April 29, 2015

Frozen Shoulder Treatment Options

Although over 300 million people worldwide suffer from this condition, frozen shoulder (adhesive capsulitis) still seems to be a relatively new condition in the medical world. The percentage of people suffering from this terrible affliction seems to be growing yearly, though the reason for this is yet unclear. There are many different opinions on which treatment option is the best route to take.
Physical therapists may recommend lengthy rehabilitation programs while athletic therapists and shoulder specialists suggest surgery followed by a muscle-building program to strengthen the shoulder muscles.

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None of these approaches enable a quick recovery and it is doubtful how much they actually speed up the recovery process. Some aggressive approaches have been known to create more reactive scar tissue which aggravates and makes the condition worse.

The Trigenics® OAT Manual Capsular Dissection procedure (OAT-MCD) is a revolutionary alternative that is proving to be extremely effective. A Russian medical study was published in the Russian Journal of Manual Therapy in 2012 and a medical peer reviewed study is expected to be released in Canada soon.

Below is a list of treatment options and expected outcomes to better inform you and help you decide on a path to recovery.

 

Information about different Frozen Shoulder treatment options

Frozen Shoulder Treatment Options

 

Cortisone injections

Though this treatment doesn’t eliminate the root cause of your frozen shoulder symptoms, Hydro-Cortisone steroid injections can be administered to provide patients with some temporary pain relief and a very small temporary improvement in range of motion. Cortisone is a powerful steroid which targets and temporarily decreases the amount of inflammation in the affected shoulder joint. Inflammation causes tightening and stiffening of an affected joint and pressure from inflammation causes pain. Decreasing the amount of inflammation in the frozen shoulder joint with the steroid injection will sometimes have the almost immediate effect of slightly increasing mobility and somewhat diminishing pain. The drawback is that the effects usually only last a week or two. Then the shoulder returns to the same condition or sometimes even worse state than before the injection.

Another issue is that the inflammation and pain is there for a reason. It provides a medium for healing and protects the joint from further injury. When the inflammation is suddenly unnaturally reduced patients tend to use the shoulder more. This often causes more damage because the cause of the frozen shoulder has not been actually treated. Conversely, when used to treat a simple impingement or rotator cuff tendonitis, cortisone steroid injections have been reported to actually cause frozen shoulder to develop.

What’s more, cortisone is a heavy steroid which actually breaks down and emulsifies the muscle tendons and ligaments. This makes anyone injected with cortisone more susceptible to tearing of the shoulder tendons and to serious injury of the rotator cuff. It is for this reason that so many professional and elite athletes who have had cortisone injections later end up partially or completely tearing and severely damaging tendons in their bodies. Cortisone also has very many undesirable side-effects that are common with any heavy steroid. In light of these facts, The American Medical Association has actually recommended that physicians do not inject cortisone into any area of the body more than twice in a lifetime. As such, we do not recommend using this kind of treatment for frozen shoulder. Cortisone injections are not a cure and may end up worsening your frozen shoulder.

 

What about surgery?

Surgery for frozen shoulder is called an arthroscopic capsular release. In this process an arthroscope cuts through the skin and is inserted into the joint. Using this instrument the offensive adhesions are cut apart inside and around the shoulder capsule. If surgery is performed, immediate physical therapy for two months following the surgery is of utmost importance. If rehab does not begin soon after capsular release, the chance of frozen shoulder returning is quite high.

Many people try to avoid surgery whenever possible and for good reason. Surgery should always be a last resort when all else has failed. A surgical procedure which cuts open the shoulder has been shown to sometimes work in restoring range of motion to a frozen shoulder but, according to statistics, the results are about 50/50. The problem with surgery is twofold. First, if the surgery is actually effective, there will have been so much cutting inside the shoulder capsule that the patient will have to do intensive physiotherapy rehabilitation for 6-8 to regain proper shoulder movement. The second problem is more serious. Surgery has been shown in some cases to cause the body to produce more scar tissue which actually then worsens the frozen shoulder! No one with frozen shoulder wants this. So frozen shoulder sufferers must weight their options very carefully. Lastly, the risks of using a general anesthetic are also significant and should not be taken lightly.

