Your health care provider will ask about your symptoms and examine your shoulder. A diagnosis is often made when you are not able to rotate your shoulder. You may have x-rays of the shoulder. This is to make sure there is no other problem, such as arthritis or calcium deposits. Sometimes, an MRI exam shows inflammation, but these types of imaging tests are usually not needed to diagnose frozen shoulder.
- Physical Therapy of the Shoulder by Robert A. Donatelli.
- Reward Yourself.
- Physical Therapists’ Guide to Outcomes Tracking.
Steroid injections and physical therapy can improve your motion. It can take a few weeks to see progress. It may take as long as 9 months to a year for complete recovery.
Physical therapy is intense and needs to be done every day. Left untreated, the condition often gets better by itself within 2 years with little loss of motion. Risk factors for frozen shoulder, such as menopause, diabetes or thyroid problems, should also be treated. Surgery is recommended if nonsurgical treatment is not effective.
This procedure shoulder arthroscopy is done under anesthesia. During surgery the scar tissue is released cut by bringing the shoulder through a full range of motion.
Arthroscopic surgery can also be used to cut the tight ligaments and remove the scar tissue from the shoulder. After surgery, you may receive pain blocks shots so you can do physical therapy.
/ Department of Physical Therapy Annual Report by Laurie Wang - Issuu
Follow instructions on caring for your shoulder at home. Treatment with physical therapy and NSAIDs often restores motion and function of the shoulder within a year. Even untreated, the shoulder may get better by itself in 2 years. After surgery restores motion, you must continue physical therapy for several weeks or months. This is to prevent the frozen shoulder from returning. If you have shoulder pain and stiffness and think you have a frozen shoulder, contact your provider for referral and treatment.
Early treatment may help prevent stiffness. Call your provider if you develop shoulder pain that limits your range of motion for an extended period. People who have diabetes or thyroid problems will be less likely to get frozen shoulder if they keep their condition under control. American Academy of Orthopaedic Surgeons website. Frozen shoulder. Updated March Accessed December 10, Finnoff JT. Upper limb pain and dysfunction. In: Cifu DX, ed. Braddom's Physical Medicine and Rehabilitation. Philadelphia, PA: Elsevier; chap Stiff shoulder. Philadelphia, PA: Elsevier Saunders; chap Shoulder and elbow injuries.
Campbell's Operative Orthopaedics. Academic Health Center The University of Florida Academic Health Center - the most comprehensive academic health center in the Southeast - is dedicated to high-quality programs of education, research, patient care and public service. Research Studies Learn about UF clinical research studies that are seeking volunteers. There were no significant between-group differences in the secondary outcomes—disability, flexion, abduction, and hand-behind-back range of motion.
Physical Therapy of the Shoulder (Clinics in Physical Therapy)
The changes in mean scores are shown in Figure 2. Outcomes for Both Groups During the Trial a. A positive value indicated a difference between groups from the baseline assessment to 12 weeks after the cessation of treatment in favor of the group receiving STM and exercise. Mean scores SD during the trial. However, there was no difference at 12 weeks after the cessation of treatment. There were no differences between groups at either 1 week or 12 weeks after the cessation of treatment Tab.
There was no difference between groups in the distribution of PIP scores at 12 weeks after the cessation of treatment Tab. Most participants in both groups reported adherence to the exercise program Tab.
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There were no reported adverse effects for participants in either group in this trial. As determined with the t test for between-group differences, the P value was. As determined with the Mann-Whitney U test for between-group differences, the P value was. The aim of the present study was to investigate whether adding soft tissue massage to an exercise program for shoulder pain would improve pain, disability, and shoulder movement more than exercise alone.
Our results indicated that there were no significant differences between the groups in disability and range of motion, except for a small mean improvement in pain in favor of the group receiving exercise only. The proportion of participants reporting a clinically meaningful difference was higher in the group receiving exercise only at 1 week after the cessation of treatment There were no differences between groups in the proportion of participants reporting improvement in disability above the minimal clinically important difference threshold at either 1 or 12 weeks after the cessation of treatment.
