Frozen Shoulder 360° Release.
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ABSTRACT:
SUBMITTER: Cutbush K
PROVIDER: S-EPMC8084753 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Idiopathic adhesive capsulitis, or primary frozen shoulder syndrome, is a fairly common orthopaedic problem characterized by shoulder pain and loss of motion. In most cases, conservative treatment (6-month physical therapy program and intra-articular steroid injections) improves symptoms and restores shoulder motion. In refractory cases, arthroscopic capsular release is indicated. This surgical procedure carries several advantages over other treatment modalities. First, it provides precise and controlled release of the capsule and ligaments, reducing the risk of traumatic complications observed after forceful shoulder manipulation. Second, release of the capsule and the involved structures with a radiofrequency device delays healing, which prevents adhesion formation. Third, the technique is straightforward, and an oral postoperative steroid program decreases pain and allows for a pleasant early rehabilitation program. Fourth, the procedure is performed with the patient fully awake under an interscalene block, which boosts the patient's confidence and adherence to the physical therapy protocol. In patients with refractory primary frozen shoulder syndrome, arthroscopic capsular release emerges as a suitable option that leads to a faster and long-lasting recovery.
| S-EPMC4738186 | biostudies-literature
Project description:Arthroscopic pancapsular release has been recommended for recalcitrant frozen shoulder, but regaining range of motion has not been sufficient compared with the unaffected side. There is no consensus about the reasons for these remaining restrictions in range of motion, but residual capsular or connective tissue must be considered a candidate. A thickened coracohumeral ligament at the rotator interval has been reported as one of the most specific manifestations of frozen shoulder. It covers wider portions of the subscapularis tendon, supraspinatus tendon, and infraspinatus tendon than previously reported. We describe an arthroscopic surgical technique for the release of the entire coracohumeral ligament including the subscapularis and supraspinatus portions and the release of the inferior and posterior parts of the glenohumeral ligament using the 7-o'clock portal. These procedures are essential and reliable methods to release the entire joint capsule to regain full range of motion for frozen shoulder.
| S-EPMC5785948 | biostudies-literature
Project description:PURPOSE:To evaluate the effect of timing of arthroscopic release and manipulation under anesthesia for frozen shoulder in patients with diabetes and non-diabetes. METHODS:One hundred and twenty-seven patients with frozen shoulder were included in the study. Each patient was assigned to: 1) one of four groups according to the duration from symptom onset to surgery (group A: ?3 months; group B: 3-6 months; group C: 6-12 months; group D: >12 months), 2) diabetic or nondiabetic group. The outcomes were measured by shoulder range of motion (ROM), Disabilities of the Arm, Shoulder, and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) Shoulder score, the period of pain relief, overall duration of disease, and satisfaction. RESULTS:All the patients got great improvement in shoulder ROM (P < .0001) after arthroscopic surgery, but there was no statistical difference in the pre-operative and post-operative shoulder ROM between the four groups and between diabetic and nondiabetic groups. The overall duration of disease was mean 55.4~68.7 weeks, which demonstrated much shorter disease course compared with nature course. Improvement were also seen in shoulder ROM at one week to one month, and the period of total pain relief was at a mean time of 3.7 to 3.8 weeks. There were higher ASES Shoulder score in group B than in group C (P = 0.02) and higher DASH score in diabetic group in short term follow-up. CONCLUSIONS:Arthroscopic release provides effective and rapid improvements to shoulder motion and function, unrelated to the timing of surgery, in patients with frozen shoulder. The diabetic patients do not have functional outcomes as good as the nondiabetic patient at short-term follow-up.
| S-EPMC6844453 | biostudies-literature
Project description:Adhesive capsulitis is a common and challenging condition to treat. Arthroscopic capsular release is usually contemplated when conservative treatment fails or when there is severe and/or chronic loss of range of motion. This procedure can be difficult to perform because of difficult access to the joint, poor visualization, and loss of working space from retraction of the joint capsule. The articular surfaces and the axillary nerve are also at higher risk of injury. Arthroscopic scissors, shavers, and electrocautery are typically used to perform the capsular release. To perform a safer and more precise arthroscopic shoulder capsular release, a creative and innovative use of a flexible hip arthroscopy radiofrequency ablator is described.
| S-EPMC3678626 | biostudies-literature
Project description:Combined lesions of the glenoid labrum are a relatively common finding in shoulder instability patients. Even so, relatively few studies have been published evaluating outcomes after repair of these complex labral detachments. To achieve a successful outcome, accurate identification of all pathologic lesions in the shoulder combined with an organized, stepwise approach to sometimes circumferential labral fixation is required. Repair of 360° labral tears can be effectively and efficiently achieved by implementing the reproducible steps and sequence described to reconstruct these circumferential labral tears.
