Frozen Shoulder Manipulation

If you've gotten to the point where you feel a frozen shoulder manipulation is your only course of action, then there are some points to consider:

• If you have not yet reached the "frozen" stage of Adhesive Capsulitis within a full year your doctor may recommend a manipulation under anesthesia.
• There is a 70-75% success rate (success defined as any improvement in ROM, not necessarily function)
• This success rate is less likely with diabetics
• There is a small but still present risk of sustaining a fracture during the procedure (best research shows this as small as 2%)
• Most manipulations are done as outpatient and you will need someone to drive you home after the procedure
• There is to be an expected increase in pain for several days following a frozen shoulder manipulation. This is due to soft tissue trauma, increased swelling, and induced inflammation in the shoulder due to the procedure causing micro tears in the joint capsule
• Physical Therapy or frozen shoulder exercise is generally prescribed for 3-4 months following a manipulation
• There is risk of infection following injection into the shoulder joint

Obviously a manipulation should be a last resort and preferably should be considered only after a second opinion. Once the manipulation is performed, physical therapy should be initiated as early as day 1 following the procedure as the shoulder joint will stiffen up quickly and render the procedure useless if early movement is not performed.

The best course of action is always a conservative approach using frozen shoulder exercise versus a frozen shoulder manipulation. There are many treatment programs specific to treating a frozen shoulder which are effective in returning functional range of motion and reducing pain.

Topical Rubs Can Give Frozen Shoulder Pain Relief

While it's true that topical rubs such as Icy Hot, Biofreeze, etc... only provide short-term relief for frozen shoulder pain sufferers, they do have their place in the treatment of adhesive capsulitis, provided the patient has a targeted program and only uses it as an adjunct to treatment.

These or similar rubs work basically by irritating the skin, giving the recipient a warming sensation. This warming sensation is then translated by the brain into pain relief. This is known as the "pain gate" phenomenon and basically means that certain pain pathways in the peripheral nervous system can only process a certain amount of pain signals at any given time. After that, the "gate" is shut off to further pain signals in that pathway.

Think of it this way, if you have a headache and someone suddenly stomps on your toe, your headache is suddenly gone and the focus of pain is now on your freshly stomped toe. Same thing with topical rubs: Shoulder pain present? Rub in Biofreeze... ointment irritates the skin and therefore pushing a large amount of "irritant" pain signals to the brain, overriding the shoulder pain signals, and subsequently PAIN RELIEF!

Now there are certain rubs that are more effective at generating the amount of "heat" than others. A little research and experimentation will help you decide although I have found Biofreeze to be very effective for patients.

Even the best frozen shoulder exercise programs needs a boost, and often the answer can be found in the wide variety of ointments available on the market today. Don't fall for pitches that state a particular product "goes deeper" than another product, as this simply isn't true. NO topical ointment can penetrate past the dermal layers into the muscle, and thank GOD for this because then you're talking some SERIOUS pain. Therefore do not consider a higher cost product necessarily more effective.

Frozen Shoulder Pain Relief - How Long Does It Take?

I hate to sound wishy washy, but the length of time to get frozen shoulder pain relief depends upon a number of factors, even with a good frozen shoulder program. As much as I would like to give a general "catch all" answer but it honestly would be misleading. Therefore I will try to break it (pain relief time it takes) down:
(The following assumes the person is in stage II freezing stage -- These are my statistics based on clinical treatment, NOT nationwide or CDC statistics.

• If you are greater than age 45 (most frozen shoulder sufferers are) then you are in the "takes longer" category. Here, generally in my experience, relief comes in spurts with consistent exercise but I have typically seen significant progress with range of motion in about 3-4 weeks. If you are attending therapy 2-3 times per week with a trained manual therapist who is performing joint mobilization then this time frame is less. Remember, you must gain range of motion before you will have any lasting pain relief.
  
