Shoulder - Adhesive Capsulitis (frozen shoulder)
Description
Frozen shoulder is a thickening and inflammation of the layer of tissue/capsule surrounding the glenohumeral joint.
What are the causes?
Frozen shoulder can occur after an injury, in which the patient is unable to move the shoulder for an extended period of time. However, the majority of cases occur without a pre-existing injury or known cause. Research has demonstrated that women between the ages of 40-60 years old, patients with diabetes or thyroid disease or patients that have had a recent viral infection may be at higher risk.
What are the symptoms?
Frozen shoulder can be classified into three phases. In the first phase, patients experience pain associated with and without movement, night pain and a progressive loss of motion, particularly moving the arm away from the body and rotating the shoulder joint. The second phase typically sees a decrease in the pain and severe losses of motion in the planes previously described in the first phase. Phase three is the gradual restoration of motion and no pain. There is usually no or minimal loss of strength in any phase, which differentiates frozen shoulder from bursitis or rotator cuff tendon damage.
How is it diagnosed?
Dr. Liu will perform a thorough history and physical examination to evaluate shoulder motion. Loss of both active (when the patient lifts the arm on his own) and passive (when the doctor moves the shoulder without help from the patient) motion indicates a frozen shoulder. Strength in all the muscles is preserved. X-rays are usually taken and show no abnormality. An MRI may show inflammation around the “ball and socket” joint.
Non-operative
Your surgeon may prescribe anti-inflammatory medication, cryotherapy and activity modification to decrease pain and inflammation. An injection into the “ball and socket” joint may be helpful in decreasing the progression of the disease in the first phase and shorten the course of the inflammation (9-12 months). Physical therapy is usually not indicated in the first two phases, as overstretching may increase the inflammation. Frozen shoulder is usually self-limiting and resolves in 12-18 months.
Platelet-rich plasma (PRP) injection is another non operative option for treating pain. Blood is taken from your arm and is spun down to get the healthiest healing factors - platelets and serum. The goal is to promote an anti-inflammatory effect, reduce pain, and stimulate healing. Although one injection may help, studies support a series of 2 injections, 1 x Week/2 weeks. Not covered by insurance.
Operative
Patients that do not improve over 12-18 months may be candidates for surgery. Your surgeon may perform a manipulation under anesthesia before or after surgery (forced motion to break up scarred tissue), and a minimally-invasive arthroscopy to remove the thickened and inflamed tissue. After surgery, immediate physical therapy in the hospital with continuous pain medication into and around the shoulder is initiated to maintain motion before scar tissue has an opportunity to reform.
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