24
wonder women
The HEALTH | NOVEMBER, 2018
Frozen shoulder
A condition that reduces
mobility
F
ROZEN shoulder is a condition where
the shoulder stiffens, reducing its
mobility. It is more prone towards
female of 50 years and above com-
pared to the younger age group.
Kelana Jaya Medical Centre
Consultant Orthopaedics & Trauma-
tology Dr Mohd Ikraam Ibrahim explained that
the incidence of frozen shoulder is increased if
one has diabetes.
Common causes are attributed to trauma, but
it can occur without any reason.
Removing a cyst
and depleting your
ovarian reserves
Is an ovarian cyst connected to infertility?
Thomson Hospital Consultant Obstetrician & Gynae-
cologist Dr Surinder Singh explained that it all depends
on what kind of cyst it is.
“For example – if it is an endometriosis cyst – then
obviously the disease is going to contribute towards
infertility. It is not the cyst per say, but the disease that
causes the cyst.”
“When cyst is concerned, you already know that
she has endometriosis, that this disease would cause
infertility.”
However, he pointed out that there are deferring
opinions among gynaecologist nowadays on how to treat
that cyst.
“If you go to a general gynaecologist – the first thing
that they would say is that it has to be removed. So, there
goes your eggs. Your ovarian reserves are completely
affected and it would be a tough battle to get eggs from
the woman.”
“There is a different approach where one could be
given injections, given pills to put the disease in remission
to not compromise a woman’s fertility,” he said.
Three stages of frozen shoulders When painkillers and
physiotherapy no longer work
Frozen shoulder can be divided into three stages
- the first one is what we call the inflammatory
stage or the freezing stage.
“This is the most painful stage where the
patient would complain of recurrent shoulder pain
between a month to six weeks.”
Although the X-Ray imaging
might be normal, the patient
would complain of pain.
“The second stage is what we
call the frozen stage whereby
after some time, the shoulder is
locked – frozen. During this stage,
the pain is less intense as com-
pared to the first stage. What they
would have during this time is
reduced range of motion. We call
it the reduction of global range of
motion – meaning that almost all
movements are limited.”
“Although the patient would
usually claim to have less intense
pain, they would point out that
the shoulder is a bit stuck, can’t
be lift and cannot be moved
forward. These would happen for
three to four months.” The less invasive procedure consist of a steroid
injection into the joint, with the intention of
reducing the inflammation and to expand back the
capsule to gain back the range of motion.
Meanwhile the invasive procedure involves
manipulation under anaesthesia – where a patient
is put to sleep and the doctor will
passively manipulate it or by an
arthroscopic capsular release
where a keyhole surgery is done to
divide the capsule open with the
intention that the patient gain back
her range of motion.
“However, all of these treat-
ments need to be supplemented
with physio,” Mohd Ikraam said,
otherwise it doesn’t work and
the patient wouldn’t fine any
improvement.
On the hindsight, frozen shoul-
der is self-limiting and resolves
spontaneously.
“It is only a time factor, but the
range of motion, as compared to
early intervention, will be less –
where they will be more affected,”
he said.
“The final stage
is the thawing
stage; where
the shoulder
starts to regain
back the range
of motion. This
stage usually
takes a longer
time – from six
months to one
year.”
AAOS
Dr Mohd Ikraam Ibrahim said that for some patients, the
condition can improve just by taking painkillers and by doing
physiotherapy to try and get back the range of motion.
“The final stage is the thawing stage; where the
shoulder starts to regain back the range of motion.
This stage usually takes a longer time – from six
months to one year.”
Mohd Ikraam said that for some patients, the
condition can improve just by taking painkillers
and by doing physiotherapy to try and get back
the range of motion. However, there are also a set
of patients who do not do well or are not active in
terms of movements.
“There are some patients who would complain
of frozen shoulder who wishes to get back the
range of motion, who have tried painkillers and
physiotherapy but they are unable to return to the
normal activity. For these set of patients, the option
would be to go through a less invasive or invasive
procedure.”
FROZEN SHOULDER ... In frozen shoulder, the smooth tissues of the shoulder capsule become
thick, stiff and inflamed.