A Complete Guide to Frozen Shoulder Treatment
An Overview
Frozen shoulder, medically known as adhesive capsulitis, is a painful and often debilitating condition that limits the range of motion in the shoulder joint. Many people can get relief from their problems with non-invasive methods like physical therapy, medications, and injections. However, when these non-surgical approaches fail to improve mobility and reduce pain, frozen shoulder surgery becomes necessary to regain shoulder function and quality of life.
In this article, we will walk you through the essentials of managing a frozen shoulder, including different treatment options , when they are needed, what the procedures involve, recovery expectations, and success rates.
What Is a Frozen Shoulder?
A frozen shoulder typically progresses through three stages: the freezing stage (increasing pain and stiffness), the frozen stage (stiffness remains, but pain may decrease), and the thawing stage (gradual improvement in movement). This condition can develop following injury, surgery, or even seemingly without cause, and is more common in individuals aged 40 to 60, especially women and those with diabetes.
While many cases resolve over time with proper treatment, some become so severe that surgical intervention is required to restore motion.
When Is Frozen Shoulder Surgery Recommended?
It is typically considered when:
- Non-surgical treatments like physical therapy and steroid injections fail after 6 to 12 months.
- The shoulder stiffness severely limits daily activities such as dressing, grooming, or reaching overhead.
- Imaging tests rule out other shoulder issues that might require different surgical solutions.
An orthopaedic specialist usually recommends frozen shoulder surgery only after a thorough evaluation and after exhausting all conservative measures.
Treatment of Frozen Shoulder
The two main goals of treatment are to increase motion and to decrease pain
- Steroid injections of the joint or the bursa may be indicated and can be performed in outpatient clinics or by radiologist under ultrasound guidance.
- To increase motion, physical therapy is usually prescribed.
The physical therapist moves the patient’s arm to stretch the capsule and teaches the patient home exercises that may include use of a wand or overhead pulley.
Rehabilitation
- The initial supervised physical therapy usually lasts from one to six weeks, with the frequency of visits ranging from one to three times per week.
- The patient should engage in home exercises and stretching throughout the healing process. The stretching exercises should be done at home at least once or twice daily.
- Usually frozen shoulders will resolve almost completely with time and consistent compliance with the prescribed treatment program.
- This process can vary from six to nine months for some patients, although it may take upto a year also to resolve. In diabetic patients, it takes longer and they often have recurrence of frozen symptoms.
Types of Surgery for Frozen Shoulder
To fix a frozen shoulder, there are two main types of surgery:
1. Manipulation Under Anaesthesia (MUA)
The patient is given general anaesthesia, and the surgeon moves the shoulder carefully to break up and stretch the scar tissue. During MUA, no cuts are made. However, there is a slight chance of problems, like breaking bones or hurting soft tissues, if it is not done carefully.
2. Arthroscopic Capsular Release
In an arthroscopic capsular release, the surgeon makes tiny incisions and uses a small camera (arthroscope) to guide specialised instruments. This minimally invasive procedure offers the advantage of being more precise, allowing the surgeon to directly address areas of scar tissue.
Recovery After Surgery for Frozen Shoulder
Recovery plays a critical role in the success of surgery for a frozen shoulder. Immediately after surgery, patients typically begin a supervised physical therapy program to maintain the mobility achieved during the procedure.