Arce Guillermo
Instituto Argentino de Diagnóstico y Tratamiento, Buenos Aires, Argentina.
Arthrosc Tech. 2015 Nov 19;4(6):e717-20. doi: 10.1016/j.eats.2015.06.004. eCollection 2015 Dec.
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.
特发性粘连性关节囊炎,或原发性冻结肩综合征,是一种相当常见的骨科问题,其特征为肩部疼痛和活动受限。在大多数情况下,保守治疗(为期6个月的物理治疗方案和关节内注射类固醇)可改善症状并恢复肩部活动。对于难治性病例,需进行关节镜下关节囊松解术。该手术方法相较于其他治疗方式具有多个优势。首先,它能精确、可控地松解关节囊和韧带,降低强力肩部手法操作后出现创伤性并发症的风险。其次,使用射频设备松解关节囊及相关结构可延迟愈合,从而防止粘连形成。第三,该技术操作简单,术后口服类固醇方案可减轻疼痛,并允许开展愉快的早期康复计划。第四,手术在患者清醒状态下于肌间沟阻滞麻醉下进行,这增强了患者的信心以及对物理治疗方案的依从性。对于难治性原发性冻结肩综合征患者,关节镜下关节囊松解术是一种合适的选择,可实现更快且持久的恢复。