Levy O, Rath E, Atar D
Orthopedic Dept., Soroka Medical Center, Beer Sheba.
Harefuah. 1997 Nov 2;133(9):357-9, 415.
Adhesive capsulitis is a problem for the orthopedic surgeon due to the difficulty of treatment. Although it is self-limited, few patients will wait for spontaneous resolutions while suffering pain and progressive loss of motion. Our aim was to modify the course of the disease and to shorten recovery time by combining intensive physiotherapy with intra-articular infiltration and gentle manipulation. 49 patients with 50 frozen shoulders were enrolled in the study. All patients were treated initially with physiotherapy for 4-8 weeks. If no improvement was noted the affected shoulder was infiltrated and gently manipulated. 27 of 49 patients (55%) improved dramatically with the initial physiotherapy regimen. They achieved full or nearly full range of motion, with significant relief of pain. 22 patients were infiltrated and manipulated. Elevation improved significantly from an average of 110.95 to 165.71 degrees (p < 0.001), external rotation from an average of 9.52 to 43.57 degrees (p < 0.001) and internal rotation also improved significantly (p < 0.001). Self assisted physiotherapy is the corner stone of treatment in adhesive capsulitis. When pain and limitation of passive range of motion persist, infiltration and gentle manipulation dramatically shortens the debilitating process.
粘连性关节囊炎对骨科医生来说是个难题，因为治疗困难。尽管它是自限性疾病，但很少有患者会在遭受疼痛和活动度逐渐丧失时等待自然痊愈。我们的目标是通过将强化物理治疗与关节内注射及轻柔手法相结合来改变疾病进程并缩短恢复时间。49例患者共50个肩周炎患肩纳入本研究。所有患者最初均接受4至8周的物理治疗。如果未见改善，则对患肩进行注射及轻柔手法治疗。49例患者中有27例（55%）在初始物理治疗方案下有显著改善。他们达到了完全或几乎完全的活动范围，疼痛明显缓解。22例患者接受了注射及手法治疗。抬高角度从平均110.95度显著提高到165.71度（p<0.001），外旋角度从平均9.52度提高到43.57度（p<0.001），内旋角度也显著改善（p<0.001）。自助物理治疗是粘连性关节囊炎治疗的基石。当疼痛和被动活动范围受限持续存在时，注射及轻柔手法可显著缩短衰弱过程。
