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    NHS UK Distension, Manipulation Under Anaesthetic and Arthroscopic Capsular Release

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    mert
    This document provides guidelines for outpatient physiotherapy following surgery for a frozen shoulder. The surgery involves distending, manipulating, and releasing the shoulder capsule under anesthesia. The guidelines recommend a fixed physiotherapy appointment within 2 days post-op to begin exercises to regain maximal movement tolerance while controlling pain. Exercises should focus on improving range of motion, especially lateral rotation and elevation. Patients can typically return to desk jobs within a week and manual jobs within two weeks if comfortable and able to perform duties. The primary goals are to control pain and maximize movement early through a regular home exercise program.

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    NHS UK Distension, Manipulation Under Anaesthetic and Arthroscopic Capsular Release

    Uploaded by

    mert
    20 views3 pages
    This document provides guidelines for outpatient physiotherapy following surgery for a frozen shoulder. The surgery involves distending, manipulating, and releasing the shoulder capsule under anesthesia. The guidelines recommend a fixed physiotherapy appointment within 2 days post-op to begin exercises to regain maximal movement tolerance while controlling pain. Exercises should focus on improving range of motion, especially lateral rotation and elevation. Patients can typically return to desk jobs within a week and manual jobs within two weeks if comfortable and able to perform duties. The primary goals are to control pain and maximize movement early through a regular home exercise program.

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    This document provides guidelines for outpatient physiotherapy following surgery for a frozen shoulder. The surgery involves distending, manipulating, and releasing the shoulder capsule under anesthesia. The guidelines recommend a fixed physiotherapy appointment within 2 days post-op to begin exercises to regain maximal movement tolerance while controlling pain. Exercises should focus on improving range of motion, especially lateral rotation and elevation. Patients can typically return to desk jobs within a week and manual jobs within two weeks if comfortable and able to perform duties. The primary goals are to control pain and maximize movement early through a regular home exercise program.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    20 views3 pages

    NHS UK Distension, Manipulation Under Anaesthetic and Arthroscopic Capsular Release

    Uploaded by

    mert
    This document provides guidelines for outpatient physiotherapy following surgery for a frozen shoulder. The surgery involves distending, manipulating, and releasing the shoulder capsule under anesthesia. The guidelines recommend a fixed physiotherapy appointment within 2 days post-op to begin exercises to regain maximal movement tolerance while controlling pain. Exercises should focus on improving range of motion, especially lateral rotation and elevation. Patients can typically return to desk jobs within a week and manual jobs within two weeks if comfortable and able to perform duties. The primary goals are to control pain and maximize movement early through a regular home exercise program.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    OUTPATIENT POST-OPERATIVE PHYSIOTHERAPY GUIDELINES

    Distension, manipulation under anaesthetic and arthroscopic capsular


    release (of the shoulder )

    Indicated for patients with un-resolving or very slow resolving frozen shoulders with marked
    functional limitations. The presentation for surgery will normally be stiffness rather than
    severe pain (as in the earlier stages of frozen shoulder). Surgery is performed to try and
    improve range of movement. Usually hydrodilatation will usually have been tried
    previously.

    Normally the joint:


    a) Will be examined under anaesthetic (EUA)
    b) Arthroscope introduced (visualisation of the joint)
    c) Saline pumped in under pressure to ‘distend’ the capsule
    d) Manipulation or forced passive stretch to Gleno-humeral joint range (Manipulation
    Under Anaesthetic – MUA)
    e) Arthroscopic Capsular Release - release of contracted capsule with arthroscopic
    instruments. Most prominent contracted tissues are usually anterior (limits external
    rotation) and inferior

    General guidelines for rehabilitation

    ***Fixed outpatient appointment for patient – within 2 days post operation.***

    Aim to get maximal movement early within the tolerance of pain.

    Ensure the patient knows the exercises and understands the need to move joint and keep
    pain levels down before first physiotherapy appointment.

    Advice on Return to Activity


     Driving: When adequate ROM and safe to control the car. Able to react in the event
    of an emergency i.e. able to perform an emergency stop. Usually within 1 week

     Work: Those in desk based roles should be able to return to work when comfortable
    and able to perform duties. Usually within 1 week. Those in more manual work may
    require up to 2 weeks off.

    1
    Modified Feb 202 Clare Scott-Dempster/ Jenny Harper
    Aims Suggested Treatment
     Pain well controlled  Ensure appropriate OP physiotherapy
     Get maximal movement early within the appointment made for approx. 2/7 time.
    tolerance of pain.  Elbow, Neck & Wrist ROM exercise
     Ensure patient is confident, competent  Work on restricted passive lateral
    and completes home exercise rotation and elevation in particular
    programme regularly include :
     Encourage general activity ie. Functional o External rotation stretches
    tasks o Flexion
    o Abduction stretches
     Accessory mobilisations in 0° and range
     Use of ice/heat/analgesia for pain relief
     Consider exercise in water?
     Hold relax/ Rhythmic stabilisations – PNF
    technique to the GH joint
     See patient frequently in early post-op
    phases

    Restrictions Key Milestones to Achieve


     No absolute contraindications  Ensure patient aware of importance of
    exercise in optimising outcome of
    surgery.
     Pain controlled
     Exercises four to five times a day
     Pain will increase for the first few weeks.
    However the response to surgery, if it is
    to occur, is also likely to be seen within
    the first 6-8 weeks

    References

    Rangan A, Goodchild L, Gibson J et al (2015) BESS/BOA Patient Care pathways. Frozen


    Shoulder . Shoulder and Elbow 7(4) 299-307

    Lewis J. Frozen shoulder contracture syndrome - Aetiology, diagnosis and management. Manual
    therapy. 2015;20(1):2-9.

    Rangan A, Hanchard N, McDaid C. What is the most effective treatment for frozen shoulder? Bmj.
    2016;354:i4162.

    Jones S, Hanchard N, Hamilton S, Rangan A. A qualitative study of patients' perceptions and


    priorities when living with primary frozen shoulder. BMJ open. 2013;3(9):e003452.

    2
    Modified Feb 202 Clare Scott-Dempster/ Jenny Harper
    Holt, M, Gibson, J. & Frostick, S. ‘GOST3: Guide for Orthopaedic Surgeons and Therapists’.
    3rd Ed, Liverpool Upper Limb Unit and South Manchester University Hospitals Trust, Biomet-
    Merck.

    Kibler, W B, McMullen, J and Uhl, T (2001). ‘Shoulder rehabilitation strategies, guidelines


    and practice’, Orthopedic Clinics of North America, 32, 3, 527-538.

    http://mail.bess.org.uk/application/files/9914/8127/3402/Frozen_Shoulder.pdf

    3
    Modified Feb 202 Clare Scott-Dempster/ Jenny Harper

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