Contracture
With contracture, your shoulder is painful because it is stiff. Scar tissue has formed deep in your shoulder and affects the ligaments and tendons. These tendons should be elastic and stretch as you move your shoulder. The scar tissue prevents this and limits the movement of your shoulder.
While surgery is the best course of action, other treatments are available, including just living with the condition, physical therapy exercises, medication or injections, but these are not considered reliable. If surgery is not performed, you condition will not worsen, but sometimes the pain may increase slightly. Shoulder contracture may lead to arthritis.
Click here to read the Sept. 21, 2004 article in the Wall Street Journal about "frozen shoulder."
The Surgery Experience
The purpose of the surgery is to remove the scar tissue and lengthen any ligaments and tendons that have tightened so that your shoulder can move more easily. Usually we do this operation using the arthroscope and 2-3 small (1/2”) incisions are needed.
Surgery is performed on an outpatient basis and with general anesthesia. You also will be given an injection of novocaine to decrease the pain in your shoulder after surgery. The injection will be placed in the side of your neck just above your collarbone.
You will awaken in the recovery room after your surgery with your arm supported on a pillow. An ice pack will cover your shoulder to help control the pain and swelling.
How successful is the surgery?
This type of surgery is successful about 80% of the time. No shoulder operation is 100% successful in every individual but the procedures we perform are reliable and will help restore the potential function in your shoulder. Because of the many variables involved, I can make no guarantees other than to assure you I will deliver the very best medical care possible.
Doctor’s Visits
Your first office visit is two weeks after surgery so that Dr. Gartsman can examine the surgical incision. He will give you additional instructions for exercises and discuss your allowed activity level. Six weeks after surgery, more vigorous use of the shoulder will be allowed. Office visits then occur three, six and 12 months after your surgery.
Returning to Work
For most sedentary jobs, Dr. Gartsman recommends taking one to two weeks off from work. When you return to work you should be able to manage as long as you do not have to do any heavy lifting, pushing, pulling or carrying. Most patients can start light duty work involving no lifting, pushing, pulling or carrying more than 10 pounds, one to two weeks after surgery. Return to heavy lifting or overhead use may require 6-12 months.
Rehabilitation
You will be examined two weeks after surgery to determine if you need physical therapy (only about 10% of patients require regular visits to a physical therapist).
During rehabilitation, you will use a machine called a Continuous Passive Motion (CPM) chair to move your arm in the correct movement. You will use this at home for two weeks after the operation. (delivery and pickup will be arranged). Patients use the chair one hour, four times a day. Use the ice pack for one hour after each chair session. Doctor visits will continue for six weeks after surgery, as well as visits to the therapist for additional exercises. At the three-month visit, you will begin strengthening exercises.
Complications
The most common complication from contracture involves injury to nerves around the shoulder. Usually these occur due to pressure. These usually go away in two days to six weeks. This occurs in 1-2% of patients. Permanent injury that results in diminished use, function or feeling in the extremity can occur but is exceedingly rare. Infection can occur (a 1 to 2% chance) and may require oral antibiotics, antibiotics by injection and rarely surgery.
 Click here to download Surgical Treatment of Shoulder Stiffness from Dr. Gartsman.
Click here for Arthroscopic Contracture Postoperative Instructions.
|
