Frozen Shoulder: Treatment Options and Recovery Insights

Frozen shoulder issue?

Hello Dr.
Chou,
I have been suffering greatly from frozen shoulder, and I have resorted to seeking treatment from various places in desperation.
I've tried rehabilitation, traditional Chinese medicine, chiropractic care, and massages—anything that someone recommends.
The treatment process has been very painful, and it feels like I've returned to square one with no progress in my condition.
I have personally experienced how difficult it is to raise my arm or place my hands on my hips; it has made my daily life very inconvenient.
I would like to ask Dr.
Chou if my condition has reached the point where surgery is necessary, or if rehabilitation could still lead to improvement.
(I injured my arm in a motorcycle accident in September 2008, with no fractures, but the tendon injury was not treated properly, and I only realized the severity of the situation after the New Year.) Thank you!

Ms. Chen, 40~49 year old female. Ask Date: 2009/05/06

Dr. Zhou Jianwen reply Rehabilitation

Hello, thank you for your inquiry.
I would like to respond to your question and provide the following advice: it may not necessarily be frozen shoulder; it could also be chronic tendonitis.
Please consult with a rehabilitation or orthopedic specialist for further evaluation and diagnosis.
Wishing you safety and happiness!

Reply Date: 2009/05/06

More Info

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. It typically develops gradually and can significantly impact daily activities, as you've experienced. The condition often arises after an injury or surgery, particularly if the shoulder is immobilized for an extended period. In your case, the history of a motorcycle accident and subsequent shoulder injury could have contributed to the development of this condition.

Understanding Frozen Shoulder
Frozen shoulder usually progresses through three stages:
1. Freezing Stage: This is when the shoulder starts to become painful, and movement becomes limited. This stage can last from six weeks to nine months.

2. Frozen Stage: Pain may begin to diminish, but the stiffness remains. This stage can last from four to six months.

3. Thawing Stage: Shoulder mobility gradually improves, and this stage can last from six months to two years.

Treatment Options
1. Physical Therapy: This is often the first line of treatment for frozen shoulder. A physical therapist can guide you through specific exercises to improve range of motion and reduce pain. Stretching and strengthening exercises are crucial in this phase.

2. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation. However, since you mentioned an allergy to NSAIDs, alternatives like acetaminophen or topical analgesics may be recommended. Corticosteroid injections into the shoulder joint can also provide relief from inflammation and pain.

3. Heat and Ice Therapy: Applying heat can help relax the muscles and improve blood flow, while ice can reduce inflammation and numb the pain. Alternating between heat and ice may be beneficial.

4. Manual Therapy: Techniques such as joint mobilization performed by a trained therapist can help improve shoulder mobility.

5. Surgery: If conservative treatments fail after a significant period (usually six months to a year), surgical options may be considered. The most common procedure is arthroscopic capsular release, where the tight capsule surrounding the shoulder joint is released to improve mobility.

Recovery Insights
Recovery from frozen shoulder can be a lengthy process, often taking several months to years. The key to recovery is patience and adherence to the prescribed rehabilitation program. Here are some insights to consider:
- Consistency is Key: Regularly performing the recommended exercises is crucial for regaining mobility. Even if progress seems slow, consistency will yield results over time.

- Avoid Overexertion: While it's important to work on mobility, avoid pushing through pain excessively, as this can lead to further injury.

- Follow-Up: Regular follow-ups with your healthcare provider or physical therapist can help monitor your progress and adjust your treatment plan as necessary.

- Lifestyle Modifications: Incorporating modifications in daily activities to avoid positions that exacerbate pain can help manage symptoms while you recover.

Conclusion
Given your history and the challenges you're facing, it may be beneficial to continue with physical therapy while considering a consultation with an orthopedic specialist if you haven't already. They can assess your condition further and discuss whether surgical intervention might be appropriate based on your progress and the severity of your symptoms. Remember, recovery from frozen shoulder is often gradual, and maintaining a positive outlook while actively participating in your rehabilitation can significantly impact your outcome.

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