Treatments for a Frozen Shoulder

Frozen Shoulder

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Frozen shoulder is a common cause of shoulder pain.  Often misdiagnosed as a rotator cuff tear, a frozen shoulder is caused by tightening of the shoulder joint capsule

Frozen shoulder can take a long time for recovery, but there are some effective treatment steps that can help to accelerate the process of healing.

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Physical Therapy

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 Physical therapy is the mainstay of treatment for a frozen shoulder.  No matter what stage of frozen shoulder you are in, physical therapy is the best treatment for this condition.

While many patients may be tempted to try to accomplish therapy on their own, working with a trained therapist is important to ensure you are doing the proper stretches.  I often use the analogy of learning to golf--you would not be a very good golfer if you just went and played, and you would be unlikely to get better.  Learning to golf requires some basic instruction, with regular follow-up to build on your knowledge and experience.  Effective physical therapy is the same--you need some basic instruction, and regular follow-up to ensure you are doing your stretches properly and to learn more advanced stretching.

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Home Stretching Program

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Stretching the shoulder is the key to effective therapy.  Shoulder stretches should be done several times each day for maximal benefit.  Therefore, if you are planning to do your stretching program 3 times a day, and you go to therapy twice a week, that means that 90% of your therapy occurs at home!

Don't get fooled that you are doing adequate stretching by going to therapy two or three times a week.  Physical therapy is where you learn, homework is the key to success.

Strengthening Not Needed

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One mistake that is often made by patients and therapists alike is to focus too much on strengthening, rather than on stretching the shoulder capsule.  While it is true that poor shoulder mechanics may develop, and strengthening may be needed to regain full shoulder function, the most important aspect of recovery from a frozen shoulder is to stretch the joint capsule.

Therefore, if you find you're being instructed to do exercises for the shoulder, talk to your doctor to make sure you are having the proper treatment.  Therapy for a frozen shoulder is very hands-on, and stretching the shoulder should be a constant theme of all of your work.

Anti-Inflammatory Medications

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Anti-inflammatory medications are effective to relieve pain associated with a frozen shoulder.  That said, they have never been shown to alter the course of treatment or to lower the duration of symptoms. 

Other pain medications may be effective, but should be used cautiously as some can have serious side-effects, including addiction.

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Ice and Heat Application

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Ice and heat application are often helpful to alleviate pain and loosen the shoulder.  Typically, patients will find the best results by using heat before stretching to loosen the shoulder muscles, and then ice after stretching to reduce inflammation and alleviate pain.

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Cortisone Shots

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Cortisone injections have been studied extensively, and have not been shown to alter the duration of symptoms for frozen shoulder.  While some patients find transient pain relief, a cortisone shot should not be considered necessary treatment for a frozen shoulder. 

Some patients find that one or two shots can help to relieve symptoms and allow them to push their stretching a little further; in those cases, cortisone may be helpful.

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Alternative Treatments

shoulder acupuncture
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Alternative treatments are often used by patients who don't want traditional medicines to relieve pain, and by patients who don't find relieve with traditional treatments.  Many patients find effective pain relief, and while these alternative therapies have not been shown to reduce the duration of symptoms, they may help patients manage their pain more effectively.

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Surgery is generally considered the last resort treatment, and fortunately most patients do find relief before reaching this step.  Surgery can be performed to forcefully stretch the shoulder while under anesthesia (manipulation under anesthesia) or break up the scarred shoulder joint capsule (release of adhesions). 

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