Published on July 13, 2014
ADHESIVE CAPSULITIS SURGICAL VIEW: ADHESIVE CAPSULITIS SURGICAL VIEW OBJECTIVES To know what are surgical management available for adhesive capsulitis. To know about evidence on surgical management for adhesive capsulitis. : OBJECTIVES To know what are surgical management available for adhesive capsulitis . To know about evidence on surgical management for adhesive capsulitis. SURGICAL INDICATIONS: SURGICAL INDICATIONS Failure to respond to non-operative care Functional deficits Full-thickness tear WHAT ARE THE SURGICAL INTERVENTION FOR ADHESIVE CAPSULITIS?: WHAT ARE THE SURGICAL INTERVENTION FOR ADHESIVE CAPSULITIS ? SURGICAL INTERVENTION: SURGICAL INTERVENTION Manipulation under anesthesia Arthroscopic capusular release Suprascapular nerve blocks Manipulation under anesthesia (MUA): Manipulation under anesthesia (MUA) MUA IS MULTIDISCIPLINATY MANUAL THERAPY TREATMENT SYSTEM WHICH IS USED TO IMPROVE ARTICULAR & SOFT TISSUE MOVEMENT& BREAKING SCAR TISSUE USING SPECALIZE CONTROLLED RELEASE, MYOFASCIAL MANIPULATION & MOBILIZATION TECHNIQUE WHILE THE PATIENT IN UNDER MODERATE TO DEEP IV SEDATION . Castellarin G et al. Manipulation and arthroscopy under general anesthesia and early rehabilitative treatment for frozen shoulders.Arch Phys Med Rehabil 2004;8:1236-40. INDICATIONS : INDICATIONS Primary idiopathic frozen shoulder 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 Adverse effects: Adverse effects a traction lesion of the brachial plexus, fracture of the shaft of the humerus , Castellarin G, et al. Manipulation and arthroscopy under general anesthesia and early rehabilitative treatment for frozen shoulders.Arch Phys Med Rehabil 2004;8:1236-40 . Arthroscopic capsular release: Arthroscopic capsular release Surgical procedure to relax the JOINT CAPSULE tissues in a joint that has a reduced range of motion due to CONTRACTURE or TISSUE ADHESIONS or joint deformities Arthroscopic capsular release for stiff shoulders: effect of etiology on outcomes. Nicholson GP . indication: indication Stage III and functional impairment as a consequence of a frozen shoulder If not improved with initial conservative measure Arthroscopic capsular release for stiff shoulders: effect of etiology on outcomes. Nicholson GP . Adverse effect: Adverse effect Infection Neuro -Vascular Damage Anaesthetic Risks SUPRASCAPULAR NERVE BLOCK FOR ADHESIVE CAPSULITIS: SUPRASCAPULAR NERVE BLOCK FOR ADHESIVE CAPSULITIS The techniques involve the injection of local anesthetic agents in close proximity to the suprascapular nerve, temporarily blocking the sensation and ability to move the upper extremity . INDICATION: INDICATION Primary Pain stage I and functional impairment as a consequence of a frozen shoulder Postoperative Management: Postoperative Management to reduce postoperative adhesion formation and swelling daily 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 Castellarin G et al. Manipulation and arthroscopy under general anesthesia and early rehabilitative treatment for frozen shoulders.Arch Phys Med Rehabil 2004;8:1236-40. Shoulder rehabilitation and physiotherapy guidelines: Shoulder rehabilitation and physiotherapy guidelines Post Operative Capsular Release and Manipulation under anesthesia Rehabilitation Protocol General points Immobilisation From 0-6 weeks: Postural control and scapulo -thoracic setting. Pendular exercises. Active assisted external rotation. Active assisted elevation in supine as comfort allows Increase range of movement as soon as tolerated through passive and active assisted movement. Active assisted exercises progressing to active exercises – utilise short lever, supine and closed kinetic chain exercises if appropriate. PowerPoint Presentation: From 6 weeks: Progress to open chain long lever – remembering function. Isometric exercises in variable starting positions progressing to resisted through range strengthening. Continue to progress through graduated strengthening while maintaining range and quality of movement. Functional Milestones Driving: See general principles of rehabilitation Swimming: 6-8 weeks Recreation: 8-10 weeks Light work/gardening: 6-8 weeks Heavy manual work/gardening: 10-12 weeks Bristol Shoulder and Elbow Surgery Mr Iain Packham FRCS ( Tr & Orth ) Consultant in Trauma and Orthopaedic surgery - Specialist Shoulder and Elbow surgeon SUMMARY: SUMMARY Level II evidence is found for both the surgery Over 80% success of ACR and the freedom from pain is quicker than MUA. ACR Diagnose other associated pathologies and cost effective treatment Capsular release is safer and more effective than for people who have developed a resistant stiff (frozen) shoulder after injury, trauma or fractures, as well as for diabetics. SCNB is used as primary care management but the outcome is not significant. Intensive physiotherapy is essential after the ACR & MUA surgery REFERENCE : REFERENCE MUA vs home exercise (level II) Slight better moblility at 3 month No difference in 6 and 12 month MUA have effect of improve motion and pain relief for approx 23 years Ng CY, Amin AK, Narborough S, McMullan L, Cook R, Brenkel IJ. Manipulation under anaesthesia and early physiotherapy facilitate recovery of patients with frozen shoulder syndrome. Scott Med J. 2009; 54(1):29-31. 86 patients Outcome-DASH score,ROM,VAS Result-improvement in ROM and function and reduce pain Kivimäki J, Pohjolainen T, Malmivaara A, et al. Manipulation under anesthesia with home exercises versus home exercises alone in the treatment of frozen shoulder: a randomized, controlled trial with 125 patients. J Shoulder Elbow Surg. 2007;16(6):722-726. 125 patients Result-improvement in ROM and function and reduce pain PowerPoint Presentation: Long-Term Outcomes After Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis Hugh M.J. Le Lievre and George A.C. Murrell, MD, Dphil no compilation, early significant improvements in shoulder range of motion, pain frequency and severity, and function. These improvements were maintained and/or enhanced at seven years Burkhart, Arthroscopy, 2001 59 arthroscopic RCR Average follow-up 3.5 yrs 95 % G/E result regardless of tear size Rapid return overhead function Nicholson GP. Arthroscopic capsular release for stiff shoulders: effect of etiology on outcomes. Arthroscopy. 2003;19(1):40-49. provided significant pain relief, restoration of motion, and function within an average of 3 months. PowerPoint Presentation: Suprascapular nerve block for the treatment of frozen shoulder in primary care: a randomized trial, DAVID S JONES 30 patients Patients’ pain levels and ranges of movement were assessed over a 12-week period This study suggests that suprascapular nerve block is a safe and effective treatment for frozen shoulder in primary Care Treatment of severe scapulohumeral periarthritis with combined use of suprascapular nerve blockade and manipulation therapy: a report of 49 c ases , Qing-Zhong QIU efficacy, safety, stability, and no treatment for recurrence there was no fracture, dislocation, nerve damage The advantage of this therapy is to maximize adhesion technique overcomes again after release, making the subsequent release technique is easy to implement, compared with conventional therapy solves the differential efficacy and drawbacks of treatment in the foreseeable future, after the release treatment methods Patients can effectively functional exercises.