My father has a significant frozen shoulder. Despite one surgery already and months of rehab, he still can't lift his arm up nose high or hold it up for more than a second. The surgeon who saw him wants us to have another specialist take a look before they settle on a treatment plan. What can this second surgeon offer that the first one hasn't already told us?
Some shoulder problems are so complex and so difficult, it's not always clear what treatment approach to take or if surgery can even help. This may be the case with massive rotator cuff tears, shoulder instability, or adhesive capsulitis (frozen shoulder).
Each patient must be examined and considered on an individual basis. Imaging studies such as MRI and arthroscopic exam help with the decision-making process, but the surgeon can't just rely on the results of those tests to find the optimal treatment for each problem. It's also important to consider why the patient has the problem in the first place.
For example, if there is a chronic problem like adhesive capsulitis (frozen shoulder), is it because a previous surgery failed? And if so, why did it fail? Were there surgical technical errors or other undetected injuries that affected the outcome? Was there some bony deformity, soft tissue imbalance, or other anatomical reason why this patient didn't get a positive result from the previous surgical treatment?
In the case of a frozen shoulder, the joint capsule may be scarred down or fibrosed. The joint capsule is a group of tendon fibers wrapped in connective tissue surrounding the joint. Surgery may be needed to remove the adhesions and move the shoulder through its full range-of-motion. This is done with the patient anesthetized.
Injury, immobilization, and diabetes mellitus are the three most common reasons people develop a frozen shoulder. Sometimes, cardiac patients who have had coronary artery bypass surgery or people who have been immobilized in an intensive care unit for any reason develop this shoulder problem.
Once the specialist and the surgeon have completed all of their tests and evaluations, a plan of care can be established for your father. The goal is to choose the most optimal treatment approach for each individual situation. When patients present with complex and challenging problems, a second opinion is always helpful.
Pietro M. Tonino, MD, MBA, et al. Complex Shoulder Disorders: Evaluation and Treatment. In Journal of the American Academy of Orthopaedic Surgeons. March 2009. Vol. 17. No. 3. Pp. 125-136.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.