Shoulder Adhesive Capsulitis | Frozen Shoulder Treatment
David N. Woznica, MD
A typical new patient will come into our Oak Park or Ft. Myers clinic. They will sit on the examination table and they will tell us a story that sounds something like this:
“I have “frozen shoulder.” It is not getting better. My doctor and my physical therapist tell me that if I do not treat it, it will probably go away by itself. It may be in a few months, in a few years, but maybe not at all. Physical therapy has helped me, but I yo-yo, some days my shoulder feels really good, some days it does not feel that good, some days it is really very painful.
I do a lot of exercises at home to keep my shoulder mobile and keep the range of motion from getting worse. I did not like my continued care choices the doctor and my therapist were offering. More painkillers, more anti-inflammatories, more physical therapy, the schedule of 2-3 times a week is more than I can keep. I have been offered cortisone which I would like to avoid unless absolutely necessary and I have been offered to be put under (manipulation under anesthesia), but I did not like the risks my doctor told me about and she told me the frozen shoulder may just come back again anyway. I am looking for something to help me on a more permanent basis.”
There are some people with Adhesive Capsulitis of the shoulder, or more commonly a “frozen shoulder,” who get great benefit from cortisone injections, ART or Active Release therapy, chiropractic manipulations, and sometime no treatment at all, the problem “thaws,” out. These are not the people we see in our clinics. We see the people for who treatments have not helped their frozen shoulder and they are thinking about manipulation under anesthesia or shoulder arthroscopic surgery and are exploring other options.
The term adhesive capsulitis refers to scar tissue that forms inside a joint due to lack of movement. In the simplest terms, “use it or lose it.” If you do not move your shoulder through its normal range of motion, you may lose your ability to do so.
What caused your shoulder to freeze is open to debate
Many people have no idea what caused this shoulder problem. Over time their shoulder hurt. They would get up in the morning with pain reach for some aspirin or Advil or Tylenol and be on their way hoping that their shoulder would not be a problem all day long.
Frozen shoulder is an interesting entity we are not really sure why it happens it seems to be more prevalent in people with diabetes. There appears also to be a connection with some type of autoimmune reaction (inflammation) in the shoulder.
- Research suggests that frozen shoulder can simply appear spontaneously without a cause. It may disappear in that same fashion.
- Immobilization following an injury or surgery is also speculated. Many people come into our office after prolonged periods of shoulder immobilization. The capsule of tissue surrounding his/her shoulder is inflamed and shrink. This is what causes the very painful condition and to have an extremely limited range of motion. The pain may have died down after a few weeks or months but their lack of range of motion continued.
Frozen shoulder appears to occur in three main phases:
- In the first stage, shoulder pain increases with movement and gets worse at night. As the pain increases, so does the loss of motion. This phase usually lasts 2 to 9 months.
- During the second stage, the arm may be easier to move, but the range of motion is limited – close to 50 percent less than the other arm. This phase may last 4 to 12 months.
- The third stage involves a resolution of the condition. Over a 12 to 24-month period, the sufferer will experience gradual improvement in the mobility of the shoulder. However, treatment is usually necessary to achieve proper motion.
As controversial as the origins of shoulder adhesive capsulitis are, so are the treatments. Especially treatments that may make a patient’s shoulder worse.
For some people, surgery is necessary and there will be good improvement. This was reported by the Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, in their study, reported in the Journal of shoulder and elbow surgery (1).
In the journal Pain Physician, doctors noted that some patients will move onto a shoulder nerve block if surgery or other treatments are not successful.(2)
Other treatments for frozen shoulder include shoulder exercise, manual therapy, and anti-inflammatory or NSAIDs which have been shown to produce short-term pain benefit, but both have been shown to result in long-term loss of function and even more chronic pain by inhibiting the healing process of soft tissues and accelerating cartilage degeneration.
Particular in arthroscopic frozen shoulder procedures is a significantly worse result in diabetic patients (of whom frozen shoulder can be as common as occurring in nearly 20% of diabetic patients) with a tendency towards persistent limitation of movement two years after operation.(4)
Prolotherapy for Frozen Shoulder
We typically inject a shoulder capsule with a large amount of Prolotherapy numbing solution to stretch out the shoulder joint. The numb shoulder can then be gently manipulated. Often several sessions of this treatment regiment are needed to achieve the shoulder’s original full range of motion.
In our clinical observations, we have seen Prolotherapy offer the most curative results as a frozen shoulder treatment at getting the shoulder more motion, eliminating pain, and restoring the structures of the joint.
In independent research, doctors writing in the journal The archives of bone and joint surgery commented on a case history of a patient treated with Platelet Rich Plasma injections for frozen shoulder.
The doctors noted that Platelet-rich plasma can produce collagen and growth factors, which increases stem cells and consequently enhances the healing.
- A 45-year-old man with shoulder adhesive capsulitis underwent two consecutive platelet-rich plasma injections at the seventh and eighth month after initiation of symptoms. He was measured for pain, function, and Range of Motion ROM.
- After the first injection, the patient reported a 60% improvement regarding shoulder pain and no night pain.
- Also, two-fold improvement for ROM and more than 70% improvement for function were reported.(5)
If you have questions about your shoulder problems, you can get help and information from our Caring Medical Staff.
1 Barnes CP, Lam PH, Murrell GA. Short-term outcomes after arthroscopic capsular release for adhesive capsulitis. J Shoulder Elbow Surg. 2016 Sep;25(9):e256-64. [Google Scholar]
2. Chang KV, Wu WT, Hung CY, Han DS, Yang RS, Chang CH, Lin CP. Comparative Effectiveness of Suprascapular Nerve Block in the Relief of Acute Post-Operative Shoulder Pain: A Systematic Review and Meta-analysis. Pain Physician. 2016 Sep-Oct;19(7):445-56. [Google Scholar]
3. Koh KH. Corticosteroid injection for adhesive capsulitis in primary care: a systematic review of randomised clinical trials. Singapore Med J. 2016 Aug 29. [Google Scholar]
4. Mehta SS, Singh HP, Pandey R. Comparative outcome of arthroscopic release for frozen shoulder in patients with and without diabetes. Bone Joint J. 2014 Oct;96-B(10):1355-8. doi: 10.1302/0301-620X.96B10.34476. [Google Scholar]
5. Aslani H, Nourbakhsh ST, Zafarani Z, et al. Platelet-Rich Plasma for Frozen Shoulder: A Case Report. Archives of Bone and Joint Surgery. 2016;4(1):90-93. [Google Scholar]