Current Best Practice for Frozen Shoulder
Background: Frozen Shoulder or Adhesive Capsulitis is painful shoulder condition that results from inflammation and adhesions in the glenohumeral joint and joint capsule. The onset is typically insidious and progressive. Frozen shoulder most commonly effects people in their 6th decade of life. The exact cause is unknown.
Exam: The hallmark feature of frozen shoulder is loss of glenohumeral range of motion. In particular, there is a loss of internal and external range of motion. Many will have difficulty or inability to reach into their back pocket. Pain with passive range of motion and rotator cuff strength testing is common.
Imaging: Xrays are usually normal. MRI can show findings suggestive of frozen shoulder.
Differential Diagnosis: Rotator cuff syndrome, glenohumeral arthritis, cervical radiculopathy, shoulder fracture.
Treatment: Frozen shoulder treatment can be challenging. Steroid injections into the subacromial bursa and/or glenohumeral joint can provide some pain relief. The mainstay of treatment is physical therapy and diligent home exercise program to restore motion. However, this can take months. Diabetic patients have a more resistant course.
Sometimes, patients fail to progress. In these cases, glenohumeral hydrodilitation can be very effective. This is a simple, in-office procedure injecting high-volume saline into the joint along with lidocaine and steroid. The goal is to expand the contracted capsule and potentially cause capsule rupture. The procedure is followed immediately by aggressive physical therapy. Hydrodilitation has a high success rate for resolving frozen shoulder1,2. Some patients will fail and may require manipulation under anesthesia or arthroscopic capsular release.
Happy to help with any of your shoulder pain issues! As always, I’m available for NEXT DAY if not SAME DAY appointments for all urgent head-to-toe orthopedic issues.
Steve Meyers, MD
Fellowship-Trained Sports Medicine
Non-Surgical and Regenerative Orthopedics
Assistant Professor – Family Medicine @ TCU and UNTHSC School of Medicine
Texas Health Care Bone & Joint Clinic
1651 W. Rosedale #200
Ft Worth, TX 76104
(817) 661-8498
References:
1. https://pubmed.ncbi.nlm.nih.gov/32349602/
2. https://pubmed.ncbi.nlm.nih.gov/20006315/
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