Joey Wahler (Host): It's a painful and debilitating condition, so we're discussing frozen shoulder and its treatment options. Our guest, Dr. Christopher Donaldson, an Orthopedic Surgeon. This is BayCare HealthChat. Thanks for joining us. I'm Joey Wahler.

Hi there, Dr. Donaldson. Thanks for being with us.

Christopher Donaldson, MD: Hello. How are you?

Host: I'm good. Yourself?

Christopher Donaldson, MD: Good. Thank you.

Host: Great to have you aboard. So first, what exactly in a nutshell is frozen shoulder and what are its symptoms typically?

Christopher Donaldson, MD: Yeah. So frozen shoulder is a condition that is experienced clearly in people's shoulders, that is a painful condition. It most commonly happens insidiously, which means without really recognizable cause and of its own accord. It is essentially an increase in inflammation and pain, that then generates stiffness in the patient's shoulder. And then that pain and stiffness we classify as frozen shoulder where the lining of the joint sort of becomes irritated and tightens in the shoulder.

Host: So how would the feeling there differ from other shoulder pain?

Christopher Donaldson, MD: When we look at pain as a symptom, that can really be generalized to many conditions, but specifically around frozen shoulder, the pain is pretty significant in regards to severity. And so say for instance, a rotator cuff tear or a shoulder separation or a dislocation can be painful, pretty severely, but then tapers off.

Frozen shoulder, as you move the shoulder to more extremes of motion becomes more and more painful. The less you move it, the less painful it is. But typically folks say my shoulder is very unusually painful for the things that  I'm doing with it.

Host: Gotcha. So you mentioned a moment ago that usually people won't necessarily realize a particular moment or incident that caused the pain. So what are the causes?

Christopher Donaldson, MD: Yeah. So the causes really are unknown. There has been some projections to suggest that this may be viral related or traumatically related. Unfortunately, there's really not been a correlation to directly say that it is related to a trauma or to genetics or to viral etiologies. Those are just some proposals that researchers have made to try to figure out the etiology or the cause of it. But there really hasn't been anything specifically borne out in the literature.

Host: Now those who've recently had surgery, like for a broken arm, for instance, from what I understand may also be susceptible to this because of a lack of shoulder movement and stiffness that sets in, right?

Christopher Donaldson, MD: That's correct. Postoperative adhesive capsulitis or postoperative shoulder stiffness and frozen shoulder can happen as secondary to the trauma of the surgery. And then subsequently the pain that limits patients from moving their shoulder can generate the frozen shoulder in that specific population.

But we do know that there are conditions that are associated, again not necessarily caused, but associated with frozen shoulder; things like diabetes or thyroid disease. Those things can also be correlated with frozen shoulder disease as well.

Host: Right. And I'm going to ask you about what you just mentioned there in a moment, but first, how is frozen shoulder usually diagnosed?

Christopher Donaldson, MD: Frozen shoulder really is a clinical diagnosis. There are characteristics that we can identify on MRI findings. Edema or fluid in the lining, we call that the capsule of the shoulder. A reduction in the space of the joint of the shoulder. Those things can be seen objectively on imaging studies like MRI, but really it's a disease where we want to put together the disease symptoms and signs, lack of motion, increased pain and then the history of the patient with maybe one of those comorbidities like diabetes or thyroid disease to allow us to bring a clinical diagnosis of frozen shoulder.

Host: So, if someone's having shoulder pain and suspects it might be this condition, at what point should they see a doctor?

Christopher Donaldson, MD: I think when they've tried the simple or more straightforward opportunities to control their symptoms, taking anti-inflammatory medicines to reduce the discomfort, limiting some of their activities they may feel that are inciting the symptoms of discomfort or pain; and that's not effectively treating those symptoms; that's a point in time when I would encourage patients to seek further medical care and expertise. So that we can make that diagnosis efficiently and effectively early in the process so that we can get the early intervention, which can hopefully lead to less time out of activities, out of work and less inconveniences and pain and discomfort in someone's life.

