Physical Therapy Or Surgery - Which Is Best For A Frozen Shoulder?

You may have gotten the bad news from your doctor - "You have a frozen shoulder". Worse yet, he or she may have told you the terrible statistics regarding this condition: A frozen shoulder can take up to 2-3 years to heal on it's own. Now that's awful news or good news depending on which side of the coin you are viewing. On one hand 2-3 years suffering through a stiff and painful shoulder sounds like pure hell. On the other hand at least there's hope that your condition will improve and may not be permanent.

Personally, I don't like the sound of living with gut wrenching pain every time I try to reach to open a door or get a glass out of my kitchen cabinet. I want pain relief now, not 24-36 months from now. Your doctor may even suggest surgery or physical therapy. But which is best?

Surgery for a frozen shoulder involves arthroscopic methods which are supposed to release the tiny adhesions that have formed between the joint capsule and rotator cuff tendons. Anytime surgery is done anywhere on the body there is risk for infection. Therefore the risk may significantly outweigh to potential benefit, particularly if your immune system is down for any reason. Also if you are diabetic then you can look forward to slow healing times.

Another type of "surgery" that may be suggested is not really surgery at all. I'm speaking of manipulation under anesthesia. While the risk for infection is not present, you still have all of the risks associated with being put under anesthesia, including death. The risk of death, however small, is never an option to me, that is unless the pain is so bad that death would be a welcome option.

Physical therapy for frozen shoulder involves performing specific exercises at frequent intervals to increase shoulder range of motion (ROM). Increasing range of motion will lessen the pain and stiffness as adhesions are released. Physical therapy also involves joint mobilization by a trained therapist which loosens the joint capsule allowing for greater ROM. Your therapist may also introduce modalities such as ultrasound (typically used for focused deep heat), electrical stimulation (for short-term pain relief), and massage (relaxes spasms and tight muscles). Physical therapy, if performed in a structured program designed for this condition, can significantly reduce the chance of permanent dysfunction and can hasten recovery.

So when faced with the decision between physical therapy or surgery to treat a frozen shoulder, in my opinion, physical therapy wins hands down. It's simple - the benefits outweigh the risks. However even the best exercise can be risky without a proper diagnosis, therefore consult with your doctor before beginning any program or treatment for a frozen shoulder.

Top Frozen Shoulder Remedies

After suffering through the pain and debility of a frozen shoulder back in 1998, I finally realized what my physical therapy patients had been talking about. Not that I wasn't listening, but I mean I finally understood their desperate cries and the reasons they sought relief in the form of home frozen shoulder remedies. With this type of pain an individual will try most anything, including the absurd, to find a relief from this type of pain. Now I still stand firm on the fact that a good, organized physical therapy program is the best frozen shoulder treatment -- this based on the outcomes I see with most of my patients. However, not all patients subscribe to diligently following a program of exercise and stretching, but those that do will eventually break the cycle of pain and debility.

Frozen shoulder remedies have their place, though, despite their strangeness at times. Therefore I will list below the top frozen shoulder remedies as told to me over the years. Remember that some of these are anecdotal and anyone following them without advice from a doctor is doing so at their own risk -- the risk of increasing pain, dysfunction, or the risk of the remedy providing nothing in the way of relief.

1. Mustard Poultice -- This one is still used, mostly by the elderly. It consist of mustard powder mixed with water to form a paste. This paste is wrapped in cheesecloth or muslin cloth and applied to the affected area then covered with plastic wrap.
2. TENS unit -- These units are small portable electrical stimulation units which provide a current to the involved area. They have been widely used in physical therapy and by chiropractors as an adjunct to frozen shoulder treatment. They are really a "coping mechanism" meant to help the patient "tune out" the shoulder pain by irritating the skin. This works by bombarding the sensory nerves with electrical stimulations which override the nerves that signal pain to the brain (simply put). They are NOT the cure for a frozen shoulder.
3. Epsom salt bath -- The warm water does more for relief than the salts do. The idea is that the salts some how "draw" out the toxins that cause pain.
   
4. Auto part lubricant -- I'll avoid using the trademark name of this one, but it won't be hard to guess. Starts with a "W" and ends with a number. This remedy is more of a skin irritant and does nothing to heal a frozen shoulder.
   

These are the top remedies I hear of from some of my patients. I typically do not argue with anyone believing that they help (TENS actually does help with muscle spasm), but rather point out to the patient that there are other solutions that provide more lasting relief. Besides, who am I to argue that something does not work if it does work in the patient's mind (placebo effect).

Frozen Shoulder Therapy Massage

Will Massage Help My Frozen Shoulder?

The benefits of massage in frozen shoulder therapy are numerous. Besides just "feeling good" a massage calls in to play the release of pain inhibitors which can often sustain relief hours after receiving the massage. The type of massage most effective is "trigger point" massage and can be viewed in this video.

Trigger point massage involves applying pressure to particularly painful areas in the rotator cuff which contribute to stiffness and soreness when attempting to move the affected shoulder. Although a trained massage therapist is most effective in determining these trigger points, anyone can apply the massage and find these areas through feedback from the sufferer of the frozen shoulder.

Before beginning the massage it's best to apply moist heat for approximately 10 minutes to the affected shoulder. When applying the massage use a scent-free massage lotion or cream to reduce friction.

It's best to start with the person lying on their side with a pillow under their affected arm. The person applying the massage should start with "stroking" the affected arm. This induces relaxtion initially which is "key" to maximizing the effects of the massage. Next, gradual increasing pressure should be applied in a circular fashion to the back and side of the shoulder, taking note of painful trigger point areas as the patient responds.

Once a trigger point is found, the area should be worked on for 2-3 minutes before moving on to the next area. After completing massage to the shoulder for about 15-20 minutes, the patient should be left to lie in a relaxed position for another 5 minutes before getting up.

More information regarding frozen shoulder exercise and treatment can be found at http://www.squidoo.com/Melt_Frozen_Shoulder