Georgiannos Dimitrios, Markopoulos George, Devetzi Eirini, Bisbinas Ilias
Orthopaedics and Trauma Surgery 424 Military General Hospital, Thessaloniki, Greece.
Rheumatology 424 Military General Hospital, Thessaloniki, Greece.
Open Orthop J. 2017 Feb 28;11:65-76. doi: 10.2174/1874325001711010065. eCollection 2017.
Adhesive capsulitis of the shoulder (ACS) is a common self-limiting condition characterized by disabling pain and restricted movements. Its pathophysiology is poorly understood, clinically it is characterized by stages of pain and stiffness, and finally often patients never recover fully. However, there is no consensus about available methods of treatment for ACS. The aims of this paper are to discuss and develop issues regarding approaches to management in ACS in the stages of it.
A review of the literature was performed and guidelines for the treatment of that clinical entity for doctors and health care professionals are provided.
Anti-inflammatory medications, steroid and/or hyaluronate injections and physiotherapy is the mainstay of conservative management either alone in the first stages or in combination with other treatment modalities in the later stages. Next line of treatment, involving minor to moderate intervention, includes suprascapular nerve block, distension arthrography and manipulation under anaesthesia. In order to avoid complications of "blind intervention", arthroscopic capsular release is gradually more commonly applied, and in recalcitrant severe cases open release is a useful option.
Various modalities of conservative management and gradually more surgical release are applied. However, often clinicians choose on personal experience and training rather than on published evidence.
肩周炎（ACS）是一种常见的自限性疾病，其特征为疼痛剧烈且活动受限。其病理生理机制尚不清楚，临床上表现为疼痛和僵硬阶段，最终很多患者往往无法完全康复。然而，对于肩周炎现有的治疗方法尚无共识。本文旨在讨论并阐述肩周炎各阶段的治疗方法相关问题。
进行了文献综述，并为医生和医护人员提供了该临床病症的治疗指南。
抗炎药物、类固醇和/或透明质酸注射以及物理治疗是保守治疗的主要方法，在疾病初期可单独使用，后期可与其他治疗方式联合使用。二线治疗包括轻度至中度干预，如肩胛上神经阻滞、关节造影扩张术和麻醉下手法松解。为避免“盲目干预”的并发症，关节镜下关节囊松解术的应用逐渐增多，对于顽固的严重病例，开放松解术是一种有效的选择。
采用了多种保守治疗方式，手术松解也越来越多。然而，临床医生往往根据个人经验和培训进行选择，而非依据已发表的证据。
