<b>Bone marrow decompression for treatment of the frozen shoulder</b>

Abstract

The frozen shoulder is said to resolve spontaneously though the affected duration varies individually, however, its cause is not yet elucidated. Among them, however, some patients often suffer from night insomnia due to severe pain and hardly sleep when the affected side is located inferiorly. This severe pain may require a medical intervention in some cases. In this study, humeroscapular bone marrow decompression with bone perforation from the greater tubercle of humerus to the cavity of bone marrow of head of humerus was performed in 12 patients with frozen shoulder, 14 shoulders in total. The age of patients enrolled in this study ranged from 54 to 78 years with the mean of 69.5 years. There were 3 females and 9 males. The right shoulder was affected in 10 cases and the left in 4 cases.Six cases were outpatients and the remaining 6 cases were inpatients. As a result, omalgia disappeared immediately after operation in 8 shoulder joints (57%; markedly effective cases). This immediate pain-relieving effect lasted for 2 - 12 months, 6.9 months on the average. The observation period ranged from 2 to 12 months. At the averaged 7.6 months of observation period, a markedly effective outcome was found in 9 shoulder joints (64%) and an effective outcome including those with VAS 10 - 30 ⁄ 100 was found in 10 shoulder joints (71%). As for complications, postoperative hemorrhage was seen only in 1 case, which was however successfully arrested by compression. In the osteomyelographic examination simultaneously performed, some difference was noted in the venograms of the inside and outside of bone marrow between markedly effective and non-effective cases. In markedly effective cases, the circumflex humeral veins and axilliary vein could be imaged from immediately after infusion of contrast medium, while the diaphysis was generally imaged as a thin venogram.In non-effective cases, on the other hand,no vein was imaged in the subcapital region with thickened and meandered vein in the diaphysis (probably being the central venous sinus). These osteomyelographic findings were estimated to reflect an elevated state of humeral intramedullary pressure, suggesting that an elevated humeral intramedullary pressure and subsequently induced circulatory disturbance in the bone marrow may be involved in the case of frozen shoulder. Humeroscapular bone marrow decompression is considered to be useful for eliminating and suppressing pain episodes in frozen shoulder with a significant influence on the clinical course and thus to be a promising therapeutic strategy for frozen shoulder.