Adhesive Capsulitis: Current Concepts


Adhesive capsulitis, commonly known as "frozen shoulder," affects from 2% to 5% of the general population, causing global loss of motion of the shoulder. Although the precise pathobiology of adhesive capsulitis remains unknown, this disease is marked by contraction of the shoulder capsule and an abundance of fibroblasts and myofibroblasts within the collagen matrix, accompanied by synovitis, inflammation, and pain. It can occur idiopathically, postoperatively, or following trauma. Diagnosis is based on a presentation of pain with absent or limited shoulder mobility. Although radiography fails to show any pathology, MRI reveals a reduced capsular volume, a small or absent inferior pouch, and thickened ligaments, especially in the rotator interval. The mainstay of treatment for adhesive capsulitis has been physical therapy with or without intra-articular injection of corticosteroids. However, manipulation can damage the shoulder and is unlikely to release adhesion of the rotator interval. Arthroscopic capsular release is a safe and reliable treatment option for recalcitrant adhesive capsulitis. The additional use of continuous regional anesthesia for up to 72 hours after arthroscopic surgery is a safe and reliable addition to this already proven technique, allowing patients to begin physical therapy without pain.

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