Distension arthogram of the shoulder

Transcription

1 Patient information Distension arthogram of the shoulder This leaflet has been designed to give you some more information about having a distension arthogram of the shoulder. Your doctor believes you will benefit from this procedure. The aim of the procedure is to improve your function and range of movement. Barts Health Therapies Department

2 Why do I need a distension arthrogram? Your doctor has diagnosed you with a frozen shoulder, also known as adhesive capsulitis. The cause for this is not fully understood. Most cases occur in people between the ages of 40 and 60. It is five times more common in people with diabetes and is more common in women than men. People with other conditions such as heart or lung disease have an increased risk of developing frozen shoulder. The shoulder joint capsule becomes inflamed and contracted and loses its normal elasticity, resulting in severe shoulder pain, stiffness and reduced range of movement. Whilst the condition will usually resolve spontaneously this can take up to four years, you will probably already have tried physiotherapy, oral painkillers and anti-inflammatory medications and or shoulder injections to attempt to relieve the debilitating symptoms of pain and stiffness. What is a distension arthrogram? A distension arthrogram is where a special liquid is injected into your shoulder joint. Studies have shown this to be effective in helping to relieve symptoms of pain, improving range of movement and function. It is thought that by instilling a large amount of fluid into the shoulder joint capsule that it breaks down scar tissue, thereby improving range of movement and reducing pain and stiffness. Guide to the procedure: A distension arthrogram is a procedure that is performed by a radiology doctor in the x-ray department of your hospital. It takes about 15 minutes to perform and there is no need to fast prior to this procedure. After obtaining your consent you will be asked to lie down on your back. The procedure is done using x-ray or ultrasound guidance. The skin is cleaned and a needle is inserted into the shoulder joint. A small amount of x-ray dye is injected to make sure the needle is correctly positioned. Then a mixture of saline, steroid and local anaesthetic is injected. Approximately 40mls of fluid is injected into the shoulder joint. Understandably this may result in some discomfort during the injection. What are the risks of having a distension arthrogram? All procedures involve an element of risk, these are very small but you need to be aware of them and can discuss them with your doctor at any time. The main risks are Complications relating to the local anaesthetic. Infection might be introduced into the joint at the time of an injection. If the joint becomes more painful and hot then you should consult your GP immediately. Stiffness and or pain around the shoulder. Damage to nerves or blood vessels around the shoulder. Need to re-do the procedure if your symptoms are not relieved. If X-ray dye is used and there is a very small risk of allergic reaction. Very occasionally people notice a flare in their pain within the first hours after an injection. This usually settles spontaneously over the next couple of days. 2

3 Temporary flush of the face can occur in females. Local steroid injections may sometimes interfere with the menstrual cycle in females and could cause bleeding outside of the normal cycle in pre-menopausal women. It may also cause bleeding in post-menopausal women. If you are diabetic your sugar levels may be altered temporarily. Questions that we are often asked about the procedure: Getting ready for your procedure The staff will ask routine questions about your health, the medicine you take at the moment and any allergies you may have. You will be able to discuss the procedure with a doctor. You will be asked to sign a consent form to say that you understand the procedure, and what the procedure involves. When will I go home? You will be discharged home the same day as your procedure. Your shoulder is likely to be uncomfortable in the first few days post-procedure. This is normal. Discharge information Will I be in pain? It is normal to feel some pain following your procedure. This can be helped with regular oral pain killers. Using ice on your shoulder can be helpful in reducing pain. Wrap a bag of crushed ice, or frozen peas in a damp towel. Protect any dressings from getting wet with a layer of cling film, or a plastic bag, before applying the ice pack for minutes at a time. Posture can make a big difference to your pain after your procedure. Avoid hitching your shoulder or holding it in an elevated position. Also try to avoid slumping or standing/sitting with round shoulders as this puts more stress onto your shoulder. Are there things that I should avoid? We advise you to avoid heavy lifting or strenuous exercise for a day or two following the injection. Do I need to do exercises? Yes (see at the end of this leaflet) you will be shown exercises by the physiotherapist and you will need to continue with the exercises once you go home. It is extremely important that you commence these exercises straight away after this procedure to ensure you achieve the maximum possible benefit. 3

