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Name:
Explaining Frozen Shoulder to Patients, in a Very Simple Manner
Description:
Explaining Frozen Shoulder to Patients, in a Very Simple Manner
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T00H17M20S
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https://cadmoreoriginalmedia.blob.core.windows.net/abfd6b04-36bf-4323-8175-5697e8fbfb6c/EXPLAINING FROZEN SHOULDER TO PATIENTS%2c IN A VERY SIMPLE MAN.mp4?sv=2019-02-02&sr=c&sig=g1Hb01mubJlF15aU9xXt5Ke5i4EKPPWozTWNsxIuow8%3D&st=2024-11-24T00%3A13%3A49Z&se=2024-11-24T02%3A18%3A49Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Hello, my friends, how are you? This is me, Dr. Sergio, here from Sao Paolo, Brazil. And in this video, I'm showing you a very, very interesting lecture about how to explain aggressive capsule or frozen shoulder syndrome to our patients in the office. This is a very nice way of explaining this common problem in a very easy language with a very easy way.
So I hope you'll like it. Feel free. My good orthopedic surgeon, friend, or even physical therapist to use not only these ideas to explain this problem to our patients in your respective offices, but also to use some of my images if you feel comfortable with that. So I hope you like it. Please don't forget to subscribe to the channel or show it to your friends.
Leave your comment. Give us your thumbs up, and let's see the video. And what about frozen shoulder, so I'm very happy to talk about it, so let's understand something that is a mess in many patients minds, and definitely it must not be. So frozen shoulder is a mystery to many patients, and believe me, it doesn't have to be. Uh, many orthopedic surgeons, they don't understand the problem, especially when they are not shoulder specialists.
I would say that the extreme majority of the shoulder guys, they really understand the theoretical concepts and then it becomes absolutely possible to manage. I love to treat this. It gives me not trouble, but we have to invest in these cases. I'm treating eight cases now in my office and the extreme majority of them, they go very nicely in the end. So I've been treating frozen shoulder since 2005.
As my friends, I love to, to talk, to deal with it. Everything relies on a very good comprehension of the theoretical concepts of the problem in the doctor's mind. And results, they really may take some time, but they are in the vast majority. Good so there is light in the end of the tunnel. Believe me, this is my life for these 16 years. So let's understand just a little of anatomy.
This is a joint like a finger, so every joint has two bones. This is a bone. And this is a bone, which is involved by a capsule. OK, so we have a capsule that involve the bones. And when we think about the shoulder, this is a shoulder and the capsule. The capsule of the shoulder is very, very large. So it allows us to move our shoulder in every position that we can because it's very ample.
So we it allows the shoulder to move in every direction. So what is frozen shoulder? A frozen shoulder is a situation where the shoulder loses movement because of differences that happen in the capsule. And I'm going to tell you when. In every frozen shoulder, the joint is absolutely OK. So the ball in the socket, they don't have problems. The problems is not in the joint.
So whenever I have, I would say a very bad shoulder, 82-year-old lady, all of a lot of joint degeneration. The cartilage is gone. It's very stiff. This is not a frozen shoulder because there is no normality of the joints, surfaces the ball in the socket. It's not working nice in frozen shoulder. The ball in the socket is perfect.
The problem is the structure that involves the ball in the socket, which is the capsule. This is a way of understanding that I have differences, differences in the capsule and with them, we simply cannot move. So this is a normal show that a very normal capsule, which allows motion. And this is another shoulder with differences. And when I have adhesions, I don't have motion.
So this is frozen shoulder that can happen for a lot of reasons. A lot of people make a lot of confusion, but Doctor Sergio frozen shoulder adhesive capsulize is what we have to understand. This is different names for the same story. The problem is the literature I say medical literature is very confusing. OK, so there are different names and there is not a consensus among specialists.
This is a problem that happened not only in orthopedic, it happened. It happens in other fields, but it doesn't matter, ok? It's not because of that, we cannot understand, because in the end, we have to think about primary and secondary frozen shoulder. And I'm going to explain in a minute, but this name is very good. So why Ed is encapsulated is very good is a very good name.
