Bach H Gregory, Goldberg Benjamin A
Department of Orthopaedic Surgery, University of Illinois-Chicago, 60612, USA.
J Am Acad Orthop Surg. 2006 May;14(5):265-77. doi: 10.5435/00124635-200605000-00002.
Posterior capsular contracture is a common cause of shoulder pain in which the patient presents with restricted internal rotation and reproduction of pain. Increased anterosuperior translation of the humeral head occurs with forward flexion and can mimic the pain reported with impingement syndrome; however, the patient with impingement syndrome presents with normal range of motion. Initial management of posterior capsular contracture should be nonsurgical, emphasizing range-of-motion stretching with the goal of restoring normal motion. For patients who fail nonsurgical management, arthroscopic posterior capsule release can result in improved motion and pain relief. In the throwing athlete, repetitive forces on the posteroinferior capsule may cause posteroinferior capsular hypertrophy and limited internal rotation. This may be the initial pathologic event in the so-called dead arm syndrome, leading to a superior labrum anteroposterior lesion and, possibly, rotator cuff tear. Management involves regaining internal rotation such that the loss of internal rotation is not greater than the increase in external rotation. In the athlete who fails nonsurgical management, a selective posteroinferior capsulotomy can improve motion, reduce pain, and prevent further shoulder injury.
后囊挛缩是肩部疼痛的常见原因，患者表现为内旋受限和疼痛再现。肱骨头在向前屈曲时出现前上移位增加，可模拟撞击综合征所报告的疼痛；然而，撞击综合征患者的活动范围正常。后囊挛缩的初始治疗应是非手术治疗，强调进行活动范围拉伸，目标是恢复正常活动。对于非手术治疗失败的患者，关节镜下后囊松解可改善活动并缓解疼痛。在投掷运动员中，后下囊上的重复力量可能导致后下囊肥大和内旋受限。这可能是所谓死臂综合征的初始病理事件，导致上盂唇前后部损伤，并可能导致肩袖撕裂。治疗包括恢复内旋，使内旋的丧失不大于外旋的增加。对于非手术治疗失败的运动员，选择性后下囊切开术可改善活动、减轻疼痛并预防进一步的肩部损伤。
