Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Post-Traumatic Shoulder Stiffness

SYMPTOMS

There is gradual onset of diffuse pain or ache, and stiffness in the shoulder after previous trauma or immobilisation.
Physiotherapy, after manipulation under anaesthesia and arthroscopic release, improves the condition dramatically. Secondary problems in the neck and upper back are almost inevitable and must be addressed.

AETIOLOGY

This disorder has similar symptoms to frozen shoulder but has a traumatic background and can be treated much more aggressively. It is usually caused by fibrosis and scarring after a bleeding in or around the joint, which may affect either or both the gleno-humeral joint and the sub-acromial compartment.

CLINICAL FINDINGS

The shoulder is passively restricted in movements in all directions. The condition is very painful.

INVESTIGATIONS

This is a clinical diagnosis. Xrays should be taken in different planes to rule out bony pathology. MRI is usually not helpful since it is a static examination and the syndrome is a dynamic problem. However, there may be an underlying rotator cuff tear or bursitis.

REFERRALS   

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon to determine the diagnosis and for consideration of surgery. In almost all cases, a thorough rehabilitation programme, including specific treatment, thoraco-scapular control training, strength, flexibility and posture training is required after surgical release.

EXERCISE PRESCRIPTION

Most sports and activities are possible but secondary symptoms due to compensation and avoidance of pain are common and must be addressed. Running should be avoided since the shoulder will be sensitive to this type of impact and holding the arm still while running will cause secondary upper back and neck pain. Swimming is usually difficult but warm water can be helpful to release the shoulder. The specific rehabilitation should aim to achieve over time a full range of controlled motion, good posture and thoraco-scapular control.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs. Previously positive tests should be negative. Functional strength, control and flexibility should be comparable with the other shoulder.

DIFFERENTIAL DIAGNOSES 
 
Frozen shoulder or nerve entrapment from the cervical spine.

PROGNOSIS

Excellent-Good.

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