Occupational Therapy & Physiotherapy Service ADVICE FOR PATIENTS FOLLOWING TREATMENT FOR FROZEN SHOULDER SYNDROME

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1 If you require this document in Braille, large print or another language, please call the Community Patient Advice and Liaison Service (PALS) on: Occupational Therapy & Physiotherapy Service If you would like to comment on, or know more about orthopaedic therapy services: Please contact: Orthopaedic Therapy Team: ADVICE FOR PATIENTS FOLLOWING TREATMENT FOR FROZEN SHOULDER SYNDROME Patient information leaflet THERAPIST... Creation Date December 2008 Updated April Next review date April 2013 Produced by Orthopaedic Therapy Team Whiston Hospital Warrington Road. St Helens Hospital Marshalls Cross Road.

2 ABOUT YOUR SHOULDER NOTES The shoulder is designed to give a large amount oft movement. Some movement occurs between the shoulder blade and chest wall. However, most shoulder movements are at the ball and socket joint. The ball at the top of your arm bone (humerus) fits into the shallow socket (glenoid) which is part of the shoulder blade (scapula). 2 15

3 NOTES There is a loose bag or capsule which surrounds the joint (see picture on previous page). This is supported by ligaments and muscles. Why the shoulder requires manipulation under anaesthetic or arthroscopic capsular release Your shoulder has become inflamed and tight. Often this is due to a frozen shoulder. This process can start without apparent cause. Sometimes the pain and tightness follows a minor accident/injury, or after an operation. At other times it is associated with diabetes. It can be a problem for 12 to 24 months, sometimes even longer. About 20% of people with a frozen shoulder get it again on the other side. Other people have a stiff shoulder because of an earlier major injury. In this case. the inflammation is less of a problem but the tightness of the capsule, due to scarring, prevents good movement. About manipulation under anaesthetic and arthroscopic capsular release The aim of the manipulation under anaesthetic operation is to try and increase the range of movement in your shoulder. The tight capsule will be torn by forceful but careful and controlled stretching of the arm while you are asleep. The operation may also include keyhole surgery or arthroscopy. In this case 2 or 3 small incisions (5mm) will be made around your shoulder in order for the arthroscope and the surgical releasing instruments to be passed into the joint. The scarring and tight capsule will be carefully released from the inside in order to improve your shoulder movements (arthroscopic capsular release). 14 3

4 BENEFITS: The following should be improved after your operation. However, remember this will not happen immediately, and will depend on you doing your exercises. A decrease in pain originating from your shoulder. Increase in the range of movement of your shoulder. Complications of Manipulation Under Anaesthetic: Persistent pain and/or stiffness in/around the shoulder. Risk of fracture of the humerus. Risk of damage to the nerves around the shoulder. Complications of Arthroscopic Capsular Release: Exercise advice: It is normal to feel discomfort, aching and stretching sensations whilst doing these exercises. Having painkillers and / or using ice before exercising helps to minimise this. If you have intense or prolonged pain, e.g. longer than 30 minutes, try doing the exercises less forcefully or less often. If this does not help, discuss your problems with your therapist. Aim to do several short exercise sessions through out the day rather than one or two longer ones. e.g minutes, 4 times a day. Start with the number of repetitions of each exercise advised by your therapist (usually 10) but try to increase this as and when you are able. Try to develop a routine, do your exercises every day. If you put the time and effort in, you will see the improvement. Persistent pain and/or stiffness in/around the shoulder Risk of damage to the nerves around the shoulder. Risk of superficial wound infection. N.B. There is sometimes a recurrence of frozen shoulder syndrome, (more commonly in diabetic patients), which then requires a repeat of the above procedures. 4 13

5 QUESTIONS WE ARE OFTEN ASKED: Stand sideways against a wall with your arm close to your side and elbow at a right angle. Push your forearm to the side against the wall. Hold for approx seconds. Stand with your upper arm close to your side, elbow at a right angle and the back of your hand against a wall. Push the back of your hand against the wall. Hold approx seconds. Stand in a doorway with your elbow close to your side, elbow at a right angle Place your hand against the wall. Push your hand inwards against the wall. Hold approx seconds. Will it be painful? During the operation local anaesthetic will be put into your shoulder to help reduce the pain. You will wake up in the recovery area of the theatre and then be returned to the ward. Be prepared to take the tablets advised in the hospital as soon as you start to feel pain. If stronger tablets are required, talk to your G.P. The use of ice packs or heat may also help relieve pain in your shoulder. The amount of pain you experience will vary and each person is different, therefore take whatever pain relief you need. Is heat or cold better for pain relief? You may find an ice pack over the area helpful. Use a packet of frozen peas, placing a wet paper towel between your skin and the ice pack. If you have a wound, use a plastic bag or cling film to protect it from getting wet until it has healed. Leave on for minutes and repeat several times a day. This would be first choice if the joint feels warm and is inflamed. However, if this does not help and the joint is not warm, try heat over the area by using a hot water bottle. 12 5

