Treating a Frozen Shoulder

Question: Do you have any help for a frozen shoulder?

Dr. Hibberd's Answer:

A frozen shoulder is a very descriptive term for exactly what has happened to an otherwise usually hyper-mobile and very versatile joint. Clearly, a plain X-ray is best first to exclude an obvious fracture. Then an MRI can be very useful to exclude an underlying rotator cuff tear or rupture when the shoulder is frozen and examination is limited due to pain and restrictive movement.

When shoulder injury occurs, it is very important to seek professional assistance in its management, especially if symptoms are unusually uncomfortable or not improving after several days, or you may become the next victim of a "frozen shoulder."

The shoulder is stabilized by a rotator cuff consisting of group of four muscles and their tendons. The shoulder joint itself has a ball and a shallow socket. Injury to any of these structures will affect shoulder function to varying degrees.

Unattended, some minor injuries such as a lowly tendonitis can escalate to a major disability when the shoulder is held immobile and with restricted range of motion for too long, resulting in a "frozen shoulder."

Usually an MRI will help delineate the damaged tissue and aid with treatment planning.

Often, a frozen shoulder is released by a combination of physical therapy and anti-inflammatory medications. Rarely, if the joint freezes totally, adhesive changes are broken down by manipulation under anesthesia, or occasionally, via an endoscope. Local corticosteroids are often used, but as in any constrictive joint problem, complications are always possible.

The lesson here is seeking attention for shoulder injuries early, so an appropriate treatment plan can be prescribed to minimize the possibility of developing a frozen shoulder.

The good news is that I have yet to see a frozen shoulder that could not be eventually released, though sometimes not without considerable time, effort, and resources. Often there is an underlying rotator cuff injury or fracture that set the stage for the frozen shoulder. Not all of these conditions need surgical management, but a skilled orthopedic consultant is useful.