| S-EPMC6153397 | biostudies-literature
Project description:BackgroundWe aimed to retrospectively determine the effects of arthroscopic pan-capsular release with or without entire coracohumeral ligament (CHL) release and diabetes mellitus (DM) in patients with frozen shoulder (FS).MethodsThe study included 34 patients (20 male and 14 female patients) who underwent arthroscopic pan-capsular release without entire CHL release (group 1) and 26 patients (6 male and 20 female patients) who underwent entire CHL release for FS (group 2). Patients with a minimum of 12 months of follow-up were included, and range of motion (ROM) and the shoulder rating scale of the University of California at Los Angeles (UCLA) scoring system were evaluated.ResultsIn group 2, external rotation and hand-behind-the-back (HBB) ROMs were significantly increased compared with group 1 at the final follow-up (external rotation, 53.1° ± 15.2° vs. 41.3° ± 20.5° [P = .044]; HBB level, T6 [interquartile range, T5-T9] vs. T11 [interquartile range, T8-L4] [P < .001]). Total UCLA scores and UCLA scores for pain (9.2 ± 1.5 vs. 10.0, P = .003), function (8.5 ± 1.4 vs. 10.0, P < .001), and active forward flexion (4.6 ± 0.6 vs. 4.9 ± 0.2, P < .011) were significantly greater in group 2 at the final follow-up. Patients without DM tended to have greater recovery of forward flexion and HBB ROMs and better total, pain, and function UCLA scores compared with those with DM. In group 2, there were no significant differences in ROMs and UCLA scores between the patients with DM and those without DM.ConclusionArthroscopic entire CHL release is an essential treatment option for FS patients to regain ROMs and function and to reduce pain.
| S-EPMC7738570 | biostudies-literature
Project description:IntroductionFrozen shoulder is a common, fibro-proliferative disease characterised by the insidious onset of pain and progressively restricted range of shoulder movement. Despite the prevalence of this disease, there is limited understanding of the molecular mechanisms underpinning the pathogenesis of this debilitating disease. Previous studies have identified increased myofibroblast differentiation and proliferation, immune cell influx and dysregulated cytokine production. We hypothesised that subpopulations within the fibroblast compartment may take on an activated phenotype, thus initiating the inflammatory processes observed in frozen shoulder. Therefore, we sought to evaluate the presence and possible pathogenic role of known stromal activation proteins in Frozen shoulder.MethodsShoulder capsule samples were collected from 10 patients with idiopathic frozen shoulder and 10 patients undergoing shoulder stabilisation surgery. Fibroblast activation marker expression (CD248, CD146, VCAM and PDPN, FAP) was quantified using immunohistochemistry. Control and diseased fibroblasts were cultured for in vitro studies from capsule biopsies from instability and frozen shoulder surgeries, respectively. The inflammatory profile and effects of IL-1β upon diseased and control fibroblasts was assessed using ELISA, immunohistochemistry and qPCR.ResultsImmunohistochemistry demonstrated increased expression of fibroblast activation markers CD248, CD146, VCAM and PDPN in the frozen shoulder group compared with control (p < 0.05). Fibroblasts cultured from diseased capsule produced elevated levels of inflammatory protein (IL-6, IL-8 & CCL-20) in comparison to control fibroblasts. Exposing control fibroblasts to an inflammatory stimuli, (IL-1ß) significantly increased stromal activation marker transcript and protein expression (CD248, PDPN and VCAM).ConclusionsThese results show that fibroblasts have an activated phenotype in frozen shoulder and this is associated with inflammatory cytokine dysregulation. Furthermore, it supports the hypothesis that activated fibroblasts may be involved in regulating the inflammatory and fibrotic processes involved in this disease.
| S-EPMC6478286 | biostudies-literature
Project description:It is fairly well understood that frozen shoulder involves several stages, which reflect the series of process from capsular inflammation and fibrosis to spontaneous resolution of this fibrosis. However, the underlying pathophysiologic process remains poorly determined. For this reason, management of frozen shoulder remains controversial. Determining the pathophysiological processes of frozen shoulder is a pivotal milestone in the development of novel treatment for patients with frozen shoulder. This article reviews what is known to date about the biological pathophysiology of frozen shoulder. Although articles for the pathophysiology of frozen shoulder provide inconsistent and inconclusive results, they have suggested both inflammation and fibrosis mediated by cytokines, growth factors, matrix metalloproteinases, and immune cells. Proinflammatory cytokines and growth factors released from immune cells control the action of fibroblast and matrix remodeling is regulated by the matrix metalloproteinases and their inhibitors. To improve our understanding of the disease continuum, better characterizing the biology of these processes at clearly defined stages will be needed. Further basic studies that use standardized protocols are required to more narrowly identify the role of cytokines, growth factors, matrix metalloproteinases, and immune cells. The results of these studies will provide needed clarity into the control mechanism of the pathogenesis of frozen shoulder and help identify new therapeutic targets for its treatment.
| S-EPMC5994312 | biostudies-literature
Project description:Frozen shoulder, also known as adhesive capsulitis, is a common presentation in the primary care setting and can be significantly painful and disabling. The condition progresses in three stages: freezing (painful), frozen (adhesive) and thawing, and is often self-limiting. Common conservative treatments include nonsteroidal anti-inflammatory drugs, oral glucocorticoids, intra-articular glucocorticoid injections and/or physical therapy. However, many physicians may find themselves limited to prescribing medications for treatment. This article elaborates on physical therapy exercises targeted at adhesive capsulitis, which can be used in combination with common analgesics.
| S-EPMC5917053 | biostudies-literature