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What is Frozen Shoulder?
Frozen shoulder, or adhesive capsulitis, is a condition that causes pain and restricted movement in the shoulder. The joint of the shoulder is held together by a joint capsule, which becomes thickened and results in a global restriction of shoulder movement. This manifests with shoulder motion being stuck or frozen.
Various triggers have been associated with adhesive capsulitis, and surgery is a common trigger with the rate of Frozen shoulder after surgery projected to be 5 to 33%. To learn more about causes and traditional treatments for adhesive capsulitis or frozen shoulder click here.
Physical Therapy, medications, corticosteroid injections. Among these, steroid injections are the most common treatment in clinical practice, although the effect is not long-lasting and has been associated with adverse events to the tendon and bone.
In many cases, adhesive capsulitis resolves on its own. In other people, conservative treatments don’t work and patients consider surgery (manipulation under anesthesia or shoulder arthroscopic surgery).
High-volume distention of the shoulder joint capsule has been shown to provide pain relief and immediate improvement in range of motion. This procedure has shown superior results when compared to other conservative treatments, and in a recent study by Gallacher et al. (2018) showed similar results to surgery. In this study, high-volume distention showed similar improvement in range of motion and pain when compared to surgery (arthroscopic capsular release).
High-volume distention is an office-based procedure performed with local anesthesia and involves injecting fluid into the intra-articular space to expand the stiff joint capsule and eliminate adhesion or scar tissue limiting the range of motion and causing pain. High-volume dilation should be considered before surgery.
In a recent study by Dr. Lee et al, 15 patients with chronic adhesive capsulitis were treated with an intra-articular PRP injection and followed for 6 months after the injection. At the 6-month follow up the patients that had received the PRP injection had a significant improvement in pain and range of motion compared to a matched control group that only received a steroid injection. Conclusion: PRP demonstrated a significant improvement in pain and function in patients with a frozen shoulder compared to steroid injections.
PRP is a natural reservoir of cytokines and growth factors and has been shown to inhibit the release of proinflammatory molecules in joints.
Manipulation Under Anesthesia