Frozen shoulder is a common problem. It often begins without warning, although it can occur after shoulder trauma or surgery, as well. The primary issues are shrinking and severe inflammation of the shoulder lining. Both of these are responsible for the main symptoms: Progressive shoulder stiffness and pain.
Typically your symptoms of frozen shoulder will follow a relatively predictable path. In the earliest pre-frozen phase, you will begin to note some pain and some early stiffness. Usually, the symptoms then worsen, resulting in a highly inflammatory freezing phase in which often there is severe pain and worsening stiffness. The frozen phase is next. During this stage, your range of motion will remain low but stable. It neither worsens or improves. Your pain, on the other hand, is likely to improve some. During this stage, there is usually pain only when you attempt to move your shoulder beyond its limits. The thawing phase follows. In this phase, both your shoulder’s range of motion and pain slowly normalize.
Frozen shoulder that does not occur from surgery or trauma, often resolves without treatment. It is like a wave. It begins slowly. Progresses until it crests. Then slowly recedes until it is gone. Even though frozen shoulder almost always resolves spontaneously, because it can be so painful and your recovery can sometimes take so long, treatment is often sought to help get through the process.
As you might expect, what phase of the disorder you’re in often determines what type of frozen shoulder treatment you should undergo.
Frozen Shoulder Treatment
In the first two phases of frozen shoulder, the process is getting progressively worse, and there really is no way to stop it. All we can do is try to make it more tolerable. As a result, the mainstays of treatment in these early phases are pain control with anti-inflammatory medications, Tylenol, occasionally stronger pain medications, oral steroids and/or steroid (cortisone) injections. Additionally, your doctor will also often attempt to maintain your shoulder motion with a gentle but frequent stretching program. This is usually performed under the guidance of a physical therapist. Surgery in these early phases is often unsuccessful. Since the process is progressive and unrelenting, surgery during these stages often results in persistent or recurrent symptoms.
Since the symptoms are resolving during the final thawing phase, treatment during this stage is usually limited to over-the-counter medications and physical therapy.
The middle, frozen, stage is a relatively static period. Furthermore, when frozen shoulder recovery stalls or seemingly is not improving, you’re often stuck in this phase. That’s the bad news. The good news is that in this phase there are more frozen shoulder treatment options. Not only can we continue with those treatments (pain management, physical therapy, injections, oral steroids) appropriate in the first two phases but we can also consider surgery.
Frozen Shoulder Surgery
There are two surgical options for frozen shoulder: A shoulder manipulation or shoulder arthroscopy. The surgery is unlikely to rid the frozen shoulder of all symptoms, but rather it is intended to improve your range of motion and function and shorten your overall recovery time.
A manipulation is a simple procedure in which your surgeon carefully moves your arm through its full range of motion. During the surgery, the shortened tissue is torn, rapidly restoring your shoulder motion. There are no cuts, and no instruments are placed into your shoulder or anywhere else for that matter. Of course, this is performed under anesthesia so that you don’t feel a thing during the surgery. This procedure is quick, easy and since there is no cutting of your skin and since nothing penetrates your shoulder, the amount of post-op pain and swelling is relatively small. Furthermore, the risks of this surgery tend to be low as well. Fractures, instability and nerve injuries can occur but these are exceedingly rare.
Shoulder arthroscopy allows your surgeon to enter your shoulder through tiny holes using instruments that allow him or her to see inside your shoulder as well as to perform the necessary procedure. Typically during this surgery, your surgeon will release the contracted shoulder lining and remove inflamed tissue when possible. Sometimes, your doctor will include a manipulation as well. Arthroscopy also is performed under anesthesia. So you won’t feel anything during this procedure either. However because this is an invasive procedure, you can expect more postoperative pain and swelling than after an isolated manipulation. Similarly, although the risks of this procedure are typically slight, they are somewhat greater than for a manipulation alone.
Manipulation or Arthroscopy?
Whether to perform an isolated manipulation or a shoulder arthroscopy is a decision that you and your surgeon will have to make together. There is no conclusive evidence that one is superior to the other. However, your surgeon may prefer one over the other in some particular situations. Either way, whichever surgery you and your doctor choose, your surgery will almost always be followed by a period of regular physical therapy to maintain the gains obtained at surgery.
Frozen shoulder is a common and often debilitating problem. Fortunately, it often resolves spontaneously. Unfortunately, this can sometimes take several years. Frozen shoulder treatment options depend on the stage of your disease. Both nonoperative and surgical treatment options exist. Which treatment is best for you will often require an evaluation by your sports medicine shoulder specialist.