Nebraska's Leading Frozen Shoulder Treatment
Are you struggling with limited shoulder movement, enduring pain, and finding it difficult to reach behind your back? These symptoms might point to a condition known as frozen shoulder syndrome, also known as adhesive capsulitis. Notably, this ailment is more prevalent in individuals with diabetes. It could be unnerving and painful, but it can typically be alleviated without frozen shoulder surgery.
At Nebraska Hand & Shoulder Institute, we specialize in providing expert diagnosis and effective treatment for frozen shoulders. Our professional team employs cutting-edge techniques aimed at frozen shoulder pain relief. We understand the discomfort associated with a frozen shoulder, and it is our priority to help you regain your shoulder function and enjoy a life free from pain.
Understanding Frozen Shoulder
Don't let the pain and discomfort of frozen shoulder continue to hinder your daily activities. Contact us and schedule an appointment today. Let our team design a comprehensive treatment plan tailored to your condition and start your journey to recovery.
Frozen shoulder is a condition where the shoulder's ligamentous capsule tightens, limiting motion. It often occurs when a person doesn't move their arm through a full range of motion, leading to gradual tightening and pain, resulting in a stiff, "frozen" shoulder. Neck pain, arthritis, or restricted blood flow can also contribute, as can subacromial bursitis. In the past, a common scenario was an older person with a broken wrist, who limited arm movement, eventually developing a frozen shoulder.
Diabetes significantly increases the risk, with a 10-20% incidence compared to 2-5% in the general population. The underlying physiology in diabetics may differ from non-diabetics. Treatment aims to relieve pain and prevent further motion loss. The condition naturally resolves over two years, often leaving some restricted motion. Pain management includes medication such as corticosteroid injections, non-narcotic analgesics like Tylenol or tramadol, and gabapentin. Assisted range of motion with a therapist can help, especially when combined with heat. For severe cases with significant motion loss, stretching under anesthesia may be necessary. The use of arthroscopy is debated and reserved for severe cases, where traditional methods don't maintain improved motion.
Natural History
An untreated frozen shoulder takes about two years or more to go from start to finish for a person to run the course as far as the pain is concerned. Frequently the shoulder will end up with some restricted motion but pain-free if untreated; asking each person to live in pain, however, for two years without any intervention while she can't move the arm is generally unacceptable. The person is just hurting too much and wants to take advantage of some sort of help.
The person who gets frozen shoulder on one side has a 34% chance for developing it on the other side as well if it develops spontaneously. Over the years I have seen a number of patients who have come in with one shoulder only to be followed in a year or more with the opposite shoulder.
Diagnosis
A frozen shoulder is diagnosed on the basis of symptoms including decreased motion, particularly reduced ability to reach behind your back. An arthrogram or an MRI scan may be required to be certain that the rotator cuff is not also torn. This might demand more early aggressive surgical treatment. Treatment initially should consist of a non-addicting analgesic such as acetaminophen and perhaps a corticosteroid injection to see if the person does get significant relief from the same since it is such a non-harmful treatment. If a significant benefit of more than a day or two is not experienced with a cortisone injection, it should probably not be repeated. If one gets lasting benefit, a repeat injection might be warranted a few weeks later.
A trial of NSAID (anti-inflammatory pills) may be of benefit and is certainly low risk. If the patient is not showing dramatic progress then manipulation under anesthesia in the operating room should be considered leaving open the option of possible arthroscopic capsular release. Home exercises should be continued indefinitely.
Frozen Shoulder Treatment
The primary treatment for a frozen shoulder is physical therapy, involving hot compresses and assisted range of motion exercises. Patients often take analgesics like acetaminophen or, in severe cases, hydrocodone. Nonsteroidal anti-inflammatory drugs such as meloxicam, ibuprofen, or celecoxib may also help. Corticosteroid injections offer temporary relief but aren't highly effective overall.
In resistant cases, manipulation under general anesthesia can stretch the joint. This involves relaxing the muscles entirely, followed by an aggressive outpatient physical therapy program. Typically, patients experience a frozen shoulder for months before reaching this intervention stage.
For severe stiffness or pain, arthroscopic shoulder capsular release might be considered. This involves manipulating the shoulder and using a fiberoptic scope to release the tightened capsule with small surgical tools. Due to the high cost and risks, such as nerve injury, this is not usually the first treatment choice. Even the option of manipulation often motivates patients to engage more in physical therapy and home exercises.
The Risks of Treatment
The risk of gentle manipulation of the shoulder is almost zero. There is a theoretical risk of breaking the humerus, i.e. a fracture, particularly in the case of someone with osteoporotic (weak) bone. There is a theoretical risk to the nerves around the shoulder or brachial plexus going into the arm from the neck. I have never actually heard of a case of this occurring.
Arthroscopic capsular release on the other hand has the remote risk of infection and a significant risk of axillary nerve injury because it lies so close to the underside of the glenohumeral capsule.
Relieve Frozen Shoulder Pain
If you’re grappling with a frozen shoulder and seeking expert care, Nebraska Hand & Shoulder Institute is here to help. Our team of specialists is dedicated to providing personalized treatment plans to restore mobility and alleviate pain. Don’t let stiffness hold you back any longer—contact us today to explore your options and take a step towards regaining your freedom of movement.