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15 April 2009

Treatment of frozen shoulder

The treatment of a frozen shoulder usually requires an aggressive combination of antiinflammatory medication, cortisone injection(s) into the shoulder, and physical therapy. Without aggressive treatment, a frozen shoulder can be permanent.

Diligent physical therapy is often key and can include ultrasound, electric stimulation, range-of-motion exercise maneuvers, ice packs, and eventually strengthening exercises. Physical therapy can take weeks to months for recovery, depending on the severity of the scarring of the tissues around the shoulder.

It is very important for people with a frozen shoulder to avoid reinjuring the shoulder tissues during the rehabilitation period. These individuals should avoid sudden, jerking motions of or heavy lifting with the affected shoulder.

Sometimes frozen shoulders are resistant to treatment. Patients with resistant frozen shoulders can be considered for release of the scar tissue by arthroscopic surgery or manipulation of the scarred shoulder under anesthesia. This manipulation is performed to physically break up the scar tissue of the joint capsule. It carries the risk of breaking the arm bone (humerus fracture). It is very important for patients that undergo manipulation to partake in an active exercise program for the shoulder after the procedure. It is only with continued exercise of the shoulder that mobility and function is optimized.

Prevention of Frozen Shoulder:

Many causes of shoulder strain cannot be prevented but some simple steps can reduce the risk of specific types of problems:
  • Falls. Take an inventory of your home and identifying "falls waiting to happen," such as loose stairs and uneven floor tiles.
  • Strains. Take time to warm up before playing sports or participating in activities that require extensive use of the shoulder. Begin a program of stretching several weeks in advance.
  • Underuse. As people grow older, they tend to use their shoulders less. As a result, the muscles and connective tissue can lose flexibility. A well-rounded exercise program should include upper-body activities and strengthening.
  • Tendinitis and Bursitis. Commonly associated with aging, these conditions result from inflammation of the soft tissue in and around the shoulder. Both may result from either overuse of the shoulder or from lack of use, which leads to gradual loss of range-of-motion (the degree to which the shoulder can move in different directions). Anti-inflammatory drugs and physical therapy aimed at restoring motion are the mainstays of treatment in virtually all cases.
  • Impingement. The muscles of the rotator cuff extend through a kind of tunnel between the roof of the shoulder and the ball of the joint. Over time, the size and shape of the tunnel and its soft tissue content can change, causing the muscles to scrape and stick, a condition known as impingement. In many instances, impingement can cause rotator cuff tears. Therapy almost always begins with anti-inflammatory drugs, heat and cold therapy, and exercises to try to improve range-of-motion.
  • Instability. Because of an injury or as a consequence of overuse, the shoulder's soft tissues may loosen and fail to hold the joint together tightly - a condition called instability. In minor cases, the shoulder loosens and has a tendency to slip and slide within the socket. Dislocation is the most extreme form of instability, as the humeral head (ball) actually slips out of the glenoid (cup). Medication and strengthening exercises can improve shoulder stability, but in some instances surgery is necessary to tighten the connective tissue.

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