4 Getting back to normal how you can help yourself to recover Sleeping can be uncomfortable if you try and lie on the side that has had the procedure. We would recommend that initially you lie on your back or on the opposite side. If you lie on your back support your arm with a folded pillow under your lower arm. Make sure that your elbow is above your shoulder. If you are on your side then a folded pillow supports your affected arm from your elbow to your wrist. In the first few days after the procedure you will find it helps to support your arm on pillows with your elbow in front of your shoulder and slightly out to the side when you are sitting down (see picture). Try and avoid letting your affected shoulder hitch or rise up when you move it. It can lead to bad habits in your movement and eventually cause neck pain. How long will it take me to recover? Some patients have a benefit immediately following the injection. For others it can take a couple of weeks before they feel any improvement. Returning to work Return to work is dependent on the nature of your work and how quickly your pain settles. The following are guidelines only: Sedentary work as soon as you feel comfortable. Light manual work as soon as you feel comfortable. Heavy manual work weeks. Leisure activities You can usually begin driving one to two days after your procedure if you feel comfortable and have good range of movement. It is suggested that you check you can safely do a three point turn and an emergency stop before your return to driving. Check you can manage all the controls and start with short journeys. Notes 4

5 Exercises Day One after the procedure: Use painkillers and/or ice packs to reduce the pain before you exercise, if necessary. Do short, frequent sessions (e.g minutes, 4 times a day) rather than one long session. It is normal for you to feel aching, discomfort or stretching sensations when doing these exercises. However, intense and lasting pain (e.g. for more than 30 minutes) is an indication to change the exercise by doing it less forcefully or often. When you are not doing your exercises ensure your shoulder is supported by pillows or your sling as described earlier in this leaflet, to assist with pain relief. Ensure you keep your neck, elbow, wrist and hand moving after the procedure. These exercises can be started straight after the procedure: 1. It is important to set the shoulder blades in a good position before commencing with these exercises. In order to do this you need to sit up straight with elbows by your sides, gently lift the tips of your shoulders very slowly upwards about two centimetres. The base of your shoulder blades will lift up and outwards very slightly. Hold for five seconds In lying position 2. Lying or sitting. Slowly take your affected arm up towards the ceiling. You can clasp your hands together to allow your un-affected side to help with the movement if necessary. 5

6 3. Lying on your back. Reach your hands up towards your ears and slowly let your elbows drop out and down towards the bed, In sitting position a) Start with your upper arms close to your sides and elbows at right angles. Rest your palm on a table on a piece of cloth (a tea towel) or a plastic bag that will slide easily along the table b) Slowly slide your hand forward across the table reaching out as far as you feel comfortable In standing position 5. Sit or stand. Keep your upper arms close to your sides and elbows at right angles. Turn your forearms outwards. 6

7 6. In standing, rest your un-affected arm on a table and lean slowly forwards allowing your affected arm to hang down. Slowly swing your arm in a pendulum motion forwards and backwards. 7. Stand facing a wall. Walk your fingers up the wall as high as you feel comfortable. Then slowly lower your hand down in the same way. Day 7+ Continue with the above exercises with the aim of trying to regain full shoulder range of movement. 7

8 Where can I get more information? The telephone numbers and contacts below are available for you to contact a physiotherapist. You will have the opportunity to ask your Orthopaedic Surgeon questions about the operation during your consultation or you can also contact them via their secretary through the Barts Health switchboard. - this is a very good site that has a lot of information written by Orthopaedic Surgeons specialising in the upper limb. Patient Advice and Liaison Service (PALS) If you need general information or advice about Trust services, please contact the Patient Advice and Liaison Service (PALS) on or visit Alternatively please contact staff who are providing your care if you require clinical advice. Your health records To enable us to improve the quality of the care that we provide, your health records are kept by the Trust and may be used for teaching, training, audit and research. Further information on how the Trust uses your information can be found on our website at Contact information Barts Health Therapies Department The Royal London Hospital Telephone No: bhnt.bartshealthphysio@nhs.net Mile End Hospital Telephone No: bhnt.bartshealthphysio@nhs.net Authors: Elizabeth Foster, specialist physiotherapist, Jenny Harper, extended scope physiotherapist and Susan Cross, MSK radiologist. Large print and other languages For this leaflet in large print, please ring or For help interpreting this leaflet in other languages, please ring Reference: BH/PIN/182 Publication date: January 2014 All our patient information leaflets are reviewed every three years. Barts Health NHS Trust Switchboard: