Adhesive Capsulitis

Injections for Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis is a condition characterized by pain and loss of motion in shoulder joint. It commonly affects the left shoulder than right and occurs more often in women than men. The exact cause of frozen shoulder is not known. It is most commonly associated with diabetes and a few other endocrine diseases. The main symptoms include pain, stiffness, and decreased motion of the shoulder.

Frozen shoulder is a self-limiting disease and symptoms usually subside after a year. Treatment is aimed at pain control and restoration of motion.

The treatment of frozen shoulder requires a combination of non-steroidal anti-inflammatory medications, steroid injections, and physical therapy.

Cortisone injections: Cortisone injections are given directly into, or near to the shoulder joint. It reduces the inflammation within the frozen shoulder joint. Cortisone is a type of corticosteroid released by the adrenal gland in response to stress.

Cortisone is a potent anti-inflammatory medicine that can reduce inflammation, but is not pain reliever. Cortisone injections typically result in pain relief within a few days, which is because the inflammation diminishes. The effects may last for several weeks.

The most common side effect is a "cortisone flare". This is a condition where the injected cortisone crystallizes and causes a brief period of severe pain, that usually only lasts for a day or two. This is treated by application of ice to the injected area. Other side effects include whitening of the skin at the injection site, infection, a transient elevation in their blood sugar in patients with diabetes.

Arthroscopic capsular releases/manipulation

Arthroscopic capsular release and manipulation under anesthesia (MUA) are the surgical procedures performed to treat the frozen shoulder. Frozen shoulder, also called adhesive capsulitis is a condition characterized by pain and loss of motion in shoulder joint.

This procedure is extremely useful in cases of frozen shoulder that do not respond to therapy and rehabilitation. The aim of the surgery is to decrease pain, reduce the recovery time and help to gain full range of movement.

A manipulation under anesthesia (MUA) is most commonly indicated in patients with simple frozen shoulder. This procedure is performed with the patient sedated under anesthesia. Your surgeon moves the shoulder through a range of motion which causes the capsule and scar tissue to stretch or tear. Thus, the tight capsule is released allowing increased range of motion. The procedure involves freeing the shoulder by manipulation and does not involve any incisions.

Arthroscopic capsular release is a keyhole surgery that involves the release of the tight, constricted capsule. During the procedure 2 to 3 holes are made in the shoulder. The thickened, swollen abnormal capsule tissue is cut and removed using a special radiofrequency thermal probe. It is an effective treatment for most people with stiff shoulder after injury, trauma, or fracture, and diabetes.

Following capsular release, immediate rehabilitation is necessary to prevent the recurrence of frozen shoulder. The aim of the rehabilitation is to reduce pain and to restore full range of motion.

• Pain medications are recommended to control pain
• Following these procedures regular exercises need to be done in order to achieve full range of motion
• If you feel comfortable and have good range of movement, you can begin driving 1 week after your surgery
• Returning to work depends on the nature of your work. If you are in a sedentary job you may be able to return as early as 1 week after surgery but if your job requires heavy lifting or using your arm at shoulder height, it may take longer time to return to your work
• Full range of motion is achieved at 4 - 6 weeks

An appointment with the physiotherapist will be arranged in the first week following your surgery. The amount of exercises you require will depend on your progress.