Shoulder Stiffness- a Common Problem in India

Many middle aged people complain of shoulder stiffness. They have tried some physiotherapy without success and are disabled in their daily activities. Some have accepted it and carry on.

The causes of shoulder stiffness can be one out of four
1) Adhesive capsulitis syn Frozen shoulder
2) Stiffness in diabetics
3) Stiffness following some internal fixation of fracture
4) Osteoarthritis of the shoulder.

Stiffness in diabetics is the most commonly encountered one and is particularly difficult to treat. Idiopathic shoulder stiffness is a rare condition. It occurs without a known cause. Tears of the rotator cuff may be seen in a small proportion of these people.

Stiffness after internal fixation occurs in those people who had sustained a fracture of the upper humerus and undergone internal fixation. Osteoarthritis of the shoulder is a rare condition. Symptoms-The affected arm cannot reach behind the back commonly. Lifting the arm forward (elevation) and turning it out (external rotation) may be hampered to a variable degree. Pain accompanies stiffness in early stages and is worse on sleeping on the affected side. Sleep is disturbed and the patient may become depressed due to chronic pain.

Treatment- Physiotherapy under the supervision of an able person is the mainstay and primary treatment. It can be carried out as part of a home exercise program. When there is no success, your shoulder surgeon may advise a manipulation under anesthesia. After being put to sleep, your arm will be put through a range of movement. After the procedure, continuous passive motion will be started.

An Arthroscope is a pencil like instrument which carries a source of light and a camera into a joint to visualize the interior. Other instruments like shavers, punches, radio frequency, Laser can be introduced inside and tight structures can be release.

Arthroscopic release of a stiff shoulder is particularly rewarding and can be accomplished through tiny key-hole incisions. Only the tight structures are divided with an instrument under direct visualization of the arthroscope. The amount of pain is less after this surgery.