Q: What's the best way to recover from a frozen shoulder?

A: Many adults (mostly women) between the ages of 40 and 60 years of age develop a strange case of shoulder pain and stiffness called adhesive capsulitis. You may be more familiar with the term frozen shoulder to describe this condition.

There isn't a one-best-treatment known for adhesive capsulitis. A review study was published on the topic. The authors are two orthopedic surgeons from the Hospital for Special Surgery in New York City. They report that studies done so far just haven't been able to come to a single evidence-based set of treatment guidelines for this problem.

They offered their "preferred" method with the caution that although this set of steps seems to work for them, no studies have been done to prove the validity of their approach.

Having said that, they recommend using a cortisone injection into the joint only during stage one. The steroid helps stop the inflammatory process that often gets out of hand if left untreated. They don't recommend the use of oral (pills taken by mouth) steroids but oral nonsteroidal antiinflammatories (NSAIDs) are given throughout all stages.

Physical Therapy is the mainstay of nonoperative treatment during all stages. The therapist decides what approach to take based on the stage of disease. Early on, the goal is to reduce pain and interrupt the inflammatory cycle. This can be done with modalities such as electrical stimulation, joint mobilization, the use of cold, and iontophoresis. Iontophoresis is a way to push medications through the skin directly into the inflamed tissue.

During stage two, the therapist will address the capsular tightness and adhesions. Joint mobilization techniques are used to keep the joint sliding and gliding smoothly and to prevent scar tissue from forming. Keeping full shoulder and scapular (shoulder blade) motion is a priority. Special stretching techniques are used to prevent pain that could cause muscles around the shoulder to tighten even more.

Physical Therapy for the later (more chronic) stages continues in a similar fashion with added strengthening exercises. If conservative care fails to relieve pain and stiffness, then arthroscopic surgery is considered as the next step. The surgeon cuts the capsule, releases adhesions, and manipulates the shoulder (moves the arm through its full motion) under anesthesia. Physical Therapy resumes immediately (the next day) after surgery.

Hopefully, your condition caught so early can be treated and turned around without the need for surgery. Your orthopedic surgeon is the best one to advise you based on your age, general health, condition of the shoulder, and any other factors that could affect your rehab and recovery.

Reference: Andrew S. Neviaser, MD, and Jo A. Hannafin, MD, PhD. Adhesive Capsulitis. A Review of Current Treatment. In The American Journal of Sports Medicine. November 2010. Vol. 38. No. 11. Pp. 2346-2356.

Kesler Physical & Massage Therapy provides services for Physical Therapy in Chevy Chase and Washington, DC.