Comprehensive ultrasound guided interventions for the intractable frozen shoulder
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- čas přidán 13. 09. 2024
- Compared to other joints, a painless and wider range of movement is needed
and essential for our daily life in the shoulder joint.
I may feel less discomfort if I have a limited range of motion in the hip joint
except for extreme conditions such as kicking.
Minor painful limited motion of the shoulder joint will suffer you
more than any other joint pathologies.
So, the frozen shoulder becomes an uninvited early guest for a young adult.
Most frozen shoulder patients visit a doctor for their pain and limited range of motion.
I measure the passive range of abduction, external rotation, and internal rotation for diagnosis.
A capsular limitation of motion is the clue to the clinical diagnosis of adhesive capsulitis.
Inflammation and fibrosis are the primary pathologies of the frozen shoulder.
Currently, there are many treatment options for reducing pain and releasing capsular contracture.
The physiotherapy, exercise, and mobilization techniques are essential
and well-proven remedies of shoulder joint contracture.
I have been long experienced in sling exercise therapy since 2004.
This instrument gives me a second-hand relieving therapist’s energy,
and it saved a lot of time to cure the frozen shoulder.
But according to my study.
On average, I had to spend 25 sessions of time for the intractable frozen shoulder.
It is one of my philosophies:
Besides the money they spend, time is valuable to the patient.
I am the kind of person who is never satisfied.
And I have tried to save time.
I have found manipulation under anesthesia
after diverting the injection target to the coracohumeral ligament,
and the inferior capsule is the crucial timekeeper.
I put details about the coracohumeral ligament in this video.
Also, I put diverse techniques on my channel separately.
So, I will put it together for better understanding.
The first step is the interscalene block.
Let the patient supine oblique position like a cervical nerve root block.
after covering the neck with a sterile surgical drape,
I put the ultrasound probe on the interscalene brachial plexus
and then punctured the skin to the lateral side of the probe.
and goes to the lateral border of the interscalene brachial plexus .
changing the needle location, gently hydro-dissect
the whole lateral border of the brachial plexus on real-time image guidance.
and then retrieve the needle and re-direct to over the
C5 root to cover the medial aspect of the brachial plexus.
It will take time to anesthetize the brachial plexus. Usually, it takes about 20 min.
The second step is to prepare the drug for the coracohumeral ligament
and inferior joint capsular injection.
Draw 25 units of botulinum toxin.
Draw another 25 units of botulinum toxin in another syringe.
In one syringe, add 20mg of triamcinolone. It is for the inferior capsular injection.
Connect this syringe to the 2-inch 24- gauge needle.
It is long because the inferior capsule is placed deep.
Next, add 1 ml of dexamethasone palmitate to another syringe.
It is for the coracohumeral ligament injection
connect this syringe to the 1.5 inches 24- gauge needle.
I prefer dexamethasone for the coracohumeral injection.
It will be absorbed soon because of water-soluble steroids.
My first target is the coracohumeral ligament.
I will trace the coracohumeral ligament transversely
and trace the intra-articular portion of the biceps brachii tendon.
I will go to the triangular low echo coracohumeral ligament.
The next target is the inferior glenohumeral joint capsule.
Most of the patients had difficulties rotating the arm externally in the frozen shoulder.
So, I ask the patient to rotate the arm as much as they can bear.
Here is the tip on how to find the target and put the needle.
Trace the bony cortical echo of the humerus shaft and the lesser tubercle first.
Slide the probe medially while everting the probe to the outer side
until you find this hypoechoic inferior capsule.
I will put the needle into the inferior capsule.
The pulsating vessels are anterior or posterior circumflex humeral arteries.
It passes and forms the inferior border of the subscapularis muscle.
Let her take a rest for 20 minutes or more.
Third step is the manual mobilization.
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#이미지트레이닝 #만성통증 #통증 #초음파시술 #초음파 #시술 #안전한시술
This is very well done. The interscalene block is very useful and the manipulations were done with great care so as to not cause further injury. Really nice treatment here.
sure. extreme care not to injure any nerve. Please confirm the respiration status. I check the chest x-ray before procedure
I am completely amaze with your technique sir
thank you so much
Advanced concept and technology thank you
thank you
Thanks Prof 🙏
thank you
Thank you for this wonderful explanation of multiple treatment approaches to frozen shoulder. I have done so many treatment variations for frozen shoulder with mixed results. I like how you have explained your reasoning for the interscalene block with manipulation, coracohumeral ligament injection, and inferior joint capsular injection. I am wondering what anesthetic volume and dosage % you are using for the interscalene block? Much gratitude for the care you put into pain management.
thank you for your comment, I use total 12 ml of fluid, mixture of 7ml of 2% mepivacaine with 5ml of saline.
thanks Dr. can you explain why do you use botulinum and dextrose? can i change dexamethasone to diprospan or depomedrol?
There are many videos explaining the use of the botox and dextrose, please find and watch. I do not recommend use particulate stroid in the tendon or MSK pain
Thanks. But the music are dystracting.
is it too loud?