Is frozen shoulder always improved with physical therapy, or are there sometimes other measures that must be taken? How long should it take to heal?
In many cases, physical therapy is all that’s needed to treat frozen shoulder. It can take time, however. Even with treatment, it may be six months to a year before full function is restored. If there’s ongoing pain involved or if physical therapy isn’t enough to resolve the problem, then medication injections or, rarely, surgery may be necessary to treat frozen shoulder.
Frozen shoulder, also called adhesive capsulitis, happens when the ligaments that hold the shoulder joint in place tighten due to inflammation and restrict the joint’s movement. The condition typically progresses through three stages. During the first stage, moving the shoulder becomes painful. In the second stage, the pain subsides, but the shoulder becomes stiffer and more difficult to move. In the third stage, the stiffness decreases, and the shoulder’s range of motion gradually returns.
It’s not clear what causes frozen shoulder, but people with diabetes, those who have thyroid problems and anyone who has had shoulder surgery are at an increased risk for developing this disorder. Frozen shoulder usually can be identified based on a person’s symptoms, but, in some situations, an X-ray, MRI or other imaging exams may be needed to rule out other problems.
A thorough and careful assessment is important because frozen shoulder is commonly misdiagnosed as being a rotator cuff tear. And people who have rotator cuff tears often are told they have frozen shoulder. Accordingly, it is critical that patients who are thought to have either condition be evaluated for the other to ensure an accurate diagnosis and proper treatment.
Physical therapy is the mainstay of treatment for frozen shoulder. A physical therapist can provide exercises to help restore the shoulder’s range of motion and mobility. In more than 90 percent of cases, frozen shoulder goes away with physical therapy and time. But, even when physical therapy is done consistently, it still may take up to a year to gain back all lost shoulder function.
The pain that characterizes the first stage of frozen shoulder usually can be managed with nonprescription medications that reduce inflammation, such as ibuprofen and aspirin. If that’s not enough, stronger prescription anti-inflammatory drugs may be useful.
In cases with significant pain and stiffness, an injection of a corticosteroid medication into the joint often is recommended. That medication can decrease inflammation and make physical therapy easier to perform. When shoulder stiffness is not accompanied by pain, corticosteroid injections are less beneficial.
Stiffness that lasts beyond a full course of physical therapy over six to 12 months or shoulder stiffness that gets significantly worse during physical therapy may signal that surgery is needed to release the tight ligaments and remove scar tissue. The surgery usually can be done arthroscopically through two to three small incisions as an outpatient procedure, so an overnight hospital stay is not required. Physical therapy is still necessary for several weeks or more after surgery to prevent frozen shoulder from coming back.
After it has been successfully treated, it’s uncommon for frozen shoulder to return in the same shoulder. But some patients may go on to have it in the other shoulder. In people who have medical issues that put them at risk for the condition, treating those disorders may decrease the likelihood of developing frozen shoulder.
Christopher Camp, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.
EXERCISE VERSUS CALCIUM SUPPLEMENTS
My doctor says that exercise is even better than calcium supplements for helping maintain bone density and prevent fractures. Can you explain why?
Both calcium and physical activity are important for bone health. But when you consider the net benefits of calcium, especially in supplement form, it’s unlikely to serve as a good substitute for regular exercise.
Calcium is an important mineral that your body uses to build and maintain strong bones. Foods that are high in calcium include dairy products, dark green leafy vegetables and certain fish, such as sardines. Various foods and beverages, such as cereals and fruit juices, may be fortified with calcium and vitamin D, as vitamin D enhances absorption of calcium.
Calcium in supplement form may help people who can’t get enough calcium from their diet or for those who poorly absorb calcium because of conditions such as untreated celiac disease or bariatric surgery.
However, recent evidence suggests that increasing calcium intake through supplements has a modest and limited effect on bone density. Calcium supplements also can have certain side effects. They can cause constipation, interfere with other drugs and, at higher doses, may be linked to the development of kidney stones. Studies suggest a potential link between excessive amounts of calcium and conditions such as heart disease and prostate cancer.
On the other hand, regular exercise that uses a variety of muscle groups and includes some strength training helps you build a protective framework around your skeleton. It also helps you move more easily and improves your balance. Exercise helps decrease your risk of falling and breaking a bone, which is the ultimate concern.
Ingesting the recommended daily amounts of calcium primarily through dietary sources and staying physically active appear to be the best approaches to limit your fracture risk.
Matthew T. Drake, M.D., Ph.D., Hematology, Mayo Clinic, Rochester, Minn.
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