Download Distension arthogram of the shoulder

Patient information
Distension arthogram of
the shoulder
This leaflet has been designed to give you some more information about having a
distension arthogram of the shoulder. Your doctor believes you will benefit from this
procedure. The aim of the procedure is to improve your function and range of movement.
Barts Health Therapies Department
Why do I need a distension arthrogram?
Your doctor has diagnosed you with a frozen shoulder, also known as adhesive capsulitis.
The cause for this is not fully understood. Most cases occur in people between the ages
of 40 and 60. It is five times more common in people with diabetes and is more common in
women than men. People with other conditions such as heart or lung disease have an
increased risk of developing frozen shoulder.
The shoulder joint capsule becomes inflamed and contracted and loses its normal
elasticity, resulting in severe shoulder pain, stiffness and reduced range of movement.
Whilst the condition will usually resolve spontaneously this can take up to four years, you
will probably already have tried physiotherapy, oral painkillers and anti-inflammatory
medications and or shoulder injections to attempt to relieve the debilitating symptoms of
pain and stiffness.
What is a distension arthrogram?
A distension arthrogram is where a special liquid is injected into your shoulder joint.
Studies have shown this to be effective in helping to relieve symptoms of pain, improving
range of movement and function. It is thought that by instilling a large amount of fluid into
the shoulder joint capsule that it breaks down scar tissue, thereby improving range of
movement and reducing pain and stiffness.
Guide to the procedure:
A distension arthrogram is a procedure that is performed by a radiology doctor in the x-ray
department of your hospital. It takes about 15 minutes to perform and there is no need to
fast prior to this procedure.
After obtaining your consent you will be asked to lie down on your back. The procedure is
done using x-ray or ultrasound guidance. The skin is cleaned and a needle is inserted into
the shoulder joint. A small amount of x-ray dye is injected to make sure the needle is
correctly positioned. Then a mixture of saline, steroid and local anaesthetic is injected.
Approximately 40mls of fluid is injected into the shoulder joint. Understandably this may
result in some discomfort during the injection.
What are the risks of having a distension arthrogram?
All procedures involve an element of risk, these are very small but you need to be aware of
them and can discuss them with your doctor at any time. The main risks are
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Complications relating to the local anaesthetic.
Infection might be introduced into the joint at the time of an injection. If the joint
becomes more painful and hot then you should consult your GP immediately.
Stiffness and or pain around the shoulder.
Damage to nerves or blood vessels around the shoulder.
Need to re-do the procedure if your symptoms are not relieved.
If X-ray dye is used and there is a very small risk of allergic reaction.
Very occasionally people notice a flare in their pain within the first 24-48 hours after
an injection. This usually settles spontaneously over the next couple of days.
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Temporary flush of the face can occur in females.
Local steroid injections may sometimes interfere with the menstrual cycle in females
and could cause bleeding outside of the normal cycle in pre-menopausal women. It
may also cause bleeding in post-menopausal women.
If you are diabetic your sugar levels may be altered temporarily.
Questions that we are often asked about the procedure:
Getting ready for your procedure
The staff will ask routine questions about your health, the medicine you take at the
moment and any allergies you may have. You will be able to discuss the procedure with a
doctor. You will be asked to sign a consent form to say that you understand the procedure,
and what the procedure involves.
When will I go home?
You will be discharged home the same day as your procedure. Your shoulder is likely to
be uncomfortable in the first few days’ post-procedure. This is normal.
Discharge information
Will I be in pain?
It is normal to feel some pain following your procedure. This can be helped with regular
oral pain killers. Using ice on your shoulder can be helpful in reducing pain. Wrap a bag of
crushed ice, or frozen peas in a damp towel. Protect any dressings from getting wet with a
layer of cling film, or a plastic bag, before applying the ice pack for 10-15 minutes at a
time.
Posture can make a big difference to your pain after your procedure. Avoid ‘hitching’ your
shoulder or holding it in an elevated position. Also try to avoid slumping or standing/sitting
with round shoulders as this puts more stress onto your shoulder.
Are there things that I should avoid?
We advise you to avoid heavy lifting or strenuous exercise for a day or two following the
injection.
Do I need to do exercises?
Yes (see at the end of this leaflet) you will be shown exercises by the physiotherapist and
you will need to continue with the exercises once you go home.
It is extremely important that you commence these exercises straight away after this
procedure to ensure you achieve the maximum possible benefit.
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Getting back to normal – how you can help yourself to recover
Sleeping can be uncomfortable if you try and lie on the
side that has had the procedure. We would recommend
that initially you lie on your back or on the opposite side.
If you lie on your back support your arm with a folded
pillow under your lower arm. Make sure that your elbow
is above your shoulder. If you are on your side then a
folded pillow supports your affected arm from your elbow
to your wrist.
