Frozen shoulder

Reinfried Haule

1. FROZEN SHOULDER ADHESIVE CAPSULITIS BY REINFRIED D. HAULE

2. Learning objectives ANATOMY OF THE SHOULDER DEFINITION EPIDERMIOLOGY ETIOLOGY STAGES PATHOLOGY DIAGNOSIS MANAGEMENT COMPLICATIONS

3. ANATOMY

4. Anatomy……… Types of movement occurring at the shoulder joint includes

5. FROZEN SHOULDER DEFINITION Refers to an inflammation condition of the shoulder presented by pain and reduced range of motion of the shoulder A patient also presents with stiffness of the shoulder that progresses overtime leading to loss of motion at all plains Characterized by progressive pain and stiffness which usually resolves spontaneously after 18 months.

6. epidemiology Affects 2% to 5% of the total world population Its more common between the age of 40-65 More in women than in Men Bilateral involvement occurs in 10 to 40 % of cases Does not usually recur in the same shoulder 70% of the cases are women

7. etiology The causes of this condition is classified into primary and secondary Primary –idiopathic that is no clear cause Secondary – involves; -immobilization -diabetic mellitus -hypo and hyperthyroidism -autoimmune conditions -trauma (including surgeries) -history of cervical disc diseases -advanced age

8. Stages of frozen shoulder Freezing (pain) Frozen (stiffness) Thawing (reduction)

9. Freezing (pain) phase This takes place from (2-9 months) There is an insidious onset of pain with progressive loss of motion its characterized by synovitis that progresses to capsular thickening (particularly in the anterior and inferior portions of the capsule) with an associated reduction in synovial fluid.

10. Frozen (stiffness/adhesive) phase Last between (4-12) months fibrosis of the capsule is more pronounced, and thickening of the rotator cuff tendons is common. There is pain with progressive loss of motion and muscle atrophy

11. Thawing (resolution) phase Takes place in about (6-9months) There is pain resolution and complete range of motion is gradually attained after 1-3 yrs

12. Every joint is covered by a capsule that is made up with a lining known as a synovium. Inflammation of the synovium (synovitis) is the initial cause of pain. Fibrosis, in the process of tissue repair brings about the reduced range of motion The pathology

13. diagnosis This condition is a clinical diagnosis that is diagnosed through Clinical presentation Physical examination

14. Clinical presentation Gradual onset of progressive pain Pain worsens during night (awakens from sleep)especially when lying towards the affected shoulder) Reduced range of motion in all planes Difficulties with activities of daily living such as tucking in shirt, fastening a bra, combing hair Complaints of neck pain and pain down the arm (pain put stress to the neck)

15. Physical examination Measurable reduction in both passive and active range of motion External rotation is marked restricted Abduction is restricted Flexion and internal rotation are slightly limited

16. investigations Bloods works tumor markers, cell blood count, blood glucose Radiology plain x-ray- , MRI

17. Treatment modality Physical therapy and heating Manipulation under anaesthesia (70% cases respond well) Steroids injection Anti inflammatory e.g. NSAIDS Diabetic control e.g use of insulin

18. Physical therapyand heating The capsule must be heated using ultrasonic modalities through the joints Physical exercise to stimulate motion such as pendulum, shoulder wheel and pulley exercises Pendulum exercise Shoulder wheel exercise Pulley exercise

19. surgical If no improvements after 4 months of conservative treatment then; Orthoscopic procedure (cutting the capsule internally) should be done followed by immediate physiotherapy after wound healing It’s a successful procedure in most cases

20. complications Persistent stiffness and pain despite therapy Loss of functional use of the upper extremity If forceful manipulation, the joints can dislocate or there can be neurovascular injury

21. THANKS