Frozen ShoulderDr. Howard Liss treats disorders that cause pain and disability by providing consultative services and soft tissue and joint injections when needed. When medically appropriate, he makes specific referrals for diagnostic testing (lab work, imaging, electrodiagnosis), physical and occupational therapy, interventional procedures (epidurals and facet joint injections), and surgery.
Usually occurring on one side, frozen shoulder is a condition characterized by swelling and inflammation of the joint capsule, which leads to the development of scar tissue. In effect, the entire joint becomes stiff and movement is dramatically restricted. Even so, frozen shoulder may be best understood by its medical name, adhesive capsulitis, which literally means “sticky” (adhesive) “inflammation” (capsulitis).
Frozen shoulder is classified as primary or secondary. For the most part, if there is no evidence or significant reason for an individual’s symptoms, it is labeled as primary adhesive capsulitis. In turn, if symptoms follow a sports injury, traumatic event or if symptoms are illness-related, it is considered secondary adhesive capsulitis.
Aside from its classification, frozen shoulder typically moves through three phases. Lasting from two-nine months, the first phase is notably painful, as symptoms gradually appear and worsen. Often called the “freezing phase,” pain may become worse at night when lying on the affected shoulder. As pain increases and scar tissue forms, the shoulder joint becomes stiff in phase two. As individuals use their shoulder less and less (due to pain and decreased range of motion), muscles can begin to wear away. Yet, in the final phase of frozen shoulder (thawing phase), symptoms improve and range of motion increases as individuals begin using their shoulder again.
Multiple theories continue to circulate regarding what causes frozen shoulder, or adhesive capsulitis. While it is prevalent in those with diabetes, there may be a hormonal component. Also, poor posture or prolonged inactivity may also contribute to this condition.
Treatment and Rehabilitation for Frozen Shoulder
Treatment and rehabilitation for frozen shoulder varies from patient to patient, depending on which stage the condition is in. Even so, effective treatment centers on pain management, reducing inflammation and improving and maintaining mobility.
Physiatrists are best positioned to identify, develop and lead rehabilitation protocols for patients suffering from frozen shoulder. Favoring a conservative blend of treatments, physiatrists make specifications for exercise, therapy, stretching, body mechanics training and lifestyle management.
To better understand, consider a patient in the phase one, or freezing phase of adhesive capsulitis. Reducing pain and inflammation is the initial goal of treatment in this stage, as individuals are often in pain. To accomplish this, patients may use cold therapy (ice packs), anti-inflammatory medication, steroid injections, ultrasound, TENS treatment or laser treatment. When pain and inflammation are under control, rehabilitation focuses on mobility exercises and shoulder stretching to maintain some level of movement. In turn, for patients experiencing the least amount of movement in phase two, rehabilitation will likely incorporate isometric or static contraction exercises that do not require joint movement. In some cases, therapists help patients by performing mobilization exercises to increase their range of motion. If patients are entering therapy in phase three of frozen shoulder condition, rehabilitative efforts are usually aimed at strengthening shoulder muscles that have weakened from inactivity.
While physical therapy and conditioning remain a large part of rehabilitation for frozen shoulder, physiatrists tailor treatment to include patient education and awareness. For instance, while patients participate in exercises and stretching, they learn about body positioning, posture and other body mechanics that maintain strength while preventing further injury.
At the Howard Liss, M.D. Rehabilitation Institute in Tenafly, patients can rely on Dr. Liss to put together the right treatment, therapy and rehabilitation plan to ensure the most optimal outcome. Dr. Liss works closely with other specialists required to rehabilitate patients suffering from chronic pain or serious injuries, and Dr. Liss will refer patients as needed to ensure appropriate treatment. With extensive education and exposure to a variety of conditions that affect the cervical and lumbar spine, bones, nerves, joints, ligaments, tendons, muscles, brain, and spinal cord, Dr. Liss is uniquely positioned to help patients manage their pain and maximize their functioning.
Contact our office today to schedule a consultation with Dr. Liss.