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Management of shoulder stiffness
This document discusses the management of shoulder stiffness from various causes such as adhesive capsulitis and postoperative stiffness. Adhesive capsulitis is characterized by fibroblastic proliferation in the shoulder capsule similar to Dupuytren's contracture. Risk factors include diabetes. Non-operative management includes physiotherapy, steroid injections, hydrodilation, and nerve blocks, with hydrodilation providing relief in 75% of cases. For postoperative stiffness, the majority can be treated non-operatively but some may require manipulation under anesthesia or arthroscopic capsular release. Post-operative physical therapy is important for recovery.
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Management of shoulder stiffness
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- 3. Causes of Stiffness •Adhesive Capsulitis • Post-op Stiffness • Other causes • Arthritis • Inflammatory • Traumatic, pain inhibition, • Claims, PPI ....
- 4. Adhesive capsulitis • Pathology •Similar to Dupuytren’s • Fibroblastic proliferation • Etiology • ?infective • ?inflammatory • ?autoimmune
- 5. Associations • Diabetes...get BloodSugar levels • Dupuytren’s contracture
- 6. Natural history • 3Classic phases • Freezing • Frozen • Thawing Duration: Is it always18 -24months?
- 7. Presentation • The Story •The examination • One single screening test
- 8. Investigations • XRAYS • Thisis a clinical diagnosis
- 9. Differentials • Sudden onsetsevere pain • Adhesive capsulitis • Calcific tendonitis • PT syndrome • Loss of ER • Adhesive capsulitis • OA • Locked Post dislocation
- 10. Post op Stiffness •Is it Common?
- 11. Prevalence • 234 Arthroscopies •37% stiff at 3 months • 6% stiff at 6 months • 4% Stiff at 9 months • 3% stiff at 1 year Puneet Monga, Holly N. Raghallaigh, Lennard Funk. Stiffness after arthroscopic shoulder surgery: incidence, management and classification. Shoulder & Elbow. Volume 4(3), 169–173, July 2012
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- 13. Management • 4 neededactive intervention • 2 hydrodilatation • 2 capsular release
- 14. Residual Stiffness • Osteoarthriticwashouts: 3 • Cuff repairs: 2 • ASD &Debridement of partial cuff T: 1
- 15. Recovery Overall pattern ofregaining ROM over time (All Patients). Percentage of patients still having persistent stiffness versus time (months postop)
- 16. Minor Stiffness Recovery patternfor Grade 1 Stiffness over time. Percentage of grade 1 stiffness patients still recovering versus time (months post-op)
- 17. Severe Stiffness Recovery patternfor Grade 2/3 Stiffness over time. Percentage of grade 2/3 stiffness patients still recovering versus time (months post-op)
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- 19. Physiotherapy in themanagement of Adhesive Capsulitis
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- 21. Non operative mgx •Steroid: good for Pain not ROM • Hydrodilation: moderate ST relief • Oral steroids: short term moderate effect • SS nerve block: Pain relief Tashjian RZ. The effectiveness of nonoperative treatment for frozen shoulder: a systematic review. Clin J Sport Med. 2012 Mar;22(2):168-9.
- 22. Hydrodilatation • 75% referredpatients avoided surgery Temperley, Augustine. Departmental Audit W’ton Hospital. 2013
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- 24. Operative treatment • 89.5%can be treated non-operatively • 10% pts’ needed release at 12 months from the onset of symptoms Levine WN, Kashyap CP, Bak SF, Ahmad CS, Blaine TA, Bigliani LU. Nonoperative management of idiopathic adhesive capsulitis.J Shoulder Elbow Surg. 2007 Sep-Oct;16(5):569-73.
- 25. Options for a Surgeon •MUA • Arthroscopic Release
- 26. MUA Principle The Codman’s Paradox Imagecourtesy: orthop.washington.edu
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- 30. Post op Management •On the day • First review • Post-op Therapy