The Shoulder Joint is a ball sitting on a socket. This is covered with a watertight layer (akin to a ball in a polyethylene bag) known as the Capsule. If the capsule shrinks, the ball cannot move freely in the socket. This is a true Frozen Shoulder, also known as Adhesive Capsulitis.
A frozen shoulder is suggested during examination when the shoulder range of motion is significantly limited, with either the patient or the examiner attempting the movement. In other conditions affecting the shoulder, the examiner can normally elicit almost complete range of movement despite some pain. Thus the single most important determinant of diagnosing a Frozen Shoulder is lack of passive range of motion especially external rotation (touching the back of the head).
Conditions associated with a Frozen Shoulder are prior injuries or long immobilization after an injury or surgery. Diabetics and post cardiac and breast surgery patients are more prone to develop this condition.
The treatment of a frozen shoulder usually requires an aggressive combination of antiinflammatory medication, injection(s) into the shoulder, and physical therapy. Without aggressive treatment, a frozen shoulder can become permanent. Physical therapy can take weeks to months for recovery, depending on the severity of the scarring of the tissues around the shoulder.Sometimes frozen shoulders are resistant to treatment. Patients with resistant frozen shoulders can be considered for release of the scar tissue by arthroscopic surgery.
Patients are admitted an evening before/morning of the surgery. The procedure involves introducing a 4mm diameter telescope through one hole (portal) and a 4mm instrument through another portal. The tight capsule is released and the scar tissue removed. The patient wakes up with a small bandage around the shoulder and is under a continous pain relieving delivery system. He is encouraged to participate in an aggressive physiotherapy programme the very next day. He is discharged from hospital a day after surgery. The two stitches are removed at two weeks.
This procedure has immediate and very good results. Patients need to pursue aggressive physiotherapy for approximately 3 weeks post operatively. Thereafter they are virtually painfree with a normal range of motion.
Manipulation of the shoulder under anesthesia is not a well recommended treatment at our centre due to the reported complications associated with this procedure such as muscle tears and fractured bones.