Scott Webb (Host): Frozen shoulder is fairly common and painful. And if we're suffering from it, it's best to seek medical attention. And joining me today to tell us more about frozen shoulder are Dr. Matthew Rachwalski. He's a board-certified physician in Sports Medicine, practicing at Franciscan Health. And Michael Topor is here. He's a physical therapist practicing at Franciscan Health.

This is the Franciscan Health Doc Pod. I'm Scott Webb. So, it's great to have you both here today. We're going to talk about frozen shoulder and what does that mean and is that literal and all that good stuff. Doctor, I'm going to start with you. Maybe the most basic one, what does that mean? What is frozen shoulder?

Dr. Matthew Rachwalski: Yeah, that's a great question. So basically, what a frozen shoulder is, it's exactly what it sounds like, your shoulder is stuck and frozen in place. And really, what happens is you get some functional loss of both your passive and active range of motion. And really, there's a kind of a point there to hit on that I think kind of helps, you know, active is you actively moving your shoulder, and passive is someone passively moving your shoulder. And it just would basically be a scenario where you functionally cannot move your shoulder to the extremes of the normal range of motion. And then, also as either a therapist or a physician or provider is moving your shoulder, they're unable to move it to the extremes of your normal range of motion as well.

Host: So when you say frozen shoulder, you mean sort of literally like it's just sort of frozen in place. And that probably would be the biggest sign or symptom, doctor, of frozen shoulder. But what else maybe might folks experience?

Dr. Matthew Rachwalski: So, sometimes associated with the decreased range of motion, sometimes people will have pain. They'll have pain because they're, you know, unable to utilize the arm in the way that they normally would. And it just kind of depends on what stage of the disease they present at. And then, when we think of frozen shoulder, it's sort of stages that it goes through. And we think of it as freezing, frozen and thawing. So, kind of like how you would think like an ice cube almost, if that makes sense.

Host: Yeah, I see what you mean. And it makes me wonder, Michael, when we think about the causes of frozen shoulder, is it more of an acute thing, an injury thing? Is it chronic? Like, what are the causes as far as we know of frozen shoulder?

Michael Topor: Typically, a lot of frozen shoulders don't have any mechanism of injury. A lot of times, they just happen. Typically, a risk factor is people between the ages of 40 and 60 years of age, and females have a higher incidence of them, and diabetics even have a higher incidence of frozen shoulders. Post-surgical patients, typically when the shoulder and the arm is immobilized will sometimes have a tendency to go into this frozen shoulder stage. There are fractures that can occur when, again, the joint is immobilized. Essentially, individuals who have strokes sometimes can come up with frozen shoulders. There's also some research that suggests people with thyroid problems both hyper and hypothyroidism can cause frozen shoulders. There's cardiovascular disease issues that can cause frozen shoulders. Parkinson's can be another issue that can cause a frozen shoulder. But for the most part, there's really no rhyme or reason why they happen.

Host: Yeah, it's really interesting. You're going through the list of who's prone to experience this, and I am definitely not smart enough to understand how some of those things that you listed there could somehow affect one's shoulder. I guess, I'm just wondering, Michael, when do we reach out? When do folks usually reach out and when do you recommend that they reach out maybe?

Michael Topor: I would say if you are noticing your shoulder is getting very painful and it's not getting better with typical rest, ice, anti-inflammatories, over-the-counter NSAIDs, and you've noticed that this is going on for a couple of weeks, it's probably a good idea to find and seek medical attention as soon as possible. Because the sooner a frozen shoulder is correctly diagnosed, the sooner the treatment can start and the sooner, and hopefully, the shorter each one of those phases the frozen shoulder will go through.