It should be kept in mind that the group receiving exercise only reported higher pain scores at baseline; this factor may have resulted in a regression to the mean effect over the course of the trial, with larger changes being observed in this group. It should be noted that, over the course of the trial, both groups showed improvements in pain and disability at levels that would have been considered clinically worthwhile by the participants. From a practical aspect, it should be kept in mind that the addition of soft tissue massage to exercise therapy for the shoulder would involve more of a clinician's time without adding apparent benefit.
This approach would add both cost and additional burden for both the patient and the clinician. The fact that exercise therapy is a more active intervention than soft tissue massage may benefit patients with shoulder pain through increased self-efficacy and the promotion of increased activity which, in turn, decreases fear avoidance behaviors. In our previous study, the short-term effects of the type of soft tissue massage used in the present study were compared with the results for a control group, which received no treatment.
Taken together with the results of the present study, the findings of that study suggested that, compared with no treatment, soft tissue massage may be effective in the short term; however, there is no additive effect when it is combined with exercise in either the short term or the intermediate term.
The only systematic review of the effects of soft tissue massage on nonspecific shoulder pain 10 found low-quality evidence that, compared with no treatment, soft tissue massage produced moderate immediate effects in active flexion and abduction range of motion, pain, and disability scores immediately after the cessation of treatment. Studies on the longer-term effects have not been undertaken.
The present study extends scientific knowledge about the effectiveness of soft tissue massage, as no previous study specifically examined clinical outcomes after the addition of soft tissue massage to exercise therapy for the treatment of nonspecific shoulder pain. In the present study, all potential participants who had shoulder pain, were referred to physical therapists, and satisfied our inclusion criteria—regardless of reported diagnoses—were invited to enter our trial.
There may have been a subset of participants in our study population for whom soft tissue massage was effective, but this possibility was not explored in the present study. For example, the effects on acute shoulder pain may differ from the effects on chronic shoulder pain.
Further exploration to identify people whose shoulder pain is responsive to exercise and people for whom massage confers additional benefit is essential in the search for improved treatment efficacy for people with shoulder pain. Evidence regarding the efficacy of manual therapy, soft tissue mobilization, and exercise for pain in other regions of the body, such as the low back, is emerging.
The rates of self-reported exercise adherence were similar for the 2 groups in the present study, but adherence was not particularly high for either group. The effect that these adherence rates may have had on outcomes is unknown because the present study did not have adequate power to investigate the effect of higher rates of adherence to exercise regimens. The present study was pragmatic in design—to reflect the current practice in exercise prescription for shoulder pain and to allow for programs to be individualized in type and intensity of exercises for each participant.
A recent study 46 showed that it is important to consider dose when developing exercise treatments for shoulder pain, with high-dose exercise regimens being superior to low-dose exercise regimens for improving both pain and function. Future study designs could incorporate dose. Massage has been shown to be an effective treatment modality for other regions of the body.
A Cochrane systematic review concluded that massage was beneficial for improving both symptoms and disability in patients with subacute and chronic low back pain, with beneficial effects lasting for at least 12 months after treatment 47 and with effects having a magnitude similar to that of effects obtained with exercise. The addition of exercise and education to massage further improved these gains. For nonspecific shoulder pain, however, the addition of soft tissue massage does not appear to improve pain, disability, or range of motion. In the present study, a high proportion of potential participants who were screened for the trial were retained because of the broad inclusion criteria.
This feature of the present study is in accordance with the concept of nonspecific shoulder pain, for which no clear link between a pathological process and a person's presenting symptoms of pain in the shoulder region can be made. There were no reported adverse effects in the present study, consistent with the findings of our previous systematic review 10 as well as other studies demonstrating no or minimal adverse events with either soft tissue massage or exercise programs.
The fact that all potential participants who had shoulder pain, were referred to physical therapists, and satisfied our inclusion criteria were invited to enter our trial can be considered a study limitation. A further study with people who have accurately diagnosed pathology of the shoulder may reveal specific groups of people who will benefit most from treatments.