Frozen Shoulder

A new approach for the management of frozen shoulder associated with reflex sympothetic dystrophy is presented. A suprascapular nerve block was performed by needle insertion behind the lateral end of the clavicle at its junction with the insertion of the trapezius muscle; the needle was directed downwards and backwards. The suprascapular nerve was identified response to nerve stimulation. Three ml of 0.25% bupivacaine with 1:200 000 adrenaline was injected.




Ozone therapy in treatment of frozen shoulder

  1. Shoulder Joint
  2. The shoulder joint has a great range of motion with four separate articulations:
    • the glenohumeral,
    • acromioclavicular,
    • sternoclavicular and
    • scapulothoracic joints,
    • that act synergistically.
  3. Frozen shoulder
  4. Painful restriction of shoulder movement of soft tissue origin.


    These include frozen shoulder , periarthritis or pericapsulitis of the shoulder , adhesive capsulitis and adherent or obliterative bursitis.

  5. Incidence
    • Common in the fifth and sixth decades
    • Slightly more common among women
    • 2-5 percent of general population
    • 10-20 percent of people with diabetes
  6. Precipitating Factors
    • Diabetes mellitus
    • Cardiac disease or surgery.
    • Pulmonary tuberculosis.
    • Pulmonary carcinoma.
    • Hyperlipidemia.
    • Myocardial infarction.
    • Cerebrovascular accident.
    • Shoulder trauma.
  7. What happens in frozen shoulder?
  8. A diffuse inflammatory synovitis leads to a loss of the normal axillary pouch and joint volume which leads to a significant loss of motion.

    Capsular contracture is a result from adhesion of capsular surfaces or fibroblastic proliferation.

    OZONE ACTS ON FIBROSIS AND THICKENED SYNOVIUM.

  9. Patient complaints
    • Pain at shoulder region and arm
    • Problems with combing hair
    • Difficulty in wearing cloths
    • Pain while lifting weight
  10. Local injection
  11. Our Process


    • Steroid
    • Ozone
    • Ozone – steroid mixture

    Result

  12. Physiotherapy
  13. Once the initial pain of frozen shoulder lessens, certain exercises, as shown by the physiotherapist, should be done to improve shoulder mobility.