Surgical Explanations
Rehabilitation Protocols
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Frozen Shoulder/Adhesive Capsulitis
A “frozen shoulder,” or adhesive capsulitis, describes an unexplained situation where the body responds with inflammation to the tissue surrounding the shoulder joint. Stiffness and pain follow with any active or passive motion. Pain will accompany elevating the arm from the side, but there will be no sense of numbness or weakness in your hand. If the x-rays show no shoulder joint arthritis, adhesive capsulitis is the diagnosis of exclusion.
In some cases, the etiology, or the origin, of adhesive capsulitis is known. Medical science recognizes that insulin-dependent diabetics are prone to shoulder adhesive capsulitis, as increased glucose affects tissue stiffness. Patients who have prolonged immobilization from shoulder surgery or inactivity due to a prolonged hopitalization are also prone to develop adhesive capsulitis. In most cases, however, medical science is at a loss to explain the “frozen shoulder.”
Frozen shoulders generally “thaw” in several months to a year with no medical treatment; still, it is an unusual individual who wishes to put up with the pain and dysfunction of a frozen shoulder if left to its natural history. Generally, it is too aggressive to suggest surgical manipulation under anesthesia or the overzealous (and often ill-fated) surgical arthroscopic debridement. These plans often fail, resulting in an even stiffer and more painful shoulder. Nevertheless, the mere presence of this inflamed state in the shoulder tissue is unacceptable.
Dr. Bryan has joined many other orthopedic surgeons in recommending a treatment plan that includes efforts to decrease shoulder capsule tissue inflammation and immediately commencing aggressive physical therapy. Pills will not suffice in reducing inflammation. Corticosteroids such as Celestone® or DepoMedrol® --injectable steroids--are the “queens” of anti-inflammatory medicines and are the treatment he almost always recommend.
In our clinic, we most often treat shoulder adhesive capsulitis with a single injection of DepoMedrol® mixed with local anesthetic. Immediate pain relief upon movement will validate proper injection technique and location. We then discuss, in detail, the importance of self-stretching and home physical therapy along with enrollment in organized physical therapy to provide the “stick and carrot” for continued improvement.
Following the shoulder injection, there are no restrictions. Pain relief is typically dramatic and allows immediate attention to improving shoulder function on a regular basis. The return of normal shoulder motion is slow, but it is certainly quicker than if a frozen shoulder is left to resolve on its own. Recurrent episodes are uncommon, but a few patients may “plateau” during their rehabilitation--these respond well to a second intra-articular injection and renewed physical therapy efforts. |
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