Examination
The most striking clinical feature was the severe limitation of all glenohumeral movements.Abduction was 90 degrees(normal=180),external rotation was 20 degrees(normal=45).Tests for rotator cuff pathology were negative.
Special Investigations
Recent X-rays did not reveal any evidence of arthritis or calcific tendonitis and an ultrasound done in the rooms did not show any tears of the rotator cuff tendons.
Diagnosis
Given the fact that Mr L.L. was a diabetic and that his shoulder movements were severely restricted,the diagnosis in his case was very easily made – frozen shoulder.
Treatment Options
It was explained to Mr L.L.that there were 3 main treatment options:1)Nil – 100% of frozen shoulders resolve irrespective of the treatment.2)Intra-articular injection of steroid – particularly useful in the early(inflammatory) stages of the disease.3)Arthroscopic capsulotomy – very useful in the later(stiff)stages. Given that Mr L.L.had already had frozen shoulder for the last 2 years and that 2 previous injections had not helped him,he was very keen on having the operation.
Operations Details
Under general anaesthetic and in the “beach-chair”position,an examination under anaesthesia was performed.This confirmed the diagnosis of frozen shoulder,as external rotation was limited to 20 degrees and external rotation with the arm in 90 deg abduction was only 20 deg(normal=90deg).At the same time,the anaesthetist placed an indwelling catheter along the brachial plexus,for intra- and postop pain relief. Arthroscopic assessment of the glenohumeral joint was then done,which revealed all the classical signs of frozen shoulder viz.severe inflammation and a very thickened capsule. With the camera placed posteriorly,a special capsulotomy forceps was used to divide the anterior capsule,taking care not to damage the tendon of subscapularis.The camera was then placed anteriorly and the forceps used to release the posterior capsule without damaging the axillary nerve.
Postoperative Course
Mr L.L. stayed in hospital for one night and received physiotherapy 3 hrs after the procedure,as well as the following morning.He was discharged with his indwelling catheter,which continued to give him continuous pain relief while at home.He also continued to receive twice daily physio until the catheter was removed two days later. 12 days after the procedure,Mr L.L.reported that his level of pain had dropped from a preop level of 8/10 to 1/10.His range of movement had also increased by an average of 50%.He was quite happy to return to work at that stage.