Frozen shoulder can be thawed

It wasn't arthritis. Instead, Safferstone had developed a classic case of frozen shoulder a one-two-three punch of pain, lost movement and, usually, a months-long recovery.

The condition, formally known as "adhesive capsulitis," afflicts about 3% of the general population; 70% of patients are women and most are 40 to 60 years old, says Beth Shubin Stein, an orthopedic surgeon at the Hospital for Special Surgery in New York.

In other words, here's one more thing that just might slow down a few baby boomers.

The condition is especially common in people such as Safferstone, who have diabetes.

This is probably the most pressing problem that (orthopedic surgeons) see" in midlife women, Shubin Stein says.

Though the condition can be triggered by trauma, such as a fall, the cause is unclear, says Benjamin Shaffer, an orthopedic surgeon in Washington, D.C. Doctors do know that patients have inflamed shoulder joints that gradually become surrounded by hardened scar tissue, or "adhesions."

Three stages before the thaw

Here's how it goes for most patients:

Stage 1: The shoulder hurts, especially at night, and the pain worsens with time. "These patients do not sleep," Shubin Stein says. This lasts up to three months.

Stage 2: The pain continues and the shoulder stiffens; overhead movements (like putting away dishes, raising a tennis racket or styling hair) are tough or impossible. This can last up to nine months.

Stage 3: The pain is gone, but the stiffness remains until a gradual thaw sets in. This can last up to 13 months.

Add up all those months and you get two years, which is a lot of time for anyone to be sidetracked by pain and stiffness. And some patients have symptoms that linger even longer, Shaffer says.

Yet, in the past, many doctors treated frozen shoulders with "benign neglect," assuring patients that their condition, while painful and annoying, was not permanent, Shubin Stein says.

These days, she says, patients are much more likely to get a shot or two of cortisone in the affected shoulder.

New research, led by other doctors at the Hospital for Special Surgery, suggests that early injections of cortisone might not only stop the pain but also help patients regain movement more quickly.

Carol Gette, 56, of Westport, Conn., developed a stiff shoulder this year about two months after falling on a marble floor. It stayed stiff for seven months.

"I just stopped using my left arm. I couldn't do anything with it. I had to use my right hand to raise my left arm," she says. But after a single shot followed by eight weeks of physical therapy, Gette says, she is raising her arm above her head and using it normally, with no pain.

But the shots don't work for everyone, and studies don't prove they hasten overall recovery. One reason for inconsistent results may be that doctors don't always get the shots into the right part of the shoulder, studies suggest. (Some physicians do the injections with X-ray guidance to minimize errors.)

In any case, a few patients who don't improve with steroids and physical therapy do need surgery, Shaffer says.

Safferstone was one of those tough cases. She says her stiffness got so bad that "my husband was having to comb my hair." But after surgery, combined with aggressive physical therapy, she's wielding her own comb again.

It's "wonderful," she says.

Answer I was very surprised, needles, in the heart of the location, Xiaogang physically very strong, a lot of chest wall thickness than normal from the needle reach the heart through the chest wall to be part of, lung, shattered pericardium, the heart in contact with before, also heart coated with a layer, coated also quite hard. After penetration into the pericardial acupuncture heart, it is obviously very strong with foreign forces, so that pin rapid access to the heart, so we estimate may be fell down to the ground after a special status, with a stretch, this needle He ejected into the heart of the inside.

Q have not seen such a situation?

Answer this is highly unusual, in my own career in the Medical never seen, I do not know the outside world in a pin into the heart of any reason, it is very rare.

Asked how he found in the heart of a needle?

FOR this to the search of his mother from the start with his mother in the annual health check, body check when doctors discovered his mother had abnormal cardiac position, in the heart of the right chest, her internal organs are to the whole, there are medical a term called the mirror , local doctors may consider such genetic deformity, confirmed that two children have such a situation, the proposed inspection children.n

Answer from Xiaogang trauma to the hospital by a doctor with a period of about three months, then after the fact on the needle into caused heart valve damage, his mother told me Xiaogang college entrance examination during regular reading books, seen very late, tired, in Xiaogang Before this very diligent, home help stem some heavy household chores, but this time sweating tired easily found Xiaogang, now in retrospect estimated needle injury is a possible cardiac function, causing these symptoms.

Ask your hospital have done what checks?

FOR Xiaogang According to the hospital after cardiac chest films have found a needle, most people will immediately think how a needle in the heart, but doctors would like to address is that the root cause any damage to the heart, so also do further examination, electrocardiogram done to him CT and found this needle penetrating ventricular wall and mitral valve damage, heart function in damage. In such circumstances, not only to take injections, we need to repair mitral valve.n

Asked for Xiaogang situation, how then developed a treatment program?

