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Frozen shoulder

adhesive capsulitis
by

chathchai pookarnjanamorakot

on 10 January 2013

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Transcript of Frozen shoulder

Chathchai Pookarnjanamorakot Frozen shoulder Codman in 1934 Epidemiology "frozen shoulder" prevalence 2% in the general population
- older > 40 years
- 70% are woman
- Diabetic type I ~ 11%
- no racial predilection Griggs et al, JBJS 82A; 2000 Pathology "the process of the immunomodulated, as they found a chronic inflammatory response with fibroblastic proliferation" Aetiology To date is unknown Clinical picture Codman's diagnostic criteria (1934)
- shoulder pain with slow onset
- pain felt in deltoid insertion
- inability to sleep on affected side
- atrophy of supra or infra spinatus
- sometimes minimal local tenderness
- restriction of active and passive ROM
- painful and restricted; elev & Ext rotation Natural history In 1987 Neviaser and Neviaser described 4 stages - Pain
- global restriction of movement
- limited passive external rotation The female patients who do not have an intrinsic emotional, psychological or personality disorder can overcome adhesive capsulitis better than those who do. Hand et al. JBJS 89; 2007 Secondary Extrinsic Intrinsic Systemic - Diabetes
- Hypothyroid
- Hyperthyroid
- Hypoadrenal - Cardio pulmonary
- Cervical spine
- Stroke
- Parkinson's
- Humerus fracture - Rotator cuff
- Biceps tendinitis
- Calcific tendinitis
- AC joint stage 1 stage 4 pain with active and passive ROM
present less than 10 weeks
intra-articular injection gives significant improvement in range of motion stage 2 chronic nagging pain over 10 -36 weeks Occurs at 4 -12 months
almost no ext rotation Stage 3 Occurs usually from 12 to 42 months Patient education Conservative Physiotherapy Aggressive treatment Patient education
Non-surgical treatment
Surgery to reduce frustration and encourage compliance
there is no consensus on a standard management protocol Lubiecki et al. J Orthop Surg 2007 Medication no randomized, controlled study to confirmed the effectiveness of NSAIDs Intra-articular steroids IA injecton has better pain relief than physiotherapy,
analgesics or placebo "Buchbinder R et al. Ann Rheum Dis 2004; 63: 1460-9" IA steroids combined with PT were more effective in impoving shoulder ROM than when each of these was used individual "Carette et al. Intra-articular steroids, physiotherapy or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo controlled trial. Arth Rheum 2003; 48: 829-38" A combination of steroids(Triamcinolone) and distension had the same outcome at two years as manipulation under anaesthesia Jacobs et al. Manipulation or intra-articular steroid in the management of adhesive capsulitis of the shoulder? A prospective randomized trial. J Shoulder Elbow Surg 2009; 18: 348-53 Intra-articular steroid injections provide similar outcomes when compared to manipulation and arthroscopic arthrolysis De Carli A, et al. Shoulder adhesive capsulitis: manipulation and arthroscopic arthrolysis or intra-articular steroid injections?. Int Orthop. 2012; 36(1): 101-6 Intra-articular corticosteroid injections significantly improve short term pain, function and range of motion and are safe for use in diabetic patients with idiopathic adhesive capsulitis of the shoulder Roh et al. Intra-articular corticosteroid injection in diabetic patients with adhesive capsulitis: a randomized controlled trial. Knee Surg Sports Traumtol Arthrosc. 2012; 20(10): 1947-52 Hydrodylation suggested as an outpatient procedure IA injection of a large amount of normal saline 1st by Andren and Lundberg in 1965 Patients who were treated with hydrodilatation had significantly better VAS pain and Constant scores than manipulation under anaesthesia Quraishi NA, et al. Thawing the frozen shoulder: A randomized trial comparing manipulation under anaesthesia with hydrodilatation. J Bone Joint Surg Br. 2007; 89B: 1197-200 Einar Kristian Tveita, RanaTariq, Solve Sesseng, Niels Gunnar Juel. Hydrodilatation, corticosteroids and adhesive capsulitis: A randomized controlled trial. BMC Musculoskelet Disord. 2008 Apr 19;9 :53 stage 1: Dilatation combined with steroid injections equivalent to steroid in adhesive capsulitis interrupting the cycle of inflammation
using modalities that can relieve the pain
educating the activity modification stage 2: stretch the capsule
pain control Diercks RL, Stevens M. Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy patients with frozen shoulder syndrome folowed up or two years. J Shoulder Elow Surg 2004: 13:499-502 MUA: manipulation under anaesthesia
Open capsular release
Arthroscopic capsular release MUA DuPlay in 1872 indicated when the functional disability persists 4 - 6 wks
Kessel et al (1981) > 6 months the arthroscopic examination should be performed before a closed manipulation Anderson NH, Sojdbjerg JO, et al. Frozen shoulder: arthroscopy and manipulation under general anaesthesia and early passive mobilization. J Shoulder Elbow Surg 1998; 7 : 218-22
Sheridan MA, Hannafin JA. Upper extremity: emphasis on frozen shoulder. Orthop Clin V Am 2006; 37: 531-9 Comparable outcomes with manipulation or home exercise for treatment of frozen shoulder Kivimaki J et al. Manipulation under anaesthesia with home exercise versus home exercise alone in the treatment of frozen shoulder: A randomized, controlled trial with 125 patients. J Shoulder Elbow Surg 2007; 16 : 722-26 Contraindications to manipulation under anaesthesia Significant osteopenia
Recent soft-tissue repair in shoulder
Presence of a fracture
Neurological injury Open capsular release Arthroscopic capsular release Surgery OPEN ASK aim to release the coracohumeral lig.
Ozaki showes 94% improvement
Testo due to post-op limitation limited for cases that are not ideal for arthroscopic release Advantage:
evaluation of both space
synovectomy in stage 2
precise and complete release of the capsule
min. post-op pain
post-op rahab start immediately RISKS recurrent stiffness
ant. shoulder dislocation
axillary nerve palsy The management options: stage 1. IA steroid + PT
stage 2. IA steroid + ASK released
stage 3. ASK released
stage 4. monitoring & progress active PT
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