Q: I have had a painful shoulder for six months. Now I can barely move it. My doctor said that I need surgery and referred me to an orthopedic specialist. What do you think?
-- Munster, Ind.
A: The shoulder is a ball and socket joint. The large round head (ball) of the upper arm bone (humerus) fits into a shallow cup (socket joint) of the shoulder blade (scapula). Ball and socket joints provide a lot of stability and allow a considerable range of motion as well.
The joint is protected against separation by the tendons and ligaments that surround it. The joint is surrounded by a tough capsule. This area is also surrounded by and connected with several muscles that are collectively called the rotator cuff.
Any injury or inflammation around the shoulder, including tendinitis, bursitis, and rotator cuff injury may lead to frozen shoulder. Frozen shoulder (also known as adhesive capsulitis) is a relatively common problem that occurs when the inflammation results in scarring, thickening or shrinking. The result is pain and significant limitation of movement.
Frozen shoulder occurs more frequently in people with diabetes, chronic inflammatory arthritis of the shoulder, or after chest or breast surgery. Long-term immobility of the shoulder joint for any reason increases the risk of developing a frozen shoulder.
The diagnosis of frozen shoulder can be confirmed by arthrography, in which a contrast dye is injected into the shoulder joint and X-rays are taken.
Arthritis or damage to muscles around the shoulder can cause swelling, pain, or stiffness of the joint that can mimic the limitation of movement caused by a frozen shoulder. Injury to individual tendons of the rotator cuff can also limit the range of motion of the shoulder joint, but usually not in all directions, as seen in a frozen shoulder.
Although it's small comfort for someone living with the pain and loss of function, most people with frozen shoulder recover within a few months, whether treated or not. However, as you know, some frozen shoulders can become chronic.
Whether the cause is known or not, treatment consists of relieving pain and improving range of motion. Unfortunately, there is no magic pill for this painful condition, and available treatment procedures don't always fix the problem.
For a minor condition, educating yourself about the condition and a program of home stretching exercises may be enough. But many with frozen shoulder will require aggressive manipulation and physical therapy, with or without steroids injected directly into the joint to reduce inflammation. A nerve block may also be used in combination with this therapy.
Sometimes manipulation of the area while the person is under anesthesia is suggested to improve the mobility of the affected shoulder during therapy. In more severe cases, arthroscopic surgery may be required to release the contracted shoulder.
Orthopedists, in conjunction with physical therapists, are the health professionals best trained to treat this condition. I suggest you get another opinion and discuss some of what you've learned from this column.