Shoulder and Elbow Treatments

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Frozen Shoulder

Frozen shoulder is a disabling condition, identified as shoulder pain and stiffness.

The symptoms and signs include:

Global restriction of shoulder movement with a painful arch of movement at the outset.

Limitation of external rotation and elevation, eventhough x-rays will show as normal.

The condition is classified as Primary Idiopathic Frozen Shoulder. This is identified by global limitation of glenohumeral motion, with a loss of compliance of the shoulder capsule. There is usually no specific underlying cause found for this condition.

A secondary stiff shoulder or Secondary Frozen Shoulder, presents after injury or surgery. It may also follow an accompanying condition, such as subacromial impingement or a rotator cuff tear.

The frozen shoulder has been found to be more common in association with the following conditions:

  1. Diabetes. There is a 2-4 times increased risk for diabetics of developing frozen shoulder, especially poorly controlled Insulin-dependent diabetics.
  2. Endocrine abnormalities, particularly hypothyroidism
  3. Trauma.

Diagnosis: The diagnosis of a Primary Idiopathic Frozen Shoulder is made on the basis of:

  1. Age: 40-60 years old, females more common than males
  2. Pain: The pain is of a constant nature, severe, affecting sleep, shooting pain with forceful movement.
  3. Loss of external rotation: Loss of external rotation (passive external rotation <0 degrees)

Natural History: The disease goes through 3 stages. These stages last for approximately 2 years.

Stages:

  1. Freezing phrase: This is associated with pain and loss of movement for about 3-6 months.
  2. Frozen phase: This lasts for approximately 3-6 months, with pain at extreme range of movement and marked stiffness.
  3. Thawing phase: This last for approximately 9-18 months, usually painless and the stiffness starts to gradual resolve at this stage.

Treatments: Treatment options include

  1. Nothing.
  2. Physiotherapy.
  3. Distention injections under x-ray control.
  4. Steroid injection into the joint.
  5. Manipulation under anesthetics plus steroid injection.
  6. Arthroscopic capsular release.

Non-Operative Treatment:

Physiotherapy can improve range of movement, but not necessarily pain. Jackin's exercises can be done at home. In my experience, distention of the joint with local anesthetic and steroid under x-ray control combined with physiotherapy is quite successful in the first stage of frozen shoulder. However once the second stage is reached then surgical solution is usually the treatment option.

Further Information: - Manipulation under Anaesthetic (MUA) and Arthroscopic Release for the treatment of Frozen Shoulder




If you would like treatment for Frozen Shoulder by a Hull shoulder surgeon, please complete our contact form for treatment in the Yorkshire area. Alternatively call Mr Der Tavitain's private secretary on 01482 672417.