 

What about manipulation under general anesthetic (MUA)?

A surgeon or qualified, licensed manual medicine specialist such as a Chiropractic or Osteopathic physician can perform a manipulation under anesthesia (MUA). These heavy and quite drastic manipulations are performed with the patient fully sedated on an operating room table. The doctor forcibly moves the shoulder into end-range positions to literally break and tear up frozen shoulder adhesions. The problem with MUA is that the performing doctors also often break up the shoulder capsule which seriously damages the shoulder. There is no actual surgery involved and there are no incisions made during an MUA. However this procedure is very forceful and is performed without any conscious input from the patient. As a result, many patients who undergo this procedure end up with permanent damage to the shoulder capsule and soft tissues of the shoulder joint. Research studies and statistics on MUA prove this. Damage to the nerves and breaking of the bones as well as shoulder dislocations have also been reported to occur with some frequency during MUA. It is for these reasons that MUA has largely fallen out of favor amongst health professionals as a treatment for frozen shoulder.

 

Physiotherapy

Diligent physical therapy is useful and essential for recovery from many conditions. Frozen shoulder is not one of them. There is no evidence that physiotherapy helps frozen shoulder at all. Physical therapy targeting frozen shoulder takes months to years depending on the severity of the scarring of the tissues around the shoulder. Overaggressive physical therapy has also been shown to significantly worsen frozen shoulder. The body responds to additional trauma by over-reacting and laying down more scar tissue around the shoulder capsule. All forms of physical therapy for frozen shoulder are basically useless, can often be torturous, and have sometimes been known to significantly worsen the condition. Frozen shoulder sufferers have notoriously spent thousands of dollars and countless hours getting treatments which do nothing to help and sometimes even worsen the condition. Do not waste your time, energy, and money getting physical therapy sessions to try and alleviate your frozen shoulder. If after reading this, you decide to try physiotherapy, be sure to ask the physiotherapist if they have ever had much success treating frozen shoulder. Many fail to realize that, although physiotherapy appears to work, the person’s frozen shoulder would have improved on its own during the timeframe of recovery.

It is very important for people suffering from frozen shoulder to avoid aggravating the shoulder tissues during the rehabilitation period. These individuals should avoid sudden, jerking motions or heavy lifting with the affected shoulder.

We get feedback from every patient that we treat and cure. Almost every patient has tried physiotherapy and reports that it does not help.

 

Neil Asher Technique (NAT)

The Neil Asher Technique is a gradual multiple-treatment osteopathic method of treating frozen shoulder. Although their web site posts a study which they did to prove that this technique is more effective than physiotherapy, the form of physiotherapy they used for comparison is notoriously ineffective for frozen shoulder. So the bar was set pretty low. Either way, the technique is basically a soft tissue pressure technique which still requires many months of therapy for those who it is reported to help. The procedure is quite passive with no apparent risks for further damage and as such, if you feel you have the time and the money to try it out, we do not recommend against it. It is better to try conservative treatments first than to subject yourself to potential serious damage from surgery or MUA. On the other hand, there are many patients whom we have cured who tell us that the NAT had not worked for them at all.

 

OTZ method

The OTZ technique is a new chiropractic method of treating what they refer to as “frozen shoulder syndrome” which is more correctly known as shoulder impingement syndrome. Chiropractors claim to be able to cure frozen shoulder by manipulating or adjusting the upper neck bones. This is seen by most medical professionals as simply ridiculous. The heavy scar tissue and adhesions which surround the shoulder capsule cannot be separated with a chiropractic adjustment of the neck vertebrae. To support this contention, there are a number of YouTube videos showing before and after videos and a number of patient testimonials on their web site. These patients in these videos are likely authentic. The only problem is that the condition the OTZ practitioners refer to as frozen shoulder is not the adhesive capsulitis type of frozen shoulder that Dr. Austin Oolo’s OAT procedure cures. The condition they post on their video and website appears to be classic shoulder impingement syndrome which, in some ways mimics frozen shoulder but which is quite easily treatable by most chiropractors or physiotherapists who know what they are doing. What is apparently occurring with the OTZ technique is a misrepresentation of the term frozen shoulder. We consider this to be a technique which only serves to delegitimize the chiropractic profession in the eyes of those who understand the true cause of the adhesive capsulitis type of frozen shoulder.

