Frozen Shoulder Pain Relief

If you are experiencing pain or stiffness in your shoulder joint, then you may be suffering from the condition adhesive capsulitis, also known as frozen shoulder. Adhesive capsulitis occurs when the connective tissue in the shoulder that covers the bones, ligaments and tendons thickens and stiffens. There is no consensus on why this occurs in some patients, but it is more commonly found among people with diabetes or have had their shoulders immobilized following an arm fracture or surgery.

There are a variety of treatment options that range from over-the-counter pain medications to physical therapy and surgery. The most common option is to monitor the joint and allow it to heal on its own while engaging in physical therapy to restore range of motion before resorting to more aggressive therapies.

Why Your Shoulder Is Vulnerable

You probably don’t think about the amazing versatility of your shoulder as you go about your daily business, but its unique functionality is also partly to blame for its vulnerability to adhesive capsulitis. This joint is the intersection of the collarbone (clavicle), shoulder blade (scapula) and upper arm bone (humerus). The shoulder has the most extensive range of motion of any joint in the human body.

The shoulder is a ball-and-socket joint that is surrounded by a joint capsule which is filled with synovial fluid and fluid-filled sacs called bursa that lubricate and cushion the joint. Much of this soft tissue is susceptible to damage that can lead to adhesive capsulitis.

What Is Frozen Shoulder?

When adhesive capsulitis occurs, it usually starts with damage to the shoulder, either through injury or inflammation. Pain usually accompanies these conditions which makes it more difficult to move the limb.

If the joint is kept immobile for a sustained period of time, the joint capsule will thicken and stiffen, making it more difficult to move your arm. If the condition remains untreated for several months, then scar tissue may form in the joint capsule, making it even more difficult to move the arm.

In general, it usually takes several months for frozen shoulder to appear. There are typically three stages in the life cycle of adhesive capsulitis:

  • Initial freezing stage—movement of your upper arm is accompanied by pain, and you begin to experience reduced mobility in your shoulder.
  • Frozen stage—pain may begin to subside, but you find that your shoulder is very stiff. You may not be able to move your upper arm much at all.
  • Healing or thawing stage—you should experience less pain while your arm gains range of motion. Some patients may advance to this stage without medical intervention, while others will require treatment like physical therapy.

The most common symptoms include

  • Pain that often worsens at night
  • Inhibited range of motion
  • Stiffness and difficulty raising the arm

Adhesive capsulitis is most likely to appear among patients who don’t participate in physical therapy after an injury or surgery involving the arm. These people often keep their arm in a sling for long periods that limit use of the shoulder. Although it is less likely, adhesive capsulitis may also appear among patients with diabetes, thyroid disorders, depression and Parkinson’s disease.

How Frozen Shoulder Is Diagnosed

If you see a physician to diagnose your shoulder condition, your physician will initially examine the range of motion in the shoulder and any pain symptoms that may accompany movement. The physician may also order an X-ray or MRI to rule out similar conditions like torn rotator cuff, joint dislocation, osteoarthritis or bone fragment.

Available Treatments for Frozen Shoulder

Generally speaking, the purpose of adhesive capsulitis treatment is to relieve pain and restore healthy range of motion to the shoulder joint. The foundation of frozen shoulder therapies is almost always a robust exercise regimen that loosens tough joint tissue. 

If you suspect that you are suffering from adhesive capsulitis, you should visit your doctor who can recommend the most appropriate treatment option from among the following:

  • Pain medications—in most cases of frozen shoulder, your physician will recommend non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen that should relieve pain and inflammation in the shoulder. If symptoms are severe, your doctor may prescribe more potent pain killers or anti-inflammatory drugs.
  • Physical therapy—it is absolutely essential that patients with severe adhesive capsulitis symptoms engage in vigorous physical therapy. Initially, patients will be manually manipulated by the therapist to determine the patient’s range of motion as well as loosen up any stiffened or scar tissue. Then, you will be taught specific stretches that help loosen up the joint, which will eventually be followed by strengthening exercises. After you gain mastery of these exercises, you should be allowed to perform them on your own at home, with only occasional sessions with a therapist.
  • Steroid injections—for some patients with large amounts of joint inflammation and pain, it may be necessary to use corticosteroids. Steroid injections are most commonly used in the early stages of treatment to help loosen up the joint. The analgesic and improved range of motion properties of steroid injections may last from 3 to 6 months.
  • Joint distention—if the joint tissue is extremely stiff, your doctor may inject water into the joint capsule to stretch the soft tissue and make it more pliable.
  • Surgical joint manipulation—in extreme cases where the shoulder does not respond to more conservative therapies, it may be necessary to place the patient under anesthesia. While under, the doctor will manually manipulate the joint to stretch or tear the stiff tissue. The procedure should increase the range of motion while also relieving shoulder pain.
  • Capsule release—if the joint capsule tissue will not respond to other forms of treatment, it may be necessary to cut the shoulder’s soft tissue. Typically, this procedure is performed arthroscopically and involves only minor incisions which allow insertion of very thin surgical cutting tools. Due to the minimally invasive nature of shoulder arthroscopy, there are only minor scars and the recovery period is greatly shortened.

Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care

M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees.  The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship.  Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA and you should not post any of your private health information. 

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