Toft Felix, Moro Fabrizio, Scheibel Markus
Klinik für Orthopädie, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Schweiz.
Abteilung für Schulter- und Ellenbogenchirurgie, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz.
Unfallchirurg. 2019 Dec;122(12):925-933. doi: 10.1007/s00113-019-00726-0.
Apart from primary or idiopathic frozen shoulder, the secondary form of glenohumeral stiffness can also develop after trauma or surgery. The cause for these secondary forms of restricted range of motion can be distinguished into intra-articular and extra-articular factors. Posttraumatic stiffness can develop after minor or major trauma to the bony or soft tissues of the shoulder girdle. After minor trauma the course and clinical presentation is similar to the primary form as pathomorphological correlates are often not detectable; therefore, treatment protocols are adapted according to those for primary shoulder stiffness. Shoulder stiffness after major trauma is mainly caused by scarring and adhesions of gliding structures and often necessitates surgical release if resolution under conservative treatment fails. Postoperative shoulder stiffness is a common problem after rotator cuff surgery or fracture fixation, even though incidences vary widely between different surgical procedures. Apart from the abovementioned scarring, overstuffing implants or tightening of soft tissue structures can lead to restricted range of motion. Stiffness after shoulder arthroplasty is rare and should prompt further diagnostic work-up to differentiate implant, surgery or patient-specific causes. Furthermore, an inflammatory shoulder stiffness similar to the primary or minor trauma form can develop after surgery. Reviewing the literature, shoulder stiffness has been reported most often after rotator cuff reconstruction surgery, followed by fracture fixation surgery, instability operations and lastly shoulder arthroplasty.
除原发性或特发性冻结肩外，创伤或手术后也可出现继发性盂肱关节僵硬。这些继发性活动范围受限的原因可分为关节内和关节外因素。创伤后僵硬可发生于肩胛带骨或软组织的轻微或严重创伤后。轻微创伤后的病程和临床表现与原发性相似，因为病理形态学关联往往无法检测到；因此，治疗方案根据原发性肩关节僵硬的方案进行调整。严重创伤后的肩关节僵硬主要由滑动结构的瘢痕形成和粘连引起，如果保守治疗无法缓解，通常需要手术松解。术后肩关节僵硬是肩袖手术或骨折固定术后常见的问题，尽管不同手术的发生率差异很大。除上述瘢痕形成外，植入物填充过多或软组织结构收紧也可导致活动范围受限。肩关节置换术后僵硬罕见，应进一步进行诊断检查以区分植入物、手术或患者特异性原因。此外，手术后可出现与原发性或轻微创伤形式相似的炎症性肩关节僵硬。回顾文献，肩袖重建手术后肩关节僵硬的报道最为常见，其次是骨折固定手术、不稳定手术，最后是肩关节置换术。
