Adhesive capsulitis (frozen shoulder syndrome)

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Adhesive capsulitis (frozen shoulder syndrome)

The scapula is the largest sesamoid bone in the body, floating in a sea of multi-direction soft tissue pulleys. No where is there a better example of tensional integrity displayed than the scapula and it’s fascial links.

The scapula has many muscular attachments linking the humerus and the spine to it intimately. Perhaps most interesting are the domino effect of mechanical actions that the scapula allows during arm motions. For instance, the seemingly simple act of raising the right arm is not just the deltoid contracting but rather the upper trapezius/serratus anterior upwardly rotating the scapula to keep the glenohumeral joint free from impingement during the raise. However, none of this can happen unless the antagonist downward rotators, the Levator Scapulae and Rhomboids, contract to balance the upward rotation of the scap via a stable point at the spine. This ensures that arm motion is always accompanied by forces on the cervical and thoracic spine via these links. It is often functional deficiency of the Levator/Rhomboid that disrupts the rhythm of scapular motion potentially leading to strain transferred to their spinal connections. If the muscles cannot maintain an even tension, a conflict can result in the neck with pain resulting along with shoulder impingement.

Adhesive capsulitis (frozen shoulder syndrome) - is a rare condition of painful stiffness of shoulder's muscles. In this case may be revealed two principal distinctive moment:

  • shoulder pain - pain in the glenohumeral joint during motion and at rest
  • contractures - muscle limitation in the amount of abstraction hands to the side when it is picked up and the impossibility of institutions sick hands behind his back
Muscles of the shoulder joint in the diagnosis of osteoarthritis shoulder (scapulohumeral periarthrosis) spastic cut.
In the adhesive capsulate (frozen shoulder syndrome, scapulohumeral periartrite) patient concerned about pain in the shoulder (shoulder joint) during movement and at rest.

Frozen periarthrosis (arthrosis of the shoulder joint, adhesive capsulitis, or the syndrome of "frozen shoulder") often develops gradually, not noticeable to the patient. Women suddenly find that they can not fasten and unfasten the bra itself, since this motion (abduction), his hands behind his back gives them a pain in the shoulder. In severe cases, severe pain in the shoulder joint, the patient is not able to bring this hand the spoon to his mouth, for as it may disturb the pain in my shoulder.

In a patient with arthritis of shoulder joint disturbed sleep because he could not find a comfortable position for your hands while you sleep. so that the shoulder had not ached with pain.

Adhesive capsulitis (frozen shoulder syndrome) causes

The cause of such diseases as arthrosis of the shoulder joint (humeroscapular periarthrosis) is still uncertain. At the same time, there are several theories of arthrosis of the shoulder joint (humeroscapular periarthrosis):

  • shoulder injury (falling on his hand, sports overload)
  • presence of protrusions or herniation of intervertebral discs of the cervical spine
  • hereditary factor etc.
  • long and the same type of physical exertion on the muscles and ligaments of the shoulder (long-term work with one hand, playing guitar, etc.)
In the adhesive capsulate the range of motion of the scapula and the shoulder joint is severely limited due to muscle pain.


Adhesive capsulitis (frozen shoulder syndrome) diagnosis

The examination established the degree of muscle tension in the shoulder girdle, the amount of motion in the shoulder joint. The x-ray of shoulder joint, usually visible changes of articular surfaces are missing.

In the diagnosis of shoulder joint range of motion in adhesive capsulitis (frozen shoulder syndrome) drastically reduced.

MRI of the shoulder joint also does not record any significant structural changes in the initial stage of humeroscapular periarthrosis. Organic changes appear later, with time, as a result of prolonged lack of a complete range of motion in the shoulder joint. On MRI scan of the shoulder joint they look like:

  • signs effusion of synovial fluid into the cavity of the shoulder joint
  • thickening of the ligaments
  • signs of inflammation and swelling of the muscle of the shoulders rotator cuff
  • signs of inflammation and swelling of the acromioclavicular joint
  • deformation of the cartilage of the humeral head, etc.
MRI of shoulder joint in the frontal projections may show no change in the cavity on the surface of the joint and its ligaments.


Adhesive capsulitis (frozen shoulder syndrome) treatment

Adhesive capsulitis (frozen shoulder syndrome) treatment for quite a long and painful, as it requires constant exposure to the constricted muscles surrounding the shoulder joint. Such patients have to treat the shoulder joint for several months

Approach to treatment should be quite an active part of the medical staff, otherwise there is a risk of ankylosis of shoulder joint with all the subsequent remedial actions, deadlines and financial costs for the patient.

Elimination of swelling, inflammation, pain, restore range of motion in the shoulder joint and muscles in the treatment of osteoarthritis (humeroscapular periarthrosis) accelerated by the use of physiotherapy.
The subacromial space is infiltrated with an anesthetic when subacromial impingement is the cause of the shoulder pain.
In the treatment of frozen shoulder syndrome patient performs specific exercises.

Adhesive capsulitis (frozen shoulder syndrome) treatment includes the effects on spastic muscles of the shoulder girdle, with a gradual increase in range of motion in the shoulder joint:

  • muscle manipulation technique on the shoulder belt, lifting the painful muscle hypertonicity
  • gymnastics for a gradual increase in volume of motion in joints
  • trigger point injection with an anesthetics (lidocaine, procaine) and long-acting hormonal preparations (kenalog, diprospan) in trigger points around the shoulder joint and shoulder blades
  • physiotherapy (UHF, CMT) in the projection of the shoulder joint and shoulder blades
  • endoscopic surgery (arthroscopy of the shoulder joint)