Host: Gotcha. Now, you mentioned that diabetics and those with thyroid disease can be more susceptible to frozen shoulder. Maybe explain to us a little bit better, please, why that is and if there's anything those patients can do to help prevent it.

Christopher Donaldson, MD: The exact answer of why those specific groups of patients are susceptible, I think is unknown, but we do know that the better controlled each of those disease processes are, so controlling the thyroid disease or controlling blood sugars in diabetics within an acceptable and tight range, we do know that reduces the length and severity of the frozen shoulder symptoms which is important when you talk about returning patients back to their life and their activities.

Host: So for patients in general, then, what treatments are available?

Christopher Donaldson, MD: I think we typically try to identify the least risky and least disruptive treatment options first, so that would mean maybe limiting or changing activities to limit discomfort, then using anti-inflammatory medications that are over the counter or at a prescription dose by mouth can be effective.

Both home and formal physical therapy to continue with range of motion and, and, and shoulder, what we call kinetics or making sure that the shoulder is performing properly and is in alignment properly is helpful. In the surgeon's office, the orthopedic surgeon's office, we can offer interventions such as cortisone injections and then sometimes trans(cutaneous) electrical neural stimulation or TENS units, which are these stickers that can be put on the shoulder to reduce muscle spasm.

So those things are ways that we can reduce the symptom severity. As well as hopefully shorten the course of frozen shoulder.

Host: And that TENS treatment that you just talked about, why might you use that as opposed to one of the other options?

Christopher Donaldson, MD: I think TENS is a complement to the other options that we have. Each of those treatment modalities or treatment avenues have a specific area that we're targeting, whether that be reducing the inflammation by medicine, the TENS would be effective at reducing spasm, therapy can increase stretching the lining of the shoulder. So each of those have opportunities to reduce a specific component of the disease that we're seeing.

Host: Okay. A couple of other things. Whatever the treatment, generally speaking, when treated, which is also in this case for frozen shoulder, sometimes referred to as thawing, you would say it typically takes how long for that recovery to fully take effect?

Christopher Donaldson, MD: I think the difficult part is that there are some frozen shoulder courses that are relatively short. A month, six weeks, or two months. Unfortunately, some of the frozen shoulder courses can take an upwards of one to two years before they completely thaw out or terminate and result in normal range of motion in a pain-free way.

There really are no reliable indicators to understand which of the two courses, shorter course versus a longer course, that might be in front of the patient. And I think that's the challenging sort of difficulty that patients face is the unknown of how long is this going to happen and how long am I going to be impaired by this. Because we really don't have a reliable indicator to give them for prognosis of that, that course.

Host: Understood. And so having said that regarding timetable being kind of a wide-open range, in summary here, Doctor, what's your message for those listening about the prognosis for effectively being treated for frozen shoulder, putting aside for the moment how long that might take. At the end of the day, what are the chances that they'll see some relief from this?

Christopher Donaldson, MD: So yeah, I think the message really from myself to the patients is, it's important to understand that despite the difficulties and severity, which may seem quite acute and quite severe for patients, that although length of course is unknown, it is important to know that there is sort of light at the end of the tunnel. That at the end of this, there really is encouraging results and a prognosis to say that you will get through this pretty significantly uncomfortable and sometimes painful course that may last several months, but it will happen, and at the end of it, there really is little residual pain and limitations in regards to stiffness or range of motion that we see, so encouraged to say, the end result is good. Unfortunately the road or pathway to get there may be a little bit uncertain, there is light at the end of the tunnel.

Host: Well, I'm sure for people listening, they're affected, that that's comforting just to hear. Folks, we trust you're now more familiar with frozen shoulder. Dr. Donaldson, thanks so much again.

Christopher Donaldson, MD: Thank you. I appreciate it.

Host: Same here. And for more information or to connect with a provider, please visit BayCare.org. Again, that's B-A-Y-C-A-R-E.org. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. For more health tips and updates, follow BayCare on your social channels. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks again for listening to BayCare HealthChat.