Surgical release for stiff frozen shoulders: Surgery to remove scar tissue and release contractures can lessen pain and improve function for stiff shoulders that have not responded to rehabilitation or physical therapy.
Last updated Wednesday, January 26, 2005
Figure 6 - Continuous passive motion machine Figure 7 - Sample empty progress chart Figure 8 - Sample progress chart Figure 9 - Two-year follow-up data After the surgeryContinuous passive motion and exercise As soon as the procedure is completed, we place the arm in
continuous passive motion. Early motion achieves several goals. It
prevents formation of adhesions or scarring during the critical early
healing period. It also demonstrates to the patient that the shoulder
can and should be moved immediately. Finally, early movement seems to
increase the comfort, speed, and completeness of motion recovery. The
use of the continuous passive motion after surgery is greatly
facilitated by a brachial plexus block for the surgical procedure. This
type of anesthesia can give 12 to 18 hours of post-operative
anesthesia, allowing the awake patient the opportunity to observe the
increase in motion gained by the procedure without experiencing early
post-operative pain.
On the first day after surgery, the patient resumes the stiff shoulder exercises.
Each day the patient is in the hospital, we plot the range of elevation
(overhead reach) and rotation on charts posted in the patient's
hospital room. These charts (see figures) provide positive
reinforcement for the patient's progress.
Ideally, before discharge the patient can demonstrate comfortable
assisted motion to 140 degrees of elevation, 40 degrees of external
rotation, internal rotation until able to reach T12 with the thumb, and
cross body adduction comparable to the normal side. The wall charts
reflect these discharge goals. With this program, the patient becomes
the center of the treatment team and is motivated to continue the
exercises after discharge.
The two-year follow-up data for twelve patients having open surgical
release for refractory frozen shoulders are encouraging (see figure). Disclaimer
This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.
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