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My mother was recently diagnosed with a frozen shoulder for unknown reasons. She says she hasn't hurt herself or fallen down, but of course she wouldn't tell us if she did. She doesn't want therapy and says the doctor told her it would get better on its own. That doesn't sound right. What do you think?

Frozen shoulder is the layperson's term for a medical condition calledadhesive capsulitis. Inflammation of the tissues in and around the shoulder joint leads to fibrosis (scarring). The result is the joint gets stuck and can't move smoothly anymore. Painful and limited shoulder motion are the two main characteristics of this condition. There is some evidence that the condition gradually gets better. For that reason, it is considered self-limiting. It appears to go through several stages. There's an initial period of pain, then stiffness (the frozen part), then recovery or the thawing phase. Sometimes the stiff, frozen stage is divided into the process of freezing and then the frozen phase. The whole process takes anywhere from 12 to 18 months. But at least half of the patients say they still have stiffness and loss of motion for years. So, what can be done about this condition? And what works best? At the very least, it's clear that teaching the patient about the process and what to expect is important. They should be prepared for the fact that this is not a quick and easy problem to solve. A couple of Advil and a few exercises aren't the answer. A consistent, daily program of exercises to relieve symptoms and restore motion is important. Muscles stretch easier when they are warmed up. So, before starting a program of flexibility exercises, patients are encouraged to apply some form of moist heat before and during stretching. A couple visits to a physical therapist can help your mother get started. The therapist will assess the joint and determine how to stretch in a way that won't overload the tissues and cause increased irritability. For patients in the early (painful) stages of adhesive capsulitis, low-intensity, short-duration range-of-motion may be best. The goal is to decrease pain and muscle guarding while increasing shoulder and arm motion. The therapist can also perform a technique called joint mobilization to help restore normal joint sensory awareness, gliding, and sliding motions. Joint mobilization is a way to move the joint surfaces to increase motion. The technique involves some sliding and gliding of the shoulder joint in a variety of different directions. Which way to go is determined by areas of movement restriction. All joint mobilizations are followed up with an active home program of gentle stretching at first progressing to longer stretches with more pressure or force. If your mother does not appear to be making any progress (or even seems to be getting worse), a steroid injection into the joint can help. The effect on reducing or eliminating joint pain makes it possible to move more. Staying home and doing nothing is an option, but not one that is highly advisable. Just a small amount of supervision and direction in setting up and encouraging a daily home program may help prevent further problems down the road.

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