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PPTS Healthy Times Newsletter
January 2010
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What is a Frozen Shoulder?
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Frozen shoulder, or adhesive capsulitis, is a condition that causes restriction of motion in the shoulder joint.Frozen shoulder causes the capsule surrounding the shoulder joint to contract and form scar tissue.
What causes frozen shoulder? There are patients who develop a frozen shoulder after a traumatic injury to the shoulder, but this is not the usual cause. Some risk factors for developing a frozen shoulder include:
Age & Gender: Frozen shoulder most commonly affects patients between the ages of 40 to 60 years old, and it is twice as common in women than in men.
Endocrine Disorders: Patients with diabetes are at particular risk for developing a frozen shoulder. Other endocrine abnormalities, such as thyroid problems, can also lead to this condition.
Shoulder Trauma or Surgery: Patients who sustain a shoulder injury, or undergo surgery on the shoulder can develop a frozen shoulder joint. When injury or surgery is followed by prolonged joint immobilization, the risk of developing a frozen shoulder is highest.
Other Systemic Conditions: Several systemic conditions such as heart disease and Parkinson's disease have also been associated with an increased risk for developing a frozen shoulder.
What happens with a frozen shoulder? The shoulder joint becomes stiff and scarred. The shoulder joint is a ball and socket joint. The ball is the top of the arm bone (the humeral head), and the socket is part of the shoulder blade (the glenoid). Surrounding this ball-and-socket joint is a capsule of tissue that envelops the joint.
Normally, the shoulder joint allows more motion than any other joint in the body. When a patient develops a frozen shoulder, the capsule that surrounds the shoulder joint becomes contracted. The patients form bands of scar tissue called adhesions. The contraction of the capsule and the formation of the adhesions cause the frozen shoulder to become stiff and cause movement to become painful.
A frozen shoulder causes a typical set of symptoms that can be identified by your doctor or physical therapist. The most important finding is restricted movement. Other shoulder conditions can cause difficulty with movement of the shoulder, such as a rotator cuff tear; therefore it is important to have an examiner familiar with this condition form a proper diagnosis.
What are the typical symptoms of a frozen shoulder?
- Shoulder pain; usually a dull, aching pain
- Limited movement of the shoulder
- Difficulty with activities such as brushing hair, putting on shirts/bras
- Pain when trying to sleep on the affected shoulder
What tests are needed to diagnose a frozen shoulder? Most often, a frozen shoulder can be diagnosed on examination, and no special tests are needed. An x-ray is usually obtained to ensure the shoulder joint appears normal, and there is not evidence of traumatic injury or arthritic changes to the joint. An MRI is sometimes performed if the diagnosis is in question, but this test is better at looking for other problems, rather than looking for frozen shoulder. If an MRI is done, it is best performed with an injection of contrast fluid into the shoulder joint prior to the MRI. This will help show if the capsule of the shoulder is scarred down, as would be expected in patients with a frozen shoulder.
Frozen shoulder treatment primarily consists of pain relief and physical therapy. Most patients find relief with these simple steps, although the entire treatment process can take several months or longer.
Stretching exercises for a frozen shoulder serves two functions: First, to increase the motion in the joint.
Secondly, to minimize the loss of muscle on the affected arm (muscle atrophy)
The importance of stretching and exercises cannot be overemphasized as these are the key to successful frozen shoulder treatment. Patients cannot expect to have successful frozen shoulder treatment if they perform exercises only when working with a therapist. These exercises and stretches must be performed several times daily.
Moist Heat; Applications of moist heat to the shoulder can help to loosen the joint and provide relief of pain.
Anti-Inflammatory Medications; help in offering pain relief but does not significantly alter the course of treatment.
Cortisone Injections; Used to decrease inflammation in joint.
Physical Therapy; Physical therapists can help a patient develop a stretching and exercise program, and can also incorporate ultrasound, ice, heat, and other modalities into the rehabilitation for frozen shoulder. As said previously, it is important that patients perform their stretches and exercise several times daily--not only when working with the therapist.
Will I need surgery for a frozen shoulder? If the above treatments do not resolve the frozen shoulder, occasionally a patient will need to have surgery. If surgery is performed, immediate physical therapy following any procedure is of the utmost importance. If rehab does not begin soon after capsular release, the chance of the frozen shoulder returning is quite high.
Will my shoulder return to normal? Most patients who have a frozen shoulder will have slight limitations in shoulder motion, even years after the condition resolves. However, this limit in motion is minimal, and often only noticed when performing a careful physical examination. The vast majority of patients who develop a frozen shoulder will recover their functional motion with therapy and stretching alone.
Source: Article written by Dr. Jonathan Cluett, MD; Medical Multimedia Group, Inc.
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Achilles Tendonitis Research Study at Midwestern University
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Midwestern University is conducting a research study that is focused on Achilles Tendinosis/tendonitis. They are looking for males who are in good health, non-smokers and non-diabetics males between the ages of 21-60. The study will be focused on evaluating the role of exercise in the development of tendon pain in the Achilles.
Physicians Physical Therapy Service is proud to work with Midwestern University and their research and development studies. PPTS is also an active participant, and sponsor of their upcoming Doctorate of Physical Therapy program. Playing an active role in helping Midwestern University develop the next generation of great physical therapists right here in Arizona is important.
The research is led by Dr. Chad Carroll MD of Midwestern University. All participants will be paid for their participation in this study. For more information or to participate, please contact Dr. Chad Carroll at ccarro@midwestern.edu
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3rd Annual Health Fair in Glendale
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Physicians Physical Therapy Service is proud to participate at this great annual event. Come and meet our staff from our PPTS @ Arrowhead clinic. Many of Glendale's best health and wellness providers will be at the 3rd Annual Health Fair. This event is hosted by the Foothills Recreation and Aquatics Center.
Where: Foothills Recreational and Aquatic Center
5600 W. Union Hills Drive
Glendale, AZ 85308
When: Saturday January, 23, 2010
Time: 10:00am-1:00pm
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