Frozen Shoulder
Printed From: CyberPT - Your Online Physical Therapy Resource
Category: Patient Forum
Forum Name: Shoulder Injuries/Conditions
Forum Description: Patients can post questions and experiences about shoulder injuries/conditions.
URL: http://www.cyberpt.com/ptforum/forum_posts.asp?TID=550
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Topic: Frozen Shoulder
Posted By: Kris
Subject: Frozen Shoulder
Date Posted: Jan 19 2010 at 6:20pm
Does anyone know a doctor who performs hydrodilation of the shoulder capsule to aid in the relieve of Frozen Shoulder in the New York area?
Secondarily, I see many reports of successful use of this treatment on the web, but mostly from Europe and India. How come so little information is available about the use of this procedure in America?
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Replies:
Posted By: R Edge
Date Posted: Jan 24 2010 at 8:51pm
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Did a little research to see why hydrodilation isn't commonly performed
in the USA but wasn't able to come to a conclusion. I understand it
will not be effective if there is a capsular tear as the tear will not
allow for sufficient back pressure and the fluid will leak out. An
informative article I found
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2051310/pdf/aco121-025d.pdf - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2051310/pdf/aco121-025d.pdf
supports hydrodilation. I'll have to ask the orthopaedic surgeon we
work with next time I see him to get his thoughts.
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Posted By: Kris
Date Posted: Jan 25 2010 at 8:18am
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Thanks for the info. I have an appointment with a doctor who performs this procedure. I will try to post some information after the consultation or procedure. Any further information from your end would be welcome.
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Posted By: Ask a PT
Date Posted: Feb 20 2010 at 1:47pm
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Hi Kris,
Did you undergo the procedure? Talked to the orthopaedic shoulder surgeon today and he stated he doesn't perform the hydrodilation procedure because he has not found that a substantial amount of pressure can be generated to break up the adhesions in the capsule. He stated alot more surgeons would be performing the hydrodilation procedure if there were more evidence which supports it.
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Posted By: Kris
Date Posted: Feb 20 2010 at 2:14pm
Thank you for following up with your info.
I DID have the procedure done at the Hospital for Special Surgery in NYC.
Done in a surgical room, the injection was essentially painless, and took a total of about 12-15 minutes. There was no pain from the procedure afterwards or the next day. The doctor told me to expect about 10% improvement in ROM that day, and about 10 % per week for the next 5 weeks in conjunction with going to his recommended physical therapist 2x per week, at which point I am to see him again to determine whether to continue with just PT for another 5-7 weeks or if a second injection may be necessary. So far, it is 3 weeks since the procedure, and the 10% rule appears to be close to accurate. The most important thing thus far is an amazing reduction in the excruciating and debilitating pain I was experiencing on a daily basis, and trying to sleep at night. From day one, I could roll over onto the bad side and get a decent night's sleep, which alone made it worth it! This doctor claims he has had success with virtually all patients not suffering from diabetes, with 80% requiring just one injection, and 20% requiring 2. I might be one of the 20% as he said I had one of the worst cases of FS he has seen, from the viewpoint of lost Range of Motion. I will certainly update this posting, upon seeing him in a couple of weeks and getting his assessment. My impression thus far is Thank God I opted for this instead of the risks, pain and long rehab associated with an operation.
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Posted By: Kris
Date Posted: Mar 14 2010 at 10:19am
So I had my first visit with the Doctor this week, at the 5-week point since he injected the saline. With the great help of a very hands-on Physical Therapist (insisted upon by the Doctor), lifting my arm straight outward and upward has gone from about a very painful 95 degrees pre-procedure and 110 post-procedure, to approaching 180 degrees 5 weeks later. That is what we have been working on. Now for the next 5 weeks, we will be working on sideward-upward movement of the arm and also behind the back. Pain is virtually non-existent in daily activities. Just stiffness remains, in those sideways and behind the back motions. The Doctor feels that full ROM will be attained by June, after another 5 weeks of PT and home exercises of another 6-8 weeks. He has been right on the money so far. The exercise he insists upon every day is pulling the arm across the chest while lying down. He has increased the time frame from 2 minutes to 5 minutes. The Physical Therapist has given me about a half-dozen (and building) other exercises to do daily, now really working on internal and external rotation. Most entail varieties of stretching for longer and longer periods, now up to 3-5 minutes per exercise. He is also introducing a few strength exercises now that I am capable. Once again, I can not state enough how happy I am that I opted for capsular distension (hydrodilation, shoulder lavage, etc.) via saline injection rather than the risks, pain and hassle of surgery. Surgery would have also meant the risk of a buildup of scar tissue, reducing post-surgical ROM. The saline procedure still entails discipline in faithfully going twice a week for Physical Therapy, plus doing the recommended daily exercises (a good half hour per day), but offered an almost immediate ease in doing everyday things with little to no pain post-procedure.
I will try to answer any questions you may have as to my experience.
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Posted By: Ask a PT
Date Posted: Mar 16 2010 at 4:14pm
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Hey Kris - that is wonderful! Glad to hear the hydrodilation and therapy has helped. Do you know what kind of success rate your surgeon has for his patient's who have this procedure? Are there criteria which makes a patient more appropriate for this procedure vs. another procedure?
Thanks for the update!
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Posted By: Kris
Date Posted: Mar 17 2010 at 8:38am
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The Doctor who performed the saline injection procedure is not a surgeon. He is a Physiatrist, who specializes in non-surgical, minimally invasive approaches to back, shoulder, knee problems, etc.
As mentioned in one of my earlier posts, he claims to be successful in almost all cases of non-Diabetes-related Frozen Shoulder. 80% require just one injection, 20% require 2. I asked him how many times he had performed the procedure and off the top of his head he said over 500. I was skeptical going in, since one hears very little about this procedure, I had an extremely limited ROM and a lot of pain, and both orthopedic surgeons said surgery was my ONLY option. Neither ever even mentioned the saline injection procedure, which makes me furious now. I will be writing both of them a pointed letter. As for physical therapy, it was of no help, in fact made my condition increasingly worse prior to the saline injection. However, it has been indispensible post-procedure. Again, the post-procedure PT has been quite aggressive and hands-on to continue to break up the adhesions that had formed during the many months of the whole Frozen Shoulder episode.
I will update my condition after the balance 4-5 weeks of PT recommended by the Doctor.
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Posted By: Ask a PT
Date Posted: Mar 18 2010 at 12:15pm
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Thanks so much for sharing your story and educating us on other options for treating frozen shoulder. Hopefully your experience will help not only bring more awareness of hydrodilation to others suffering from frozen shoulder but to the health care provider community as well.
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Posted By: Kris
Date Posted: Dec 24 2010 at 4:11pm
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Just wanted to update the log since it has been a year since I was suffering almost unimaginably from frozen shoulder. As mentioned in my earlier posts, I had success with the injection of saline solution into the shoulder capsule early February, 2010. Since I last posted in the Spring of 2010, my Range of Motion reached just about 100% of what it was pre-frozen shoulder within a few months of the procedure, also thanks to fairly aggressive PT. There has been no recurrence, and I am able to do all of the strength building exercises recommended to me by the PT during my rehab. I finished rehab late May of 2010, and have been doing resistance training with elastic bands to continue build strength with no problem. I once again can not stress enough how happy I was to have done that procedure in lieu of the option of risky and painful surgery.
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Posted By: Ask a PT
Date Posted: Dec 27 2010 at 4:17pm
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Thanks for the update Kris. That is great that you are doing well and that the hyrodilation was a success for you! Have a happy new year!
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