Frozen Shoulder Treatment Options
Adhesive capsulitis, more commonly known as frozen shoulder, is a painful condition in which the strong connective tissue that forms a capsule covering the shoulder ball-and-socket joint thickens and tightens, causing pain and inhibiting movement. About 2% to 5% of the population experiences frozen shoulder. Frozen shoulder typically affects people in their 50s and 60s, and women more often than men. Too often, people delay a trip to the doctor thinking their symptoms will improve with time. But an early diagnosis allows you and your doctor to start one of many available treatment options and increase the prospect of a full recovery.
Diagnosing Frozen Shoulder
A number of causes can trigger frozen shoulder: chronic joint inflammation; an upper arm or shoulder injury, such as rotator cuff tear; or some type of shoulder surgery. To reach a frozen shoulder diagnosis, a family physician or orthopedist will ask you about symptoms, possible injury, and medical history, then perform a physical examination to check your range of motion and level of pain. He or she may order x-rays or MRI (magnetic resonance imaging) to look for tears or other damage. Frozen shoulder has three phases: freezing (pain with upper arm and shoulder movement); frozen (less pain, but restricted movement); and thawing (gradual healing and increased range of motion). Treatment options may vary depending on the stage.
Typically the first line of treatment for frozen shoulder is physical therapy to loosen the shoulder capsule and restore motion. During your initial visit, the physical therapist will gather information about your health history, any possible shoulder injury, and how long the shoulder has been immobile. Then he or she will assess your range of motion by measuring your shoulder extension in various positions. Based on this information, the therapist determines the number of therapy sessions needed to restore normal or near-normal range of motion.
The timeframe for therapy depends on the severity of the condition (as well as taking into account what your insurance will cover) but can last from three months to a year. Therapy appointments often include warming up your arm and shoulder muscles using an arm bicycle, followed by the therapist stretching your arm and shoulder to slowly manipulate them beyond the "frozen" range of motion. You’ll also likely be asked to perform frozen shoulder exercises and stretches at home between appointments.
As you make progress, your therapist will introduce new exercises and stretches, which you’ll be encouraged to continue after physical therapy treatments end.
In conjunction with physical therapy, the orthopedist will likely recommend anti-inflammatory medication (usually non-prescription) to provide frozen shoulder pain relief and reduce swelling. If anti-inflammatory drugs are not effective, your doctor may prescribe oral steroids or cortisone injections.
Dry needling—which should not be confused with acupuncture—is an optional treatment for frozen shoulder. During these treatments, a physical therapist with dry-needling training locates trigger points in tight muscle tissues and inserts monofilament needles into those areas to increase blood flow, lessen stiffness, and reduce pain. The procedure lasts about 20 minutes. While you may experience mild discomfort when needles are inserted, many people experience a greater range of motion immediately following a dry needling treatment. However, some insurance companies do not cover dry needling, so check your coverage before scheduling any treatments. And always talk to your doctor before trying any alternate therapy.
In severe cases of frozen shoulder, your doctor may suggest surgery. The good news is 90% of frozen shoulder patients improve with non-surgical treatment. The purpose of frozen shoulder surgery is to release the tightened joint capsule. An orthopedic surgeon may either manipulate the joint, forcing scar tissue to loosen and tear, or use arthroscopy to make cuts in the joint capsule, releasing tightness. Sometimes surgeons use a combination of both procedures. Following surgery, you’ll likely need physical therapy to continue the process of unfreezing the shoulder. Commitment to physical therapy is crucial for regaining full or nearly full use of the shoulder. The recovery period for frozen shoulder surgery ranges from six weeks to three months.
While there is no definitive cause for frozen shoulder, it’s important to pay attention when symptoms first occur and seek treatment early. By working promptly with your doctor, you can find more immediate pain relief and have a better chance of recovering your full range of motion.