Introduction
Orthopedic
surgeons regularly come across adhesive capsulitis in medical exercise. This
condition can motive prolonged pain and incapacity, regularly lasting two years
or more. While a few instances might also warrant surgical intervention,
conservative treatment remains the mainstay. Arthroscopic capsular release has
emerged as a dependable manner for patients who do now not reply to
non-operative management. This paper reviews the orthopedic literature, offers
a scientific history, and outlines the surgical technique for arthroscopic
capsular release.
Overview of Frozen Shoulder Syndrome
Adhesive
capsulitis, generally referred to as frozen shoulder syndrome, impacts about 5%
of the population. It is characterized by way of fibrosis and inflammation of
the glenohumeral joint pill, resulting in severe ache and restrained shoulder
mobility lasting from 1 to 24 months.
Historical Background
The term
“frozen shoulder” has been used for many years. Originally categorized
“periarthritis,” the condition become later defined by Nevasier as “adhesive
capsulitis” based totally on surgical and histological critiques. He defined it
as a thickening and contraction of the joint tablet, which adheres to the
humera
Clinical Presentation
Adhesive
capsulitis generally presents with shoulder pain observed by means of a
innovative loss of movement. The most commonly affected movements are outside
rotation, flexion, and abduction. Women are more commonly affected, whilst men
often revel in longer healing durations.
Classification of Adhesive Capsulitis
Adhesive
capsulitis is divided into:
- Primary (Idiopathic): Occurs without a recognized reason and may contain an autoimmune response.
- Secondary: Occurs after trauma, surgical treatment, or in association with situations inclusive of diabetes, stroke, rotator cuff tears, or cardiovascular dise
Associated Conditions
There is a
strong affiliation among adhesive capsulitis and systemic conditions. Studies
have proven a higher occurrence of diabetes, coronary heart sickness, and
submit-stroke complications in sufferers with frozen shoulder. Diabetics often
revel in more extreme symptoms and slower healing.
Differential Diagnosis
It is
important to differentiate adhesive capsulitis from other conditions consisting
of:
- Chronic Regional Pain Syndrome (CRPS)
- Shoulder girdle tumors
- Sympathetic dystrophy
These
conditions can mimic frozen shoulder however often gift with additional signs
and symptoms including swelling, pores and skin adjustments, or systemic signs
and symptoms.
Stages of Adhesive
Capsulitis

The
situation progresses thru three degrees:
- Painful Stage: Marked by using extreme ache and constrained motion.
- Frozen Stage: Characterized by stiffness and reduced movement.
- Thawing Stage: Gradual go back of movement and discount in ache.
Shoulder Kinematics and Muscle Imbalance
Muscle imbalance, especially among the upper and lower trapezius, results in altered scapular movement. Patients frequently exhibit the "shrug signal" because of the overactivation of the upper trapezius, indicating relevant nervous machine adaptation and negative capsular mobility.
Kinematic and Postural Changes
Abnormal shoulder kinematics consist of immoderate scapular elevation and upward rotation all through arm elevation. Patients may additionally expand negative posture which include anterior shoulder positioning and thoracic kyphosis, further impairing shoulder feature.
Pathophysiology and Tissue Changes
Histological
studies verify fibrosis, thickening, and contracture of the joint capsule in
adhesive capsulitis. Along with ligament and capsular restrictions, muscle
tightness and fascial adhesions make a contribution to restricted variety of
motion and pain.
Role of
Physical Therapy

Physical
therapists use multimodal remedy techniques to cope with muscular tightness,
capsular restrictions, and neuromuscular imbalances. Interventions aim to
restore motion, reduce ache, and accurate postural dysfunctions.
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