In the News - What is Frozen Shoulder? Symptoms, Treatment, and a Possible Pandemic Connection

We were recently asked to share our experience with diagnosing and treating frozen shoulder, also known as adhesive capsulitis, with the Washington Post. In particular, we discussed the potential increase in the number of frozen shoulder cases we have seen since the onset of the pandemic.

“From a biological standpoint, there’s some theories on how if you get covid, then your body is sort of in a heightened inflammatory state, and frozen shoulder fundamentally is an inflammation problem,” said Michael Fu, a shoulder specialist and assistant attending orthopedic surgeon at the Hospital for Special Surgery in New York. Fu added that limits to access to care, such as in-person physical therapy sessions, during the pandemic and changes in people’s daily activities might also be possible triggers.

“The shoulder capsule — it’s a thin lining around the joint itself — has to maintain a delicate balance between flexibility, pliability and also integrity,” Fu said. “Once you get into this cascade of a little bit of inflammation or microtrauma that leads to more inflammation, that just sets off the whole cycle of adhesive capsulitis, where the capsule, which is normally really thin like a piece of tissue paper almost, then becomes really thick and like cardboard, and that’s how your shoulder gets tight and you lose range of motion.”

Read the full article from the Washington Post.

Frozen Shoulder (Adhesive Capsulitis) Surgery

We have extensive experience in treating frozen shoulder, including frozen shoulder capsular release surgery if non-surgical treatments have failed. Please feel free to contact our office if you would like to be seen for a frozen shoulder.

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About the Author

Dr. Michael Fu is an orthopedic surgeon and shoulder specialist at the Hospital for Special Surgery (HSS) in New York City (NYC) and New Jersey (NJ), the best hospital for orthopedics as ranked by U.S. News & World Report. Dr. Fu is an expert at shoulder rotator cuff repair surgery, shoulder instability surgery, and shoulder replacement. Dr. Fu was educated at Columbia University and Yale School of Medicine, followed by orthopedic surgery residency at HSS and sports medicine & shoulder surgery fellowship at Rush University Medical Center in Chicago. He has been a team physician for the Chicago Bulls, Chicago White Sox, DePaul University, and NYC’s PSAL.

Disclaimer: All materials presented on this website are the opinions of Dr. Michael Fu and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Michael Fu for your specific case, we recommend contacting our office to make an appointment.

Journal Club - Return to Golf and Golf-Specific Performance After Anatomic Total Shoulder Arthroplasty and Reverse Total Shoulder Arthroplasty

Michael Fu, MD

Journal Club is a recurring series where we highlight the latest orthopedic shoulder research, and discuss potential applications and ramifications for our patients.

Title

Return to golf and golf-specific performance after anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty

Authors

Drew A. Lansdown, MD, Edward C. Cheung, MD, Mya S. Aung, BS, Alan L. Zhang, MD, Brian T. Feeley, MD, C. Benjamin Ma, MD

Journal

Seminars in Arthroplasty: Journal of Shoulder and Elbow Surgery. 2021 February 8.

Abstract

Background

Golf is a common sporting activity that patients continue to participate into older age, including after joint replacement surgery. The influence of shoulder replacement on golf performance remains unclear. We hypothesized that patients undergoing anatomic total shoulder arthroplasty (TSA) would have significantly better return to play rates and better performance metrics, including handicap, driving distance, and 7-iron distance, after shoulder replacement relative to those treated with reverse total shoulder arthroplasty (RTSA).

Methods

Patients were retrospectively surveyed after anatomic TSA and RTSA with regards to return to golf and golf performance before and after shoulder replacement. Patients reported if they were able to return to golf after shoulder replacement, timing of return to golf, and driving distance, 7-iron distance, handicap, and difficulty with specific shot types upon returning to golf. Significance was defined as P < .05.

Results

The survey was completed by 31 patients with a total of 37 replaced shoulders (68.0 ± 8.1 years; 87% male) out of 44 patients who indicated they played golf. The overall return to golf rate was 74%. Patients undergoing anatomic TSA returned at a significantly higher rate relative to patients treated with RTSA (93% [14 of 15] vs. 56% [9 of 16], P= .037). There was no difference between groups with regards to drive distance, 7-iron distance, and handicap. There were also no differences between preoperative and postoperative values for patients who were able to return to golf. Overall, patients played golf less frequently afterward than they did prior to shoulder replacement (P= .013).

