Frozen Shoulder

What is the shoulder?

The shoulder is a complex ball-and-socket joint that allows full movement of the arm.

It offers a wide range of motion, but also makes it vulnerable to injury.

At the shoulder, three major bones meet and create a 90-degree angle. These bones are the

Collarbone (clavicle)
The shoulder blade (scapula)
Humerus, the largest bone of the arm.

Three joints are formed from the junctions of these three bones and the sternum. These joints are the

Glenohumeral joint,
Acromioclavicular (AC) joint and
Sternoclavicular joint.

Each joint in the shoulder is surrounded by cartilage for padding, ligaments to connect the bones, muscles and tendons to attach the muscles to the bones.

What is Frozen Shoulder?

Frozen Shoulder (adhesive capsulitis), is pain, stiffness and a loss of motion in your shoulder. Shoulder pains begin slowly until there is a complete loss of motion in the shoulder.

Typically the course of frozen shoulder occurs in three different phases that last about a year. Rarely it can last up to 3 years.

Freezing stage - The patient develops a slow onset of pain. As the pain worsens, the shoulder loses motion.
Frozen stage - The patient experiences a slow improvement in pain, but the stiffness remains.
Thawing stage - the patient slowly regains full mobilisation of their shoulder as it returns to normal.

Causes of Frozen Shoulder:

Doctors aren't sure why Frozen Shoulder occurs, however it is more likely to occur in patients who recently had to immobilize their shoulder for a long period or trauma (after surgery or an arm fracture)

Other causes are:

Diabetes
Thyroid disorders
Heart Disease
Parkinson’s Disease

Frozen Shoulder symptoms

Frozen Shoulder may cause pain and sufferers have the following symptoms:

Dull Pain
Aching Pain
Pain worsens with movement
Lack of mobility

Diagnosis of Frozen Shoulder

Dr Biggs will need to diagnose the specific nature of Frozen Shoulder

Often, Frozen Shoulder can be identified during a physical exam by a medical professional. By examining the joint the cause of symptoms can be pinpointed.

Diagnostic methods include:

Consultation - During this consultation Dr Biggs will:

Take a medical history
Perform a physical examination
Assess the joint’s range of motion

Blood Test – to pinpoint the cause in undiagnosed

Arthroscopy

Imaging tests - In order to clearly understand the nature of any loss of the joint space or bone spur formation imaging scans are required:

X-rays - Dense structures, such as bone, show up clearly on x-rays. X-rays may show other problems in your shoulder, such as arthritis.
MRI - can create detailed images of both hard and soft tissues. An MRI can produce cross-sectional images of internal structures required if the diagnosis is unclear.
Ultrasound - can allow the doctor to examine the inside of your affected area in motion.

While not all of these approaches or tests are required to confirm the diagnosis, this diagnostic process will also allow Dr Biggs to review any possible risks or existing conditions that could interfere with the surgery or its outcome.

Treatment for Frozen Shoulder

Nonsurgical treatments can include:

Frozen shoulder generally improves over time, however it can take up to 3 years. If symptoms are not relieved by therapy and medication, Surgery may be required.

Non-steroidal anti-inflammatory medication
Steroid injections (hydrodistension)

Frozen Shoulder Surgery

Surgery for frozen shoulder involves cutting the tight ligaments and capsule and remove the scar tissue from the affected shoulder.

It can be performed with an arthroscope or with an open technique (larger incision). The primary advantage of arthroscopic technique is a shorter recovery time.

Minimally Invasive Shoulder Surgery

Frozen Shoulder surgery can now be performed arthroscopically, depending on the patient’s particular situation, with much smaller incisions.

Two or three small incisions(portals) are made. Each incision is called a portal.

In one portal, the arthroscope is inserted to view the shoulder joint. Along with the arthroscope, a sterile solution is pumped to the joint which expands the shoulder joint, giving the surgeon a clear view and room to work.

With the images from the arthroscope as a guide, the surgeon can look for any pathology or anomaly. The large image on the television screen allows the surgeon to see the joint directly and to determine the extent of the injuries, and then perform the particular surgical procedure, if necessary.

