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Frozen Shoulder and Physiotherapy

Frozen shoulder is the condition of pain and stiffness in the shoulder joint accompanied by loss of motion. An inflammation in or around the shoulder may trigger the body’s normal defensive response of stiffness. When the shoulder becomes stiff, it becomes too painful too move. Someone with frozen shoulder may not be able to reach above and over the head or touch the back.

While there is no definite cause of frozen shoulder, over 90 percent of patients experience full recovery. Doctors recommend physical therapy for frozen shoulder as the best treatment.

Physical therapy for frozen shoulder starts with reducing the pain and stiffness of the shoulder and increasing blood circulation through heat. One effective way of the heating method is taking a 10-minute hot shower or bath. Alternatively, the physical therapist may apply heat to your shoulder locally with the use of heating pads, wraps or towels. Hot water bottles and heat creams and ointments may also be used.

Shoulder massage is also a good way to start physical therapy for frozen shoulder as it increases the flow of blood and oxygen into the area. Once pain is reduced either through heating or through massage, the therapist proceeds with a series of physical therapy exercises.

In physical therapy for frozen shoulder, you will first perform weight and non-weight stretching exercises to improve the flexibility of your shoulder joint. The common exercises include arm swing with weights, arm raise, overhead stretch, stretching your arms across your body, and towel stretch.

It is important to note that during these stretching exercises, you should feel tension but you should not overstretch your shoulder to the point where you feel pain or severe discomfort. These exercises are done once or twice daily until the shoulder restores its normal range of movement.

Your doctor will advise you should you need to perform other exercises to tone and strengthen your shoulder muscles such as rotation exercises. Remember not to force movement in your shoulder. This does not mean you should not move it at all but instead to limit activities that may further injure your shoulder.

If physical therapy for frozen shoulder does not work for you, your doctor may recommend surgical treatment. The good news is physical therapy for frozen shoulder is usually enough for patients to get effective results that improve with time. If you have frozen shoulder, consult a physical therapist and get the treatment that you need.

Manipulation under Anaesthesia (MUA) for Frozen Shoulder

The main indication for manipulation under anesthesia is primary idiopathic frozen shoulder. It is important to distinguish between this and post-traumatic stiffness, which does not usually respond well to manipulation. The ideal time for manipulation of the frozen shoulder is at the stage when night pain is decreasing but the stiffness has reached a maximum. Physiotherapy at this stage usually makes the shoulder more painful but is of course invaluable immediately after the manipulation and possible injection.

Technique

The patient lies supine under general anesthesia with the head resting on a head ring, and if the patient is being manipulated on a trolley, the stretcher pole is removed from the affected side. The surgeon should stand at the head end of the table with one hand stabilizing the scapula in the resting position. The surgeon’s other hand should then be placed in the patient’s axilla such that the surgeon’s forearm is resting against the whole of the inside of the patient’s arm.

First, abduction is taken to the patient’s free limit, and then the patient is forcibly abducted while the scapula is maintained down in the anatomic position. The scapula must not move at any stage. This maneuver will rupture the inferior capsule. The shoulder is then forcibly adducted such that the affected elbow is pushed in front of the patient’s chin to rupture the posterior capsule. Finally, forcible external rotation and internal rotation are added, but great care is taken here because it is during these final rotation maneuvers that a spiral fracture can be caused.

Postoperative Management

For the first few days, daily physiotherapy (possible home physiotherapy) is encouraged, and a home exercise program is begun whereby the patient is asked to put the shoulder through the maximum range of movements, stretching to extremes at least three times a day. The patient should have been prewarned that this may be a very uncomfortable procedure. Majority of patients undergo physiotherapy as outpatients.

Although the shoulder may have been manipulated through a full range of movements under anesthesia, this is rarely gained immediately after recovery and it takes several weeks to regain the full range of motion. Recovery from this procedure can be extremely variable. However, if the shoulder gives with one definite snap during the manipulation, then a good result is usually achieved quite quickly.

CURE YOUR FROZEN SHOULDER TODAY. CALL (65) 64712744 OR SMS TO (65) 92357641 FOR APPOINTMENT