Wellness
it up, and you’ll see just how long this process can take. But most people aren’t willing to wait that long, as Bragg notes—and in his opinion, there’s no reason why they should. “I tell my patients that progress is going to be slow, and you’re going to William be frustrated. But we’re Bragg, M.D. not going to let it take two years.” In the great majority of cases, a frozen shoulder will resolve with nonsurgical methods (or even nontreatment), but if a patient hasn’t seen results somewhere between six months and a year, Bragg says, he may suggest a surgical intervention. “When a shoulder issue is having a significant impact on a person’s mental health, their ability to function in leisure activities, their ability to do their job and be productive in society—at some point, you don’t just say, ‘Let’s wait longer.’ You make the choice to try to help them with an intervention.” Deciding whether to pull that trigger can be tricky, Bragg says, and it’s also a last resort. But in stubborn cases, manipulation under anesthesia (which stretches the shoulder capsule) and arthroscopy are options.
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PHYSICAL THERAPY IS KEY. To get
the shoulder moving normally again, physical therapy and a whole lot of stretching are widely considered the most essential treatment tools. “I’m a little biased,” says Mark Eddy, owner and president of Campus Commons Physical Therapy in Sacramento. “But I believe physical therapy can help a lot of people with this problem.” A practicing physical therapist for more than 25 years, Eddy says he can usually find some reason behind a frozen shoulder if he asks enough questions. When working with client Jim Burk, the mild nature of the precipitating event took them both by surprise: After reaching behind his back to tie the strings of his apron, Burk felt a “twang” in his shoulder, and things got worse from there. “It was a very humbling experience,” says the 66-year-old Sacramentan. “I was used to going to the gym,
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lifting weights, staying in shape, and sudand one shot only. “Cortisone shots are denly I was having trouble trying to raise overall safe and effective,” Sheridan says. my arm over my head.” After about seven “But multiple injections, particularly in a months of twice-weekly therapy sessions short period of time, may have deleterious and regular stretching at home, Burk effects on the soft tissues and the cartilage says, “I was out of pain of the shoulder.” Timing, TO GET THE SHOULDER and had my arm moveagain, is key: According to the MOVING NORMALLY ment back.” findings of a large-scale study Eddy cautions that not AGAIN, PHYSICAL published in December 2020 all therapy is created THER APY AND A in JAMA Network Open, corequal; what matters, he WHOLE LOT OF ticosteroid use in patients who says, is approach. In treating STRETCHING ARE have had frozen shoulder for frozen shoulder, Eddy says, he WIDELY CONSIDERED less than a year is associated and his staff typically use a THE MOST ESSENTIAL with better outcomes. Coucombination of range-of-moTREATMENT TOOLS. pling the treatment with a tion exercises, joint mobilizahome exercise program maxtion techniques and hands-on manual imizes chances for recovery, the study says. therapy, moving the shoulder in various directions “so that the shoulder, scapular MULTIMODAL WORKS BEST. As the region and the capsule itself frees up and foregoing suggests, a multimodal gains mobility.” Early intervention, he approach is often the best way to stresses, is key. “I’ve found therapy is most beat frozen shoulder. In my own case, useful early on,” says Eddy. “If you wait nonsteroidal anti-inflammatories and too long, you may be in a phase where it physical therapy got the engine started, may not be beneficial.” but it was acupuncture that ultimately Bragg agrees timing is everything, notgot me out of the woods. Jim Burk, who ing physical therapy can be counterinitially dodged the cortisone shot, made productive if shoulder pain isn’t a different choice when he conunder control—so the fi rst fronted a frozen shoulder in his step for most patients, he other arm and says he’s glad he says, is anti-inflammatories. did. “It [the shot] was effective almost immediately,” says Burk, TO GET THE SHOT, OR who paired it with the at-home Mark Eddy NOT? When frozen exercises he’d learned the fi rst shoulder pain hits, most time around. Burk’s “other arm” exfirst reach for the Advil (or other NSAID perience isn’t uncommon: A whopping of choice) and an ice pack. But to attack 20 to 30% of frozen shoulder sufferers pain and inflammation more aggresare estimated to experience an occursively, a cortisone (steroid) injection, rence in the opposite arm, according to given directly into the shoulder joint, is the American Physical Therapy Assocommonly used. Should your primary ciation. care doctor do it? That is a matter of debate. Bragg, for one, recommends an PREVENTION MAY BE POSSIBLE. image-guided injection, performed by a Or is it? Experts say there’s no specialist, for best results. surefire way to prevent a frozen Steroid use may not be for everyone. shoulder. But keeping the shoulder moving might help, notes Bragg, directing “Do you really want to put something into his comment to those who have an inyour body that could break down your jury or other shoulder issue, such as imtissues or have other harmful ramificapingement. “Being immobile will just tions?” as Eddy asks. But most convenmake you stiff and potentially lead to tional clinicians agree that when used frozen shoulder,” he says. “You don’t want appropriately, the benefits outweigh the to turn one problem into two.” risks. The general rule of thumb? One shot,
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SACRAMENTO MAGAZINE November 2022
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10/17/22 3:29 PM