Monday Medical: Unfreezing frozen shoulders
For Steamboat Pilot & Today
Stiff, painful shoulder? You may be experiencing a condition known as “frozen shoulder.”
The condition can develop after trauma or surgery, or on its own, most commonly in women ages 40 to 60. It is also more prevalent in people with conditions such as diabetes and thyroid disease.
“We don’t know what starts it when it develops on its own,” said Dr. Adam Wilson, an orthopedic surgeon in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center. “Cells that line normal tissue get activated and start building up extra tissue, causing thickening in the shoulder capsule, which limits motion.”
The pain and stiffening develop in three stages. Stage one, or “freezing,” is marked by pain that worsens with motion and may be felt at night and while resting.
Stage two is the “frozen” stage, in which the painful shoulder joint is used less and so becomes stiff with a decreased range of motion.
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Eventually, stage three or “thawing” begins, in which mobility returns to the joint, and pain decreases and eventually disappears.
“It will theoretically get better on its own without treatment, but that being said, these stages are prolonged,” Wilson said.
“Freezing” can last for six weeks to nine months; the “frozen” stage usually lasts for six to nine months; and “thawing” can take up to two years. Altogether, the condition may last for three years if left untreated.
But various treatments may help. First-line treatment is anti-inflammatory medications and heat or ice to relieve pain, along with aggressive physical therapy to maintain and restore full range of motion.
“A stiff shoulder is a painful shoulder. Getting people moving can decrease their pain,” Wilson said. “For most people, the first-line treatment works, but that can still be a four- to six-month process with physical therapy. It’s not something we can make better instantly.”
In addition, a steroid injection within the joint may help break the inflammatory cycle, which may reduce thickening and stiffening in the shoulder capsule.
As with many conditions, it’s best to start treatment sooner rather than later.
“If you can break that cycle before it starts getting too stiff and too tight, then the overall treatment should be less,” Wilson said. “When you’re further into the course or have a fully frozen shoulder, it may take a little more aggressive therapy to get people out of it.”
If first-line treatment isn’t enough, it may be helpful to try a procedure in which the shoulder is forcibly moved to break up scar tissue and release thickening while a person is under anesthesia.
Alternatively, scar tissue and thickening can be released through an arthroscopic procedure.
“Treating the frozen shoulder helps people return to their normal life activities, their recreational activities, their work activities — just getting back to life,” Wilson said. “It can be severely limiting if you can’t reach over head or around.”
Don’t be alarmed if parts of the treatment process are uncomfortable.
“Working with a physical therapist and doing exercises at home is not comfortable, but when people push through the discomfort, that ultimately helps them get out of the pain cycle,” Wilson said.
If you have shoulder pain or stiffness, don’t just assume it’s frozen shoulder: rather, see your health provider.
“Shoulder pain by itself can be caused by a number of things,” Wilson said. “When there’s shoulder pain, especially when people get to a point where they start noticing a loss of function, that’s definitely a time to come to see us to help figure it out.”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at email@example.com.
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