This may involve repairing a tear in the labrum as well as tightening the capsule and ligaments.

After stabilising the shoulder, the portals (incisions) are closed by suturing or by tape.

Untreated Frozen Shoulder

Frozen Shoulder is not life threatening but can severely impact a patient’s quality of life and function.

It can affect anyone: elite athletes and the active individual, manual labourers and office workers.

Shoulder Impingement can lead to

Short Term Impact – lack or arm mobility
Long Term Impact – continued arm mobility and recurring instances of Frozen Shoulder

Frozen Shoulder Surgery Risks

As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.

It is important that the patient is informed of these risks before the surgery takes place.

Complications can be medical (general) or specific to surgery.

Medical complications include those of the anaesthetic and your general well being. Almost any medical condition can occur so this list is not complete. Complications include:

Allergic reactions to medications
Blood loss requiring transfusion with its low risk of disease transmission
Heart attacks, strokes, kidney failure, pneumonia, bladder infections.
Complications from nerve blocks such as infection or nerve damage.

Serious medical problems can lead to ongoing health concerns, prolonged hospitalisation or rarely death.

Specific complications for surgery are rare but may include:

Infection - Infections can occur superficially at the incision or in the joint space of the shoulder, a more serious infection. Infection rates vary; if it occurs it can be treated with antibiotics but may require further surgery.

Shoulder Stiffness - Shoulder stiffness with loss of range of motion is a common complication that can be greatly minimized with strict adherence to your occupational therapy program prescribed by your surgeon.

Damage to nerves of Blood Vessels - Also rare but can lead to weakness or loss of sensation in part of the arm. Damage to blood vessels may require further surgery if bleeding is ongoing.

Damage to the joint - Joint damage to the cartilage or other structures can occur during surgery and may require another operation to repair.

Blood Clots (Deep Venous Thrombosis) - Blood Clots can form in the arm muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If the patient suffers arm pain, redness or swelling, or have shortness of breath at any stage, contact Dr Biggs

Surgery Preparation

Once Dr Biggs decides that surgery is required, preparation is necessary to achieve the best results and a quick, problem free recovery.

Preparing mentally and physically for surgery is an important step toward a successful result.

Dr Biggs will create a treatment plan and
patients will also need to understand the process and their role in it

Participating and completing a tailored exercise program before (ie. pre-hab) with a trained physiotherapist will achieve the best result after surgery.

Dr Biggs will also need to:

Discuss any medications being taken with your doctor or physician to see which ones should be stopped before surgery
Do not eat or drink anything, including water, for 6 hours before surgery
Stop taking aspirin, warfarin, anti-inflammatory medications or drugs that increase the risk of bleeding one week before surgery to minimise bleeding
Review blood replacement options (including banking blood) with your doctor
Stop or cut down smoking to reduce your surgery risks and improve your recovery

Post Surgery

The patient will wake up in the recovery room and then be transferred back to their hospital room.

Pain medication will be provided to keep the patient comfortable.
A bandage will be around the operated shoulder and the arm will be in a sling or brace.
The sling will be worn for about 4-6 weeks to facilitate healing.

Dr Biggs will see the patient prior to discharge and explain the findings of the operation and what was done during Surgery.

The bandage will usually be removed 48 hours post surgery and place dressings provided by your surgeon over the area.
It is normal for the shoulder to swell after the surgery.Placing Ice-Packs on the shoulder will help to reduce swelling. Ice packs should be applied to the area for 20 min 3-4 times a day until swelling has reduced.

The patient should keep a pillow under their elbow while lying in bed.

The patient will not be allowed to lift anything over your head or anything greater than 1 kilo for the first 6 weeks.
7-10 days after surgery Dr Biggs will see the patient to monitor their progress and remove the sutures.

It is recommended that the patient not drive during the first 6 weeks while wearing a sling due to safety reasons and the risk of injury to the surgical site.

The patient will be given specific instructions regarding activity and a rehabilitation program of exercise and strengthening.

Eating a healthy diet and not smoking will promote healing.

Frozen Shoulder - Patient Info Handouts