Frozen Shoulder
Dr.Senthil Velan
MBBS, MRCS (Edin), FRCS (Tr & Orth), FEBOT(France), D Orth, Dip SicoT.
Fellowship in Shoulder Elbow Surgery (Bournemouth, UK)
Fellowship in Knee Surgery (Bournemouth, UK)
Consultant Orthopaedic Surgeon.
Apollo Hospitals Ayanambakkam
Apollo Clinic Annanagar, First Med Hospitals.
For Appointments contact 09566222533/nexusortho@yahoo.com
Frozen Shoulder causes Pain and limitations of movements of Shoulder. 2% and 5%of the general population can be affected by this condition . It is more common in women than in
men and the age of sufferers tends to be between 40 years and 60 years .In most cases pain in shoulder is the initial symptom and gradually stiffness accompanies it.
In severe cases there is complete restriction of Shoulder movements.
What causes frozen shoulder?
Frozen shoulder happens when the covering of shoulder called capsule becomes thickened.
It is not a true inflammatory condition , and in most cases there is no obvious causative factor but it can occur secondary to a shoulder injury or shoulder surgery.
It is also more common in persons suffering from
Diabetes
Duypuytrens Contracture- a condition where small lumps of thickened tissue form in the hands and fingers
Other health conditions, such as heart disease and stroke.
When to see a Shoulder Specialist?
You should visit a Shoulder specialist if you have shoulder pain that limits your range of movement.
A diagnosis of frozen shoulder needs to be made early so treatment for the condition can be started quickly to help prevent long-term pain and stiffness developing in your joint.
What investigations will be needed?
In most cases the only investigation required will be a plain X ray of shoulder. But if the Shoulder specialist suspects other pathologies in the shoulder an MRI scan may be required to rule out problems like rotator cuss tear/tendinitis.
Treating frozen shoulder
Some people with frozen shoulder may get better over a period of 18-24 months. In other cases, symptoms can persist for several years.
Studies suggest that about 50% of people with frozen shoulder continue to experience symptoms up to seven years after the condition starts. However, with appropriate treatment it is possible to shorten the period of disability.
The aim of treatment is to keep your joint as mobile and pain free as possible while your shoulder heals. The type of treatment you receive will depend on how severe your frozen shoulder is and how far it has progressed.
Treating frozen shoulder
A frozen shoulder may get better naturally, but recovery is often slow and may take at least 18-24 months.
The aim of treatment is to keep your shoulder joint as pain free and mobile as possible while your shoulder heals.
Early stage
The first stage of a frozen shoulder is the most painful stage. Therefore, treatment is mainly focused on relieving the pain.
During this stage, your doctor may recommend that you avoid movements that make the pain worse, such as stretching overhead. However, you should not stop moving altogether.
Painkillers
If you are in pain, you may be prescribed painkillers, such as paracetamol or a combination of paracetamol and codeine.
Some painkillers, such as paracetamol, are also available over-the-counter from pharmacies.
If your pain is more severe, your doctor may recommend or prescribe a non steroidal anti inflammatory medications (NSAID). As well as easing pain.They are most effective when taken regularly, rather than when symptoms are most painful.
Corticosteroid injections
If you have severe frozen shoulder, painkillers may not be enough to control the pain. If this is the case, it may be possible to have a corticosteroid injection in your shoulder joint.
Corticosteroid are medicines that contain hormones (powerful chemicals that have a wide range of effects on the body). They help reduce pain and inflammation. Corticosteroid may also be given with local anaesthetic (painkilling medication).
Corticosteroid injections can help relieve pain and improve the movement in your shoulder. However, injections will not cure your condition and your symptoms may gradually return.
Corticosteroid injections will not be used after the pain has faded from your shoulder and only the stiffness remains.
Having too many corticosteroid injections may damage your shoulder, so you may only be able to have this type of treatment up to three times. You will need at least 3-4 weeks between injections.
Later stages
After the initial, painful stage, stiffness is the main symptom of a frozen shoulder. At this time, your doctor may suggest you start shoulder exercises, and you may be referred to a physiotherapist.
Physiotherapy
A physiotherapist can use a number of techniques to help you maintain movement and flexibility in your shoulder. If you are referred to a physiotherapist, you may have treatments such as:
stretching exercises using specific techniques to move the joint in all directions
massage thermotherapy with warm or cold temperature packs
.
Surgery
Surgery for frozen shoulder may be recommended if your symptoms are severe, causing significant problems and other treatments have not worked after a few months.
There are two possible surgical procedures which are explained in more detail below.
Manipulation
You can have your shoulder manipulated (moved) while you are under general anaesthetic (painkilling medication that puts you to sleep).
During the procedure, your shoulder will be moved in a controlled way and stretched while you are asleep. In addition, you will usually have corticosteroid and local anaesthetic injected into your shoulder joint.
Afterwards, you will usually require physiotherapy to help maintain mobility in your shoulder.
Arthroscopic capsular release
Arthroscopic capsular release is an alternative procedure to manipulation. It is a keyhole or non-invasive surgery. The Shoulder specialist will carry out the procedure after making a small incision that is less than 1 cm (0.4in) long.
The surgeon will use a special probe to open up your contracted shoulder capsule. They will then remove any bands of scar tissue that have formed in your shoulder capsule, which should greatly improve your symptoms.
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| Arthrosocpic picture of Frozen Shoulder |
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| Arthroscopic release of Tight anterior interval |
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| Arthroscopic release of inferior capsule |
Procedure details.
After documenting scapulohumeral range of motion and giving consideration to manipulation under anesthesia, the surgeon establishes a standard posterior portal and performs a diagnostic sequence. The long head of the biceps is inspected, and the rotator interval is defined by the anterior edge of the supraspinatus and the superior border of the subscapularis .
The rotator interval is typically opened up, and scar tissue is typically released from the undersurface of the subscapularis. This permits translation of the humeral head inferiorly and laterally and allows for complete release of the anterior capsule. Capsular release will then continue along the inferior capsule. The surgeon must be careful while releasing the inferior portion of the capsule, because the axillary nerve courses just inferiorly from medial to lateral in an anterior-to-posterior direction. Posterior capsular release can then be performed by placement of the camera anteriorly and by use of a posterior working portal.
Instructions after Surgery
As with manipulation, after having arthroscopic capsular release surgery you will need physiotherapy. This will help you regain a full range of movement in your shoulder joint.
The Physiotherapist will see you and inform you of excercises that should be done on a regular basis.
Driving can be resumed in a few days after surgery. Sporting activities involving significant upper body movements can be resumed after two weeks duration.
