Don’t shoulder the pain

Shoulder pain is incredibly common. Some studies suggest that it accounts for anything up to 70% of musculoskeletal attendances at a GP surgery.

One of the commonest causes of shoulder pain is ‘frozen shoulder’ – medically known as adhesive capsulitis. Historically, there has been no magic bullet cure for this process and a patient could expect to suffer through two to three years of ‘freezing’ shoulder (pain in the joint), ‘frozen’ shoulder (pain and stiffness in the joint) and ‘thawing’ shoulder (just stiffness).

Treatment options were usually simple analgesics and physiotherapy and exercise-based treatment while the condition resolved itself. Simple steroid injections to try and alleviate the pain could also help. Alternative measures, including acupuncture and osteopathy can also provide some relief from the symptoms.

For patients with very severe symptoms, there was the option of either manipulation under anaesthetic or an arthroscopic release operation – both of which are fairly painful, and require a general anaesthetic and a lot of post-surgical rehab.

However, there is another procedure that has become increasingly popular over the last few years. Hydro-dilation is the injection of a combination of saline solution, steroid and anaesthetic into the joint. The idea is to expand the capsule of the inflamed joint and stretch it out – rapidly diminishing pain and improving range of movement.

I first mentioned this in the newsletter back in 2013, when myself and a musculoskeletal colleague, Dr Syed Babar, had undertaken over 100 cases very successfully. This number is up to now 300-plus, and the results for hydro-dilation are very good, with 80% plus patients reporting being either pain-free or virtually pain-free after one month – thereby avoiding 18 to 24 months of pain and stiffness.

Significant relief is almost within a few minutes of the first injection. After the second injection two weeks later, the symptoms are dramatically reduced or disappear altogether.

Hydro-dilation has numerous advantages. It is a short, 10-15-minute outpatient procedure, performed under local anaesthetic with an ultrasound-guided injection. There is only minor discomfort during the injection, and fewer physiotherapy sessions are required. More importantly, patients avoid the need for surgery. Because of this, the technique is being embraced more and more by the sports medicine and orthopaedic community, and is often the first treatment offered once the diagnosis has been established.

If you think you are suffering from a frozen shoulder, my advice is to seek referral to an appropriate specialist through your GP. You would then be assessed clinically to assess your symptoms and signs – normally severe pain and a globalised restriction of range of

movement. An MRI scan is usually performed to confirm the diagnosis, and most importantly, to exclude any other pathology.

The two hydro-dilation injections are performed under local anaesthetic. Following the first injection, patients normally experience relief within a few minutes and then need a short, intensive outpatient physiotherapy programme. The second injection is administered two weeks later, and patients are usually dischargeable at four weeks.