Frozen Shoulder Treatment Options
Adhesive capsulitis is a self-limited disease, meaning that in the majority of cases, adhesive capsulitis tends to resolve on its own, with a high likelihood of spontaneous recovery occurring within a time frame of 18 to 30 months. The primary emphasis of treatment is on providing relief from symptoms and enhancing the range of motion (ROM) in the affected shoulder.
Treatment is generally progressive, starting with the least invasive methods and monitoring improvement. It often requires ongoing management and patience, as a full recovery may take anywhere from several months to a few years. Coordination with healthcare professionals, including physical therapists and orthopedic specialists, ensures that the treatment plan is tailored to the individual’s symptoms and needs.
- Physical Therapy: Working with a physical therapist who can guide specific exercises and stretches to improve mobility in the shoulder is often essential. This can include gentle stretching and strengthening exercises.
- Pain Relief Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or prescription pain relievers may be recommended to manage pain and inflammation.
- Heat and Ice Application: Applying heat can help with loosening the shoulder, making it easier to move, while ice can help reduce inflammation and alleviate pain.
- Oral corticosteroids: These have been shown to provide short-term pain relief for improved range of motion and function.
- Corticosteroid Injections: Injecting corticosteroids directly into the shoulder joint may help reduce inflammation and pain, and improve function, decrease pain and increase range of motion.
- Joint Distension (Hydrodilation): This involves injecting sterile fluid into the joint to stretch it. This procedure can help reduce pain and improve movement in the short-term/
- Home Exercises: Following a prescribed set of exercises at home can further support recovery and rehabilitation.
Surgery is typically considered during Stage 2 when the shoulder is frozen and conservative measures have failed to provide relief. Options includes:
- Manipulation under anesthesia: This is where the shoulder is gently manipulated under anesthesia to break up the adhesions. This can be effective in increasing range of motion but is risky.
- Arthroscopic Capsular Release: This is a minimally invasive surgery where small incisions are made, and a camera (arthroscope) is inserted into the joint. Using specialized instruments, the surgeon carefully cuts through and releases the stiff portions of the joint capsule. This can provide significant relief from stiffness and improve mobility. Arthroscopic capsular release is generally considered a low-risk procedure with good outcomes.
- Open Capsular Release: In more severe or complex cases, a traditional open surgery might be necessary. This involves a larger incision, and the joint capsule is cut and released. Open surgery provides the surgeon with more direct access to the shoulder structures but has a longer recovery time and higher risk of complications compared to arthroscopic surgery.
- Combination of Manipulation under anesthesia and Arthroscopic Release: Sometimes, a combination of Manipulation under anesthesia and arthroscopic release might be used to maximize results, particularly if the shoulder is severely restricted. This approach can provide the benefits of both procedures.
After surgical intervention, physical therapy is almost always a critical part of the recovery process. Tailored exercises and stretches help maintain the improvements in range of motion and prevent the shoulder from becoming stiff again.
It is essential to note that surgical options are typically considered a last resort after other treatment options have been explored and found inadequate. Surgery for adhesive capsulitis is generally effective but is not without risks and requires a careful discussion with Dr. Reynolds. He will evaluate each individual’s specific condition and needs to determine the best course of action.