6 Do I need to wear a sling? You will be given a sling before you leave hospital. It is for comfort only. You can take it off and put on as you wish. You are advised to discard it as soon as you feel able. Remember, this operation has been done to try and increase your shoulder movement, so do not keep your arm in the sling for long periods without doing regular exercises. Alternatively, you can rest your arm on pillows placed in front of you. If you are lying on your back to sleep, you may find placing a thin pillow or small rolled towel under your upper arm will be comfortable. Stand, holding a towel as shown. Pull up the involved hand as high as possible When can I go home? Often you can go home the same day. Do I need to do exercises? Yes. (see end of this leaflet). You will be shown how by the physiotherapist and you will need to continue with the exercises when you go home. They aim to stop your shoulder getting stiff and to strengthen the muscles around your shoulder. Stand with your back against the wall. Keep your upper arm close to your side and elbow at a right angle. Push the elbow back against the wall. Hold approx seconds. When do I return to clinic? Depending on your surgeon and the type of operation you have, you will be seen in clinic 2-6 weeks later to check your progress. Please discuss any queries or worries you may have when you are at the clinic. Further clinic appointments are made after this as necessary. 6 Stand facing a wall. Keep your upper arm close to your side with elbow at a right angle. Push your fist against the wall. Hold for approx seconds. 11

7 Lying on your back with elbows against your body and at a right angle, hold a stick in your hands. Move the stick sideways thus pushing the arm to be exercised outwards. Lying on your back with hands behind your neck and elbows pointing towards the ceiling. Move elbows apart and down to touch the bed. How am I likely to progress? Phase 1: Getting over the operation pain. The initial increase in pain for the first few days/weeks may affect your ability to do everyday activities, especially if your dominant hand (right if you are right handed) is the side of your operation. Try to use your arm for daily activities, particularly if the joint feels more stiff than painful. Even though the shoulder is painful, you need to try to do regular exercises, little and often. Out-patient physiotherapy will be offered if it is required. Take medication and use ice/heat to try and keep the pain level down Phase 2: Regaining everyday movements. Stand holding a stick behind your back with your elbows straight. Lift the stick upwards away from your body. The pain from the operation should gradually lessen and you will be able to exercise more frequently and vigorously. Normally the improvement in movement will occur within 4-6 weeks of the operation. Some movements will improve quicker than others. Getting your hand up behind your back is often the most difficult. Are there things I should avoid? Stand with your arms behind your back. Grasp the wrist of the arm you want to exercise. Slide your hands up your back. 10 Not really. The worst that can happen is to cause yourself pain, therefore avoid heavy lifting for the first few weeks. However, do not be frightened to start moving the arm as soon as you can. Gradually the movements will become less painful. 7

8 When can I drive? You can drive as soon as you feel able to control the vehicle comfortably. This is normally between one and two weeks. It is advisable to start with short journeys. When can I return to work? This depends on your symptoms and the nature of your work. EXERCISES Stand leaning on a table with one hand. Let your arm hang relaxed straight down. Swing your arm forwards and backwards and then side to side. Do approx 30seconds each direction Light work (No lifting) 10 days 6 weeks Medium work (Light lifting) 6 weeks onwards Heavy work (Above shoulder level) 3-6 months Lying on your back with elbows straight. Lift both arms at the same time keeping them as close as possible to your ear. When can I return to leisure activities? This will depend on how much movement and strength you have in your shoulder after your operation. Discuss the activities you are interested in with your therapist or consultant but it is usually advisable to start with short sessions and gradually build up the effort involved. Swimming or exercise in water can be commenced as soon as you like. (If you have any wounds, these should be healed first) This is just a guide and can be discussed with the doctor or physiotherapist at your out patient appointments. Lying on your back with elbows straight. Use one arm or a stick to lift up the other arm keeping it as close as possible to your ear. Stand and grip one end of the stick with the arm to be exercised. Lift the arm up sideways by assisting it with the other arm. 8 9