Patient information : Dr S Vrancic
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1.Frozen shoulder syndrome:
What is a frozen shoulder?
A frozen shoulder, also known as adhesive capsulitis, is a condition which causes pain and stiffness in your shoulder. With time, the shoulder becomes very hard to move.
What causes a frozen shoulder?
The causes are not fully understood. The shoulder capsule over time thickens, and scar tissue develops which makes the shoulder very painful, and difficult to move.
What are the risk factors for a frozen shoulder?
People over 40 years of age are more likely to get a frozen shoulder. If you have diabetes, or a thyroid condition, you may be at increased risk. Recent surgery on any part of your upper body, including heart surgery may trigger a frozen shoulder. Prolonged immobilisation of the shoulder can also bring it on.
How do I know if I have a frozen shoulder?
A frozen shoulder is difficult to move in any all directions. Someone else is also unable to move your shoulder fully. The pain is a constant dull ache, which can be very severe with sudden movements. There are three stages to a frozen shoulder:
•Stage 1: Pain / Freezing:
oThe pain begins gradually, and as it increases, the shoulder begins to lose movement. This stage typically lasts between six weeks and 9 months, with an average of 6 months.
•Stage 2: Stiffness / Frozen:
oThe pain in the shoulder begins to ease slightly, but almost all movement in the shoulder becomes more difficult. Daily activities may be severely affected. This stage will overlap the Pain stage, and also typically lasts 4 to 6 months.
•Stage 3: Thawing/ Resolution:
oShoulder movements gradually return during this stage. Strength and range can take up to 2 years to return to normal.
How is a frozen shoulder treated?
There is no “cure” for a frozen shoulder, except time. There are many different options available for symptomatic relief. Simple measures such as anti-inflammatory tablets may help with the pain. Gentle exercises such as stretching can help, but may exacerbate the pain. Heat packs, hot showers or a warm swimming pool can provide some relief.
Surgery is rarely offered, and the goal of surgery is to stretch and release the stiffened joint capsule.
2. Shoulder exercises and stretching
Stage One – Passive Movement.
POSTURE: Please pay attention to your posture before commencing your exercises.
Pendulum, Circular Exercises:
Bend forward at the waist, and support yourself if needed. Gently make circular movements with your affected arm, both clockwise and anti-clockwise.
Do these exercises as often as you can.
Passive/ assisted forward elevation:
Lie down flat on a bed, without a pillow. Use your unaffected arm to lift both arms above and over your head. Bring your arms back half-way, then put them above your head again.
You may need someone to help you with this exercise initially. Make sure your arm is supported at all times. Try and relax your muscles when your arm is supported.
Repeat at least 10 times
Passive shoulder rotation:
Tuck your arm by your side, and keep your elbow bent, and place your hand on your tummy. With your elbow tucked by your side, turn your forearm so you hand now is in front of you. Return your hand to your tummy.
Repeat at least 10 times.
3. Shoulder impingement syndrome
What is “Impingement Syndrome”?
Impingement is one of the most common causes of shoulder pain. It is a result of pressure on the tendons of the shoulder (rotator cuff) from a part of the shoulder blade called the acromion. This pressure occurs every time the arm is lifted. This causes pain and “catching”, and may limit movement.
What are the risk factors for Impingement?
It is common in anyone who does a lot of repetitive, overhead activities. Pain can also occur as the result of a fall or injury to the shoulder. The pain can even start with no apparent cause.
What are the symptoms of Impingement Syndrome?
There is usually pain with overhead activities, and especially pain at night when in bed. The pain may radiate from the shoulder down the front of the arm. The pain is often more severe with sudden lifting and reaching movements. There may also be pain when lowering the arm from a high position.
Daily activities such as dressing, toileting and hair care may be affected. The arm may begin to feel weak with overhead activities, or when trying to do things behind your back.
How is impingement syndrome diagnosed?
Dr Vrancic will review your symptoms and physically examine both shoulders. An x-ray of your shoulder may show a bony spur of the acromion. An ultrasound or MRI may also be ordered to show the swelling and fluid around the shoulder tendons. These tests can also help diagnose any underlying tears in the shoulder tendons.
What non-surgical treatment options are there?
Avoiding overhead activities and resting the arm will help. A short course of anti-inflammatory medication can also help, if able to be tolerated. Dr Vrancic strongly recommends visiting a physiotherapist for a program of stretching, strengthening and postural retraining that can be continued as a home exercise program.
Dr Vrancic may also offer an injection of cortisone and local anaesthetic into the affected area to help decrease the pain and inflammation around the tendons. Non-surgical treatment may decrease the pain associated with impingement syndrome. Dr Vrancic may recommend these measures which can take 2-3 months to show an improvement.
What surgical treatments are there for Impingement Syndrome?
When non-surgical measures do not relieve the pain, Dr Vrancic may offer surgery. The goal is to remove the cause of the impingement, and make more space for the tendons of the shoulder to move. The most common technique is called a “Sub-Acromial Decompression”. This can be performed under a general anaesthetic , either through the arthroscope, or via an open incision placed on the front of the shoulder. Other problems in the shoulder such as AC joint arthritis, and rotator cuff tears may also be addressed at the time of surgery.
What can I do after surgery?
If Dr Vrancic only performs a sub-acromial decompression, then you will wake up in a sling. Movement of the affected shoulder should commence the next morning, and the sling discarded as soon as comfortable. The shoulder, elbow and hand must be moved frequently. Swelling and bruising may persist for up to two weeks.
Regular pain relief should be taken to allow you to do these movements. Regular ice-packs to the affected shoulder will also decrease your pain. Should your surgery involve a rotator cuff repair, then your rehabilitation will be different.
You should return to your physiotherapist within the first week following surgery, to help with your range of movement. It can take at least 3 months for the pain to go, and up to one year for the shoulder to feel normal again.
You are permitted to drive and return to work when your pain allows.
