Dr. Shapiro is a board-certified orthopedic surgeon, with a clinical emphasis in shoulder and elbow surgery, arthroscopic surgery, and sports medicine. On average, he performs over 300 shoulder surgeries yearly, encompassing several arthroscopic surgeries. He employs arthroscopy for a plethora of shoulder repairs, such as:
- Rotator cuff repair (to repair a torn rotator cuff)
- Repair of the labral tears of the shoulder joint (SLAP tears)
- Repair of shoulder instability (dislocation)
- Subacromial decompression (removal of bone spurs)
- Inflammation of bursae (fluid-filled sacs located near the tendons)
- Biceps tendon repair (for a tear in the biceps tendon)
- Frozen shoulder release (done to release a frozen shoulder)
Amongst these, frozen shoulder garners a lot of medical and surgical attention. This is because the condition is fairly common in the general population and can greatly impact an individual’s quality of life.
What is Frozen Shoulder?
Frozen shoulder (also called adhesive capsulitis) is a long-standing, disabling shoulder condition that causes pain, stiffness, and loss of normal range of motion in the shoulder. The disorder usually hits people in their 40s to 60s — women more often than men. While the condition may improve on its own at some stage, but that may take quite a long time — sometimes between 1 to 3 years.
What are the Symptoms of Frozen Shoulder?
In general, frozen shoulder progresses through three phases:
- Freezing (painful) phase: During this stage, your shoulder begins to hurt gradually with the pain reaching its intensity over the course of weeks, making shoulder movements harder and harder.
- This phase typically lasts from 6 weeks to 9 months.
- Frozen (adhesive) phase: After a few months, the pain actually gets better but your shoulder becomes increasingly stiff (frozen), making it outright impossible to raise your arm.
- The stiffness may last for 3-9 months.
- Thawing (resolution) phase: After a few more months, the shoulder movements become a lot better and may eventually return to normal. Pain may disappear but can keep returning back.
- This takes between 9 months to 2 years.
What causes Frozen Shoulder?
In frozen shoulder, the capsule that encloses the shoulder joint becomes so thick and tight that it restricts motion. Why the shoulder gets jammed or stuck is still not clear. However, a few factors may increase your likelihood of developing frozen shoulder, such as:
- Diabetes
- Thyroid disorders
- Parkinson’s disease
- Cardiac and lung diseases
- Stroke
- Major neurosurgical or cardiac surgeries where patients are bedbound and shoulder remains immobilized for quite a long time
- Conditions where the shoulder has been immobilized by placing it in a sling such as after injury or surgery of the rotator cuff
Why is it Important to Treat Frozen Shoulder?
The condition is typically self-limiting. With that said, some cases of frozen shoulder fail to resolve with up to 50% of patients remaining symptomatic for ten years, causing considerable disability. In such cases, timely management becomes crucial.
Nonsurgical Treatment
Most people with frozen shoulder improve with simple measures to control pain and restore motion, such as:
- Taking anti-inflammatory pills like ibuprofen and naproxen to tame the pain and swelling.
- Receiving powerful anti-inflammatory steroid injections directly into your shoulder joint.
- Having physical therapy sessions
- Shows promise in bringing about pain relief and return of shoulder movements.
- Entails stretching or range-of-motion exercises for the shoulder.
- Heat therapy, prior to starting the exercises, may help loosen up your shoulder and offer some pain relief.
- Strengthening exercises can be added during the second and third stages to maintain muscle strength.
Surgical Treatment
While aggressive conservative treatment remains the preferred approach for treating frozen shoulder, some patients may be resistant to the above measures. In such cases, Dr. Shapiro recommends surgical release (called arthroscopic release) or MUA (manipulation under anesthesia) typically during the “Frozen” stage. The goal of the surgery is to address the problem area (taut shoulder capsule) by stretching and freeing it.
Arthroscopic Capsular Release
During this procedure, the surgeon passes a small camera (called arthroscope) through a cut on your skin into your shoulder joint. Small tools are then inserted through other minor incisions in order to cut and release the tight capsule encasing your shoulder joint. A successful, complete release of the capsule entails special attention to the nearby nerves.
The technique is preferred over MUA because it’s minimally invasive and allows full access to the joint without damaging the rotator cuff, posing fewer risks. Moreover, the arthroscopic approach has been shown to be more effective in restoring motion.
MUA
This procedure involves freeing the shoulder by manipulating it under general anesthesia, in which your surgeon will give you several medicines to put you into a sleep-like state. MUA attempts to move your stiff shoulder so as to stretch or rupture the capsule and scar tissue. This loosens up the frozen shoulder and improves mobility.
When can you return to work after Shoulder Arthroscopy?
This highly depends on the nature of your job. If your job doesn’t warrant using the operated arm, then you should expect to resume work after 5-7 days. However, it is important that you rest the treated arm to enable proper healing and avoid disrupting the surgical site. Thus, if your job involves more use of your operated arm, then taking some extra time off from work would be better.
