Carter Rowe an eminent American Shoulder Surgeon stated about Frozen Shoulder:
‘We have all had to claim that the idiopathic frozen shoulder is a self-limited condition and that the majority of patients become pain-free with a full range of motion within a year to 18 months. Our problem has been: How can we shorten the painful period effectively?’.
This will depend on the stage and tailored to the patient’s individual needs.
The effectiveness of these is variable and usually very strong ones are necessary.Initially mild ones will be tried. These will often only be needed at night.
Usually do not help. Celebrex has been advocated in the early phase.
3. Injections into the shoulder
The effect of these is variable, they may only give temporary relief of the pain but insome cases they may hasten the end of the first phase.
4. TENS – Transcutaneous Electrical Neural Stimulation
This can be very effective in some patients and is administered by a physiotherapist.
Pain at night and the inability to sleep is a major problem.
It is more comfortable to sleep in a recliner or propped up in bed. Laying the arm on pillows is helpful. A heating pad can be beneficial.
The use of Amitriptylline (normally an antidepressant) has been shown to be very effective in helping the patient sleep.
Any attempts to stretch the joint to improve movement will just exacerbate the pain.
Local therapy is however very helpful and massage of the periscapular muscles.
It is important to maintain the movement that one has but not to stretch past the limit as this will just exacerbate the pain.
Its use is controversial. It may shorten the frozen phase of the syndrome.
The timing of manipulation is important: if done too early ie: in the freezing phase, it can make the pain worse and lengthen the duration of the freezing phase.
9. Arthroscopy and release
Increased vasculature in the capsule / lining of the joint
Looking in the shoulder with an arthroscope can better define the stage and then a release can be done. The results of release with the arthroscope and results of manipulation have been shown to be the same.
As with the manipulation, the timing of this is very important. Some surgeons advocate this in all patients but there is no evidence to show that it changes the natural history of the condition.
An arthroscopy and release is done as a last resort in a patient in which no other forms of treatment have been able to control the pain.
Increases vessels seen in the joint capsule or lining in a frozen shoulder.
Different treatments or medication will work for different patients, thus patients must find what works for them and take that treatment till the condition recovers of its own accord.
NO TREATMENT HAS BEEN SHOWN TO EFFECTIVELY ALTER THE NATURAL HISTORY OF FROZEN SHOULDER. IT IS THUS THAT SUPPORTIVE TREATMENT ONLY IS NOW ADVISED.