It is a suffix from a grammatical point of view, which means inflammation. So I have inflammation in my tendon, so I have tendinitis in my wrist or in my leg. So it is mean inflammation. And because of this inflammation, I have this inflammation happening in the capsule, leaving to adhesions. So this is a name that was established in the 1934 and in almost 90 years after is still a very good name.
And the only point is Dr. Sergio, why does it happen? Pay attention. Everybody We still don't know. Many theories are there, but the thing is still we can manage frozen shoulder in spite of not knowing why does it happen? My message to the audience, don't worry about it. Let doctors understand it with time, because if you have it, a good doctor will manage that and you will be OK.
So when does it happen? This is important for people to understand that we have two different scenarios, but I am primary frozen shoulder, which is called by many one adhesive capsulize and secondary frozen shoulder. They are different in terms of the cause. When I have a primary frozen shoulder generally in this side of the planet, when we have white people, which is not so common in India, because the color of the people in India is a little bit different, I know I have seen me thousands of Indian people in 25 different cities.
I know that putting this place in this side of the world in Canada, the United States in Europe is mostly common in women from 40 to 60 white women. It's related to diabetes and child problems, but many they don't have it, and it's not clear why does it happen, but whenever we make a diagnosis, we treat it in the same way and it's the primary frozen shoulder cases when we don't know the cause.
This is not common. OK, super, super known in the literature, but I see two three cases every year. It's not very common. And the disease has three phases. OK the first one is the inflammatory phase and the symptoms. They are very similar to rotator cuff symptoms. And the patient and then we come to the stiffness phase in which we have much less pain.
I'm going to talk about that now and the defrosting phase, so. How does the disease, the primary frozen shoulder behaves if we do nothing, if we do absolutely nothing is a self limited problem which may take 1 and 1/2 year or even two years to get better. First, we have inflammation that may last from three to six months. In this moment of the problem, the patient has very typical pain pain to elevate, pain to sleep, and he doesn't have stiffness, so it's difficult to establish the diagnosis.
Very difficult to say. You have a primary frozen shoulder when the disease. The problem is happening for two months. Even very experienced guys and I include myself in this. And I am not talking about my surgical skills. I'm talking about my clinical skills. They have difficulty and I have to. And then you have the second phase, which is the stiffness, which may happen from four months until 9 months and maybe one year, which is characterized by much less pain.
Stiffness become clear in physical examination, and then it becomes quite easier to diagnose. I have received it in my office. A lot of patients, they say, oh, I had a doctor treating me, he was it was he was thinking of rotator cuff. Now I am six months down the line, and now he told me I have. A frozen shoulder, and he doesn't know what to do, and he sent me to you.
This is not uncommon in my life. And then we have phase three, the frost and phase. In which basically no pain, only stiffness that gets better, quite fast. This is the recovery phase. This is when my patients, they disappear from the office. They are extremely dedicated to treatment in phase one and phase two and in phase three. They don't go to my consultations anymore and I don't get angry with them because I know they are getting better.
Secondary frozen shoulder is basically the same story, but I have a clear cause a trigger, as we say. As a rule, it happens after a surgery, it can be because of a fracture that I operated, even because of a rotator cuff tear. It happens a lot and never after non operative treatment of a fracture. And even after a contusion, I have seen patients that they had a follow at home and they develop a secondary frozen shoulder.
So many different causes, they call to jump to a common denominator. Mathematically speaking. That put them in the clinical scenario of a secondary frozen shoulder. And how do we do a diagnosis? The diagnosis is clinical. The doctor must have a very good knowledge of what we call pathophysiology in the mind is a very good clinical ability.
Very, very, very, very, very well done medical consultation, the biggest challenge is when we have a 49-year-old lady with a primary frozen shoulder in phase one, I'm treating one lady right now. I had difficulty to establish the diagnosis in January, and I formalized the diagnosis now in the beginning of April. And she's doing fine now because she went into phase two.
Very well done physical examination x-rays. They are normal and we would do an MRI. In very special situations, but this is a discussion to doctors, we can talk about it, but the diagnosis is absolutely clinical. So how do we treat a frozen shoulder? So first of all, I need to understand, is it a primary one? Is it a secondary one in which phase of the disease?
