The ugly face of frozen shoulder

I can not help to be disturbed by the few patients I saw with frozen shoulders “gone wrong” over the past few weeks. There were 3 ladies all with similar stories: surgeons operated on their shoulders not making the diagnosis of incipient or established frozen shoulder and performed surgical procedures – in some cases probably for the wrong diagnosis. It is abundantly clear that if any surgery is done to the shoulder in the presence of an existing frozen shoulder it is literally simillar to adding “fuel to the fire”. The pain of the frozen shoulder intensifies severely and the natural course of the condition is prolonged by months to years. Neurological sequelae ensue and the problem becomes one that is virtually untreatable with pain and stiffness rendering the individual incapable of functioning in domestic, social and professional environments.

The main message is that treating doctors should be weary of making diagnoses of “arthritis, impingement, calcific tendinitis” and others especially in females in the age group 45-55 where the conditon of frozen shoulder occurs frequently and avoid surgery before ruling out the presence of frozen shoulder

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Time lost due to injuries and operations has a great impact on sportsmen and the absence from their teams may impact on their position in their teams and their income. One should tailor the treatment and permission to return (given by the surgeon and rehab team) optimal consideration.
It has been my observation that often blanket rules are applied without knowledge or attention to the exact patho-anatomy of the specific injury or operation

For each different injury and operation different rules would apply. In a short series of these blogs we will examine the different injuries, their management and when players could be allowed to return to their previous activity levels. In most injuries the following has to be taken into account:

1. Have the damaged structures healed to be able to sustain the demands of the particular sport?

2. Has the flexibility, co-ordination and muscle strength returned to the previous level?

Once these criteria are satisfied the player can usually be returned to his full sporting activity.

In the following few blogs the different injuries will be examined and the surgical procedures used in some of them will be mentioned with guidelines as far as return to play are concerned.

Of particular interest to me has been the concept of “accelerated rehab” for professional rugby players and that will be addressed in this series

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Teaching GP’s shoulder injections

I was involved with the MSD GP workshop today. The event was a Continuous Professional Development event and well organised by the MSD company. To see more than 80 GP’s attending and keen to learn was reassuring and the public should be aware that their doctors spend time and energy to increase their skills.
My job was to teach and demonstrate the techniques of injecting shoulders with Celestone Soluspan ( cortisone) , the indications , the potental complications and most importantly to do it safely and effectively. These techniques can be viewed on our website as well:
The participants showed keen interest and ability and I am of the opinion that they will return to their practices being better doctors with their increased skill in dealing with shoulder problems ( and of course with the other joints which were dealt with by other experts on this day-long course

Cortisone injections into the shoulder

The different spaces where injections in the shoulder can be given

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My trip to the Smith and Nephew surgical lab in York, UK

I returned from the surgical training lab in York (U.K.) and want to compliment the Smith and Nephew company for the facility they have erected for the surgical training of orthopedic surgeons in arthroscopic and open techniques.
We had a successful course and there were 40 participating surgeons from Germany, Austria, Poland and Russia.
I am happy that I was granted the honour to lecture on Arthroscopic rotator cuff repair, arthroscopic shoulder stabilization and demonstrating the Latarjet procedure on a cadaver specimen.

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Shoulder information

I am an orthopedic surgeon specialising in the management of shoulder problems both non-operatively as well as surgically – always endeavouring to minimise the intervention and making it is as effective as possible. I am passionate about disseminating information to empower sufferers to make the most informed decisions about their treatment. That is achieved by our website and this blog.

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