From the Columbia University Medical Center, Department of Orthopedics, Center for Shoulder Elbow and Sports Medicine, New York, NY.
J Am Acad Orthop Surg. 2019 Jun 15;27(12):e544-e554. doi: 10.5435/JAAOS-D-17-00606.
Adhesive capsulitis presents clinically as limited, active and passive range of motion caused by the formation of adhesions of the glenohumeral joint capsule. Radiographically, it is thickening of the capsule and rotator interval. The pathology of the disease, and its classification, relates to inflammation and formation of extensive scar tissue. Risk factors include diabetes, hyperthyroidism, and previous cervical spine surgery. Nonsurgical management includes physical therapy, corticosteroid injections, extracorporeal shock wave therapy, calcitonin, ultrasonography-guided hydrodissection, and hyaluronic acid injections. Most patients will see complete resolution of symptoms with nonsurgical management, and there appears to be a role of early corticosteroid injection in shortening the overall duration of symptoms. Surgical intervention, including manipulation under anesthesia, arthroscopic capsular release both limited and circumferential, and the authors' technique are described in this article. Complications include fracture, glenoid and labral injuries, neurapraxia, and rotator cuff pathology. Postoperative care should always include early physical therapy.
粘连性肩关节囊炎临床上表现为肩关节囊的粘连导致关节活动度受限，主动和被动活动均受限。影像学上表现为关节囊增厚和旋转间隙变窄。该疾病的病理学及其分类与炎症和广泛的瘢痕组织形成有关。危险因素包括糖尿病、甲状腺功能亢进症和先前的颈椎手术。非手术治疗包括物理治疗、皮质类固醇注射、体外冲击波治疗、降钙素、超声引导下的水分离和透明质酸注射。大多数患者通过非手术治疗可完全缓解症状，并且早期皮质类固醇注射似乎可以缩短症状的总持续时间。手术干预包括麻醉下手法松解、关节镜下囊切开术（有限和环形）以及作者的技术，在本文中均有描述。并发症包括骨折、肩盂和肩唇损伤、神经麻痹和肩袖病变。术后护理应始终包括早期物理治疗。
