Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

After months of exercises, hot baths, acupuncture, and even hypnosis, my frozen shoulder is still as stuck as ever. I think I've gained a total of 10 degrees of motion I didn't have when I started. I've even tried steroid injections (against my better judgment). I am truly stuck. Is there any help for someone like me?

Answer:

You didn't mention the reason why you have a frozen shoulder (also known as adhesive capsulitis). Sometimes the underlying cause (if there is one) is a predictor of what will happen or how to best treat it. For example, patients with diabetes who develop a frozen shoulder have a longer course of recovery with variable results compared to someone who may have fallen onto an outstretched hand or on to the elbow/upper arm. Without that information, we will proceed as if you have primary adhesive capsulitis (no precipitating cause). The first thing to be aware of is that it can take 12 to 18 months (or longer) to move through the various stages of such a frozen shoulder. Exercises can be helpful but they should be done based on how irritable the affected tissues are (low, moderate, high). For example, someone with high irritability has pain that limits motion and function. Someone with low irritability may have slightly restricted motion with stiffness, but no pain. For patients with primary adhesive capsulitis (remember primary means it wasn't caused by something else like diabetes), the patient usually begins with high irritability. As the condition gets better, the level of irritability goes down to moderate, and then to low. Early on during the painful, high irritability stage, short-duration gentle range-of-motion may be best. The result will be to decrease pain and muscle guarding with the net effect of increasing shoulder and arm motion. This is where many people get stuck. They overstretch the tissues causing a cycle of pain, tissue damage, fibrosis (scar tissue formation), and then stiffness. Further forceful stretching starts the cycle over again. Assessment of irritability begins with a sleep history. Can you sleep through the night? Can you lie on that side for more than an hour? If yes, you are probably in the low irritability phase and can tolerate a more vigorous program of stretching exercises. A second way to determine level of irritability is to see if the primary problem is pain or stiffness. Stiffness is a sign of fibrosis (scarring). Pain is an indication that there is an inflammatory process going on. If you have been down this path carefully and under the supervision of a physical therapist without results,then surgery may be advised. Under anesthesia, the surgeon may manipulate (move) the shoulder. With the muscles around the shoulder completely relaxed, the surgeon can put the shoulder through its full range-of-motion, breaking any adhesions present in all directions. There are some potential problems with manipulation such as fractures or dislocations. It's not a good procedure for anyone with bone loss or who can't perform the necessary follow-up program of exercises. Open incision surgery isn't really done on a frozen shoulder. The surgeon may go into the joint using an arthroscope and release the joint capsule This isn't always the best option since bleeding into the joint from this procedure can cause the formation of more scar tissue. It sounds like your next step is to go back to your physician for a discussion of your situation and a change in the plan of care. There may be some treatment options left to consider but an exam is needed first to find out where you are in the process and to determine what might work best for you. Martin J. Kelley, PT, DPT, OCS, et al. Frozen Shoulder: Evidence and Proposed Model Guiding Rehabilitation.In Journal of Orthopaedic & Sports Physical Therapy. February 2009. Vol. 39. No. 1. Pp. 135-148.

*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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