| Přispěvatelé: |
Eygendaal, Denise, van den Bekerom, Michel P. J., The, B., Graduate School, Orthopaedic Surgery, Eygendaal, D., van den Bekerom, M.P.J., Poll-The, B-T., Faculteit der Geneeskunde |
| Popis: |
A frozen shoulder is characterized by pain and stiffness caused by a thickened, contracted capsule of the glenohumeral joint, resulting in marked disabilities in daily life. The pathophysiology of frozen starts with an inflammatory process which triggers a cascade leading to capsular tissue fibrosis. The majority of frozen shoulder patients can be treated non-surgical. Intra-articular corticosteroids should be given early, because they can counteract the inflammatory cascade and decrease the differentiation of fibroblasts into myofibroblasts, but can not undo the capsular fibrosis which has already been formed. Non-surgical treatment should be the initial treatment of choice for FS. This should consist of the combination of an early intra-articular corticosteroid injection, followed by physiotherapy guided by tissue irritability. If conservative treatment is insufficient, manipulation under anesthesia can improve range of motion, pain and function within six weeks to three months. We suggest to use the following criteria before proceeding with MUA: - Unable to cope with the pain and stiffness of a FS - Clinical signs of a FS in stage 2 with external rotation being less than 50% compared to the contralateral shoulder - Decrease of pain in relation to stage 1, and pain mainly at the end range of motion - Failure to respond to an intra-articular injection - A minimal duration of six months of conservative treatment including an intra-articular corticosteroid injection and physiotherapy Future research should focus on prognostic factors predicting the natural course of FS, and advance medical therapies to interrupt the involved inflammatory signalling pathways. |