The problem the patient is this is done by 5 things a well done medical consultation. A well done medical consultation. Very well done medical consultation over. This is not five minutes talk, good physical examination, good physical examination. If the patient is in the painful phase, we can manage that with a lot of medication. Medications I have a good knowledge about that.
I don't want to talk about it because it's a very ample discussion. But see, we can use, I would say, anti depressive medication and many others, but we can't discuss it. But I think that my intention is not to discuss this, but to give awareness of how the problem is managed to population. Physiotherapy is interesting, but it takes time, and this is a technique that was developed in Brazil, in this city 20 years ago, more or less.
I love it. I do a lot. I did for injections of that this week, which is suprascapular nerve blocks. It's injections that we do in between the neck and the shoulder in a nerve, which is called suprascapular nerve. And it helps to control pain, and it helps to defrost to gain motion again.
It's a very complicated pharmacological explanation. Neurochemical explanation I don't think is necessary to explain here, at least. But believe me, it works a lot. I've been doing this for 12 years and it works too much. And what to expect if I have a frozen shoulder? Well, first of all, the doctor must understand, is it primary secondary, but see the treatment takes time.
This is very important. Whenever you diagnose, you establish the diagnosis. It may take three to six months to get better. Progressively, I never say to patients less than three months, never OK, at least three months. But see, in six months I can reach very good results. The extreme majority of the cases will not require surgery, I repeat.
The extreme majority of the cases will have good outcomes without surgery. This is establishing all over the literature all over the world. I operate one case of stiffness frozen shoulder every three or four years, and I do. I don't know how many shoulders I operate in a year, at least one 100 and I do one surgery every 200 or 300 because it's very common to have frozen shoulder, but is very uncommon to operate it.
Surgery is a super exception. Surgery for frozen shoulder is a super exception. I do, as I said, one every three years. We do it by arthroscopy, this is something important, the outcomes, they are very good. So see, you can have a frozen shoulder in the end of in the end of the tunnel, you will have a good light. It's not a monster.
It depends on very good comprehension by the doctor. But this is a nice world. I love to treat it. It takes time with the patients. They really get better. So, my friends, I hope you like it. And please don't forget. Subscribe leave your comment. Give us your thumbs up.
Feel free to use all of these ideas and images you have just seen to explain this problem to your patients in your office, and we see each other in the next video, as Dr. Sergio always says. And we always keep saying, never stop flying. See, you're my good friends, folks.
Segment:0 .
Hello, my friends, how are you? This is me, Dr. Sergio, here from Sao Paolo, Brazil. And in this video, I'm showing you a very, very interesting lecture about how to explain aggressive capsule or frozen shoulder syndrome to our patients in the office. This is a very nice way of explaining this common problem in a very easy language with a very easy way.
So I hope you'll like it. Feel free. My good orthopedic surgeon, friend, or even physical therapist to use not only these ideas to explain this problem to our patients in your respective offices, but also to use some of my images if you feel comfortable with that. So I hope you like it. Please don't forget to subscribe to the channel or show it to your friends.
Leave your comment. Give us your thumbs up, and let's see the video. And what about frozen shoulder, so I'm very happy to talk about it, so let's understand something that is a mess in many patients minds, and definitely it must not be. So frozen shoulder is a mystery to many patients, and believe me, it doesn't have to be. Uh, many orthopedic surgeons, they don't understand the problem, especially when they are not shoulder specialists.
I would say that the extreme majority of the shoulder guys, they really understand the theoretical concepts and then it becomes absolutely possible to manage. I love to treat this. It gives me not trouble, but we have to invest in these cases. I'm treating eight cases now in my office and the extreme majority of them, they go very nicely in the end. So I've been treating frozen shoulder since 2005.
As my friends, I love to, to talk, to deal with it. Everything relies on a very good comprehension of the theoretical concepts of the problem in the doctor's mind. And results, they really may take some time, but they are in the vast majority. Good so there is light in the end of the tunnel. Believe me, this is my life for these 16 years. So let's understand just a little of anatomy.
