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Frozen shoulder dr vivek baliga review


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Consultant Internal Medicine Dr Vivek Baliga reviews a common medical problem - frozen shoulder. It is simple to treat but carries a significant morbidity if ignored. Aimed at medical students.

Published in: Health & Medicine
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Frozen shoulder dr vivek baliga review

  1. 1. Frozen Shoulder - A Review Dr Vivek Baliga Consultant Physician Baliga Diagnostics
  2. 2. What Is Frozen Shoulder? ● Also called adhesive capsulitis ● Clinical condition where the movement of the shoulder becomes restricted ● Range from mild restriction all the way to severe restriction accompanied by a great deal of pain ● First recorded case of frozen shoulder was described in 1872 by Duplay in this article on ‘periarthritis scapulohumeral’. ● The term ‘frozen shoulder’ was coined by Codman in 1934.
  3. 3. Incidence Of Frozen Shoulder ● 3 to 5% incidence of frozen shoulder in the general population. ● Those who have diabetes can have up to a 20% incidence ● One of the most common clinical conditions encountered by orthopaedic surgeons. ● Typical patient who has frozen shoulder is a woman between the age of 50 to 70 years
  4. 4. Associated Conditions ● Diabetes mellitus ● Hyperthyroidism ● Hypothyroidism ● Heart disease (cardiovascular disease) ● Tuberculosis ● Parkinson’s Disease ● Stroke - Immobility ● History of injury to the arm - tears, fractures etc.
  5. 5. Classification ● Primary Frozen Shoulder ○ Idiopathic frozen shoulder is insidious in onset ● Secondary frozen shoulder ○ Follows trauma or injury to the shoulder joint and subsequent requirement for immobilisation.
  6. 6. Clinical Stages Freezing or Painful stage ● Mild restriction of the shoulder joint ● Patients may not necessarily seek medical attention. Frozen or Transitional stage ● Pain remains constant ● Range of movement of the shoulder joint becomes limited ● Lasts between 4 to 12 months Thawing stage ● Range of movement returns to normal gradually over a 12 to 42 month period.
  7. 7. Symptoms ● Gradual onset shoulder pain ● Inability to lift the arm up beyond a certain point - abduction and external rotation becomes painful ● Discomfort localised to the area of insertion of deltoid muscle ● Inability to sleep on the affected side ● Normal shoulder x-ray
  8. 8. Diagnosis A diagnosis of frozen shoulder is often made clinically. X-rays may not necessarily be helpful. Blood tests may determine other associated conditions. There is usually no specific need for an MRI scan as a clinical diagnosis is often sufficient.
  9. 9. Treatment ● Non-Operative ● Operative
  10. 10. Non-Operative Treatment ● Non-steroidal anti-inflammatory drugs can help relieve pain to an extent and remain the first choice of treatment. ○ They do not change the natural course of the disease. ● Intra-articular corticosteroid injections ○ There may be some short-term benefit. ○ Subacromial or glenohumeral approach is considered ● Exercise Therapy ○ Aim behind exercise therapy is to prevent a further reduction in the range of movement of the shoulder joint. ○ Exercises include passive mobilisation and capsular stretching.
  11. 11. Surgical Treatment ● Surgical treatment is only recommended in those individuals who have not seen any difference in their symptoms following at least 2 months of nonsurgical therapies. ● Manipulation under anaesthesia ○ Individual is placed under anaesthesia and the shoulder joint is manipulated so as to loosen the tissues and allow full range of movement. ● Arthroscopic release and repair ○ The tightened coracohumeral ligament and contracted capsule can be loosened and released
  12. 12. Conclusion ● Frozen shoulder is a common condition that carries a significant morbidity. ● Treatments revolve around non-surgical methods in combination with steroid agents. ● However, a small number of patients will require surgical release of the shoulder capsule for complete benefit. References Uppal HS, Evans JP, Smith C. Frozen shoulder: A systematic review of therapeutic options. World Journal of Orthopedics. 2015;6(2):263-268. doi:10.5312/wjo.v6.i2.263.