Adhesive Capsulitis: A Review of Pathophysiology and Arthroscopic Capsular Releas

Adhesive Capsulitis


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 humeraAdhesive Capsulitis

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.

Adhesive Capsulitis
Stages of Adhesive Capsulitis

The situation progresses thru three degrees:

  1. Painful Stage: Marked by using extreme ache and constrained motion.
  2. Frozen Stage: Characterized by stiffness and reduced movement.
  3. 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
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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