Frozen Shoulder

Adhesive Capsulitis

An Inflamed Shoulder Capsule

Your shoulder is a ball-and-socket joint. The round end of your upper arm bone (humerus) fits into a shallow groove on your shoulder blade (scapula) much like a golf ball rest on a tee.  The muscles, ligaments and joint lining help increase the stability of this inherently unstable joint. The joint lining is made of connective tissue and is called the shoulder capsule. It surrounds the joint and plays an important role in stability while allowing movement. When the capsule becomes inflamed and the joint stiffens it can “freeze.” A “Frozen shoulder,” is the common term used for the medical condition called adhesive capsulitis. It is an inflammatory condition characterized by stiffness, pain and progressive loss of shoulder motion.

When frozen shoulder occurs, the inflammation may cause bands of tissue (adhesions) to develop between your tendons and ligaments and the shoulder bones are unable to move freely within the joint. In some cases, this loss can be progressive and slowly over time, useful motion can decrease. As a result, pain and significant loss of movement worsens. In some cases, mobility may decrease so much that performing everyday activities such as combing your hair, brushing your teeth or reaching overhead is difficult or even impossible.

Patients at risk of frozen shoulder include women over the age of 40,(frozen shoulder is twice as common in women as men) people with jobs that require repetitive motion, patients that have experienced prolonged immobility of their shoulder-perhaps due to trauma, and people with overuse injuries. It also can occur after shoulder surgery, which is why early motion after shoulder surgery is so important. Diabetics are much more likely to have problems with their shoulders than others. Elevated blood sugars seem to affect the lining of the joint and make it more likely to freeze even after only minor trauma. Still, often, there is no known cause.

Treatment Options for Frozen Shoulder

The first treatment for frozen shoulder includes medications to reduce the inflammation and physical therapy. Physical therapy is key in stretching the joint lining and helping to restore motion and function. Sometimes muscle relaxers or medications that reduce nerve sensitivity are also used. Frequently a steroid injection is required to stop the inflammatory cycle that keeps the shoulder from improving.

If these treatments are not successful or if the condition is ignored too long, surgery may be required to restore motion. Surgery for a frozen shoulder involves manipulating the joint to release the scar tissue, removing the scar tissue and removing the adhesions from inside your shoulder. If there is an underlying condition at the root of the frozen shoulder like a rotator cuff tear, ligament injury or bone spurs, these can be treated at the same time to prevent recurrence of the shoulder problem. Dr Reznik performs this surgery through a fiber-optic scope using small incisions on an out-patient basis followed by physical therapy. This procedure has been shown to be very effective in restoring motion with a low risk of complications.

Recovery Plan: Post surgical instructions

Day 1: The Day of Surgery

Maintain dressing, add 4x4 bandages if needed for drainage through dressing. Apply ice pack for 20 minute periods throughout the day. You will start exercises in the recovery room. Remember: The key to keeping your motion is early movement!

Move your fingers and wrist often. Expect some swelling. If the color of your arm or hand changes, or sensation changes notify the physician. Start pendulum and wall walk (see list) exercises tonight.

** Most patients find sleeping semi-upright is more comfortable the first few days after shoulder surgery.

Post Op Day 1:

The same as day of surgery.

Exercise: You will begin simple exercises the day of surgery.  They should be done every day for the first week post-op, to maintain blood flow and help to prevent blood clots    Once a day, in the shower, begin to flex and extend your elbow. (see list) Continue gripping exercises, and be sure to move your wrist and fingers frequently.

**Your arm sling is for comfort only, use it only as needed and when in a crowded place (this will warn people to avoid your injured area). Do your elbow, wrist, and hand exercises at least two other times each day – 15 Reps.

DAY 2 (48 hours post-operatively):

Continue same activities including using ice for 20 min. periods as needed. Take your dressing off. Shower today; supporting the affected arm with the opposite hand. You may wash under the arm, but do not use a large amount of soap. Too much soap may dry out the skin and cause a rash. Move the arm freely in the shower. Don’t be afraid to do this, it will aid in your recovery.  After your shower, dry the shoulder well and place Band-aids over incisions. Physical therapy usually begins today.

Physical Therapy:

Vital to your recovery of good shoulder function is a graduated activity and exercise program to increase muscle strength and motion.

Your physical therapy will begin 3-4 days after surgery. The physical therapist will guide you in your shoulder rehabilitation program.

It is very important for you to start therapy when recommended.

To avoid complications, postoperative follow up appointments with your physician are also required to monitor your progress.

DAY 4 – 10:

Change Band-aids daily or as needed. Maintain sling use for comfort. Continue with exercises as directed. Add biceps curls and increase the circle size when doing the Pendulum exercises. Ask your therapist for a home shoulder pulley set and start pulley exercises daily.

DAY 7 – 10:

Visit with the doctor. Further instructions will be given to continue your rehabilitation and recovery. Depending on what type of surgery you had and you own recovery rate, physical therapy will start 3 days after surgery.

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