• If you are diabetic then you also fall into the above category. This is just a fact for just about anything healthwise diabetics go through. Here, the diabetic patient, in addition to consistent exercise, joint mobilization, and stretching, must pay strict attention to his/her diet. If you are able to do cardiovascular exercise, then this will help as well. A good cardio program, believe it or not, will help significantly. This has to do with oxygen exchange and bloodflow without getting too complicated. For diabetics - 6-10 weeks for significant range of motion gains. Pain relief will follow.
• If you are less than 35 years of age you also fall into the above category. This has nothing to do with physiological factors, but rather is an issue of compliance -- This age group typically has kids, a full time job on the upward career path, busier schedule, etc... and therefore will devote less time to consistent exercise.
• If this is your second or more frozen shoulder then you typically will get over it quicker. This has to do with previous knowledge and earlier recognition and initiation of treatment.
• The group that I see with the quickest recovery is female and 35-45. By contrast I see less patients in this category. I have actually treated individuals in this group and seen significant gains in ROM within 2 weeks!
• Sufferers of frozen shoulder pain in the age group 70+ take the longest and also have less favorable outcomes. There are various reasons for this, but one has to assume that some of it has to do with compliance, bone structure/posture, and possibly pain tolerance.

Is My Shoulder Frozen?

As a physical therapist I'm often asked how to tell if someone's shoulder pain and stiffness means they are getting (or have) a frozen shoulder. A frozen shoulder (or Adhesive Capsulitis) is a specific condition typically involving adhesions which form around the joint capsule. The joint capsule is simply a fibrous structure encasing shoulder joint.

This capsule can shrink with disuse of the shoulder, such as after long term immobilization after a fracture (called adaptive shortening) causing increased stiffness and pain with range of motion. This is not a true presentation of primary frozen shoulder. Primary frozen shoulder seems to appear without cause or warning, often presenting as painful shoulder motion at first, then progressing to increased stiffness.

The treatment of these two presentations differ (at least they should), because the type of exercise used for treating a primary frozen shoulder is different than treating simple adaptive shortening. In primary frozen shoulder the first motion lost is external rotation (reach back and touch the palm of your hand to the back of your head), followed by loss of abduction (raising your arm out to the side), then flexion (forward elevation of the arm overhead), and finally internal rotation (reach behind your back as if fastening a bra (or threading your belt if you're a male).

In addition, a primary frozen shoulder will be painful at night without movement of the arm/shoulder. In contrast, adaptive shortening does not follow this pattern of loss of motion as any direction can be stiff/painful. Also with adaptive shortening the shoulder does not typically hurt at rest.

So if or a love on is asking "Is my shoulder frozen" the you can follow the above descriptions to better decide which condition you may have. In any case you should get a formal diagnosis from a physician and seek treatment from qualified professionals. It's important to get specific treatment for frozen shoulder syndrome as the wrong exercise can actually delay healing and prolong symptoms.

An excellent program for treating frozen shoulder is designed by a physical therapist and covers specific exercises and the best frozen shoulder exercise strategies for this painful condition.

frozen shoulder cure?

As a physical therapist I'm often asked if injections "cure" a frozen shoulder. I almost always begin by saying "no" and then proceed to tell the patient that an injection (typically and anti-inflammatory agent) MAY give some temporary relief, but is not the answer to their stiffness and pain.

In fact, an injection with a corticosteriod, if given multiple times, can cause way more problems than it solves. Repeat steroid injections can weaken tissues and bone and may actually put the recipient at further risk.

Now if the pain is unbearable I'm not totally against this type of injection, but would rather educate the patient on the benefits of specific frozen shoulder exercise and treatment to reduce the amount of pain and stiffness.

You see, when a frozen shoulder develops the first thing a patient does is stop moving the shoulder as much. This causes "adaptive shortening" of the joint capsule surrounding the crucial rotator cuff. When this happens the cuff muscles do not have enough "room" to perform their function and end up getting iritated due to friction againt the capsule wall.

Guess what happens then? MORE pain and stiffness. The best solution to relieving frozen shoulder pain is with a specifically targeted exercise program designed by a healthcare professional that has experience in this area. The gradual stretching of capsular tissue and release of adhesions is the true "cure" for a frozen shoulder.