Home Treatment of Frozen Shoulder
It is difficult and sometimes impossible to identify the precipitating factors in CRPS. It would seem reasonable to treat these factors to the maximum possible extent, although there are virtually no data to suggest this. Unfortunately, some of the interventions, such as immobilization41 for fractures, might contribute to CRPS. It is also logical that complications of CRPS should be prevented lest they exacerbate the syndrome. For example, if CRPS of the hand is not thoughtfully managed, the resulting frozen shoulder will make rehabilitation even more painful and difficult. Prolonged reflex ischemia (vasoconstriction) can produce nerve ischemia and additional pain.
A standard history and examination should enable a diagnosis to be made in the majority of cases.144 A longstanding comprehensive diagnostic system recognizing various independent entities such as frozen shoulder and tendonitis remains in widespread use today145 and this approach is mirrored in more recent diagnostic criteria developed using a Delphi consensus approach146 (see Table 38.4). The site and distribution of pain usually provides important diagnostic information. Lateral or anterolateral shoulder pain is often associated with impingement syndromes involving the rotator cuff or with frozen shoulder. Posterior shoulder pain can arise from tendo-nitis of the external rotators but is more generally a reflection of referred cervical pain. Similarly, poorly localized pain, or pain that is referred below the elbow into the forearm of hand, should prompt a search for more central pathology. Cluster analysis of examination findings has revealed three patterns based on range of...
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