FOR Xiaogang just to catch up with our special hospital operating room completed, in accordance with common sense or metallic foreign body to the blood vessels in the heart with the heart beat, blood flow metallic foreign body will flow, doctors do surgery first thing to determine what Needle location, the past is often done by radiologists films, in the course of transshipment, or foreign body in the process of beating heart might run away, but the operating room, preoperative re-positioning, judgment, in what location needle in the end, help the surgeon determine the needle location, and then look for open heart needle to help surgeons from needle in the process of the site at any time on his mobile make judgments.

Asked one-stop What is the operating room?

A one-stop of the modern operating room equipment and traditional imaging equipment into the operating room together, it can be for surgeons in the treatment of patients at the same time, direct observation of the condition and foreign body positioning. Therefore, the one-stop operation room is to the advantage of transit time and the patient into a treatment cycle, so not only can help the surgeon in a module of the diagnosis, treatment can not only shorten the transit time, but also shortened the operation time.

Asked one-stop What are the characteristics of the operating room?

A feature is the immediate use of functional perspective, the perspective needle in radiology examination has not changed the location to the surgeon accurate information, discussion programs in accordance with the original surgery.

Asked one-stop for the operating room to make this kind of heart surgery, what are the benefits?

A one-stop operating room for more complex cardiac malformations of other diseases, such as coronary heart disease, there are complex congenital heart disease.

Q pin in the heart of fracture, when admission is not very difficult?

A Yes, although the images that needle in the heart, but in the end, or in the heart cavity myocardium, before this doctor is not aware of, I have to remove pin, it is imperative that cardiac arrest after finding, we need the help Artificial heart and lung machine, its role is to replace the heart and lungs work, and let the heart temporarily stopped work, such facilitate surgery. Heart muscle tissue, not myocardial damage, needle into the heart fairly long time, causing serious adhesion and myocardial damage, but also in the process of admission, the needle is not imagine that it can be removed, completely wrapped in myocardial needle, so admission process to avoid heart damage.

Asked how long needles removed?n

Asked removed needles, it is necessary to Xiaogang heart repaired?

A There are two major areas surgery, first, how the integrity of the needle at the same time not take myocardial injury, which is a surgeon important work, and more importantly, Xiaogang by the valve damage, repair difficult, then, to consider If not placed a metal gave artificial valve, but we still feel that the best repair his own valve, the final operation of the valve has to prove that he can still very complete correction.

Q As a doctor, you have the effect of the entire surgery what?

FOR Xiaogang Although I feel that the injury was unfortunate, but unfortunately he is in the fortunate just can ride one-stop operating room imaging equipment, we take the integrity of the needle out at the same time, the ideal valve repair, avoid the use of artificial mechanical valves, have been very integrity of the appliance.n

A one-stop is now operating room should say that the field of cardiovascular treatment for the future development trend, as far as we understand, at least in Asia, no such operating room, North America and Europe may have such advanced technology. This technology can be complex treatment of many diseases, such as coronary heart disease, complex congenital heart disease, it can be a surgeon traditional surgery advantages of combining treatment and intervention, one-stop operating room patients can shorten the treatment time, it can not only save some the cost, but can also reduce the patients and their families see a doctor psychological burden.

Ms. Lee asked the Zhangjiagang asked, my children 6 months to check out is the lack, I would like to ask how can surgery experts, can do one-stop surgery?

Additional information :

From www.usatoday.com:
Having completed fellowship training in Joint Replacement at the Hospital for Special Surgery in New York and Sports Medicine at Massachusetts.
The Cerebral Palsy Hand Service at Hospital for Special Surgery was founded to address the orthopedic needs in the upper extremity.
The Hospital for Special Surgery is a hospital in New York City that specializes in orthopedic surgery and the treatment of rheumatologic.
Hotels near Hospital For Special Surgery, White Plains New York. Find hotels in White Plains or surrounding areas. Special negotiated rates for White Plains.
Hospital for Special Surgery 535 East 70th Street New York, New York 10021. Limb Lengthening and Deformity Correction for Adults.
The Mission of Hospital for Special Surgery is to provide the highest quality patient care, improve mobility, and enhance the quality of life for all and to.
Hospital for Special Surgery is a specialty hospital for orthopedics and rheumatology. Located.
Dr. Marx is Director of the Foster Center for Clinical Outcome Research at the Hospital for Special Surgery, and Associate Professor of Orthopedic.