Frozen Shoulder

FROZEN SHOULDER

 

Frozen Shoulder (adhesive capsulitis) is a painful disorder, which can result in severe loss of movement. The causes are not fully understood but can be spontaneous or related to mild trauma, an underlying condition such as tendonitis. The capsule of the shoulder joint becomes inflamed,then thickens and contracts. The capsule is normally loose enough to allow the shoulder to move freely. Once it becomes contracted the joint “freezes.”

The symptoms develop slowly and can be categorised into three stages:

  1. Pain increasing with movement and sometimes worse at night. As pain movement decreases. This usually lasts between two to five months.
  2. Pain begins to reduce, but stiffness remains or increases. This stage is very variable but can last up to 3 years without treatment.
  3. The condition begins to resolve with slow restoration of movement although, without treatment , a degree of permanent residual stiffness is common.

The condition is more common in women between the ages of 35 – 70 years and there is a higher incidence in diabetics. Other medical conditions associated with Adhesive Capsulitis include Hypo or Hyper thyroidism, Parkinsons Disease, Cardiac Disease or recent cardiac surgery and Dupuytrens Contracture. This is a condition where scar tissue develops in the hand causing stiffness.

The deltoid muscle overlying the shoulder can waste away and become thin. The most noticeable symptom of a frozen shoulder is the loss of movement of external rotation is lost. Loss of this movement is an important factor causing difficulty in elevating the arm above the head or to the face as in combing the hair and eating.

Treatment Options

Frozen Shoulder will generally get better on its own. However, this takes time – often two to three years. Furthermore 80% of patients having undergone only conservative treatment have a residual, measurable, permanent loss of movement thereafter: 20% are left with a severe, restrictive loss of movement.

Conservative treatment

This combines pain relief and exercises and physiotherapy at the appropriate stage. Hydrocortizone injection into the joint cavity is an effective treatment to relieve pain and reduce stiffness. Physiotherapy should only commence once the pain has begun to settle.

Surgical Treatment

ARTHROSCOPIC CAPSULAR RELEASE

Purpose

To increase the range of motion of the shoulder ( gleno humeral joint)
Indications

Patients with a restricted range of motion from Adhesive Capsulitis
( Frozen Shoulder )

Skin Incisions

Two 4 mm portals are established, one at the front and one behind the shoulder.

Procedure

  • The joint range of movement is assesedunder anaesthetic
  • A full inspection of the shoulder joint is carried out via the arthroscopy video camera
  • The thickened (fibrotic) and tight ligaments are carefully and precisely released, as necessary, to allow a normal and full range of movement of the shoulder joint to be restored; this selective procedure avoids the risk of damage to other structures in the joint.

After your operation

  • The arm may be placed in a brace (Bradford Sling), holding your arm stretched above your head during the anaesthetic; so you wake with the arm in this position.
  • The physiotherapist will see you before you leave the hospital and move the arm for you stretching the shoulder joint into the maximum range of movement. He or she will then show you specific exercises which you must perform after you leave hospital on a daily basis at home. It is useful if a friend or elative can attend during a physiotherapy session in order to learn how to help with these exercises at home. You will also need frequent physiotherapy outpatient appointments during the firs 3 weeks after the procedure; ideally every other day during the first week.
  • The sutures will need removing at 12 days after your operation; either by your G.P’s practice or at the hospital.

MANIPULATION UNDER ANAESTHETIC
Purpose

To increase the range of motion of the shoulder ( gleno- humeral joint)

Indications

Patients with a restricted range of motion from Adhesive Capsulitis ( Frozen Shoulder )

Procedure

Under general anaesthesia the shoulder joint is manipulated into the greatest possible range of motion, thereby releasing adhesions and/or a tight fibrotic capsule ( lining of the joint)

Possible associated procedures

Arthroscopy
Arthroscopic Capsular Release
Interscalene Regional Nerve Block

Main Possible Complications

Humeral Fracture
Pain causing recurrent stiffness
After your operation

  • The arm will be placed in a brace (Bradford sling), holding your arm stretched above your head during the anaesthetic ; so you wake with your arm in this position.
  • The physiotherapist will see you before you leave the hospital and move the arm for you stretching the shoulder joint into the maximum range of movement. He or she will then show you specific exercises which you must perform after you leave hospital on a daily basis at home. It is often useful if a relative or friend can attend during a physiotherapy session in order to learn how to help with these exercises at home. You will also need frequent physiotherapy outpatient appointments during the first 3 weeks after the procedure; ideally every other day during the first week.