Stiff shoulder, also known as frozen shoulder or adhesive capsulitis, is a complex condition which is less understood all over the world. In my practice, we prefer to treat most of the patients with stiff shoulder with our excellent rehab program - Pune Shoulder Rehab Program (PSRP) - which has been invented and popularized by Dr. Ashish Babhulkar. Patients typically attend our unique exercise program and are supervised for two weeks back to back.
They are assessed for improvement in range of movement, pain relief, and strength gain at the end of 2 weeks. If they are 50% better, they qualify to do a home program for the next 6-8 weeks. Almost more than 85% of patients improve with this regime. The program is a novel and unique combination of Theraband exercises and range of movement restoration. We prefer not to prescribe pain killers or mechanical modalities like Ultrasound or short wave diathermy or IFT. The idea is to initiate an improvement which the patient can then sustain by practicing at home.
Patients that come late or with severe grade III stiffness may respond sub-optimally to the rehab program and may need surgery for the same. We perform this rarely. No patient is offered surgery for this condition unless they have done a trial of rehab before. In such patients, we perform an arthroscopic adhesiolysis. This involves keyhole surgery where we release the tight adhesions which are cord-like stiff bands responsible for constraining the movements of the shoulder joint. This involves resecting the CHL ligament, anterior and posterior capsule, subacromial decompression along with a Suprascapular nerve decompression. Patients are given a nerve block for pain relief which lasts for about 10-12 hours. Some patients may also need a Fentanyl skin patch for pain relief and this usually lasts for 4-5 days. Patients are discharged the very next day after surgery. Ten days after surgery the sutures are removed and patients start their PSRP rehab movement right away. The success of this surgery depends a lot on the success and compliance of the patient to the immediate rehab program. Patients typically regain their full function in 2-3 months' time depending on how late they present for treatment.
