Frozen Shoulder Treatment Options

Although over 300 million people worldwide suffer with this condition, frozen shoulder (adhesive capsulitis) still seems to be a relatively ‘new’ condition in the medical world. The percentage of people suffering with this terrible affliction also seems to be growing yearly although the reason for this is still unclear. There are many different opinions on which treatment option is the ‘best’ route to take.
Physical therapists may recommend lengthy rehabilitation programs while athletic therapists and shoulder specialists suggest surgery followed by a muscle-building program to strengthen the shoulder muscles.

 

None of these approaches enables a quick recovery and it is in doubt that they actually speed up the process much at all. Some aggressive approaches have been known to aggravate or make the condition worse with the laying down of more reactive scar tissue

The OAT Trigenics® Procedure, aka “Manual Capsular Dissection or MCD”, is a revolutionary alterative that is proving to be extremely effective. A Russian medical study was published in 2012 in the Russian Journal of Manual Therapy and a medical peer reviewed study, referring to it as “MCD”, is expected to be released in Canada for 2014 with presentations to physiotherapists and orthopedic surgeons in 2013.

Below is a list of options and expected outcomes so that you can be better informed to decide on your treatment options.

CORTISONE INJECTIONS

Though this treatment doesn’t eliminate the root cause of your Frozen Shoulder symptoms, Hydro-Cortisone steroid injections can be administered to provide patients with some temporary pain relief and a very small temporary improvement in range of motion. The challenge is that the effects usually only last 1 or 2 weeks and then the shoulder returns to the same or sometimes even worse state than before the injection. Cortisone is a powerful steroid which targets and temporarily decreases the amount of inflammation in the affected shoulder joint. Inflammation causes tightening and stiffening of an affected joint and pressure from inflammation causes pain. Decreasing the amount of inflammation in the frozen shoulder joint with the steroid injection will sometimes have the almost immediate effect of slightly increasing mobility and somewhat diminishing pain.

The problem is that the inflammation and pain is there for a reason, which is to provide a medium for healing and to protect the joint from further injury. When the inflammation is suddenly unnaturally reduced and the pain lessoned with the steroid injection into the joint, patients will tend to use the shoulder more and can often cause more damage because the cause of the frozen shoulder has not been actually treated. Interestingly, cortisone steroid injections have been reported to actually cause an adhesive capsulitis frozen shoulder to develop when it is used to treat a simple impingement or rotator cuff tendonitis.

What’s more is that cortisone is a heavy steroid which actually breaks down and emulsifies the muscle tendons and ligaments. This makes anyone injected with cortisone more susceptible to serious injury of the rotator cuff and tearing of the shoulder tendons. It is for this reason that so many professional and elite athletes who have had cortisone injections later end up partially or completely tearing and severely damaging tendons in their bodies. The steroid drug cortisone also has very many undesirable side-effects that are common with any heavy steroid, all of which can be looked up on the internet under “side effects of hydrocortisone”.

In light of these facts, The American Medical Association has actually recommended that physicians do not inject any area of the body more than twice in a lifetime with cortisone. In certain cases depending on the patient case history, in the pre-op period just prior to the OAT procedure being performed, a very small amount of cortisone will sometimes be locally injected into the shoulder capsule in addition to the anesthetic lidocaine. This is because, certain cases may be at greater risk of having an increased inflammatory response over the course of a few days following the Oolo-Austin Trigenics® frozen shoulder recovery procedure being performed. In these cases, cortisone can be helpful to prevent an inflammatory over-reaction post-op. Patients who have already had 2 steroid injections into the affected shoulder will not, however, receive any cortisone prior to the OAT.

Because of the reasons above, we do not recommend having cortisone injections in an attempt to cure a frozen shoulder. It will never cure it and it could end up making it worse.

WHAT ABOUT SURGERY?

Surgery for a frozen shoulder is called an arthroscopic capsular release. In this process an arthroscope cuts through the skin and is inserted into the joint. Using this instrument the offensive adhesions are cut apart around and inside the capsule. If surgery is performed, immediate physical therapy for 2 months following the shoulder surgery is of utmost importance. If rehab does not begin soon after capsular release, the chance of the Frozen Shoulder returning is quite high.

