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Frozen Shoulder (Adhesive Capsulitis) Treatment

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The goal of the Frozen Shoulder (Adhesive Capsulitis) treatments to restore movement of the shoulder without the need for invasive methods. Our pain relief specialists use the latest anti-inflammatory medications such as Corticosteroids, heat or cold therapy to reduce swelling, and transcutaneous electrical nerve stimulation to provide shoulder pain relief. Treatment for frozen shoulder can also rely on physical therapy, as stretching and many other exercises can help get back the motion of your shoulder. As experts in pain management and pain control, our physicians offer time-tested treatments that focus on your specific level of pain. Visit our center for pain management and meet our physicians to get the shoulder pain under control in the safe, reassuring hands of New York’s best pain doctor, Dr. Raj Raval, MD, located in Downtown Brooklyn and Lower Manhattan.


Frozen-Shoulder

Frozen shoulder – adhesive capsulitis

Frozen shoulder, other referred to as adhesive capsulitis, is a condition that leads to a limitation in the shoulder movement and can be very painful.

Adhesive capsulitis occurs once the strong connective tissue, which surrounds the shoulder joint, known as the shoulder joint capsule, turns stiff, thick, and becomes inflamed. The condition is known as the frozen shoulder, as the pain that it leads to, leads to patients using the shoulder less and less. If the condition progresses and worsens, it can be even impossible to move the shoulder, leading it to a „frozen“ position.

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In the beginning stages of frozen shoulder, treatment will typically focus on non-invasive pain relief options. This is done to restore movement of the shoulder without the need for more invasive methods.

What are the risk factors for frozen shoulder?

Some factors can increase the risk of suffering from adhesive capsulitis. Age is one factor, as adhesive capsulitis more commonly affects those between 40 and 60 years old. Gender is another risk factor, as it is more likely to affect women than men. Those who have suffered a recent shoulder injury are also at an increased risk of suffering from adhesive capsulitis. If a recent injury or surgery leads to the necessity of having to rest the shoulder for a longer time, such as by using a shoulder brace or a shoulder wrap, it might lead to the shoulder getting into a “frozen “‘position. Injuries aren’t the only condition that increases the risk of suffering from adhesive capsulitis.

Diabetes is also a condition, that can increase the possibility of developing a frozen shoulder. Other health conditions that can lead to the frozen shoulder include hyperthyroidism, hypothyroidism, strokes, Parkinson’s disease, and heart diseases. A stroke is a risk factor for adhesive capsulitis, as it can also limit the movement of an arm or a shoulder.

What are the symptoms and causes of adhesive capsulitis?

The condition adhesive capsulitis, as well as its symptoms, are divided into three different stages:

In the beginning, the shoulder is stiff, and it hurts to move it. The pain begins to worsen slowly, but in some cases, it also worsens overnight. This stage typically lasts six weeks and up to nine months.

The second stage, or the “frozen “stage, is the next one, where the pain lessens. However, the shoulder remains stiff. This stage can last another two to six months, where it can get more and more challenging to complete daily activities and tasks.

The third stage, which is the “thawing “stage, or the recovery stage, is the last one, where the pain begins to lessen while the ability to move the shoulder improves. The recovery stage can last between six months to two years. Full recovery is reached once the normal motion and strength of the shoulder returns.

What does diagnosing adhesive capsulitis look like?

To diagnose the condition, your physician will first speak about your symptoms while also reviewing your medical history. Your doctor will then do a physical exam of the arms and shoulders. For example, you will be asked to move the shoulder in all directions. This is done to evaluate the range of motion and whether there is pain while moving the shoulder. You will be asked to move your shoulder yourself, which is the “active range of motion “, but your doctor will also move the shoulder for you, checking your “passive range of motion “. Those who suffer from frozen shoulder have a limited range of motion of both passive and active motion. To determine the cause of the symptoms and to exclude other possible conditions, such as arthritis, you might need to get an X-ray. Other imaging tests, such as ultrasound or magnetic resonance imaging, are typically not necessary to diagnose adhesive capsulitis. If such additional imaging tests are done, they are usually done to check for other issues, such as rotator cuff tear.

How to treat frozen shoulder?

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In the beginning stages of frozen shoulder, treatment will typically focus on non-invasive pain relief options. This is done to restore movement of the shoulder without the need for more invasive methods.

