On April 27 2018, TerBrugGen organized a shoulder symposium about the stiff shoulder. Venue of the meeting was a theme park for children (in case you are wondering why there is an image of a gnome inspired hat on the lecture stand).
The first part focused on the orthopedic approach with interesting background information on the diagnosis and treatment of the stiff shoulder.
By definition, a stiff shoulder causes a structural limitation in passive glenohumeral mobility, meaning that the stiffness is also present under anesthesia and not related to muscle tension. Another term for stiff shoulder is adhesive capsulitis in which two entities were highlighted: idiopathic versus secondary.
“Two types of frozen shoulder should be destinguished: idiopathic and secundary”.
Concerning the idiopathic capsulitis, risk factors such as diabetes, thyroid disorder, post-op heart surgery, Parkinson’s disease, long top disease and post stroke which could be important to assess during anamnesis. In the inflammatory phase, intra-articular infiltrations were recommended for pain relief. Arthrolysis is only considered after 6 months in patients with a great amount of discomfort and pain while others recommend treatment with pulsed radiofrequency.
Secondary capsulitis as often seen post-operative or post-traumatic. Post-operative stiffness can occur after instability surgery (Latarjet, Bankart surgery), arthroplasty or rotator cuff surgery. Concerning the latter, the most important risk factor of post-operative stiffness is the pre-operative limitation of shoulder internal rotation range of motion. Additionally, intra-articular pathology (fractures, loose bodies, cuff lesions,..), extra-articular adhesions (for instance after burns), bone tumors or neurologic pathology such as plexus injuries need to be taken into account.
The second part highlighted the physiotherapeutic approach with some key insights from our colleagues from Hasselt and Antwerp, both board members of schoudernetwerk Vlaanderen. First of all, multiple factors contribute to both pain and disability in the conservative treatment of stiff shoulders. Focus should lie on the modifiable factors such as psychological ones where central sensitization, self-efficacy and expectation of recovery or important issues to address during examination.
Key message: “Conservative treatment should focus on modifiable factors and adapted to reactivity state”
Additionally, physiotherapeutic treatment of stiff shoulders should be adapted to the reactivity state of the pathology (high – moderate – low) with an excellent overview in the slide below.
Stay tuned for our next blogpost which will cover the shoulder related information shared during the upcoming WCPT congress!
Written by: Dorien Borms