This document discusses periarthritis shoulder, also known as frozen shoulder. It is characterized by significant restriction of both active and passive shoulder movements, especially external rotation, due to inflammatory changes and fibrosis in the shoulder joint capsule. It typically affects females aged 40-60 and risk factors include diabetes and thyroid dysfunction. Treatment involves physiotherapy, analgesics, and steroid injections, with manipulation under anesthesia or arthroscopic capsular release considered for cases of more severe symptoms or those that fail to improve after 4-6 months of conservative treatment.

1. Peri arthritis shoulder

2. • Peri arthritis shoulder nwas the initial term suggested by Duplay
• Also known as frozen shoulder which was coined by codman
• Also known as adhesive capsulitis coined by Neviaser which is more
precise as the name it self describes the true pathology

3. • Frozen shoulder is an idiopathic, progressive , painful condition
characterized by significant restriction of both active and passive
movements particularly external rotation.
• There may be other systemic and local factors associated like diabetes
, thyroid dysfunction , degenerative disease , tendonitis , trauma
• According to which frozen shoulder is divided into
1. Primary (idiopathic)
2. Secondary

4. Pathophysiology
Inflammatory changes involving capsule of shoulder joint
Showing fibroblastic proliferation Showing fibroblasts and myofibroblast
With increased activity of polypeptide growth factors
Causing fibrosis in joint capsule
Biopt shows – inflammatory infiltration , absence of synovial lining ,
synovial fibrosis , perivascular lymphatic reactions

5. Clinical features
• Females > males
• Age group 40-60 years
• Risk factors : diabetic, thyroid dysfunction , hyper lipidemia ,
cardiovascular disease
• Gradual onset pain for several months
• Typically referred to the deltoid and may radiat to arm and elbow
• Stiffness of shoulder joint : worsening with disease progression
• External rotation is mainly involved

6. Stages of frozen shoulder
• Phase 1 :
• Also known as freezing stage
• Characterised by pain
• Almost full range of motion
• Phase 2 :
• Also known as frozen stage
• Characterised by stiffness
• Phase 3 :
• Also known as thawing stage
• Shows slow recovery in range of motion over months to years

7. • Arthroscopic stage
• Stage 1 : pre adhesive stage : full range of motion , pain is
present
• Stage 2: adhesive capsule : painful and some restrictions of
shoulder movements
• Stage 3: maturation : less severe pain , with significantly
reduced movements
• Stage 4 : chronic : severe painless restriction of movements

8. Diagnosis
• Mainly clinical
• Impingement test to rule out rotator cuff involvement
• X-rays to rule out arthritis
• MRI shows fibrotic capsule bands inferiorly and shows synovial
thickening and rules out rotator cuff injury

9. Treatment
• Physiotherapy is the mainstay of treatment
• Conservative management
• Physiotherapy
• Analgesics
• Trans cutaneous electrical nerve stimulation
• Intra articular or oral steroids

10. • Surgical management
Criteria
• More severe symptoms during initial stage
• Younger age at the time of onset
• Failure of conservative management of 4-6 months
•
• Manipulation under anaesthesia
• Arthroscopic capsular release

11. • Manipulation under anaesthesia
• Causes rupture of inferior capsule from humerus
• Not to be done in patiens with osteopenia or recently treated fractures
• Flexion, extension, abduction,adduction, external rotation, internal rotation
• Post manipulation 20ml 0.5 % bupivacaine with corticosteroid may be injected into joint
space to reduce inflammatory changes
• Arthroscopic capsular release
• More beneficial in terms of joint inspection
• But reserved only for patiens with very severe involvement and failed prior treatments
• Anterior capsule is usually released
• In some cases anterior and posterior capsules are released
• Arthroscopic release followed by early mobilization to avoid recurrent stiffness

12. Thank-you