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Exercises and Stretching
Stretching exercises for frozen shoulder serves two functions:- First, to increase the motion in the joint
- Second, to minimize the loss of muscle on the affected arm (muscle atrophy)
The importance of stretching and exercises cannot be overemphasized as these are the key to successful frozen shoulder treatment. Patients cannot expect to have successful frozen shoulder treatment if they perform exercises only when working with a therapist. These exercises and stretches must be performed several times daily.
- First, to increase the motion in the joint
- Moist Heat
Applications of moist heat to the shoulder can help to loosen the joint and provide relief of pain. Patients can apply moist heat to the shoulder, then perform their stretching exercises--this should be done at least three times daily. Moist heat can be applied by using a hot-soaked washcloth on the joint for 10 minutes before stretching. - Physical Therapy
Physical therapists can help a patient develop a stretching and exercise program, and also incorporate ultrasound, ice, heat, and other modalities into the rehabilitation for frozen shoulder. As said previously, it is important that patients perform their stretches and exercise several times daily--not only when working with the therapist. - Anti-inflammatory Medications
Anti-inflammatory medications have not been shown to significantly alter the course of a frozen shoulder, but these medications can be helpful in offering relief from the painful symptoms. - Cortisone Injections
Cortisone injections are also commonly used to decrease the inflammation in the frozen shoulder joint. It is unclear the extent of the benefit of a cortisone injection, but it can help to decrease pain, and in turn allow for more stretching and physical therapy. What is known, is the cortisone is only effective when used in conjunction with physical therapy for the management of a frozen shoulder.
If the above treatments do not resolve the frozen shoulder, occasionally a patient will need to have surgery. If this is the case, the surgeon may perform a manipulation under anesthesia. A manipulation is performed with the patient sedated under anesthesia, and the doctor moves the arm to break up adhesions caused by frozen shoulder. There is no actual surgery involved, meaning incisions are not made when a manipulation is performed.
Alternatively, or in conjunction with a manipulation, an arthroscope can be inserted into the joint to cut through adhesions. This procedure is called an arthroscopic capsular release. Surgical capsular release of a frozen shoulder is rarely necessary, but it is extremely useful in cases of frozen shoulder that do not respond to therapy and rehab. If surgery is performed, immediate physical therapy following the capsular release is of utmost importance. If rehab does not begin soon after capsular release, the chance of the frozen shoulder returning is quite high.
Will my shoulder motion return to normal?
Most patients who have a frozen shoulder will have slight limitations in shoulder motion, even years after the condition resolves. However, this limit in motion is minimal, and often only noticed when performing a careful physical examination. The vast majority of patients who develop a frozen shoulder will recover their functional motion with therapy and stretching alone.
The images in this article were generously provided by Medical Multimedia Group, Inc.
Sources:
Warner, JJ. "Frozen Shoulder: Diagnosis and Management" J. Am. Acad. Ortho. Surg., May 1997; 5: 130 - 140.
Griggs, SM; Ahn, A; Green, A. "Idiopathic Adhesive Capsulitis: A Prospective Functional Outcome Study of Nonoperative Treatment" J. Bone Joint Surg. Am., Oct 2000; 82: 1398.
Rizk, TE; Pinals, RS; and Talaiver, AS. "Corticosteroid injections in adhesive capsulitis" Arch. Phys. Med. and Rehab., 72: 20-22, 1991.
