What is frozen shoulder Frozen shoulder also known as adhesive capsulitis is a condition which can lead to stiffness and pain in the shoulder It is characterised by a progressive restriction of both active and passive shoulder movement typically affects people aged between 4060 years ID: 909569
Download Presentation The PPT/PDF document "Frozen shoulder / Adhesive capsulitis op..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Frozen shoulder / Adhesive capsulitis option grid
What
is frozen shoulder
Frozen shoulder, also known as adhesive capsulitis, is a condition which can lead to stiffness and pain in the shoulder. It is characterised by a progressive restriction of both active and passive shoulder movement typically affects people aged between 40-60 years.
[Active movement: movement produced your own muscles; Passive movement: performed by another person, such as your healthcare professional]
What
causes it and how common is it?
The condition is thought to be the result of inflammation and swelling in the lining of the shoulder joint (capsule) and its associated ligaments, with resultant contracture of the shoulder joint capsule.
Frozen Shoulder affects 2% to 5% of people during their lifetime, occurring most commonly in people between 40 and 60 years of age. Females are more
commonly affected than men.
Primary frozen shoulder occurs
with
no specific reason.
Secondary frozen shoulder is associated with number of risk factors, such as trauma, rotator cuff disease, heart disease, stroke causing hemiparesis/ hemiplegia, diabetes, thyroid disease and previous shoulder surgery. Previous history of frozen shoulder is a major risk factor for subsequent return of the disease in the contralateral shoulder. About 20% to 30% of women with existing adhesive capsulitis will be affected in the contralateral shoulder.
How long does this take to improve?
Adhesive capsulitis is a self-limiting condition. The vast majority of the people
suffer with frozen shoulder
will make a full recovery, usually within 18 to 24 months, which can be frustrating for patients. Patients with diabetes can take longer to recover.
What are the signs and symptoms?
Frozen shoulder progresses through three phases with variable signs and symptoms:
Painful phase
(lasts 2-9 months): Worsening upper arm pain (deltoid muscle), especially at night. Reduced movement
in shoulder joint due to stiffness.
Freezing phase
(lasts 4-12 months): The pain becomes less severe but is present at the end range
of your shoulder
movement. Stiffness remains and there is reduction in the range of shoulder movements. Daily activities such as putting on a jacket or combing your hair can becomes limited.
Thawing phase
(lasts 12-42 months)- Gradual improvement in range of movement with less stiffness and improvement in pain. End range pain may persist until full resolution.
How is frozen shoulder diagnosed?
Do I need an
x-ray or scan?
The history and physical examination, conducted by your healthcare professional, are sufficient to diagnose a frozen shoulder. During the clinical examination, the clinician will take a thorough history, consider the risk factors, assess your active and passive range of movement (especially rotations) and may have a feel of the shoulder.
X-rays are not, routinely, necessary and if performed, the shoulder joint usually appears normal. The NICE guidelines do not recommend Ultrasound or MRI scans, in the diagnosis of a frozen shoulder
What are my treatment options?
Frozen shoulder management
aimed at reducing the pain and stiffness to improve activities of daily living.
Usually a step-up approach is followed, starting with non-invasive treatments, and moving on to invasive ones, if required.
The severity of your symptoms and its impact on your daily activities including work or leisure would
help to decide on the treatment options
.
This aid is to help you and your healthcare professional decide what treatment options you have and together make a decision that is best for you.
Slide2What are my treatment
options?
What does this treatment involve?
How effective are they?
What are the advantages?
Are
there any side effects or complication?
Self-care / Guided self-management
Education: learning more about frozen shoulder helps
you to understand the nature of this condition and reduce anxiety
Simple basic exercises- to maintain movement
Activity modification: avoid activities that increases your pain
Using hot
or cold packs for 10-15 minutes
At night, supporting the arm with pillows (to prevent rolling onto the affected shoulder)
There is
good evidence that learning more about your problems helps with improving pain and function.
Self-management had good evidence to support the use.
You can administer at your convenience
Active
control on the management options
No side effects
No limitation on the number of times that can be used
None
Pain
medications
(ibuprofen,
paracetamol, co-
codamol
, etc.
Pain killers as advised, by your GP or pharmacist- may include paracetamol (regular more effective than ‘as required’), oral non-steroidal anti-inflammatory drugs (NSAIDs) (for example, ibuprofen) or codeine based painkillers.
Painkillers/NSAIDs can be useful in the initial painful stage in providing symptomatic relief.
Faster pain
relief
Side
effects associated with each pain killers that is variable from gastritis, dizziness, constipation etc. Please see the individual medicine related leaflet for more side effects.
Manual therapy
Manipulation of joint or soft tissues around your shoulder
Low evidence
Effective when combined with exercises
Helpful
to improve shoulder movement
Soreness after manual therapy
Physiotherapy
This
involves doing a through assessment of your shoulder to establish a diagnosis and provide e
ducation about the problem you
have
and advice of specific
exercises, activity modification
or provide joint, soft tissue
manual therapy.
Good evidence
Recommended to all patients who fail to improve with self-care
No side-effects
Specialist personalised advise
Increase
in pain post exercises if exercises are done incorrectly
Soreness after manual therapy
Corticosteroid injection
Injecting corticosteroids or cortisone
into your shoulder joint.
Corticosteroid is a strong anti-inflammatory and helps to reduce
pain
Steroid injections are very effective if they are done during the early stages of frozen shoulder
Also shown
effective
if there is no progress with conservative treatment
Offers
faster pain relief and improves sleep
Pain relief
allows you to do the exercises that improves your shoulder movement and function
Increase in blood sugar in a person with diabetes
Risk of anaphylaxis
Risk of infection
Post-injection pain or flare up
Manipulation
under anaesthesia (MUA)
While your
are under general anaesthesia, s
houlder
joint is forcefully
moved through full range of motion which causes the capsule stretch
No
effective and has limited evidence
Not recommended
No specific advantage
Possible fracture of
your arm bone
Damage to your rotator cuff tendons
Arthroscopic capsular release (Surgical release)
Capsular release involves cutting and removing part of the thickened, swollen inflamed shoulder joint lining
tissue and part of the ligaments.
Limited evidence to support the use
Recommended in specific cases
Improved mobility and
function in cases that doesn’t improve with all the other treatments.
Increase pain & stiffness
Bleeding,
nerve damage
Infection