Does frozen shoulder leads to OA of Shoulder

[sanagupta]

Hello!
Recently I came across OA of Shoulder. That too two patients in a day.Only thing common in their condition was both had almost 15 years of non treated Frozen sholder.

Condition of joint is bad with loss of joint space and osteophytes at inferior margin of acetabulum which looks almost half the size of humeral head...

Any idea how to help them..both have lots of pain in shoulder and don't want to go for replacement.

Regards, Sana
p.s. below are the xrays


<img border="0" src="http://www.physiobase.com/images/Picture_265.jpg" width="400" height="345">

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[somasimple]

Hi,

It had been demonstrated this year that many OA patients have increased muscular activity around their painful joints.
A joint that works whith a muscular strength will soon be destructed by this abnormal behaviour.

[Physiobase]

Well I would say they definately need some form of investigative surgery if nothing more than to clean up the mess in there and work out what was the injured structure in the first instance. Don't forget it might well be a neck issue as the primary cause. Perhaps hydrodilation of the caspsule with an antinflammatory additive might assist? What do others think about this approach 15 years down the track?

[MrPhysio+]

The first treatment to try is hydrodilatation, with anaesthetic and a small amount of cortisone, then immediate range of motion exercises. The treatment can be repeated in 8 to 12 weeks if needed. Be aware that a capsular tear will stop a hydrodilatation from being successful.
If a patient has had greater than 6 months of frozen shoulder, night pain, restricted flexion and internal rotation, this technique should be tried - by experienced Doctors or radiologists.
MrPhysio

[sanagupta]

Hello!
Frozen shulder as i told is 15 years old...I strongly feel that hydrodilation of the capsule only triggered the OA shld..(as suggested to me by a Ortho) later none of my clent went for follow up..lived with pain and restricted range of motion for years....Came to me for health chech up and I wanted to see ant changes like calcification of supraspinatus tendon..but superior part os shld is clear..if u can tell how to attach the scan of the X-ray on post I can post one....
Regards
Sana

[friendlypain]

Frozen shoulder is one factor that can lead to a OA shoulder... (however, it is my personal belief that the GH joint cant be classified as classic OA) I believe that all biomechanically unsound shoulders develop degenerative changes.

Before hydrodilatation, try releasing everything that attaches into the scapula (includes biceps and triceps and coracobrachialis AND pec minor) and release the pec maj and lat. It's also a good idea to perform some fascial work on the lateral border of the scapula. I have experienced an immediate increase (sometimes dramatic) in AROM of the gh joint after the first treatment. I use mainly trigger point therapy and a modified NISA approach. Treatment works on the elderly and the young and is moderately painful when subscap, teres, coracobrachialis and bicep tendons are treated. I see patients once a week when chronic for 2-3 months and each session requires 30-60 minutes of hands on. Strengthening exercises are given after the first 2-3 weeks of Tx. When acute I just do pain management because treatment forces the brain to splint the joint more aggressively. Outcomes are always positive as long as there is no calcification of the tendons. If calcification is present, AROM cannot be restored to levels prior to symptom onset but AROM can be improved so ADL's are painfree. Time of onset to time of treatment is a factor in determining if full AROM can be achieved (obviously).

Adamo

[sanagupta]

Hello!
thanx for the suggestion .i''ll try that. can u please elaborate on modified NISA approach
Regards
Sana

[friendlypain]

Modified NISA:

Start of with patient sidelying on asymptomatic side. Have them raise their hand above their head. Starting from the last rib, progressively stretch the skin using thumbs by using medial stokes to opposite sides (ie. one thumb ant. and the other post.) until you reach the teres muscle belly (patient uncomfortable). Bring arm down to anatomical position and jam the thumb as deep as it can go into the belly of the subscap (patient feels pain). Very gently and slowly raise arm into forward flex position while sliding the thumb down to apex of the scapula (patient feels pain). Do this three times ensuring effective drag with the thumb. Skin roll from lat to spinous process (snake bite sensation) ensuring full coverage of the scapula. Skin roll biceps and teres. Insert thumb into muscle belly of biceps when passively contracted position and then extend elbow using the same techniques as the subscap (you must also include ALL tendons). ART teres, infra and lats. Skin roll delts.

Hope this helps
Adamo

[sdkashif]

Have a look over this information resource.

Shoulder problems

[neurospast]

nice one, skadif. After looking at the x-rays I am wondering why the diagnose frozen shoulder was made in the first place.
I feel as with the diagnose of low back pain, sciatica and so on these diagnoses should be taken with a bucket of salt. What is evident on the X-rays is a long standing Osteo Arthritis. One could reason that a increase in tension around the shoulder could result in more friction, change in movement patterns and therefor increase of wear. But frozen shoulder is a self limiting syndrome lasting 2 years or so? And then the question should be will a period of 2 years of "abuse" result in such a wear? well I wonder with all builders and alike able to work for 10s of years. Maybe the diagnose had to be taken with a bucket of ....
Cheers

[arkesh_physio]

hi
gr8 link sdkashif.