Frozen Shoulder – Shoulder Adhesive Capsulitis Treatment
Adhesive Capsulitis of the shoulder, or more commonly “a frozen shoulder,” can be treated non-surgically with Prolotherapy and Platelet Rich Plasma PRP Prolotherapy injections. In this article we will explain Prolotherapy, PRP Prolotherapy and look at some other non-surgical options including cortisone and hyaluronic acid.
- If you have questions about Frozen Shoulder – Adhesive Capsulitis Treatments, you can get help and information from our Caring Medical Staff
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.
What caused your shoulder to freeze is open to debate.
- 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.
- However, as I will discuss below, there is speculation that frozen should falls into the microworld of ligament and tendon damage. Ligament and tendon damage is what Prolotherapy and PRP Prolotherapy treats.
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 loss of motion. This phase usually lasts 2 to 9 months.
- During the second stage, the arm may be easier to move, but 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.
Shoulder Adhesive Capsulitis Treatment
As controversial as the origins of shoulder adhesive capsulitis are, so are the treatments. Especially treatments that may make a patient worse.
The first line of treatment for a frozen shoulder is physiotherapy. Physical therapy modalities, such as myofascial release, massage, range-of-motion exercises, and ultrasound, can often release scar tissue. If these do not relieve the problem, then the scar tissue can be broken up within the joint by the physician injecting the shoulder full of a solution made up of sterile water mixed with an anesthetic.
The numb shoulder can then be gently manipulated. Often several sessions of this treatment regimen are needed to achieve the shoulder’s original full range of motion.
Perimenopausal and Premenopausal Women and higher rates of adhesive capsulitis
In the January 2018 issue of the journal Menopause, doctors in Korea published their findings on shoulder pain in perimenopausal and premenopausal women.
What they found was the most common diagnosis in the perimenopausal and premenopausal groups was adhesive capsulitis.
We will conduct a randomised controlled trial (RCT) of 500 adult patients with a clinical diagnosis of frozen shoulder, and who have radiographs that exclude other pathology. Early Structured Physiotherapy with an intra-articular steroid injection will be compared with manipulation under anaesthesia with a steroid injection or arthroscopic (keyhole) capsular release followed by manipulation. Both surgical interventions will be followed with a programme of post-procedural physiotherapy. These treatments will be undertaken in NHS hospitals across the United Kingdom. The primary outcome and endpoint will be the Oxford Shoulder Score (a patient self-reported assessment of shoulder function) at 12 months. This will also be measured at baseline, 3 and 6 months after randomisation; and on the day that treatment starts and 6 months later. Secondary outcomes include the Disabilities of Arm Shoulder and Hand (QuickDASH) score, the EQ-5D-5 L score, pain, extent of recovery and complications. We will explore the acceptability of the different treatments to patients and health care professionals using qualitative methods.
The three treatments being compared are the most frequently used in secondary care in the NHS, but there is uncertainty about which one works best and at what cost. UK FROST is a rigorously designed and adequately powered study to inform clinical decisions for the treatment of this common condition in adults.
High intensity stretch (HIS)
In the Annals of physical and rehabilitation medicine, researchers discussed the problems of patients with postoperative adhesive capsulitis. The problem is that these patients have reached a recovery plateau with standard physical therapy protocols. This the researchers say puts these patients at risk for further surgical intervention. The study suggests that patients with postoperative adhesive capsulitis of the shoulder who are unable to reach their physical therapy treatment goals with a standard protocol of physical therapy may benefit from the addition of high-intensity stretch to their treatment regimen.1
Some patients improve when they have another surgery such as arthroscopic capsular release,2 some patients will move onto a shoulder nerve block.3 Some patients may “get away” with a cortisone injection that will offer temporary relief.4
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. 5
Treatment of a frozen shoulder
Since the initial cause of the adhesive capsulitis was supraspinatus (rotator cuff) weakness, Prolotherapy injections to strengthen the rotator cuff are done in conjunction with the above technique. Complete to near-complete resolution can be accomplished using this combined approach.
A misunderstanding of the supraspinatus tendon’s referral pattern keeps clinicians from diagnosing the rotator cuff problem. This tendon refers pain to the back and side of the shoulder, leading clinicians to believe their patients have a muscle problem, when in fact they have a tendon problem. A complaint of shoulder pain is almost always a rotator cuff weakness problem. Prolotherapy is extremely effective at strengthening the rotator cuff tendons.
Prolotherapy for Frozen Shoulder
Because the initial cause of frozen shoulder is rotator cuff weakness, a better approach to treating this condition is to strengthen the supraspinatus tendon (where the weakness originates) with Prolotherapy in conjunction with physiotherapy treatments.
Prolotherapy is extremely effective at strengthening the rotator cuff tendons. In simple terms, Prolotherapy stimulates the body to repair painful areas. It does so by inducing a mild inflammatory reaction in the weakened tendons, ligaments and cartilage. Since the body heals by inflammation, Prolotherapy stimulates healing. 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 in Iran 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 first injection, the patient reported 60% improvement regarding shoulder pain, and no night pain.
- Also, two-fold improvement for ROM and more than 70% improvement for function were reported.6
Do you have questions on other areas of shoulder problems, you can review more information on our Comprehensive Prolotherapy for shoulder pain treatment page.
Are you a candidate for our non-surgical treatments? Ask our specialists:
- Ross Hauser, MD | Danielle Steilen-Matias, PA-C | Katie Worsnick, PA-C | David Woznica, MD
1 Wolin PM, Ingraffia-Welp A, Moreyra CE2, Hutton WC. High-intensity stretch treatment for severe postoperative adhesive capsulitis of the shoulder. Ann Phys Rehabil Med. 2016 Sep;59(4):242-7. [Pubmed]
2 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. [Pubmed]
3. 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. [Pubmed]
4. Koh KH. Corticosteroid injection for adhesive capsulitis in primary care: a systematic review of randomised clinical trials. Singapore Med J. 2016 Aug 29. [Pubmed]
5. 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. [Pubmed]
6. 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. [Pubmed]