Conclusion

Patients are able to return to golf after shoulder replacement, at an overall rate of 74%, including a rate of 93% for patients with anatomic TSA and 56% for patients with RTSA. Golf performance was similar before and after shoulder replacement surgery for both groups among those who were able to return to play, though overall frequency was decreased after shoulder replacement.

Level of evidence

Level III; Retrospective comparative study.

Keywords

Shoulder replacement; Return to golf; Reverse shoulder arthroplasty; Anatomic total shoulder arthroplasty; Golf performance

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Discussion - Return to Golf after Total Shoulder Replacement

As shoulder replacement becomes increasingly popular and the technology continues to evolve, patient outcomes and post-surgical expectations continue to improve as well. While total shoulder replacement is quite reliable at relieving pain and restoring function with activities of daily living, patients often want and expect to return to sports. Among patients considering shoulder replacement, the most common sports include golf, tennis, and swimming, among others.

In this study by Dr. Lansdown and colleagues at UCSF, the authors surveyed 31 golf players that underwent total shoulder replacement, both anatomic and reverse replacement. The patients were mostly men (87%), with an average age of 68 years. The authors found that patients that had anatomic shoulder replacement returned to golf at a significantly higher rate (93%) than patients that had reverse shoulder replacement (56%). Among the patients that were able to return to golf, however, there was no difference in drive distance, 7-iron distance, and handicap between the anatomic and reverse shoulder replacement patients.

This discrepancy in return to golf rates between anatomic and reverse shoulder replacement is consistent with my clinical experience as well. Compared to the reverse, anatomic shoulder replacement typically provides greater range of motion after surgery, however, the rotator cuff must be intact for an anatomic shoulder replacement to work well. This is because the anatomic shoulder replacement, as the name indicates, recreates the normal anatomy of the shoulder. For patients with rotator cuff issues in conjunction with shoulder arthritis, or rotator cuff tear arthropathy, reverse shoulder replacement is usually the better option because it does not require a rotator cuff to work. The reverse shoulder replacement is able to function in the absence of a rotator cuff because it is a more constrained prosthesis - there is more congruency between the ball and the socket, and the socket is also much deeper. Unfortunately, the trade-off for this increased stability and constraint is reduced range of motion. This likely contributes to the lower rate of return to sports after reverse shoulder replacement relative to anatomic shoulder replacement.

While the total arc of motion will be less after reverse compared to anatomic shoulder replacement, the position of that arc of motion can be influenced by surgical positioning of the implants. This is where my colleagues and I at the Hospital for Special Surgery are devoting much of our research efforts. Every patient is unique in terms of their anatomy, activities, and expectations. The ultimate goal is to perform shoulder replacement operations that are tailored to each individual patient through understanding each patient’s post-surgical goals, and patient-specific surgical planning. For example, for a patient planning to undergo reverse total shoulder replacement and wants to return to golf, we could load her CT scan into surgical planning software, create a render of her unique anatomy, consider whether this is her lead shoulder or her trail shoulder in the golf swing, and plan her surgery in such a way as to maximize the range of motion that would hopefully allow her to return to golf.

Patient-specific surgical planning for reverse total shoulder replacement, with range of motion optimization.

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About the Author

Dr. Michael Fu is an orthopedic surgeon and shoulder specialist at the Hospital for Special Surgery (HSS) in New York City (NYC) and New Jersey (NJ), the best hospital for orthopedics as ranked by U.S. News & World Report. Dr. Fu is an expert at shoulder rotator cuff repair surgery, shoulder instability surgery, and shoulder replacement. Dr. Fu was educated at Columbia University and Yale School of Medicine, followed by orthopedic surgery residency at HSS and sports medicine & shoulder surgery fellowship at Rush University Medical Center in Chicago. He has been a team physician for the Chicago Bulls, Chicago White Sox, DePaul University, and NYC’s PSAL.

Disclaimer: All materials presented on this website are the opinions of Dr. Michael Fu and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Michael Fu for your specific case, we recommend contacting our office to make an appointment.

