Questions regarding rotator cuff injury and frozen shoulder

[mkh9]

I went to my family practise doctor who saw me for about 2 minutes and he said I have a injury to my rotator cuff that is defering pain to my deltoid muscle area and/or there is also an injury to the deltoid area and I have some frozen shoulder but isn't totally frozen (at least not yet). The doctor said he didn't think it was a tear since there was no bruising. I will get an MRI only if I don't improve in the next month or with stretching.
My questions are: 1. if I get an injection into the shoulder joint would this speed the time of recovery or would it just feel better for a while? 2. would physical therapy make it go faster or is it really the same if I was given exercises to do at home? 3. If I do nothing will it take the same amount of time and the outcome be the same or would it be a worse outcome? I was injured several times by PT's for my back injury so I am reluctant to go back to another PT. Any advice? 4. Where do I go to get the injection of steroid into the joint an orthopedic surgeon or a pain doctor?
thanks,
mkh9

[mkh9]

Thank you very much. Yes this does help me to make some decisions.
mkh9

[Kurizu]

My reply to your queries:

1. Your doctor may inject a shot of anesthetic into your shoulder to help find out whether the limited movement is caused by pain or weakness. If the anesthetic relieves the pain and allows you to move your shoulder normally, the diagnosis is most likely some form of rotator cuff disease. Your doctor may then inject corticosteroids into the area to reduce inflammation. But if your shoulder is still weak after the injection of anesthetic, the problem is probably a rotator cuff tear.

Corticosteroid injection may decrease inflammation and pain. But they probably DO NOT cure rotator cuff disorders.  They usually are used AFTER other treatment (such as rest, ice or heat, NSAIDs, and physical therapy) has failed to improve the problem.

Corticosteroids have potential side effects and should be used with caution. Although they may provide relief from pain and inflammation, corticosteroids can also slow healing and weaken tendons.
The effectiveness of corticosteroid injections can vary. In some cases, the relief from inflammation and pain may last for several weeks or more. In other cases, the shot may help for only a short time.

2. Supervise PT treatment is advisable, in addition to the home exercise program given to the patient, to prevent complications such as capsular and muscular tightness associated with the condition.  There are many physical therapy modalities that can be use to control pain such as moist heat, TENS, Endolaser therapy etc. Therapeutic ultrasound is very helpful to decrease adhesion within the joint capsule.  Joint manipulation and stretching are effective in restoring normal range of motion.  Range of motion exercises and its progression should be taught to the patient very carefully because if incorrectly done may do more harm than good. Shoulder isometrics should also be taught to prevent muscle atrophy.
  
3. Frozen shoulder is a chronic condition that slowly becomes worse over a period of 3 to 12 months and then, for reasons that are not clear, follows a course of gradual improvement to normal or near-normal state.  But not all are self-limiting! Physical therapy would definitely be helpful to hasten recovery by preventing complications and loss of function.

4. Consult either a physiatrist (rehabilitation doctor) or an orthopedic doctor for the corticosteroid injection.

I hope this information will help you.