In the first few days after the procedure you will find it
helps to support your arm on pillows with your elbow
in front of your shoulder and slightly out to the side
when you are sitting down (see picture).
Try and avoid letting your affected shoulder hitch or
rise up when you move it. It can lead to bad habits in
your movement and eventually cause neck pain.
How long will it take me to recover?
Some patients have a benefit immediately following the injection. For others it can take a
couple of weeks before they feel any improvement.
Returning to work
Return to work is dependent on the nature of your work and how quickly your pain settles.
The following are guidelines only:
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Sedentary work – as soon as you feel comfortable.
Light manual work – as soon as you feel comfortable.
Heavy manual work – weeks.
Leisure activities
You can usually begin driving one to two days after your procedure if you feel comfortable
and have good range of movement. It is suggested that you check you can safely do a
three point turn and an emergency stop before your return to driving. Check you can
manage all the controls and start with short journeys.
Notes
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Exercises
Day One after the procedure:
Use painkillers and/or ice packs to reduce the pain before you exercise, if necessary.
Do short, frequent sessions (e.g. 5-10 minutes, 4 times a day) rather than one long
session. It is normal for you to feel aching, discomfort or stretching sensations when doing
these exercises. However, intense and lasting pain (e.g. for more than 30 minutes) is an
indication to change the exercise by doing it less forcefully or often.
When you are not doing your exercises ensure your shoulder is supported by pillows or
your sling as described earlier in this leaflet, to assist with pain relief.
Ensure you keep your neck, elbow, wrist and hand moving after the procedure.
These exercises can be started straight after the procedure:
1. It is important to set the shoulder blades in a good
position before commencing with these exercises.
In order to do this you need to sit up straight with elbows
by your sides, gently lift the tips of your shoulders very
slowly upwards about two centimetres. The base of your
shoulder blades will lift up and outwards very slightly.
Hold for five seconds
Repeat 10 times
In lying position
2. Lying or sitting. Slowly take your affected arm up
towards the ceiling. You can clasp your hands together to
allow your un-affected side to help with the movement if
necessary.
Repeat 10 times
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3. Lying on your back. Reach your hands up towards your
ears and slowly let your elbows drop out and down towards
the bed,
Repeat 10 times
In sitting position
a) Start with your upper arms close to your sides and
elbows at right angles. Rest your palm on a table on a
piece of cloth (a tea towel) or a plastic bag that will slide
easily along the table
b) Slowly slide your hand forward across the table reaching
out as far as you feel comfortable
Repeat 10 times
In standing position
5. Sit or stand. Keep your upper arms close to your sides
and elbows at right angles. Turn your forearms outwards.
Repeat 10 times
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6. In standing, rest your un-affected arm on a table and
lean slowly forwards allowing your affected arm to hang
down.
Slowly swing your arm in a pendulum motion forwards and
backwards.
Repeat 10 times
7. Stand facing a wall. ‘Walk’ your fingers up the wall as
high as you feel comfortable. Then slowly lower your hand
down in the same way.
Repeat 10 times
Day 7+
Continue with the above exercises with the aim of trying to regain full shoulder range of
movement.
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Where can I get more information?
The telephone numbers and email contacts below are available for you to contact a
physiotherapist. You will have the opportunity to ask your Orthopaedic Surgeon
questions about the operation during your consultation or you can also contact them
via their secretary through the Barts Health switchboard.
www.shoulderdoc.com - this is a very good site that has a lot of information written
by Orthopaedic Surgeons specialising in the upper limb.
Patient Advice and Liaison Service (PALS)
If you need general information or advice about Trust services, please contact the
Patient Advice and Liaison Service (PALS) on 020 3594 2040 or visit
www.bartshealth.nhs.uk/pals. Alternatively please contact staff who are providing
your care if you require clinical advice.
Your health records
To enable us to improve the quality of the care that we provide, your health records
are kept by the Trust and may be used for teaching, training, audit and research.
Further information on how the Trust uses your information can be found on our
website at http://www.bartshealth.nhs.uk/your-visit/advice-and-support/your-healthrecord/
Contact information
Barts Health Therapies Department
The Royal London Hospital
Telephone No: 0203 594 1179
Email: [email protected]
Mile End Hospital
Telephone No: 0208 223 8274
Email: [email protected]
Authors: Elizabeth Foster, specialist physiotherapist, Jenny Harper, extended scope
physiotherapist and Susan Cross, MSK radiologist.
Large print and other languages
For this leaflet in large print, please ring 020 3594 2040 or 020 3594 2050.
For help interpreting this leaflet in other languages, please ring 020 8223 8934.
Reference: BH/PIN/182
Publication date: January 2014
All our patient information leaflets are reviewed every three years.
©Barts Health NHS Trust
Switchboard: 020 3416 5000
www.bartshealth.nhs.uk