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Sunday, 19/11/17 02:25:05 (GMT+7)
Surgery Information
Shoulder stiffness treatment

Shoulder stiffness or "frozen shoulder" is very common and caused by many pathologies. Arthrscopic release is one of the most effective treatment option for this problem .

Frozen shoulder


The aim of management of frozen shoulder is to reduce the pain and expedite recovery of
maximal range of movement.


Post-traumatic stiffness
Post-traumatic stiffness following shoulder trauma or surgery will often resolve. The
general rule is to wait at least 12 months following the trauma. If there is residual stiffness,
it can usually be addressed by arthroscopic release, generally with good results.


Idiopathic adhesive capsulitis
Adhesive capsulitis is not necessarily a self limiting condition. Four independent groups
of researchers concluded that between 40–60% of patients with adhesive capsulitis
end up having residual objective restriction of movement after maximal recovery.


Nonoperative treatments
There is no evidence to support a beneficial role of the physical therapy modalities of short wave diathermy, ultrasonic therapy, gentle traction, pressure over sensitive points, or massage for adhesive capsulitis. In the early stages, analgesics, nonsteroidal anti-inflammatory drugs, heat, and cortisone injections into the glenohumeral joint or the biceps tendon and ice therapy may provide marginal improvement in pain but only little or no improvement in shoulder motion. A higher dose of glenohumeral steroid injection is better in terms of pain relief than a lower dose. Suprascapular and inter-scalene block of the brachial plexus with local anaesthetics have been shown to provide transient pain relief. Joint distension (hydrodilation) with sterile saline solution and 1% lidocaine with 1 mL of betamethasone sodium phosphate has been shown to significantly lower analgesic usage and
improve shoulder movement.

Manipulation under anaesthesia
The outcomes of manipulation under anaesthesia– to restore the range of movement and the pattern of recurrence – are influenced by the technique and protocol of postprocedural
physiotherapy. Manipulation with glenohumeral steroid injection and analgesia followed by intensive physiotherapy has been shown to improve range of motion. Complications of manipulation include fractures,dislocations, rotator cuff tears, brachial plexus injury, joint haemorrhage and periarticular soft tissue damage. There is an overall failure rate of 10%, and a 20% chance of residual limitation in the range of motion flowing manipulation under anaesthesia. Failure rates of manipulation are higher in diabetics. Translational manipulation, involving short amplitude high velocity thrusts at the humeral head with a short lever arm under inter-scalene block, has been reported to be a safer option.

Arthroscopic capsular release
While manipulation may help, prospective comparative studies with arthroscopic capsular release reveal patients (including diabetics) have significantly better pain relief and range of movement with an arthroscopic capsular release. Arthroscopic capsular release involves a circumferential surgical release of the capsule adjacent to the glenoid and is usually performed as a day procedure under regional anaesthesia. We have found excellent pain relief and range of motion following arthroscopic capsular release. The results depend on the finer details of the technique of release and the rehabilitation program with better outcomes associated with a more complete circumferential release and supervised early range of motion exercises at the shoulder.


Conclusion
Making the correct diagnosis when a patient presents with a stiff, painful shoulder is important as treatment varies according to the cause. Nonsurgical treatments, with the exception of hydrodilation, have had limited success in treating adhesive capsulitis. Arthroscopic capsular release can improve both pain and stiffness.

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