Many people will try to avoid surgery whenever possible and for good reason. Surgery should always be your last option when all else has failed. There is a surgical procedure which cuts open the shoulder that has been shown to sometimes work in restoring range of motion to a frozen shoulder but, according to statistics, the results are about 50/50. The problem with surgery is twofold. Firstly, if the surgery does actually work, there will have been so much cut inside the shoulder capsule that the patient will have to attend for intensive physiotherapy rehabilitation for 6-8 weeks following the surgery to regain proper shoulder movement. The second problem is more serious in that surgery has also been shown in some cases to make the shoulder lay down more scar tissue which actually then worsens the frozen shoulder! No one with frozen shoulder wants this so think twice and think very carefully what your other, more conservative options are, before you consider going under the knife. In addition, the risks of using a general anesthetic are also significant and should not be taken lightly.

WHAT ABOUT MANIPULATION UNDER GENERAL ANESTHETIC?

Alternately, a surgeon or qualified and specially licensed manual medicine specialist such as a Chiropractic or Osteopathic physician may also perform a manipulation under anesthesia. This is called MUA. These heavy and quite drastic manipulations are performed with the patient sedated in the operating room on the table under general anesthesia. The attending doctor suddenly forces the shoulder into end range positions to literally break and tear up adhesions caused by Frozen Shoulder. The problem with MUA is that the performing doctors also often break up the shoulder capsule causing serious damage to the shoulder. There is no actual surgery involved, meaning incisions are not made when a manipulation is performed. However this procedure is very forceful and is performed without any conscious input from the patient. As a result, research studies and statistics on MUA prove that many patients undergoing this procedure end up with permanent damage to the shoulder capsule and soft tissues of the shoulder joint. Damage to the nerves and breaking of the bones as well as shoulder dislocations have also been reported to occur with some frequency using MUA. It is for these reasons that MUA has largely fallen out of favor amongst health professionals as a treatment for frozen shoulder. This is a treatment option which we definitely do not recommend!

PHYSIOTHERAPY

Diligent physical therapy is often essential for recovery of many conditions but not for adhesive capsulitis frozen shoulder. There is no evidence that physiotherapy helps frozen shoulder at all. Physical therapy targeting frozen shoulder adhesive capsulitis will take months to years of treatment for recovery, depending on the severity of the scarring of the tissues around the shoulder. Over aggressive physical therapy has also been shown to significantly worsen the frozen shoulder as the body responds to additional trauma by over-reacting and laying down more scar tissue around the shoulder capsule. All forms of physical therapy for adhesive capsulitis frozen shoulder are basically useless, can often be torturous and have sometimes been known to significantly worsen the condition. Frozen shoulder sufferers have notoriously spent thousands of dollars and countless hours attending for treatments over months and years which do nothing to help and sometimes worsen the condition. We believe you will find yourself wasting your time and money attending for physical therapy sessions to alleviate your adhesive capsulitis frozen shoulder. Before you attend for physical therapy, be sure to ask the physiotherapist if they have ever had much success with frozen shoulder. The only cases, they may site as being successful, would most likely have improved of their own accord during the timeframe of treatment.

It is very important for people with a frozen shoulder to avoid aggravating the shoulder tissues during the rehabilitation period. These individuals should avoid sudden, jerking motions or heavy lifting with the affected shoulder.

Almost all cases where the OAT procedure was successfully conducted first tried physiotherapy with no success.

NEIL ASHER TECHNIQUE (NAT):

The Neil Asher Technique is a gradual multiple-treatment osteopathic method of treating frozen shoulder. Although their web site posts a “study” which they did to prove that this technique is more effective than physiotherapy, the form of physiotherapy they used for comparison is, itself, notoriously ineffective for frozen shoulder. Either way, the technique is basically a soft tissue pressure technique which still requires many months of therapy for those in which it is reported to help. On the other hand, there are also certainly cases which have presented to our clinic for the OAT in which treatments using the NAT where it had not worked at all. This being said, the Neil-Asher Technique is quite passive with no apparent risks for further damage and as such, if you feel you have the time and the money to try it out, we do not recommend against it. Better to go the conservative route first than to subject yourself to potential serious damage from treatments like surgery or MUA.

A number of cases where the OAT procedure was successfully conducted first tried NAT with no success.