One of the treatment options for frozen shoulder in this stage would be using hot and cold compresses. Treating frozen shoulder with heat and cold can help to reduce swelling and to provide pain relief. Medicines, such as nonsteroidal anti-inflammatory drugs can help to manage the pain. In cases of severe pain, you might also get prescription, stronger painkillers.

Treatment for frozen shoulder can also rely on physical therapy, as stretching and many other exercises, which your physical therapist can show you, can help get back the motion of your shoulder. At the same time, it can be of help to go on with an exercise program, which you can do at home.

Another non-invasive treatment option for adhesive capsulitis includes transcutaneous electrical nerve stimulation. This treatment uses a small device, which is battery-operated and can help to reduce the pain as it blocks nerve impulses.

Many studies show, that the most effective way of controlling pain in the early stages of frozen shoulder treatment is with the use of steroid injections. During the first three months of treatment, it can be especially helpful to use corticosteroid injections, along with hydrodilatation. Hyaluronan injections can also be used, as studies have found that they can relieve pain, especially one that occurs at night. Hydrodilatation is a procedure that is done to stretch the joint capsule. The fluid will be introduced into the shoulder joint, which can decrease pain and increase the range of movement of the shoulder. Whether the injection will be painful to you or not, will depend on some factors. Once, it will depend on whether you have a general fear of needles and whether you have had past bad experiences with needles, but also what the degree of inflammation is and the degree of restricted movement. However, generally speaking, the condition is very well tolerated and most patients only experience minimal discomfort.

There are some risks and side effects connected to hydrodilatation. One of them is that they can cause redness of the skin. This redness typically occurs on the face and rarely ever on the chest. Your skin might feel warm and hot to the touch. However, this typically goes away on its own after approximately two days. Some people have issues with sleeping during the first night and in rare cases, an infection can occur. Infection can lead to pain, swelling, redness, temperature, and an overall feeling of being unwell. If you experience such symptoms after the procedure, you must inform your doctor.

Last but not least, some alternative non-invasive options might also be discussed before moving to more severe measures. Such alternatives include acupuncture or yoga. Studies have shown that acupuncture and yoga might help to improve the symptoms of frozen shoulder and help the healing period.

Once the initial stage passes and if the issue persists, surgery might be necessary to get back the motion of the shoulder. During this procedure, you will need to be put to sleep, as your doctor will force the movement of your shoulder. This will lead to the joint capsule stretching or tearing, which can loosen the tightness. This can eventually lead to an increase in the range of motion of your shoulder. Another option for frozen shoulder treatment is shoulder arthroscopy. For this procedure, the doctor will need to cut through the tight parts of the joint capsule, which leads to capsular release. During this procedure, a small instrument is inserted through small cuts, which are done around the shoulder. In many cases, both these frozen shoulder treatments are combined, as this can help to reach even better results.

Is it possible to prevent adhesive capsulitis?

One way of preventing frozen shoulder is by starting physical therapy right after an injury.  It can ensure that patients can continue moving the shoulder and that this is done under the supervision of a professional, who can prevent worsening of an injury.

What’s the outlook for frozen shoulder?

Simple treatments, such as the use of pain relievers and shoulder exercises, in combination with a cortisone injection, are often enough to restore motion and function within a year or less. Even left completely untreated, range of motion and use of the shoulder continues to get better on its own, but often over a slower course of time. Full or nearly full recovery is seen after about two years.

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363808/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695331/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5384535/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1315655/

Do you have any questions about the Frozen Shoulder (Adhesive Capsulitis)? Would you like to schedule an appointment with the best pain relief doctor in Downtown Brooklyn and Lower Manhattan, Dr. Raval? Please call our office for a consultation and indicate which location you want to visit.

DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general information. In no way does any of the information provided reflect definitive treatment advice. It is essential to consult a best-in-class pain management specialist in New York regarding ANY questions or issues. A thorough evaluation should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call your pain doctor to schedule a consultation.

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  • Dr. Raj Raval, M.D.

    1. Board Certified
    2. Interventional Pain & Musculoskeletal Medicine Specialist
  • Education & training

    1. SUNY Downstate PMR Residency
    2. Rutgers University Fellowship
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