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What is the line of treatment for a frozen shoulder?

Q: My wife, aged 49 years, was facing difficulties in lifting her right hand. She used to experience pain in the shoulders. On examination and X-ray of the shoulder, the doctor diagnosed it to be frozen shoulder and advised physiotherapy. Accordingly, she had about 7 physiotherapy sessions. Though the pain is reduced substantially, still she cannot lift her hand fully and she continues to experience pain. The physiotherapist says that there is lot of improvement and now there is no need for further physiotherapist sessions and he has suggested a few exercises which my wife can carry out at home only. Though after 4 days of exercises she is not feeling better. Does frozen shoulder requires long time to heal? Whether physiotherapy should be continued? Apart from the treatments undergone so far, is there any other remedy/treatment available?

A:Frozen shoulder is a poorly understood condition, characterised mainly by pain and stiffness in the shoulder. True frozen shoulders account for only 1% of the stiff and painful shoulders. If the X-rays are normal and there is no history of injury, it could be a true frozen shoulder. Diabetes has to be ruled out in such cases, so if the tests are not done, please get your blood and urine sugar done. Anti-inflammatory drugs,e.g. diclofenac and ibuprofen form the mainstay of therapy including physiotherapy, which is vital. 1. Frozen shoulder is a self limiting condition, however the course can be protracted. It can last from 6 months to 2 years, before symptoms can abate, and therefore, some form of intervention is needed. 2. Physiotherapy should definitely be continued and it is important in this set up that the patient does not get a lot of pain. Adequate amounts of analgesics should be administered. It is not necessary that it has to be done by a physiotherapist. Once the patient understands what needs to be done, it can be done at home,however it is advisable to have a couple of sessions a week with the therapist so that he can monitor the progress and modify the regime. Please note that it shall require a lot of perseverance and patience on part of the patient. 3. Yes, other treatments are available, after sufficient efforts have been made for physiotherapy with a static point achieved. Injections in the joint of local anaesthetic and steroid can be very beneficial. The joint can be mobilised under anaesthesia, a procedure called MUA, can be done by an experienced surgeon, followed by physiotherapy. At the same time, saline can be injected in the joint and the joint can be distended, a procedure called brisement. The last resort is surgery, which can be performed open or arthroscopically. However after any procedure, physiotherapy is very essential, and if the patient is diabetic, recurrences are common.

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