OTZ METHOD:

The OTZ technique is a new chiropractic method of treating what they refer to as “frozen shoulder syndrome” which claims to be able to cure frozen shoulder by manipulating or “adjusting” the upper neck bones. This is seen by most medical professionals as simply ridiculous as the heavy scar tissue and adhesions which surrounding the capsule of the shoulder cannot be separated with a chiropractic “adjustment” of the neck vertebrae. To support this contention, there are a number of youtube videos showing apparent before and after videos and a number of patient testimonials on their web site. These patients in these videos are likely not fakes. The only problem is that the condition the OTZ practitioners refer to as frozen shoulder is actually not true adhesive capsulitis frozen shoulder. The condition they post on their video and website appears to be classic “shoulder impingement syndrome” which, in some ways mimics frozen shoulder but which is quite easily treatable by most chiropractors or physiotherapists who know what they are doing. What is apparently occurring with OTZ technique is a misrepresentation of the term “frozen shoulder” and we consider this to be a technique which can only serve to ridicule the chiropractic profession to those who understand the “true cause” of adhesive capsulitis frozen shoulder.

A number of cases where the OAT procedure was successfully conducted first tried OTZ with no success.

ACTIVE RELEASE TECHNIQUE (ART):

Many practitioners advertise that they can treat adhesive capsulitis frozen shoulder using a muscle stripping soft tissue technique called “active release technique” aka “ART”. Although this technique is designed for and has good results with conditions caused by tissues that have adhesions which have developed in the fascia between the muscles, it is not a technique which is effective in being able to separate the much heavier and thick adhesions which encapsulate the shoulder joint itself in cases of adhesive capsulitis. The myofascial “adhesions” treated with ART are completely different and in different anatomical locations, being found between the muscles than the adhesions which surround the shoulder joint with frozen shoulder. A great many cases presenting to the Trigenics® Frozen Shoulder Clinics have had unsuccessful ART treatments. Cases of reported improvement with ART still take many months or years to recover fully. These cases and others which still take a long time for recovery following treatments like ART or NAT, cause one to question whether or not the patient’s frozen shoulder would have recovered anyway without these treatments. Although there are numerous cases of frozen shoulder which can last for 5, 10 or more years, many cases of adhesive capsulitis will also mysteriously resolve themselves with no treatment at all within 2-3 years. But again, the problem with waiting so long is that 15% of the population never recover full mobility after natural resolution of adhesive capsulitis frozen shoulder. As such, one must always consider at which point in the lifeline of the shoulder condition was the therapy applied to be able to judge whether it was the therapy or the natural course of evolving resolution.

A number of cases where the OAT procedure was successfully conducted first tried ART with no success.

HYDRODILATION:

Hydrodilation is a new invasive medical method sometimes used in an attempt to cure frozen shoulder. With this procedure, the shoulder joint is injected with a lot of fluid until it is literally “blown up” from the inside out so as to tear up the shoulder joint adhesions using excessive pressure from within the joint capsule. The intended effect is to cause the offensive scar tissues and adhesions surrounding the joint capsule to explode and break open. A number of studies have shown some improved movement and pain reduction but there are no good published studies in the medical literature to confirm even these quite modest results. Medical studies do cite that this method has not been shown to be any more effective than cortisone injections (see above). An interesting point is that many subjects chosen for hydrodilation studies have not been able to be used for the study because they have pleaded that the procedure be stopped due to severe excruciating pain from the procedure as more and more fluid is injected into the joint in an attempt to cause it to burst apart. From a risk factor and complications perspective, damage to the shoulder joint capsule has been reported as have shoulder joint infections and premature shoulder joint arthritis . As the verdict is still really out on hydrodilation, we do not, as of yet recommend this method.

A number of cases where the OAT procedure was successfully conducted first tried hydrodilation with no success.

In Summary

For the record, Adhesive Capsulitis Frozen Shoulder cannot be cured by any method that does not create physical separation of the internal adhesive scar tissue surrounding the shoulder joint. Treatments designed to strip out fascial scar tissue between muscles such as active release technique (ART) or Myofascial Release do not address the shoulder capsule adhesions which is the cause of the condition and they are, therefore, never effective in providing an immediate resolution Standard treatment by massage therapists, physiotherapists, chiropractors and osteopaths will also not provide resolution from this terrible affliction.

In many cases, over enthusiastic treatments which are given using any of the above methods have been known to actually significantly worsen the frozen shoulder. Most treatments which are attempted by therapists for frozen shoulder adhesive capsulitis are also very painful and even sometimes described as pure “torture”. The Oolo-Austin Trigenics procedure is the only procedural operation currently proven to immediately cure frozen shoulder with a near instant return of shoulder movement and functionality.