Dr. Matthew Rachwalski: I think anytime you have somebody that's suffering with limited range of motion and pain, I'll usually tell them, you know, if you've tried some basic home remedies, some ice, maybe a little bit of heat, you've been trying to work on your motion, just kind of moving your arm around and you're not able to do that very well, and if you tried, maybe some of the over-the-counter medications, if they're safe and applicable for you, you know, some of the Tylenol or some of the NSAIDs like ibuprofen or Aleve, if you're still having pain at that point, then I think it's probably advisable to go in and get looked at, whether that's with your primary care provider first, or if you want to go see Sports Medicine or orthopedic provider or even some of our therapy colleagues actually often offer a free walk-in where you can just go in and get evaluated in the clinic and kind of see what's going on. So, those are great, great avenues for people.

Host: So, let's finish up here today and just talk about treatment options. What are our best options? You give us a sense of sort of who gets this and what they may be experiencing. So, how do you help?

Dr. Matthew Rachwalski: Yeah. So, I think it kind of depends on what stage you're in. So, you know, the freezing stage is kind of when the shoulder's stiffening up. That's usually when most people like first start getting shoulder pain. So, that's usually within the first six weeks to really up to nine months even, is really where people will have that. And then, you know, you have the frozen stage, which is where they're pretty stiff. They have the decreased range of motion, and that's usually when most people come in, you know, it's affecting their activities of daily living. They've had this for four months, maybe even up to nine months or even longer. This is kind of a self-limited disease where if you didn't do anything, over time, it starts to thaw out and you get a gradual return of motion.

Now, we wouldn't want to wait, you know, it can take up to 26 months to resolve on its own. So, we don't usually encourage people to do that, because, you know, who wants to be in pain and have limited mobility for that extended period of time. I don't think many people could afford to do that.

I think the mainstay of treatment for this is actually physical therapy, and I think that's where our physical therapy colleagues are so key and beneficial and helpful to our patients for this. We usually will get them set up with therapy to work on, you know, some gentle pain-free stretching. And a lot of times, we'll use moist heat and things like that to try to get the shoulder activated and get moving. And we usually want this to be, you know, supervised where it's not just you doing this at home, you're doing it with a licensed physical therapist, or an occupational therapist sometimes can help as well.

That's like really our first line of treatment. Sometimes if people are struggling with this, you know, they may have some pain associated with it, so we'll have them try some of the NSAIDs or non-steroidal anti-inflammatory medications like the ibuprofen or Aleve, or sometimes we'll even write in for prescription versions of those to try to help decrease their pain associated with it. And then, usually, after therapy sessions, a lot of times, we'll do some icing just because they have some pain afterwards. And in our office, we often will consider an intraarticular cortisone injection. So, we inject corticosteroid into the shoulder to try to decrease the inflammation around it and in doing so, allow the patient to have more mobility and less pain so they can get more benefit when they're working with a therapist.

Host: Yeah. And of course, Michael, you are the physical therapist in this conversation today. So, last word to you.

Michael Topor: Well, we do a nice thorough exam to make sure that we are dealing with the true frozen shoulders because there are some other shoulder issues, impingement and rotator cuff issues that might mimic a frozen shoulder at first. But if we're pretty certain it is a frozen shoulder, we like to start with some palliative easy things to kind of not irritate the capsule, so some gentle joint mobilization techniques. Therapeutic ultrasonic waves are very helpful for that. We have ultrasound units that we use that are very beneficial to help with pain and improve the capsule mobility. There are a lot of different therapeutic exercises that are beneficial for frozen shoulders. Each frozen shoulder is probably going to go through each one of those phases, and they're very painful. And hopefully, the therapy shortens each one of those phases up. So, a person who might actually have a frozen shoulder for two years may only have a frozen shoulder for eight months with good therapy.

Host: Well, it's been great having you both on today. It's always nice to learn about things. You know, you hear frozen shoulder and you assume, "Well, maybe that's not literal." But as we've learned today from both of you, it is literal, it is frozen, and we definitely don't want to wait 26 months for this to resolve on its own. So, thank you so much.

Michael Topor: Thanks, Scott.

Dr. Matthew Rachwalski: My pleasure.

Host: And for more information, go to franciscanhealth.org/orthocare. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.