Q: I had one steroid injection for my frozen shoulder so far. There's been no change that I can see so far. Are there some exercises I can do to go along with the injection treatment?

A: Before prescribing the best treatment for your shoulder, it's always important to know you have the correct diagnosis. For example, the terms frozen shoulder and adhesive capsulitis are often used interchangeably. The two terms describe the same painful, stiff condition of the shoulder no matter what causes it. A more accurate way to look at this is to refer to true adhesive capsulitis (affecting the joint capsule) as a primary adhesive capsulitis.

As the name suggests, primary adhesive capsulitis affects the fibrous ligaments that surround the shoulder forming the capsule. The condition referred to as a frozen shoulder usually doesn't involve the capsule. It may be better to refer to frozen shoulder as a secondary adhesive capsulitis.

Secondary adhesive capsulitis (or true frozen shoulder) might have some joint capsule changes but the shoulder stiffness is really coming from something outside the joint. Some of the conditions associated with secondary adhesive capsulitis include rotator cuff tears, biceps tendinitis, and arthritis. In either condition, the normally loose parts of the joint capsule stick together. This seriously limits the shoulder's ability to move, and causes the shoulder to freeze.

Exercises may help keep the fluidity of the joint and aid in maintaining (or restoring) motion. But which exercises, how to apply them, and other specific physiotherapy techniques that might help will depend on the underlying cause(s) of your shoulder problems.

This is where a physiotherapist can be most helpful in examining the entire shoulder complex and identifying the specific movement pattern impairment you have. From there, a specific home exercise program can be developed along with a few sessions of direct treatment. If you have not been evaluated by a physiotherapist for this problem, now may be a good time to make an appointment. Consult with your physician first in order to ensure the best way to coordinate treatments (steroid injections and physiotherapy).

Reference: Seung-Hyun Yoon, MD, PhD, et al. Optimal Dose of Intra-articular Corticosteroids for Adhesive Capsulitis. In The American Journal of Sports Medicine. May 2013. Vol. 41. No. 5. Pp. 1133-1139.

Kitchener Physiotherapy & Wellness provides services for physiotherapy in Kitchener.