Q1: I would like to ask your opinion on steroid injections in conjunction with therapy for frozen shoulders. Is the injection treatment effective with all stages of adhesive capsulitis, or is it recommended for only a certain stage and certain type of frozen shoulder?
Injection is best for the early stages and most often ineffective for stages three and four.
Q2: How much should a patient be pushed for range of motion during physical therapy with various stages of frozen shoulder? Would working through pain further accelerate the inflammatory process of the capsule and makes it worse?
That is tricky – they should be stretched gently but not excessively. What’s most important for these patients is to teach them to avoid painful arcs of motion and simple stretches they should do at home. Sometimes working through pain can make it worse. For example, strengthening exercises done too early can often worsen a frozen shoulder.
Q3: What is your recommendation for the treatment of extremely painful cases of frozen shoulder?
Usually my recommendation is a steroid injection followed by two weeks of rest. Of course, this recommendation would be the result of an exam with the patient.
Q4: For diabetic patients with poorly controlled blood sugar levels, what are your recommendations for treating these patients in terms of injections and manual therapy for frozen shoulder?
Tighter control of their diabetes around the time of the injection is often all that they need. I alert diabetic patients to check their blood glucose twice as often as usual and eat very carefully for the first three to four days. It is important for them to meet with a doctor to render the best recommendation.
Q5: Is frozen shoulder caused by muscle issues or nerve issues?
Neither, a frozen shoulder is an inflammatory process that usually comes out of the blue without a known cause. It is more common in women, patients with diabetes and those who have suffered from a frozen shoulder in the past.
Q6: What exactly is ‘frozen shoulder’ exactly? How would I know if I’m suffering from frozen shoulder?
A frozen shoulder is initially a painful shoulder without a history of trauma that then progresses to a painful stiff shoulder and eventually just a stiff shoulder. It is often difficult to diagnose especially at the beginning and therefore if your shoulder is painful and not improving with rest I would recommend seeing a doctor specializing in shoulder issues.
Dr. Sabrina Strickland is an orthopedic surgeon at Hospital for Special Surgery’s Women’s Sports Medicine Center and at the HSS Stamford office, where she treats both male and female patients. Her research has focused on anterior cruciate ligament injuries in women, as well as rotator cuff repair and shoulder instability.