This is a joint like a finger, so every joint has two bones. This is a bone. And this is a bone, which is involved by a capsule. OK, so we have a capsule that involve the bones. And when we think about the shoulder, this is a shoulder and the capsule. The capsule of the shoulder is very, very large. So it allows us to move our shoulder in every position that we can because it's very ample.
So we it allows the shoulder to move in every direction. So what is frozen shoulder? A frozen shoulder is a situation where the shoulder loses movement because of differences that happen in the capsule. And I'm going to tell you when. In every frozen shoulder, the joint is absolutely OK. So the ball in the socket, they don't have problems. The problems is not in the joint.
So whenever I have, I would say a very bad shoulder, 82-year-old lady, all of a lot of joint degeneration. The cartilage is gone. It's very stiff. This is not a frozen shoulder because there is no normality of the joints, surfaces the ball in the socket. It's not working nice in frozen shoulder. The ball in the socket is perfect.
The problem is the structure that involves the ball in the socket, which is the capsule. This is a way of understanding that I have differences, differences in the capsule and with them, we simply cannot move. So this is a normal show that a very normal capsule, which allows motion. And this is another shoulder with differences. And when I have adhesions, I don't have motion.
So this is frozen shoulder that can happen for a lot of reasons. A lot of people make a lot of confusion, but Doctor Sergio frozen shoulder adhesive capsulize is what we have to understand. This is different names for the same story. The problem is the literature I say medical literature is very confusing. OK, so there are different names and there is not a consensus among specialists.
This is a problem that happened not only in orthopedic, it happened. It happens in other fields, but it doesn't matter, ok? It's not because of that, we cannot understand, because in the end, we have to think about primary and secondary frozen shoulder. And I'm going to explain in a minute, but this name is very good. So why Ed is encapsulated is very good is a very good name.
It is a suffix from a grammatical point of view, which means inflammation. So I have inflammation in my tendon, so I have tendinitis in my wrist or in my leg. So it is mean inflammation. And because of this inflammation, I have this inflammation happening in the capsule, leaving to adhesions. So this is a name that was established in the 1934 and in almost 90 years after is still a very good name.
And the only point is Dr. Sergio, why does it happen? Pay attention. Everybody We still don't know. Many theories are there, but the thing is still we can manage frozen shoulder in spite of not knowing why does it happen? My message to the audience, don't worry about it. Let doctors understand it with time, because if you have it, a good doctor will manage that and you will be OK.
So when does it happen? This is important for people to understand that we have two different scenarios, but I am primary frozen shoulder, which is called by many one adhesive capsulize and secondary frozen shoulder. They are different in terms of the cause. When I have a primary frozen shoulder generally in this side of the planet, when we have white people, which is not so common in India, because the color of the people in India is a little bit different, I know I have seen me thousands of Indian people in 25 different cities.
I know that putting this place in this side of the world in Canada, the United States in Europe is mostly common in women from 40 to 60 white women. It's related to diabetes and child problems, but many they don't have it, and it's not clear why does it happen, but whenever we make a diagnosis, we treat it in the same way and it's the primary frozen shoulder cases when we don't know the cause.
This is not common. OK, super, super known in the literature, but I see two three cases every year. It's not very common. And the disease has three phases. OK the first one is the inflammatory phase and the symptoms. They are very similar to rotator cuff symptoms. And the patient and then we come to the stiffness phase in which we have much less pain.
I'm going to talk about that now and the defrosting phase, so. How does the disease, the primary frozen shoulder behaves if we do nothing, if we do absolutely nothing is a self limited problem which may take 1 and 1/2 year or even two years to get better. First, we have inflammation that may last from three to six months. In this moment of the problem, the patient has very typical pain pain to elevate, pain to sleep, and he doesn't have stiffness, so it's difficult to establish the diagnosis.
Very difficult to say. You have a primary frozen shoulder when the disease. The problem is happening for two months. Even very experienced guys and I include myself in this. And I am not talking about my surgical skills. I'm talking about my clinical skills. They have difficulty and I have to. And then you have the second phase, which is the stiffness, which may happen from four months until 9 months and maybe one year, which is characterized by much less pain.
