. The good-to-excellent results in the short-term were maintained into equally good long-term results. These results compare favorably to the 50 per cent of patients treated nonoperatively who still had pain or stiffness five to seven years later. Hugh M. J. Le Lievre, and George A. C. Murrell, MD, DPhil. Long-Term Outcomes After Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis. In The Journal of Bone & Joint Surgery. July 3, 2012. Vol. 94A. No. 13. Pp. 1208-1216.

*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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