In this episode, we'll unravel the mysteries behind frozen shoulder and rotator cuff injuries. Learn about the symptoms, frequent causes, and how these conditions differ from each other. Dr. Michael Livesey, an orthopedic surgeon at UM Upper Chesapeake Health Orthopaedics and a member of the UM Joint Network, discusses the impact of activities such as college football and breast cancer treatments and explores various treatment options and recovery times. Plus, get tips on preventive exercises and key takeaways for maintaining shoulder health.

Scott Webb (Host): Welcome to the Live Greater Podcast series, information for a healthier you, from the University of Maryland Medical System. I'm Scott Webb. Doctor, it's so nice to have you here today. We're going to talk about the rotator cuff and frozen shoulders. So, kind of all things shoulder today, if you will. So, let's start there. What is meant by frozen shoulder?

Dr. Michael Livesey: Frozen shoulder, it's known clinically as adhesive capsulitis. So when the lining of the shoulder joint or this capsule becomes inflamed, the tissue can thicken. This process causes significant pain, loss of motion, and we call this frozen shoulder.

Host: I was telling you before we got rolling, I could probably infer, is it pretty much as it sounds? So, it's painful as you say, but is it just frozen in place? Like you just pretty much can't move the shoulder?

Dr. Michael Livesey: There are multiple stages to frozen shoulder. It starts in this inflammatory phase, very painful. This can last anywhere from weeks to months, and then you progress into this frozen stage. It's defined by a loss of motion. And so, you have significant stiffness in the shoulder and gradually motion will return, but this whole process can take months exceeding a year.

Host: I see what you're saying. So, there's stages and the pain may decrease, but the frozen part of it may increase. So, good to understand what frozen shoulder is. And let's talk a little bit about the rotator cuff. Exactly what is it, right? And how an injured rotator cuff differs from frozen shoulder.

Dr. Michael Livesey: Rotator cuff, it's a group of four muscles. Each muscle is attached to the bone by a tendon. Rotator cuff, the job of the cuff is to stabilize the shoulder joint. And then, it also assists in rotational motion of the shoulder and elevation of the arm. So, rotator cuff injuries and frozen shoulder, they can be confused, they can both cause loss of motion, but there are distinguishing clinical features. So, frozen shoulder is defined by loss of both active and passive motion. Active motion is achieved by one's own power using a muscle. So if I asked you to raise your arm overhead, that's active motion. Passive motion is motion achieved without firing muscles. So if I were to take your arm and lift it myself overhead, I would be moving your arm through passive motion. So with frozen shoulder, you lose both active and passive, whereas with a rotator cuff injury, you may lose active motion when you associate with weakness, but passive motion is often preserved.

Host: All right. So, similar in ways in that we're talking about the shoulder, but manifests sort of symptomatically a little bit differently and neither sounds terribly pleasant and I'm familiar with rotator cuff injuries and that my daughter was just diagnosed with a minor one. And I've certainly heard that from, I guess, baseball pitchers primarily. But let's talk about the causes of rotator cuff injuries and frozen shoulders and just sort of some questions. You know, can breast cancer treatments lead to frozen shoulder? Is that a thing? What type of sports is most commonly found? Take us through all this.

Dr. Michael Livesey: So, let's start with cuff injuries. So, there can be overlap between two categories, but you can think of the rotator cuff injuries in two boxes, so traumatic or degenerative. Traumatic tears are sustained following an injury. So, you have a fall, you have a shoulder dislocation, you're handling an apparatus that's a bit too heavy for you. You have new pain, weakness, loss of function.

Degenerative tears can be thought of as wear and tear injuries. So as you age, you have decreased vascularity in the rotator cuff. The tendon slowly thins out and then tears. So age, biggest risk factor by far, age. Heavy labor jobs have been associated. Diabetes, vascular disease, dyslipidemia. There's some genetic factors, smoking. Again, going in the same vein of vascular disease, it's not good for the blood vessels, it's not good for the cuff.

Frozen shoulder is not completely understood, sometimes it follows an injury or surgery where you're shutting the arm down for a period of time, the shoulder can get stiff, can get frozen. But often, it begins insidiously. So, it's gradual onset, nothing you did wrong, just wake up, shoulder's very painful, starts to stiffen. You mentioned breast cancer. So, some of the treatments have been associated with frozen shoulder. The patients who have breast cancer, treated for breast cancer are at a higher risk of frozen shoulder, so important to be aware of. Thyroid disorders, diabetes, risk factors for frozen shoulder. Often, it's nothing you did wrong. Frozen shoulder just happens sometimes.

Host: Yeah. It's really interesting, as you say, like rotator cuff is, you know, whatever, falling off a ladder, sticking your arm out or baseball or lifting heavy things. And as you're saying, like some days you just wake up sometime and all of a sudden you have beginnings, the first phase anyway, of a frozen shoulder. So, really interesting to, like I said, sort of similar, but different. Let's talk about the treatment options, both non-surgical, I'm guessing PT, something like that, injections, whatever. And then also, you know, if surgery is indicated, what's involved?

