Neurological Associates

Pain Management Center

Vero Beach, Florida

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RSD PUZZLE #75
FROZEN SHOULDER: NO SURGERY

In the case of frozen shoulder, we have adopted an aggressive approach for treatment with trigger point injections. The natural history of the frozen shoulder is the gradual deterioration of the condition complicated by inflammation due to RSD. The inflammatory effect mimics a clinical picture of rotator cuff tear, and even though almost all frozen shoulder cases are due to remote sources of RSD (e.g., hand and wrist injury, elbow injury, heart attack or stroke) without any history of direct trauma to the arm or to shoulder to cause rotator cuff tear, the orthopedists have a tendency to explore the shoulder to perform a "rotator cuff tear surgery". It is obvious that postoperatively, such a patient undergoes a severe deterioration of their RSD.

If the patient is not being treated by an orthopedist, and if a more conservative approach is applied, the patient unusually undergoes a few stellate ganglion blocks, followed by one or two trigger point injections of the shoulder, followed by manipulation of the shoulder under general anesthesia. This produces usually only provides a few days or weeks of relief and the condition recurs with more severity. By then, the trauma of manipulation of the shoulder may end up causing rotator cuff tear,
to prevent such disastrous results, we have successfully resorted to aggressively injecting and eradicating the multiple trigger points around the should with Marcaine mixed with a minimal amount of Depo- Medrol®.

In the case of your patient, because of the severity of her frozen shoulder, and because the patient had not received any Depo-Medrol® in the past, the patient was treated with the maximum allowable trigger point injections. The patient had excellent results from it.

Once the patient has had these injections, the patient is instructed to immediately exercise the shoulder and keep using it in order to prevent further recurrence of the immobilization and frozen shoulder. We have not had any case that the patient had to come back for recurrence of the frozen and repeat of the treatment.


H. Hooshmand, M.D.

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Copyright © 1997-2006 H. Hooshmand, M.D. No part of this publication may be reproduced, transmitted, stored in a retrieval system other than this specific media, transcribed, or translated into any language without the expressed written permission from the author; H. Hooshmand, M.D. and Eric Phillips and CMNE. This material is for informational and education purposes. It is not meant to take the place of your physician. Before starting, changing, or stopping any treatments or medicines consult your physician.

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The material on the Neurological Associates Pain Management Center Homepage and all it's associated, linked or reference pages is for informational and education purposes. It is not meant to take the place of your physician. Before starting, changing, or stopping any treatments or medicines consult your physician. H. Hooshmand, M.D., Neurological Associates Pain Management Center and Associates will not be held liable for any damage or loss as a result of information provided on this page or associated documentation. Again, this WEB SITE is simply published as an information source and should not be used to treat or make judgments on RSD/CRPS. All associated material on this web site may not be copied, reproduced or quoted without expressed written permission from the owner; Copyright © 1999-2006 H. Hooshmand, M.D.

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This page was last updated on 3/11/2000.