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Frozen Shoulder

Frozen shoulder, also known as Adhesive Capsulitis is a very painful condition which results in stiffening of the shoulder joint.

Classically patients lose the ability to reach out for objects and report difficulty getting dressed. The pain can be extremely severe and even painkillers cannot control the pain.
It can happen after an injury, after surgery or quite often without any precipitating factors. It is commonly associated with Diabetes and many patients who come to clinic have suffered from Diabetes for a length of time.

• Severe pain in shoulder
• Marked Reduction in the range of motion
• Loss of sleep at night
• Inability to carry out normal daily activities

Stages of Disease

Frozen shoulder used to be described into 3 phases of the disease
1. Freezing – The shoulder is extremely painful and becomes progressively more painful
2. Frozen – The shoulder is less painful but is still very stiff
3. Thawing – the stiffness of the shoulder starts to ease off

More recently Frozen shoulder has been simplified into 2 stages
1. Pain predominant – you will be in a lot of pain whilst the shoulder steadily stiffens up. You will have difficulty in simple activities and sleep
will be disturbed
2. Stiffness predominant – the pain starts to settle but you generally continue to have a stiff shoulder and difficulty performing activities

When you come to clinic a thorough history and examination is usually sufficient to diagnose the problem. Frozen shoulder is usually a clinical diagnosis. This means you cannot ‘see’ frozen shoulder on a scan and the diagnosis is made via discussion and examination. You will usually have an x ray to show that there is no arthritis which can sometimes be mistaken for frozen shoulder.

The treatment for frozen shoulder varies with how long the condition has been affecting you. Treatment may involve a steroid injection, inflation of water into the joint or a surgical release of the shoulder. All treatments run in tandem with ongoing physiotherapy.

If you are a diabetic then your HbA1c needs to be below 70 for any treatment to commence.

Freezing / Pain Predominant Phase

Physiotherapy – gentle movements of the shoulder without causing lots of pain is vital to ensure that any potential movement is retained. Physio is important to run alongside any invasive intervention that is agreed.

Injection – a simple steroid injection into the shoulder joint can help with settling the pain down. It may not completely eliminate the pain and very occasionally you may require a second injection.

Frozen / Stiffness Predominant Phase

Hydrodilatation – You will be referred to a Consultant Radiologist for a 30- minute appointment. Under the guidance of x-ray local anaesthetic will be infiltrated into the front of the shoulder. A needle is then inserted into the shoulder and your shoulder is physically expanded by filling it water. A small amount of local anaesthetic and steroid is instilled into the shoulder to help with pain both during and following the procedure. Physiotherapy will follow the procedure.

Manipulation under Anaesthetic

You will be admitted for a day case procedure, which involves a very short general anaesthetic. Once anesthetised, your shoulder will be manipulated and moved around in a set manner to release the tight contracted tissue in the joint.

Arthroscopic Capsular Release

If a manipulation of the shoulder is not sufficient then you will require keyhole surgery to release the scar tissue. This involves a general anaesthetic and 3 small incisions around the shoulder. Through these incisions the scar tissue that causes the stiffness inside the joint are released. The incisions are sutured and the stitches require removal at 2 weeks. Once again physiotherapy is required in the weeks after the operation.

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Shoulder problems including pain, are one of the more common reasons for clinic visits for musculoskeletal symptoms. The shoulder is the most movable joint.

Aftercare

Following the operation, you will normally have a bulky dressing covering your wound. This is then removed to reveal the sticky dressing at 48 hours until 14 days following your operation. The stitches will require removal at 14 days. You will require a wound check either at the hospital or your GP practice at 14 days.

Physiotherapy following treatment is crucial to the rehabilitation of the shoulder to ensure a successful outcome. On occasion it may not seem like you are making huge amounts of progress but it is vital to keep pushing on even with small gentle exercises.

This depends on the nature of your work. For a sedentary occupation the time off is normally 6-8 weeks. For a manual occupation this can be as long as 3-4 months.
It is normally safe to drive within 2-3 weeks of your operation but can take up to 6-8 weeks before you are completely comfortable to start driving.
This depends on the intensity of the sport and can range from 6 weeks to 3 months off.

Stiffness

Due to pain after surgery, patient may be reluctant to perform their exercises. If you do not gently rehabilitate your shoulder it can become stiff and you can re-develop a frozen shoulder.

Anaesthetic Risk

Anaesthetic in the modern era are extremely safe however there are still minor risks associated with the different techniques which the anaesthetist will discuss with you before your surgery.

Infection

(1%) is a risk with all surgery.  In the majority of cases these are infections around the wound and can be treated with a course of antibiotics.  The more unusual deep-seated infections however can require admission to hospital and surgery to clean the wound out if necessary.

Nerve Injury 

Is a potential but very rare risk with this surgery.  Often the nerves at greatest risk are the tiny nerves supplying skin in the area of the wound and cutting through these may result in an area of numbness that is not often troublesome.

What our patients who have treated in our Clinic did say?

Patient
Patient
BMI The Beardwood Hospital
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From start to finish I received the utmost care and consideration from Mr Hadi. He took time to listen to my history and then go through the procedure with myself . The course of treatment provided was very effective as was the aftercare. I do not feel he could have done anymore.
Patient
Patient
BMI The Beardwood Hospital
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What a lovely man. Explained everything fully and gave me options regarding treatment including surgical repair which I opted for. I was treated with kindness and respect. The surgery was carried out efficiently and after care was superb. Would definitely recommend Mr Hadi.
Patient
Patient
Royal Blackburn Teaching Hospital
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Recently needed an operation on my shoulder. The treatment I received was second to none. Mr Hadi explained everything fully beforehand, making sure I was fully informed and again was exceptional in my aftercare and recovery. I felt supported and valued as a patient. Professional and approachable throughout. Highly recommend! Thank you.
Patient
Patient
BMI The Beardwood Hospital
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I could not have asked for better care. Excellent bedside manner, totally professional, would highly recommend.
Patient
Patient
BMI The Beardwood Hospital
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The information i was given during treatment was great, al my questions were answered in a way I understood. I was never made to feel my questions were stupid. Really great experience
Patient
Patient
BMI The Beardwood Hospital
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Mr Hadi has a real understanding of making patients feel assured and at ease at all stages of treatment. He explains the pros and cons of the procedure and gives you time to decide if you want to go ahead
Patient
Patient
BMI The Beardwood Hospital
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I have had a few operations over the years on my shoulder, and I didn't see results straightaway, I was told it may not improve at all, however last year I underwent another operation on my shoulder. 12 months later I am less pain now than I was from my original operation in 2008.
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