Frozen Shoulder

Frozen Shoulder
January 28, 2016

After more than 6000 successful surgeries in the hand and upper extremity field, Dr. Vikas Gupta says, “we suspect frozen shoulder only after our physical examinations reveal limited active and passive shoulder movement in a patient but to rule out other possibilities too we run certain tests on the patient as frozen shoulder affects only 2% of the population. It could just be a broken bone or arthritis”

The patient should immediately consult our medical team >> click here for appointment

adhesive-capsulitis-edited--300x230Frozen shoulder (adhesive capsulitis) is a disorder marked by pain and loss of motion or stiffness in the shoulder. The tissues around the joint stiffen, scar tissue forms, and shoulder movements become difficult and painful.

Simply put by Dr. Vikas Gupta, the current Head, Shoulder and Hand Division, MAX Saket & Gurgaon, former  Director of the department ‘The Hand & Upper Extremity Surgery’ The Medanta Institute of Bone & Joint Disease, Gurgaon, “Though causes of frozen shoulder have still not been fully comprehended yet patients with diabetes, thyroid problems, heart disease or stroke, parkinson’s disease or patients with previous history of shoulder or arm surgery or fracture are more likely to suffer from it and is a condition that commonly occurs in people between 40 to 60 years of age. Women tend to suffer with frozen shoulder more than men.”

You should consult an orthopedic if you think you have a frozen shoulder, or if you have persistent shoulder pain that limits your movement.

The patient should immediately consult our medical team >> click here for appointment

With Dr. Vikas Gupta being an eminent presence at various conferences and workshops to present lectures/ papers, some complex cases who have been treated by him believe he is one of the most efficient surgeons in this field in India today.

Talking about treatment options and techniques Dr. Gupta stresses, “Initially we dwell on certain gentle, progressive range-of-motion exercises, stretching and advising the patient to use their shoulder more and also prescribe pain-relieving and anti- inflammatory drugs or injections to reduce the pain and inflammation depending on the severity of the problem.”

Surgery for frozen shoulder is usually considered only after a concerted effort at all other conservative treatments have failed. Usually two surgeries are performed. One is called manipulation under anesthesia where you are put to sleep and then your arm is moved into positions that stretch the tight tissue. In the other surgery we use an arthroscope to cut through tight tissues and scar tissue. These surgeries can both be done at the same time. Most patients have good outcomes with these procedures.”

An experience holder of 25 years in this field Dr. Gupta strictly emphasizes on the skill and expertise of the surgeon that performs the surgery to avoid complications.

FAQ – Frozen Shoulder

When there is extreme pain and stiffness in your shoulder due to which the movements of your shoulder become limited or restricted, it is termed as frozen shoulder medically also known as Adhesive Capsulitis.

It is still not fully understood why we develop frozen shoulder but for some reason, the shoulder joint becomes stiff and the capsule that surrounds the shoulder becomes contracted. This contraction of the capsule and the formation of adhesions cause movement to become painful. Still, people who have a higher likelihood of developing frozen shoulder are:

  • Being over 40 years of age
  • Being a woman
  • Immobility of recovery from a recent shoulder surgery or arm fracture may cause the shoulder capsule to stiffen
  • Patients with diabetes or thyroid problems
  • Patients with systemic conditions such as heart disease or  parkinson’s disease (progressive disorder of the nervous system that affects movement)
Severe pain and persistent stiffness in the shoulder joint are two main symptoms which signify a frozen shoulder. It becomes painful and difficult to carry out full range of normal shoulder movements and everyday tasks such as- bathing, dressing, driving, combing your hair, reaching for your back pocket or sleeping comfortably also start becoming affected.
Symptoms vary from mild to severe, where it may not be possible to move your shoulder at all. There are three separate stages to the condition but sometimes these stages may be difficult to distinguish and the symptoms may also vary greatly from person to person.
 
STAGE1/ FREEZING STAGE: your shoulder starts to ache and it becomes very painful when reaching out for things. The pain often worsens at night when you lie on the affected side. 
 
STAGE 2 / FROZEN STAGE: your shoulder may become increasingly stiff but the pain usually does not become worse, rather it may even decrease. 
 
STAGE 3 / THAWING STAGE: you will gradually regain some movement in your shoulder during this stage and will be able to carry out more tasks. The pain in spite of decreasing may come back occasionally to make the shoulder stiff.
When you have pain, stiffness and difficulty in moving your shoulder, your surgeon will run certain tests on you to determine that the problem indeed is of frozen shoulder. Besides physical examination of your active and passive range of movement of shoulder the surgeon will also have an X-Ray or an MRI done to rule out other probabilities.

Mostly, shoulder treatment involves controlling shoulder pain and getting back as much range of motion in the shoulder as possible. To enable this, your orthopedic might go in for certain techniques of treatment whichever is best applicable to your condition.

MEDICATIONS: your doctor may prescribe stronger pain-relieving and anti-inflammatory drugs toreduce the pain and inflammation if over the counter pain relievers do not work.

PHYSIOTHERAPY: your orthopedic may suggest psychotherapy exercises to help improve your rangeof motion in the shoulder.

INJECTIONS: Sometimes your orthopedic might inject corticosteroids into your shoulder joint to help decrease the pain in the shoulder.

JOINT DISTENSION: Another technique is to try and make the joint move easily by injecting sterile water and make the tissue stretch.

SHOULDER MANIPULATION: In this procedure your orthopedic will give you general anesthetic to make you unconscious and feel no pain. Then he/she will move your shoulder joint in differentdirections, to help loosen the tightened tissue.

SURGERY: If nothing else has helped, your doctor may recommend surgery to remove scar tissue and adhesions from inside your shoulder joint. It is usually performed with light, tube like instruments which are inserted through small incisions around your joint also known as arthroscopy.

With time pain will significantly ease and partial range of motion may be regained though it is difficult to ascertain when this might occur.
Generally the success rate is good except when the patient might be suffering from acute diabetes where it becomes relatively less successful. Complications are unpredictable but fracture of the upper arm may occur after surgery, infection of the wound is possible or very rarely the surgery might cause damage to the blood vessel or nerve.
Returning to normal activities depends on many factors including the expertise and skill of the surgeon who has performed the surgery. Generally desk work can be started by 2-3 weeks of the operation and manual work only after 4-5 weeks. Driving usually is permissible after 7-10 days of the surgery though it needs to be short.
Posted in Condition & Treatments by admin