Dr. Miller: Frozen shoulder, what is it? How do you treat it? We're going to talk about that next on Scope Radio.
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Dr. Miller: I'm Dr. Miller. I'm here with Scope Radio and I'm here with Dr. Bob Burks. He's an orthopedic surgeon and he's in the Department of Orthopedic at the University of Utah. Bob, what is commonly known as "frozen shoulder"? What is that?
Dr. Burks: Well, frozen shoulder is where the ligaments, we call it the capsule, around the shoulder shrinks up and prevents motion at the bone socket joint in the shoulder. And people will come in and it's pain with activity, not so much necessarily a lot of pain with rest. Although they can have that but they start to move their arm, use their arm and it can really be searing, significant pain.
Dr. Miller: So that tends to limit the movement. In my experience in a couple of patients is that they limit their movements over time and pretty soon, they can't move that shoulder at all.
Dr. Burks: Sure. Obviously, we see mild cases. We see cases where it's almost, we might say fused where the bone socket really doesn't move at all and so there's a span of that. But fortunately, it's a very treatable problem. And some of my happiest patients are those that come in and you can recognize it, manage it, get them past it, and their outcomes can be very good.
Dr. Miller: So what is capsulitis? Is that a problem with the tissues surrounding the muscles of the shoulder, or is it a problem of the muscles themselves, or the ligaments?
Dr. Burks: So each joint in the body has a capsule, has a boundary that surrounds the joint that gives it some control of stability but allows motion in certain planes and it contains the fluid in the joint that takes care of the cartilage. When that shrinks, scars stiffens, then it will limit motion of the joint, so the muscle tendon is all outside that capsule. So the true frozen shoulder is not a muscle tendon problem. It is a capsule ligament problem around the shoulder.
Dr. Miller: So once one develops that, how do you treat it? Is it physical therapy? Do you do surgery? Is it medication?
Dr. Burks: Yeah, first of all, you just got to make the diagnosis. I think the biggest problem that patients have is they'll see somebody who's not as familiar and they'll write it off as, "Well, it's shoulder pain. Maybe a little arthritis. Maybe a rotator cuff problem." So you have to make the diagnosis. Once you have that, then clearly, therapy is important. I emphasize with the patient that they have to be the physical therapist. So this is something that they have to do five times a day, four times a day. The physical therapist is the coach, the guide, but not the end-all.
The other thing that we find very effective is an intra-articular corticosteroid injection. So when we make the diagnosis and we have them get a controlled, within the joint, corticosteroid injection, and then they start working their therapy, I'd say 80% of the people that I see back four weeks later will say, "I feel markedly better." They may not have all their motion back but they've made tremendous change. They say, "Hey, I know this is working." Once they have that level of buy-in then they just keep getting better.
Now, there are some who don't and we may have to get more aggressive with treatment but the non-operative approach is very successful in a large number of people.
Dr. Miller: For the patient out there, what would be the first symptoms of frozen shoulder? What should they look for? So at the end of this, I mean, basically, if a patient has some pain in the shoulder and they perceive that there's less range of motion, perhaps less strength, got to have that checked out either by a sports medicine physician or primary care physician. A good exam should be done by the physician in order to determine whether this is frozen shoulder or another problem with the shoulder joint.
Once that diagnosis is made, from what I understand, Bob, the corticosteroid injection helps and then a referral to physical therapy for rather intensive physical therapy, and most of these patients get better in time. As you mentioned, these are very happy patients because at the end of their treatment sessions, they seem to be doing pretty well.
Dr. Burks: I think that's a good summary. The reason patients are happy, most of them have had this as a long-going problem, several months. When they have something done and they see an absolute change, they see an improvement, then it makes it that much more appreciated because they've already struggled with it for such a long time. This isn't a two-week problem. This was months.
Dr. Miller: Thanks very much.
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