Shoulder > Treatments
If your frozen shoulder has failed to respond to conservative
treatment consisting of rest, anti-inflammatory medication
and physical therapy, your physician may suggest manipulation
under anesthesia. In this procedure, your physician
moves your shoulder through its complete range of motion
while you are anesthetized. This effectively tears the
scar tissue that has formed in your shoulder joint capsule
and allows for freer movement of your shoulder. While
many patients report significant reduction in pain and
increased range of motion after this procedure, there
is a small risk of vascular or neurologic injury, injury
to your shoulder’s articular cartilage, or fracture
of the humerus.
The decisions you make and the actions
you take before surgery can be every bit as important
as the procedure itself in ensuring a healthy recovery.
Getting a second opinion from another qualified surgeon
is often advisable, particularly in rare or unique cases.
sure you have received any equipment you will need when
you get home from the hospital. This may include a shoulder
sling, ice packs or coolers, or heating pads. You should
receive prescriptions for any of these from your doctor
when your surgery is scheduled.
the potential risks and benefits of the surgery by asking
your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
check if the orthopedist performing the surgery is board-certified
or eligible, call the American Board of Orthopaedic
Surgery at 919-929-7103.
At most medical centers, you will
go to "patient admissions" to check in for
manipulation of your shoulder. There may be separate
check-in areas for ambulatory outpatient (patients who
go home the same day after surgery) and for overnight
inpatient surgery, so be sure to ask your physician
or an assistant about this. After you have checked in
to the hospital or clinic, you will go to a holding
area where the final preparations are made. The paperwork
is completed and your shoulder may be shaved, though
this is not always necessary. You will wear a hospital
gown and, if applicable, remove your watch, glasses,
dentures, and jewelry. You will have the opportunity
to speak with your orthopedic surgeon or an assistant,
and meet the anesthesiologist or anesthetist (a nurse
who has done graduate training to provide anesthesia
under the supervision of an anesthesiologist). Then,
you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important steps to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under anesthesia.
you will be unable to drive, arrange for someone to
help take you out of the hospital and drive you home
when you are released.
a soft, comfortable shirt that will not irritate your
skin when worn under a shoulder sling.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Manipulation of your shoulder is a
relatively simple and brief procedure that is performed
in a hospital or outpatient clinic.
usually are given an interscalene block, also referred
to as regional anesthesia, to numb your shoulder and
neck area. This is administered with an injection in
the side of your neck.
also are put under general anesthesia, and may be given
a mild sedative to help you relax.
lying on your back, the physician takes your arm and
moves it through its range of motion.
usually are taken directly to the physical therapy area
of the medical center to begin passive motion exercises.
The amount of pain you experience
following manipulation of your frozen shoulder can vary
greatly. The regional anesthetic usually wears off in
about two hours. General anesthesia wears off in about
an hour. You can expect to be given pain medication
as needed. Be sure to ask for medication – which
could be in various forms, such as local blocks, IV
narcotics, or orals - as soon as you feel pain coming
on, because pain medication works best on pain that
is building rather than on pain that is already present.
The nurses will not give you more than your doctor has
prescribed and what is considered to be safe. Ice also
helps control pain and swelling. As soon as possible
after surgery, you may begin exercises using a continuous
passive motion machine (CPM). Your temperature, blood
pressure, and heartbeat will be monitored by a nurse,
who, with the assistance of the doctor, will determine
when you are ready to leave the hospital.
Following manipulation of your frozen
shoulder, and depending on the degree of pain you are
experiencing, your physician may want you to focus on
relieving your pain rather than increasing your range
of motion. This involves rest, ice, medication, and
in some cases, immobilization of your shoulder. You
will be asked to refrain from using the affected shoulder
as much as possible. You should avoid putting strain
on your shoulder, raising your arm over your head, or
lifting heavy objects. Physicians often prescribe a
removable sling to immobilize your shoulder, but will
want you to wear for as short a period of time as possible
as motion is important during this time. Depending on
the severity of your pain, your physician also may prescribe
non-steroidal anti-inflammatory medications. Icing your
shoulder for 20 to 30 minutes at a time, three or four
times a day, also can help relieve pain and inflammation.
Some patients are given corticosteroid injections to
ease pain. The amount and frequency can vary and you
will likely wear a sling for at least a few days. Rehabilitation,
using the exercises you learned at the hospital, usually
can begin immediately.
Once your pain has decreased enough
to allow you to move your shoulder comfortably on your
own, you usually can begin performing basic stretching
exercises aimed at increasing your shoulder’s
range of motion. Some of these include a pendulum-like
motion, in which you lean over with your affected arm
hanging down and your other arm extended and resting
on a table to support your body, and then make small
circles with your affected arm. The next step is to
perform this exercise while holding a light weight.
Other exercises focus on flexing your shoulder forward
and back with gentle motions, and some use apparatus
such as a wand or pulley system. All involve the unaffected
arm "leading" the affected arm so that the
affected arm does not have to push against resistance.
As in all exercises, proceed gradually. Do not pursue
an aggressive exercise program if you experience pain
FORMAL PHYSICAL THERAPY
A physical therapist may use heat or ultrasound to ease
the pain in your shoulder and allow you to exercise
more comfortably and efficiently. Your physician also
may suggest an injection of a long-lasting anesthetic
before you perform supervised stretching exercises.
Your physical therapist then takes you through a series
of passive movements aimed at regaining range of motion
in your shoulder.
It is not uncommon for sufferers of
frozen shoulder to experience residual symptoms for
years after the initial diagnosis. These generally include
mild pain and a small loss of range of motion in the
shoulder that usually does not affect your ability to
perform everyday functions. There is no way to truly
protect yourself from a recurrence of frozen shoulder,
but physical therapy is recommended to help strengthen
and stabilize the joint. There is no way to truly protect
yourself from a recurrence of frozen shoulder, but physical
therapy is recommended to help strengthen and stabilize