Anakwenze Oke A, Hsu Jason E, Kim Jae S, Abboud Joseph A
Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Orthopedics. 2011 Sep 9;34(9):e556-60. doi: 10.3928/01477447-20110714-05.
Diagnosis of adhesive capsulitis is a clinical diagnosis based on history and physical examination. Afflicted patients exhibit active and passive loss of motion in all planes and a positive capsular stretch sign. The effect of adhesive capsulitis on acromioclavicular biomechanics leading to tenderness has not been documented in the literature. This study reports on the incidence of acromioclavicular tenderness in the presence of adhesive capsulitis. Furthermore, we note the natural history of such acromioclavicular joint pain in relation to that of adhesive capsulitis. Over a 2-year period (2005-2007), 84 patients undergoing initial evaluation for adhesive capsulitis were prospectively examined with the use of validated outcome measures and physical examination. Acromioclavicular joint tenderness results were compared and analyzed on initial evaluation and final follow-up of at least 1 year. Forty-eight patients (57%) with adhesive capsulitis had acromioclavicular joint pain on examination. At final follow-up, as range of motion improved, a significant increase in American Shoulder and Elbow Surgeons/Penn shoulder score and decrease in number of patients with acromioclavicular pain was noted with only 6 patients with residual pain (P<.05). In the presence of adhesive capsulitis, there is not only compensatory scapulothoracic motion but also acromioclavicular motion. This often results in transient symptoms at the acromioclavicular joint, which abate as the frozen shoulder resolves and glenohumeral motion improves. This is important to recognize to avoid unnecessary invasive treatment of the acromioclavicular joint when the patient presents with adhesive capsulitis.
粘连性关节囊炎的诊断是基于病史和体格检查的临床诊断。患病患者在各个平面均表现出主动和被动活动受限以及阳性关节囊牵拉征。粘连性关节囊炎对肩锁关节生物力学导致压痛的影响在文献中尚未有记载。本研究报告了粘连性关节囊炎患者中肩锁关节压痛的发生率。此外，我们还观察了这种肩锁关节疼痛与粘连性关节囊炎相关的自然病程。在2年期间（2005 - 2007年），对84例因粘连性关节囊炎接受初始评估的患者进行了前瞻性检查，采用了经过验证的疗效指标和体格检查。对肩锁关节压痛结果在初始评估和至少1年的最终随访时进行了比较和分析。48例（57%）粘连性关节囊炎患者在检查时有肩锁关节疼痛。在最终随访时，随着活动范围改善，美国肩肘外科医师协会/宾夕法尼亚肩部评分显著提高，肩锁关节疼痛患者数量减少，仅有6例患者仍有残留疼痛（P<0.05）。在存在粘连性关节囊炎的情况下，不仅有肩胛胸壁的代偿性活动，还有肩锁关节的活动。这常常导致肩锁关节出现短暂症状，随着肩周炎缓解和盂肱关节活动改善，这些症状会减轻。认识到这一点很重要，这样当患者表现为粘连性关节囊炎时，可避免对肩锁关节进行不必要的侵入性治疗。
