Surgery to cut the adhesions (capsular release) may be indicated in prolonged and severe cases; the procedure is usually performed by arthroscopy. Surgical evaluation of other problems with the shoulder, e.g., subacromial bursitis or rotator cuff tear, may be needed. Resistant adhesive capsulitis may respond to open release surgery. This technique allows the surgeon to find and correct the underlying cause of restricted glenohumeral movement such as contracture of coracohumeral ligament and rotator interval. Physical therapy may achieve improved results after surgical procedure and postoperative rehabilitation.Physical therapy is an effective procedure that provides essential exercises to improve range of motion. Patients who receive the proper training from an authorized physiotherapist can perform these exercises independently at home. The physiotherapy treatment for frozen shoulder will include manual therapy to mobilize the affected joints and release their muscles. "Pendulum stretch", "finger walk", "towel stretch", "armpit stretch" and "crossbody reach" are some essential mobility exercises specifically designed to improve the shoulder mobility of patients with frozen shoulders. There are also limited case reports of therapy utilizing vibration platforms obtaining fast results, not as a post-operative aid, but instead of surgery.Acupuncture has been found to decrease pain levels and improve shoulder function and range of motion, particularly in shoulder flexion. Acupuncture combined with shoulder exercises was found to be more effective than shoulder exercise alone. However, further studies with longer follow-up times are needed to assess mid- and long term benefits. Prognosis
Most cases of adhesive capsulitis are self limiting, but may take 1 to 3 years to fully resolve.
Mafenide (INN; usually as mafenide acetate, trade name Sulfamylon) is a sulfonamide-type medication used as an antibiotic. It was approved by the FDA in 1948. Uses
Mafenide is used to treat severe burns. It is used topically as an adjunctive therapy for second- and third-degree burns. It is bacteriostatic against many gram-positive and gram-negative organisms, including Pseudomonas aeruginosa. Some sources state that mafenide is more appropriate for non-facial burns, while chloramphenicol/prednisolone or bacitracin are more appropriate for facial burns. Mechanism of action
Mafenide works by reducing the bacterial population present in the avascular tissues of burns and permits spontaneous healing of deep partial-thickness burns. Adverse reactions
Adverse reactions can include superinfection, pain or burning upon application, rash, pruritus, tachypnea, or hyperventilation. Mafenide is metabolized to a carbonic anhydrase inhibitor, which could potentially result in metabolic acidosis. Drug interactions
There are no significant interactions. Contraindications
Mafenide is contraindicated in those with sulfonamide hypersensitivity or renal impairment. Dosage
For use as adjunctive therapy for second- and third-degree burns to prevent infection, adults and children should apply topically to a thickness of approximately 1.6 mm to cleaned and debrided wound once or twice per day with a sterile gloved hand. The burned area should be covered with cream at all times. References
External links
Mafenide information on RxList