Stiffness become clear in physical examination, and then it becomes quite easier to diagnose. I have received it in my office. A lot of patients, they say, oh, I had a doctor treating me, he was it was he was thinking of rotator cuff. Now I am six months down the line, and now he told me I have. A frozen shoulder, and he doesn't know what to do, and he sent me to you.
This is not uncommon in my life. And then we have phase three, the frost and phase. In which basically no pain, only stiffness that gets better, quite fast. This is the recovery phase. This is when my patients, they disappear from the office. They are extremely dedicated to treatment in phase one and phase two and in phase three. They don't go to my consultations anymore and I don't get angry with them because I know they are getting better.
Secondary frozen shoulder is basically the same story, but I have a clear cause a trigger, as we say. As a rule, it happens after a surgery, it can be because of a fracture that I operated, even because of a rotator cuff tear. It happens a lot and never after non operative treatment of a fracture. And even after a contusion, I have seen patients that they had a follow at home and they develop a secondary frozen shoulder.
So many different causes, they call to jump to a common denominator. Mathematically speaking. That put them in the clinical scenario of a secondary frozen shoulder. And how do we do a diagnosis? The diagnosis is clinical. The doctor must have a very good knowledge of what we call pathophysiology in the mind is a very good clinical ability.
Very, very, very, very, very well done medical consultation, the biggest challenge is when we have a 49-year-old lady with a primary frozen shoulder in phase one, I'm treating one lady right now. I had difficulty to establish the diagnosis in January, and I formalized the diagnosis now in the beginning of April. And she's doing fine now because she went into phase two.
Very well done physical examination x-rays. They are normal and we would do an MRI. In very special situations, but this is a discussion to doctors, we can talk about it, but the diagnosis is absolutely clinical. So how do we treat a frozen shoulder? So first of all, I need to understand, is it a primary one? Is it a secondary one in which phase of the disease?
The problem the patient is this is done by 5 things a well done medical consultation. A well done medical consultation. Very well done medical consultation over. This is not five minutes talk, good physical examination, good physical examination. If the patient is in the painful phase, we can manage that with a lot of medication. Medications I have a good knowledge about that.
I don't want to talk about it because it's a very ample discussion. But see, we can use, I would say, anti depressive medication and many others, but we can't discuss it. But I think that my intention is not to discuss this, but to give awareness of how the problem is managed to population. Physiotherapy is interesting, but it takes time, and this is a technique that was developed in Brazil, in this city 20 years ago, more or less.
I love it. I do a lot. I did for injections of that this week, which is suprascapular nerve blocks. It's injections that we do in between the neck and the shoulder in a nerve, which is called suprascapular nerve. And it helps to control pain, and it helps to defrost to gain motion again.
It's a very complicated pharmacological explanation. Neurochemical explanation I don't think is necessary to explain here, at least. But believe me, it works a lot. I've been doing this for 12 years and it works too much. And what to expect if I have a frozen shoulder? Well, first of all, the doctor must understand, is it primary secondary, but see the treatment takes time.
This is very important. Whenever you diagnose, you establish the diagnosis. It may take three to six months to get better. Progressively, I never say to patients less than three months, never OK, at least three months. But see, in six months I can reach very good results. The extreme majority of the cases will not require surgery, I repeat.
The extreme majority of the cases will have good outcomes without surgery. This is establishing all over the literature all over the world. I operate one case of stiffness frozen shoulder every three or four years, and I do. I don't know how many shoulders I operate in a year, at least one 100 and I do one surgery every 200 or 300 because it's very common to have frozen shoulder, but is very uncommon to operate it.
Surgery is a super exception. Surgery for frozen shoulder is a super exception. I do, as I said, one every three years. We do it by arthroscopy, this is something important, the outcomes, they are very good. So see, you can have a frozen shoulder in the end of in the end of the tunnel, you will have a good light. It's not a monster.
It depends on very good comprehension by the doctor. But this is a nice world. I love to treat it. It takes time with the patients. They really get better. So, my friends, I hope you like it. And please don't forget. Subscribe leave your comment. Give us your thumbs up.
Feel free to use all of these ideas and images you have just seen to explain this problem to your patients in your office, and we see each other in the next video, as Dr. Sergio always says. And we always keep saying, never stop flying. See, you're my good friends, folks.
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