Monday, October 13, 2008

More shoulder stuff

Thanksgiving day surfing...

My shoulder continues to feel great... There are still a few spots at the outside range of movement where I can still feel twinges.. But I suspect that may be due to lack of strength. It is certainly much easier to do most of the physio shoulder exercises now. Including actually being able to do some that I simply couldn't before

So the question now, is this a temporary relief, or can I hope for long term benefits.

From the reading below, it appears that the role of the cortisone is NOT for pain relief directly, but is for it's anti-inflamatory effects. The cortisone plus the dilation and rupturing of the capsule is to get the inflammation of that area to be reduced. Frozen shoulder can be thought of as a type of positive feedback loop, the more inflamed the area gets, the worse it gets and the more inflamed it gets... etc. This procedure hopes to break the feedback loop.

The studies seem to show that there is lasting effect as compared to other treatments and placebo, with few people requiring a second treatment and very very few people needing more than two treatments.

No 3: Shoulder hydrodilatation

As a clinical entity, frozen shoulder (adhesive capsulitis) is relatively easy to diagnose, although treatment of this condition can be frustrating. But subtle forms of capsular restriction can either mimic or enhance other causes of shoulder pain, such as a subacromial impingement. If a patient with shoulder pain presents with nocturnal pain (in the absence of a rotator cuff tear), and their range of motion is subtly restricted in end abduction, internal rotation and horizontal flexion, and their anterior-posterior glide is diminished, then a component of capsular restriction should be considered. In cases of subacromial impingement in which this capsular restriction is present, it is very difficult to treat the impingement successfully without dealing with the capsular restriction.

Capsular restriction does not usually respond favourably to manual therapy.Often attempts to mobilise the shoulder result in a flare-up of the patient’s pain. One efficient way to treat these patients is with a hydrodilatation procedure. This is performed by a radiologist under X-ray control. A needle is inserted into the offending glenohumeral joint, and a mixture of corticosteroid, local anaesthetic and saline is injected. A large volume is required, and in ideal circumstances capsular rupture is achieved. When this happens, the communication between the shoulder joint and the subscapularis bursa is seen to open up. If this treatment is successful, it is very rewarding and satisfying for practitioner and patient alike. It also allows for expedient rehabilitation of the coexisting condition.

The above matches my current experience. Very little progress with exercises and other physiotherapies. Just changing areas where the pain was. But (almost) immediate relief after treatment, and with subsequent ability to do a much wider range of exercises... My Simple Shoulder Test (see below) score went from about 8-9 out of 12 to about 2-3.

Note 1 - Frozen Shoulder is same as Adhesive Capsulitis