Harada Yohei, Iwahori Yusuke, Kajita Yukihiro, Saito Yutaka, Takahashi Ryosuke, Deie Masataka
Department of Orthopaedic Surgery, School of Medicine, Aichi Medical University, Nagakute, Japan.
Sports Medicine and Joint Center, Asahi Hospital, Kasugai, Japan.
JSES Int. 2019 Dec 16;4(1):72-76. doi: 10.1016/j.jses.2019.10.100. eCollection 2020 Mar.
Secondary frozen shoulder after traumatic anterior shoulder instability is rare. The therapeutic management and clinical outcome of this condition are not well known. This study aimed to investigate the characteristics of such rare cases and verify treatment outcomes.
We reviewed the cases of 12 patients with secondary frozen shoulder after anterior shoulder dislocation or subluxation between April 2007 and March 2018. All patients underwent physical therapy along with an intra-articular injection. Patients with refractory stiffness received arthroscopic mobilization. The range of motion, Rowe score, and University of California, Los Angeles score were evaluated at the first and final visits. A telephone survey was performed to determine the long-term outcomes including recurrent instability, the Oxford Shoulder Score, and the Oxford Instability Score.
The mean age of patients at the first visit was 42.5 years. Two patients underwent surgical treatment, which revealed scar-like tissue of the anteroinferior capsule. The range of motion, Rowe score, and University of California, Los Angeles score significantly improved at a mean follow-up of 15 months. At a mean follow-up of 82 months, the telephone survey revealed recurrent instability in 1 patient who was conservatively treated; the average Oxford Shoulder Score and Oxford Instability Score were 46.4 and 43.2, respectively.
The average patient age observed in this study was higher than the known peak age of traumatic anterior shoulder instability occurrence. Less activity, loss of capsule elasticity, or scarring after a capsular tear may lead to stiffness after traumatic anterior shoulder instability. Conservative treatment can be used as the first-line therapy, followed by effective arthroscopic mobilization when conservative treatment fails.
创伤性前肩不稳后继发性冻结肩较为罕见。这种情况的治疗管理和临床结果尚不明确。本研究旨在调查此类罕见病例的特征并验证治疗结果。
我们回顾了2007年4月至2018年3月期间12例前肩脱位或半脱位后继发性冻结肩患者的病例。所有患者均接受了物理治疗及关节内注射。对顽固性僵硬的患者进行了关节镜下松动术。在首次就诊和末次就诊时评估活动范围、Rowe评分和加州大学洛杉矶分校评分。进行电话调查以确定长期结果，包括复发性不稳、牛津肩部评分和牛津不稳评分。
首次就诊时患者的平均年龄为42.5岁。2例患者接受了手术治疗，术中发现前下关节囊有瘢痕样组织。在平均15个月的随访中，活动范围、Rowe评分和加州大学洛杉矶分校评分均有显著改善。在平均82个月的随访中，电话调查显示1例保守治疗的患者出现复发性不稳；牛津肩部评分和牛津不稳评分的平均值分别为46.4和43.2。
本研究中观察到的患者平均年龄高于已知的创伤性前肩不稳发病高峰年龄。活动减少、关节囊弹性丧失或关节囊撕裂后的瘢痕形成可能导致创伤性前肩不稳后出现僵硬。保守治疗可作为一线治疗方法，保守治疗失败后可进行有效的关节镜下松动术。
