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Best Treatment for Frozen Shoulder

Frozen Shoulder

Frozen shoulders are also called adhesive capsulitis and causes pain and stiffness in the shoulder. Over time, the shoulder becomes very hard to move actively and passively.

Frozen shoulder is usually a self-limiting disease, meaning after a period of worsening symptoms, it tends to get better, although full recovery may take up to 18 months to 3 years. Physical therapy, focusing on shoulder flexibility, is the primary treatment recommended for frozen shoulders.

Frozen shoulder most commonly affects people between the ages of 40 and 60 and occurs in women more often than men. In addition, people with diabetes are at an increased risk of developing a frozen shoulder.

Description

In a frozen shoulder, the shoulder capsule, essentially the covering of the shoulder, thickens and becomes stiff and tight. Thick bands of tissue — called adhesions — develop. In many cases, there is less synovial fluid in the joint. The most common cause of frozen shoulders is idiopathic, meaning no specific reason is responsible for developing the same. Often, there is microtrauma to the shoulder in a person with diabetes, which does not heal, thereby starting an inflammatory cascade and leading to the development of a frozen shoulder. In more than 50 per cent of cases, there is a chance that this frozen shoulder will affect the opposite shoulder within three years of affection of the primary shoulder.

The hallmark signs of this condition are severe pain and being unable to move your shoulder -- either on your own or with the help of someone else. It develops in three stages:

  • Stage 1: Freezing

    In the "freezing" stage, you slowly have more and more pain. As the pain worsens, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months.
  • Stage 2: Frozen

    Painful symptoms may improve during this stage, but the stiffness remains. Daily activities may be challenging during the 4 to 6 months of the "frozen" stage.
  • Stage 3: Thawing

    Shoulder motion slowly improves during the "thawing" stage. Complete return to normal or close to normal strength and movement typically takes six months to 2 years.
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How is a frozen shoulder diagnosed?

To diagnose a frozen shoulder, a frozen shoulder specialist will:

  • Discuss your symptoms and review your medical history.
  • Conduct a physical exam of your arms and shoulders:
  • The best doctor for a frozen shoulder will move your shoulder in all directions to check the range of motion and if there is pain with movement. This type of exam, in which a frozen shoulder specialist moves your arm and not you, determines your "passive range of motion."
  • The doctor will also watch you move your shoulder to see your "active range of motion."
  • The two types of motion are compared. People with frozen shoulders have a limited range of active and passive motion.
  • X-rays of the shoulder are also routinely obtained during the frozen shoulder treatment to ensure the cause of the symptoms is not due to another problem with the shoulder, such as calcification, rotator cuff pathology, or arthritis. Advanced imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are usually unnecessary to diagnose a frozen shoulder. They may be taken to look for other problems, such as a rotator cuff tear.

What are the best treatments for frozen shoulder?

Treatment usually involves pain relief methods until the initial phase passes. If the problem persists, therapy and surgery may be needed to regain motion if it doesn’t return independently. Some simple treatments include:

  • Cold compresses. These help reduce pain and swelling.
  • Medicines that reduce pain and swelling. These include nonsteroidal anti-inflammatory drugs (NSAIDs). Your doctor may prescribe other painkillers/anti-inflammatory drugs.
  • Physical therapy. Stretching and range of motion exercises taught by a physical therapist during frozen shoulder therapy treatment.
  • Injections: More severe pain and swelling may be managed by steroid injections. A corticosteroid, such as cortisone, is injected directly into the shoulder joint. The pre-requisite for this is that the sugar levels of people with diabetes should be under control.
  • Home exercise program. Continue the exercise program at home.

If these simple frozen shoulder treatments have not relieved pain and shoulder stiffness after about a year of trial, other procedures may be tried. These include:

  • Manipulation under anaesthesia:

    During this surgery, you will be put to sleep, and you will be forced for a movement of your shoulder. It will cause the joint capsule to stretch or tear to loosen the tightness. It will lead to an increase in the range of motion.
  • Shoulder arthroscopy:

    As one of the best treatments for a frozen shoulder, the doctor cuts through the tight parts of your joint capsule (capsular release). Small pencil-sized instruments are inserted through tiny cuts around your shoulder.

These two best treatments for frozen shoulders are often performed together to get better results.

PREVENTION

Can a frozen shoulder be prevented?

The chance of a frozen shoulder can be prevented or lessened if physical frozen shoulder therapy treatment is started shortly after any shoulder injury in which shoulder movement is painful or difficult. Avoiding trauma to the shoulder and keeping your HbA1c levels under control forms the mainstay of prevention of developing a frozen shoulder.