|The shoulder capsule surrounds the shoulder joint and rotator cuff tendons.|
Magnetic resonance imaging (MRI) and ultrasound. These studies can create better images of problems with soft tissues, such as a torn rotator cuff.
Steroid injections. Cortisone is a powerful anti-inflammatory medicine that is injected directly into your shoulder joint. I generally recommend one injection into the bursa followed by therapy. Two weeks later, I usually inject the shoulder joint itself with a steroid. This is a second injection but it goes into a separate part of the shoulder joint so it does not create any issues with excess cortisone.
Physical therapy. Specific exercises will help restore motion. These may be under the supervision of a physical therapist or via a home program. Therapy includes stretching or range of motion exercises for the shoulder. Sometimes heat is used to help loosen the shoulder up before the stretching exercises..
I advise patients to stretch frequently throughout the day.
5 minutes of stretching 5 times a day.
You should feel some stretching but it should not be painful.
You cannot do all of the exercises in 5 minutes 5 times a day, but patients can do some stretching in that time.
Below are examples of some of the exercises that might be recommended.
- External rotation — passive stretch. Stand in a doorway and bend your affected arm 90 degrees to reach the doorjamb. Keep your hand in place and rotate your body as shown in the illustration. Hold for 30 seconds. Relax and repeat.
- Forward flexion — supine position. Lie on your back with your legs straight. Use your unaffected arm to lift your affected arm overhead until you feel a gentle stretch. Hold for 15 seconds and slowly lower to start position. Relax and repeat.
- Crossover arm stretch. Gently pull one arm across your chest just below your chin as far as possible without causing pain. Hold for 30 seconds. Relax and repeat.
Manipulation under anesthesia. During this procedure, you are put to sleep. Your doctor will force your shoulder to move which causes the capsule and scar tissue to stretch or tear. This releases the tightening and increases range of motion.
I generally do not advise this as there is risk of fracture and rotator cuff tear.
Shoulder arthroscopy. In this procedure, your we will cut through tight portions of the joint capsule. This is done using pencil-sized instruments inserted through small incisions around your shoulder.
In many cases, manipulation and arthroscopy are used in combination to obtain maximum results. Most patients have very good outcomes with these procedures.
This is my preferred treatment if any procedure for frozen shoulder is advised.
Although it is a slow process, your commitment to therapy is the most important factor in returning to all the activities you enjoy.
Long-term outcomes after surgery are generally good, with most patients having reduced or no pain and greatly improved range of motion. In some cases, however, even after several years, the motion does not return completely and a small amount of stiffness remains.
Although uncommon, frozen shoulder can recur, especially if a contributing factor like diabetes is still present.
From my web site.