3 Tips for Shoulder Injury Prevention in the NBA

As a shoulder surgeon at HSS, the official hospital of the National Basketball Players Association (NBPA), I was asked to contribute my thoughts on shoulder injury prevention for the NBPA monthly newsletter. This article was circulated to NBA league personnel, teams, and agents, and I wanted to share this with my patients as well.

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A healthy shoulder is one of the most amazing joints in the human body, achieving a balance between strength, range of motion, and stability. All of these attributes need to be optimized to perform on the basketball court in the absence of pain, and even the smallest of shoulder issues can have a significant impact on your ability to play the game at the highest level. In basketball, the shoulder needs to be strong as you battle for position in the paint. It needs to be flexible as you go up for a block or reach into the passing lane. And it needs to be stable as the foundation of your jumpshot.

As a shoulder specialist, I treat athletes with the full spectrum of shoulder issues, including shoulder impingement, shoulder instability, and rotator cuff tendinitis. Shoulder disability can occur with both basketball-related shoulder injuries, overuse, and strength training that is overly focused on the large muscles around the shoulder including the pectoralis major, deltoid, and latissimus dorsi. In my experience, many athletic shoulder injuries can be prevented or treated non-surgically by focusing on stabilizing the scapula, strengthening the rotator cuff, and maximizing shoulder range of motion.

1. Scapular strengthening

As the foundation of the shoulder joint, the scapula (shoulder blade) is a uniquely-shaped bone that serves as the attachment site for 17 different muscles. This allows the scapula to contribute a significant portion of overall shoulder range of motion, as well as dynamically position the socket of the shoulder joint for optimal shoulder function. In fact, the scapula is often described as a seal balancing a ball on its nose, constantly making small adjustments to keep the ball of the shoulder joint balanced on the socket.

Despite the importance of the scapula and the number of muscles that attach to it, scapular strengthening is often overlooked. This can be achieved with scapular exercises such as scapular retractions (shoulder blade squeezes), scapular push-ups, shoulder shrugs, prone rows, and wall ball circles, among others.

2. Rotator cuff exercises

Compared to other ball-and-socket joints in the body, the shoulder has very little inherent bony stability. Instead, the shoulder relies on the rotator cuff, which is a set of four relatively small muscles around the shoulder, to keep the ball centered in the socket while the much larger muscles such as the deltoid, pectoralis, and latissimus move the arm through shoulder range of motion. In athletes with well-developed muscles around the shoulder and upper body, it is even more essential that the rotator cuff remains strong enough to keep the shoulder joint stable.

While not as satisfying as bench pressing hundreds of pounds, rotator cuff exercises include internal and external rotation against rubber band resistance, external rotation with the shoulder abducted 90 degrees, and lawn mowers, among others. This is essential to maintaining a heathy shoulder.

3. Stretching to maintain shoulder range of motion

Finally, optimizing shoulder flexibility is also important for shoulder injury prevention. By maintaining flexibility in the soft tissues around the shoulder, the ball of the shoulder joint can stay centered in the socket through the entire range of motion. If the shoulder capsule is tight, a sudden forceful motion such as going up for a block could result in a shoulder strain. In more severe cases, if there is unbalanced shoulder tightness, micro-instability of the shoulder joint can occur as well. Shoulder flexibility can be optimized through simple stretches such as table slides, wall climbs, sleeper stretches, external rotation stretches, and towel stretches behind the back, among others.

Through the course of a long season, these simple strategies involving scapular strengthening, rotator cuff exercises, and shoulder stretching will minimize the risk of a major shoulder injury and keep you healthy on the court!

Read full article

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Dr. Michael Fu is an orthopedic surgeon and shoulder specialist at the Hospital for Special Surgery (HSS) in New York City (NYC) and New Jersey (NJ), the best hospital for orthopedics as ranked by U.S. News & World Report. Dr. Fu is an expert at shoulder rotator cuff repair surgery, shoulder instability surgery, and shoulder replacement. Dr. Fu was educated at Columbia University and Yale School of Medicine, followed by orthopedic surgery residency at HSS and sports medicine & shoulder surgery fellowship at Rush University Medical Center in Chicago. He has been a team physician for the Chicago Bulls, Chicago White Sox, DePaul University, and NYC’s PSAL.

Disclaimer: All materials presented on this website are the opinions of Dr. Michael Fu and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Michael Fu for your specific case, we recommend contacting our office to make an appointment.