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Capsular release

The shoulder joint has a capsule (or thickened ligament) that surrounds the head of the Humerus (the ball) and the Glenoid (the socket). The purpose of the capsule is to act as a restraint to dislocation at the extremes of movement therefore improving the stability of the joint. When this joint capsule becomes inflamed it is commonly termed a 'Frozen Shoulder' or Adhesive Capsulitis. This is an extremely painful condition that also produces a marked restriction in movement in all directions, can make any activity of daily living problematic and severely disrupt sleep.

The causes of frozen shoulder are still largely unknown, it can happen following a traumatic fall or injury, shoulder surgery, or a prolonged immobilisation. It can often be associated with diabetes, and there is also a large group of people for which there is no explanation at all. There are 3 phases to frozen shoulder the first of which is the 'Inflammatory phase'. This phase is associated with the onset of pain and marked stiffness and can last 6 months or more. Phase 2 then begins as the initial very painful inflammatory phase settles. Often a somewhat marked restriction will remain making daily activities such as reaching behind or out in front very difficult. This second phase may last many months.

A frozen shoulder will usually spontaneously resolve and a full recovery can be made 95% of the time but this can take 18 months or more in some cases. A capsular release or MUA are surgical procedures that aim to substantially speed up the recovery of a frozen shoulder, or help those patients with severe pain. They are not an instant cure, but usually provide a good return to function and a marked decrease in pain within the first 3 months. The remaining restriction to movement can remain for 3 or more months after this.

A capsular release involves making 2/3 small holes in the shoulder and releasing the capsule surgically. A manipulation involves forcibly moving the capsule under anaesthetic. A nerve block can be used in anaesthetics that can render the arm numb for up to 24 hours or more.

These procedures can be painful initially and physiotherapy is essential to help achieve the early goals of rehabilitation following surgery.

The early goals of rehabilitation

1) Keep the pain controlled.
2) Ensure that movement is maintained as best as possible.
3) Keep expectations realistic

Pain control
1)
Pain should be controlled with prescription drugs. On leaving the ward you will have a 5 day prescription, after this time you may be able to downgrade to over the counter analgesics which can be discussed with the pharmacist or you may need to visit your GP to continue with the prescription drugs. Ice can be used at home as a useful adjunct or alternative.

2) The pain control is essential as it allows you to do your exercises regularly. The importance of regular exercises cannot be overstated. Following these procedures the capsule needs to go on and heal, if the shoulder isn't adequately moved during this period then the healing process occurs in a restricted range and you will take longer to reach a full resolution. The exercises need to be done 'little and often' and it is worth remembering why you are doing them (to ensure that during the painful stage we maintain as much movement as possible). The number and how often depends on your pain tolerance.

Milestones

Driving You may begin driving 1 week after your operation or when you feel comfortable.
Returning to work Dependent on occupation. If you are in a sedentary job you may feel happy to resume work after 1 week. If your job involves heavy lifting or using your arm at shoulder height, you may require longer.
Functional range of movement 4 - 6 Weeks.
Sleeping You should feel comfortable sleeping and tablets are no longer required by 3 months, or earlier in some cases.

Your physiotherapist will aim to see you in the first week following your surgery, to ensure you are exercising to the right level. Depending on your progress from this point will determine how regularly you need to be seen.

Early Phase Exercises For Post operative Capsular Release/MUA

These exercises are designed to complement your Capsular Release/MUA Information Sheet.

Shoulder pendular exercises
Position: Leaning your body forward. Support your body weight resting the un-operated arm on a table.
Action: Gently rock your weight from your front foot to your back foot, enabling the arm to move back and forth using your body weight. Try this also rocking side to side across body.
Reps: Repeat x6-10 x 3 per day

Assisted flexion
Position: Lying on your back.
Action: Hold your operated arm around the wrist; use your unoperated arm to raise both arms up towards your head. Allow the unoperated arm to assist the exercise.
Reps: x6-10 reps x3 per day.

Assisted External rotation
Position: Lying on your back, hold a stick or similar.
Action: Start with your elbows tucked in at sides of body. Use un-operated arm to help move the operated arm, by pushing the stick rotating the arm away from body. Keep elbows tucked in.
Reps: Repeat x6-10 x 3 per day.

Pulley Exercises
Position: Place a long piece of rope, washing line, or dressing gown cord over a door.
Action: Hold the ends of the rope; use your unoperated arm to pull on the rope enabling the other arm to raise upwards.
Reps: Repeat x 6-10 times x 3 per day

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Alternatively, please call Michele Murphy:
T: 02392 352 206

 
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