Dr. Michael Livesey: Yeah. So, you're absolutely right with steroids and physical therapy. So for cuff, again, if we think of the cuff in those two boxes, so you have a degenerative tear where it just kind of wears out over time or traumatic tear, the treatment algorithms are a little different. So, physical therapy can be successful for degenerative tears in a amajority of patients. So, no injury, cuff just wore out, coming with shoulder pain, you find you have a tear. Try physical therapy, you can try an injection. Injection can help improve pain, calm down some of the inflammation in the shoulder. If you've tried therapy, tried six weeks of therapy, that fails, then you can go in and repair the rotator cuff.

In traumatic tears, there is evidence that these do best when handled expeditiously, should be a rotator cuff repair. So, the way it works, most rotator cuff tears can be fixed arthroscopically these days. Occasionally, you have to open. But usually, it's arthroscopic. And so, you have several small incisions about the shoulder, you go in with the camera, one side. And then, you instrument through the other called portals, there's a little kind of like a sewing machine device, pass suture through the rotator cuff, and then you pull the rotator cuff back to the footprint back to his home, and you put it into anchors in the bone. And then, you have to let the shoulder rest for a bit while the tendon heals back down to bone.

Host: Okay. And for frozen shoulder, is that just more of a, you know, it'll go away on its own, give it some time, take something for the pain or is surgery ever indicated for that as well?

Dr. Michael Livesey: So, frozen shoulder is patients don't love to hear just wait and see. But, yeah, often, it's physical therapy and time. So, the first thing we try with frozen shoulder is physical therapy. For frozen shoulder, similar to cuff, you can try a steroid injection, especially in that inflammatory phase, try to calm down some of the inflammation in the shoulder. But the biggest things would be therapy, therapy, therapy, just slow, static, progressive stretching, painless stretching, and it can take months over a year to improve. You've tried a few months of therapy, things really aren't getting better. There are surgical options. You can do a capsular release, so arthroscopic surgery. And you go and you release the capsule all the way around in the shoulder. And then, you do a gentle manipulation of the arm, get that motion back fully. And then, once you've gotten the motion back fully in the operating room, very important to continue physical therapy after surgery. You still need to do that or the shoulder will freeze again. So, therapy, therapy, again, biggest, biggest factor.

Host: Yeah, I was going to ask you about recovery time. So, it sounds like a long road, unfortunately, for frozen shoulder, which you say there's not a great way. We don't really understand exactly how it happens, but, you know, get a sense anyway of the folks who are at higher risk, but it just happens. And it sounds like a long road and also sounds like a fairly long road for folks who've had rotator cuff surgery. Maybe you can just break down the recovery times.

Dr. Michael Livesey: Yeah. You bet. Frozen shoulder, yes, like you're saying, long road, months to over a year. Rotator cuff, if you get a rotator cuff repair, you'll be in a sling for about six weeks. Return to full activity after a cuff repair, about six months. If you have a degenerative tear, you decide to go the physical therapy route. Some folks will feel better after six weeks of physical therapy. Varies a little bit by tear and by patient. But if you're able to manage it non-operatively, it's a shorter route with physical therapy. If you go the surgery route, you need to let the shoulder rest to heal, and so it's a little bit of a longer road.

Host: Yeah. Yeah. It seems like by definition, you just don't know that frozen shoulder's coming on. So, what I basically want to ask you is, is there anything we can do to prevent things? So, sure, don't fall off a ladder, right? But, you know, some of these other things, you know, other than the risk factors themselves, as you talked about the many risk factors that many of us suffer from, high blood pressure, diabetes, things like that, is there anything we can do, exercises or precautions to try to prevent these conditions?

Dr. Michael Livesey: You know, a healthy diet and exercise, healthy lifestyle, gentle exercise, stretching; gentle cuff periscapular strengthening, so all the muscles around your shoulder blade, gentle theraband exercises, rotational exercises, these are all published online or you could take a one-time session with a physical therapist to go through different exercises. Anything that strengthens the cuff, again. Gentle strengthenings, it's not heavy weight lifting. Stay active. Help keep you limber, keep cuff and all the muscles around it healthy.

Host: Yeah, stay healthy, stay active, try to avoid traumatic injuries, of course. Really educational today, great to learn more about frozen shoulders. I was sort of like, I think I can infer what that means, but I never had actually had a conversation about it. Just any final thoughts, takeaways, final points here for listeners?

Dr. Michael Livesey: Yeah. To end, I would just say early recognition is important for both of these processes. If you have concerns about your shoulder, you have pain, loss of function, please come by the office. I'm a surgeon. That doesn't mean the only treatment I can offer is surgery, I'm happy to coordinate all care for the shoulder and help find the best option for you.

Host: Yeah. As you say, it's all done sort of minimally invasively now, arthroscopically. I've found that oftentimes, doctor, with surgeons, that it's like, "Yeah, I'm a surgeon and I like doing surgery, but we'll try the other stuff first," right? If we don't need to do surgery, we won't, right? We'll try physical therapy, we'll try injections, we'll give it some time. It doesn't necessarily mean because you've met with a surgeon that you have to have surgery, right?

Dr. Michael Livesey: Absolutely. Yeah, I like performing surgery, but I would not advocate for surgery unless I think it's the right treatment option. And in some cases, non-operative management is certainly the best

Host: course.

Yeah. Well, that's perfect. Really appreciate your time and your expertise today. Thanks so much.

Dr. Michael Livesey: Thank you, Scott.

Host: And find more shows like this one at umms.org/podcast and on YouTube. Thanks for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again and please share this on your social media.