Again, there are many patients whom we have cured who tell us that they tried OTZ with no success.

 

Active Release Technique (ART)

Many practitioners advertise that they can treat frozen shoulder using a muscle stripping soft tissue technique called active release technique (ART.) This technique is designed for conditions where adhesions have developed in the fascia between the muscles. The treatment has a good track record but it is not effective in being able to separate the much heavier and thicker adhesions which encapsulate the shoulder joint itself in cases of adhesive capsulitis. The myofascial adhesions treated with ART are completely different and in different anatomical locations–between the muscles rather than the frozen shoulder adhesions which surround the shoulder joint.

Patients who see improvement with ART report that it takes many months or years to recover fully. These cases still take a long time for recovery following treatments like ART or NAT. Since some cases of frozen shoulder mysteriously resolve themselves with no treatment at all in 2-3 years (sometimes it takes 5-10 years) we question whether or not the patient’s frozen shoulder would have recovered anyway without money spent on these treatments. But again, the problem with waiting it out is that 15% of the population never recover full mobility after natural resolution of frozen shoulder. As such, one must always consider what point in the lifeline of frozen shoulder was the treatment started. Otherwise, it is difficult to judge whether it was ART or the natural course of self-limiting recovery.

As with other treatments, many patients who underwent the OAT procedure and were cured, tell us that ART didn’t work for them.

 

Hydrodilatation

Hydrodilatation is a new, invasive medical treatment sometimes to try and cure frozen shoulder. With this procedure, the shoulder joint is injected with a lot of fluid. Using excessive pressure from within the joint capsule, the shoulder is literally blown up from the inside out so as to tear apart the shoulder joint adhesions. The idea is to cause the offensive scar tissues and adhesions surrounding the joint capsule to explode and break open. A number of studies have shown some improved movement and pain reduction. But there are no good published studies in medical literature to confirm even these quite modest results. Medical studies cite that this method has not been shown to be any more effective than cortisone injections. Hydrodilatation is very painful. Many subjects chosen for hydrodilatation studies have not been able to be because they quit mid-procedure due to severe excruciating pain. From a risk factor and complications perspective, damage to the shoulder joint capsule has been reported in addition to shoulder joint infections and premature shoulder joint arthritis. More studies need to be conducted on this method of treatment. We cannot not recommend it as of yet.

Our patients tell us that they tried hydrodilatation and stopped due to the pain, or completed the treatment with no success.

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In Summary

For the record, the adhesive capsulitis type of frozen shoulder cannot be cured by any method that does not physical separate internal adhesive scar tissue surrounding the shoulder joint. Treatments designed to strip out fascial scar tissue between muscles such as active release technique (ART) or Myofascial Release do not address the shoulder capsule adhesions. These adhesions are the cause of the condition. Therefore, such treatments are never effective in providing an immediate resolution. Standard treatment by massage therapists, physiotherapists, chiropractors, and osteopaths do not provide resolution from this terrible affliction.

In our opinion, physiotherapy, aggressive massage, and chiropractic manual treatments actually worsen frozen shoulder. They should not be conducted on cases of adhesive capsulitis frozen shoulder as research and clinical evidence shows that these kinds of physical therapy can often cause more inflammation and adhesion. This postpones recovery. There have been many patients whom Dr. Austin has cured using the OAT procedure who had frozen shoulder for 3-20 years. In all of these cases, the patient had been told that the condition would go away completely in 1-3 years. And they had all been going to painful physical therapy sessions which aggravated their conditions.

These are actual reports from actual patients.

 

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