Frozen Shoulder Treatment

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Frozen Shoulder treatment

Adhesive capsulitis, also known as frozen shoulder, is a condition, which develops slowly over time. This condition involves pain in the shoulder joint and severe stiffness. The pain comes from the shoulder capsule and connective tissue around the shoulder joint becoming inflamed and stiff. It gets worse over time and usually always becomes chronic. It is most common in women ages 40 to 60. With frozen shoulder stiff bands of tissue develop they are called adhesions. Also the shoulder capsule thickens and becomes tight. There are three stages of frozen shoulder: freezing, frozen, and thawing. The freezing stage is when you slowly start to lose shoulder movement and the pain begins to get worse, as stiffness settles in. This stage can last from 6 weeks to 9 months. The next stage is frozen sometimes during this stage the pain is reduced but the stiffness remains. During this stage everyday activities are very limited by pain and severely reduced range of motion. It usually lasts about 4 to 6 months. The last stage is thawing. This usually last from 6 months to 2 years and this is when shoulder movement will return to normal or as close normal as possible with treatment. Frozen shoulder is frustrating to patients because of how long the recovery process takes. However with the proper frozen shoulder treatment it can be a lot more efficient.


Currently there are no correlations between occupation and frozen shoulder. Medicines have yet to figure out the cause of this debilitating condition. There are a few factors that do increase the chances of getting frozen shoulder. The factors include having diabetes, hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease. Since women are more at risk then men there are certainly some hormonal factors. Unfortunately we just don’t know what they are. Another risk factor is when the shoulder has been immobilized due to surgery for a long period of time. Again these are just a few common factors there is no definitive cause know for adhesive capsulitis of the shoulder.

Adhesive Capsulitis Frozen Shoulder

Normal shoulder joint
Frozen shoulder joint


The main sign of adhesive capsulitis of the shoulder is stiffness in the shoulder and the inability to make simple movements. Other signs are pain and aching in the outer shoulder area and the upper arm. These symptoms usually get better over time. Frozen shoulder can last anywhere from 6 months to 3 years till it’s completely recovered. The good news is that this condition is always self-limiting; however it could leave some permanent damage if it is not managed by proper care.


The diagnosis starts with a physical exam and an assessment of your medical history. Then the doctor will test the range of motion of the shoulder. There will be a limited range of motion if the person has frozen shoulder. The doctor may also prescribe some tests such as MRI or ultrasound in order to rule out other problems. Once the doctor comes up with a diagnosis there are both surgical and nonsurgical treatments for frozen shoulder.

Diagnosis starts with a physical exam and an assessment of your medical history.


Frozen shoulder usually gets better with time but without treatment it could take as long as three years. Statistically patients recover on average of 1-1.5 years. The goal of frozen shoulder treatment is to relieve pain and restore movement in the shoulder. There are several non-surgical options for treatment. The first is non-steroidal anti-inflammatory medicines to reduce swelling and pain. The next is steroid injections and last is physical therapy. Typically physical therapy is used in combination with anti-inflammatory medication. Physical therapy is the safest and the most reliable treatment of frozen shoulder. Surgical treatment of adhesive capsulitis. There are two approaches for surgical treatment of adhesive capsulitis. The first one is called manipulation under anaesthesia. Usually manipulation under anaesthesia is relatively safe procedure. It is used successfully for chronic back pain. The goal of manipulation under anaesthesia is to break adhesions while the patient is sedated so that his muscles are relaxed. MUA is usually a safe procedure however in case of adhesive capsulitis the risk is drastically increased. The possible and frequent complications are fracture of the shoulder bone. The second type if surgical intervention is an arthroscopic surgery. Few incisions are made and the capsule of the shoulder joint is being released by multiple small cuts and the scar tissue is being removed. This procedure, however safe does not have significantly better outcomes then conservative care and should only be used in refractory cases.

Frozen shoulder treatment in NYC

Research at NYDNRehab


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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