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Suggest Treatment For Frozen Shoulder

Posted on Thu, 22 May 2014

Question: I had a fracture of the upper tuberosity on Dec 20th, 2013. It took 2 wks to get into therapy which eventually did not help because I developed frozen shoulder. On April 11 I was finally given shot of cortisone in shoulder after my orthopedic doctor declared it adhesive capsulitis without having x-ray done. Six weeks before an x-ray was done and I complained of constant pain, stiffness of movement and horrible pain at night especially, although pain, especially in upper arm was and is always there. Shouldn't the therapist and doctor have listened and examined closer. After 4 months of therapy I was told it was doing nothing, and needed six more weeks of different exercises and therapy. Now the insurance company will stop paying for treatment in two more sessions and we have just started on proper therapy. I feel cheated of right kind of therapy and cannot understand why he and the orthopedic doc did not see this is Feb.

Answered by Dr. Karl Logan (3 hours later)

Brief Answer:
Further rehabilitation required

Detailed Answer:
H,

Thanks for your question.

I presume you mean the greater tuberosity of your humerus bone at your shoulder? It would be helpful to see your X-rays if you have a copy. |Was the tuberosity displaced? or was it in its proper position?

Fractures around the shoulder take a long time to rehabilitate from and your may never regain the strength and range of motion in your shoulder joint that you had before.

A frozen shoulder or adhesive capsulitis is a difficult problem to treat. Cortisone shots and manipulation under anaesthetic of your shoulder joint can be of benefit; but often you do require prolonged physiotherapy.

This condition does improve with time but can take many months.

I would however question this diagnosis and whether your current symptoms are simply secondary to a lack of rehabilitation following your fracture.

I hope this answer your question.

Best wishes

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Karl Logan (21 hours later)

The fracture was in greater tuberosity of shoulder and was seen by a different ortho. I was in the middle of changing insurance plans which would not allow me to see same ortho for third follow after therapy started. I had about two mos of therapy and eventually saw a different orthopedic because I was not getting better. I explained all the symptoms especially the awful pain at night and in upper arm all the time-range of motion was almost nil. He did an x-ray, but all he said was no injection was necessary that day. ( I had not asked for one), I was just frustrated that nothing was helping a simple fracture get better. Doctor declared another six weeks of same type of therapy. Eventually I could not do exercises at home or one day at therapy. Therapist said there was nothing more he could do for me, shook my hand and said good luck. I was due to see doctor same day and that is when he diagnosed adhesive capsulitis and prescribed another six weeks of different method of therapy. I asked if all those months of therapy were for nothing and he said yes. I was so frustrated and in tears so went back to therapist to start another round of therapy. Problem is with insurance, who will not pay for the full six wks because of prior therapy.
You did not answer main question which was; why did the therapist not recognize symptoms of frozen shoulder or even doctor? Is it not so easily diagnosed as a secondary problem with shoulder fractures? And if I do not continue with therapy will I not recover from this frozen shoulder?

Answered by Dr. Karl Logan (1 hour later)

Brief Answer:
Not so easily diagnosed after a fracture

Detailed Answer:
Hi,

Thanks for your follow up question.

Sometimes it can be difficult to distinguish between a problem like adhesive capsulitis and the stiffness and pain that results from having a fracture. as time elapses it becomes clearer that your ongoing problems were not just as a result of the fracture but that there was something else going on.

Physiotherapy is often employed in adhesive capsulitis to help patients regain there motion and to try and relieve the pain associated with the condition. There is no strong scientific evidence that it is helpful.

The condition will improve spontaneously, but this may take up to two years. Other modalities to improve your symptoms associated with this condition were discussed previously and highlighted again below.

Treatment may be painful and taxing and consists of physical therapy, occupational therapy, Chiropractic, medication, massage therapy, hydrodilatation or surgery. A doctor may also perform manipulation under anesthesia, which breaks up the adhesions and scar tissue in the joint to help restore some range of motion. Pain and inflammation can be controlled with analgesics and NSAIDs. The condition tends to be self-limiting: it usually resolves over time without surgery, but this may take up to two years. Most people regain about 90% of shoulder motion over time. People who suffer from adhesive capsulitis may have extreme difficulty working and going about normal life activities for several months or longer.

I hope this answers your questions.

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Prasad