Arthroscopic appearance of frozen shoulder

doi:10.1016/0749-8063(91)90098-I

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 7, Issue 2, June 1991, Pages 138-143

https://doi.org/10.1016/0749-8063(91)90098-I Get rights and content

Abstract

Patients (n = 150) were referred to a shoulder clinic with a diagnosis of “frozen shoulder” and the suggestion that they be submitted to manipulation. All patients were further investigated using local anesthetic blocks, routine radiography, and, often, computed tomographic scanning and arthrograms. Subsequently, it appeared that only 37 patients qualified for the diagnosis of “primary” frozen shoulder. The others had a “secondary” frozen shoulder from some other painful cause, such as a rotator cuff tear or impingement. The 37 patients were arthroscoped and then manipulated while under general anesthesia. Patients were told that both irrigation and local injection of the joint would have an additional beneficial therapeutic effect in the recovery phase, and they gave prior consent to the procedures. There were no complications. Pain relief was striking. The arthroscopic appearance was uniform: a patchy vascular reaction around the biceps, and the opening into the subscapularis bursa. The capacity of the joint was reduced. In no patient was the infraglenoid recess obliterated, and no adhesions were seen. Such findings at routine shoulder arthroscopy should alert the surgeon to a diagnosis of frozen shoulder if the clinical presentation has been subtle. The findings raise questions about the previous pathological interpretation of this condition.

References (18)

EllmanH
Arthroscopic subacromial decompression. Analysis of 1- to 3-year results
Arthroscopy
(1987)
JohnsonLL
Arthroscopic surgery
CaspariRB
Arthroscopic reconstruction for anterior shoulder instability
Tech. Orthop
(1988)
AndrewsJR et al.
The arthroscopic treatment of glenoid labrum tears in the throwing athlete
Orthop Trans
(1984)
WileyAM
Arthroscopic evaluation and surgery for rotator cuff disease
Tech Orthop
(1985)
BunkerTD
Time for a new name for “frozen shoulder” [Editorial]
Br Med J
(1985)
CodmanEA
The shoulder
(1934)
McLaughlinHL
On “frozen” shoulder
Bull Hosp Jt Dis
(1951)
CharnleyJ
Periarthritis of the shoulder
Postgrad Med J
(1959)

There are more references available in the full text version of this article.

Cited by (150)

What is the most predictive magnetic resonance imaging finding of rotator cuff tear concomitant with shoulder stiffness?
2023, JSES International
Common magnetic resonance imaging (MRI) findings in adhesive capsulitis are not often evident in rotator cuff tear concomitant with shoulder stiffness. This study aimed to determine the most predictive MRI finding of rotator cuff tear with shoulder stiffness to differentiate from that without stiffness.
The data of patients who underwent arthroscopic rotator cuff repair between January 2014 and October 2019 were retrospectively reviewed. Stiffness was defined as forward flexion <120°, external rotation at side <30°, and internal rotation at back <L3 in the active range of motion. Propensity score matching (1-to-1) was performed between the stiff and control groups by sex, age, and tear size, and 76 patients per group were matched. Anterior capsular thickness, maximal humeral/glenoid capsular thickness in the axillary recess, coracohumeral ligament thickness, the presence of hyperintensity in the anterior capsule and humeral/glenoid capsule in the axillary recess, and hyperintensity and obliteration of the subcoracoid fat triangle were evaluated.
Anterior capsular thickness, glenoid capsular thickness in the axillary recess, and anterior and axillary capsular hyperintensities were significantly more dominant in the stiff group (all P < .05) than in the control group. Anterior capsular thickness and anterior capsular abnormal hyperintensity could be used to differentiate between the stiff and control groups (P < .05). Anterior capsular thickness showed high diagnostic performance with an area under the receiver operating characteristic curve of 0.993. The cut-off value for stiffness was 3.07 mm (sensitivity, 96.1%; specificity, 100%).
Anterior capsular thickening and abnormal hyperintensity were the most predictive MRI findings for stiffness in patients with rotator cuff tear and stiffness to differentiate from patients with rotator cuff tear without stiffness.
Association between adhesive capsulitis and thyroid disease: a meta-analysis
2023, Journal of Shoulder and Elbow Surgery
Adhesive capsulitis (AC) is a common clinical condition of the shoulders without a clear pathophysiology or etiology. Although thyroid disease has been linked to AC, an appropriate understanding of the disease and its epidemiological evidence are lacking. This metaanalysis investigated the association of AC with thyroid disease and identified which manifestations of thyroid disease contribute to the risk of AC.
The databases of PubMed, Embase, and Scopus were searched for literature retrieval up to September 20, 2022. Articles evaluating the association between AC and any type of thyroid disease were enrolled. Data from studies reporting the prevalence and its 95% confidence interval (CI) were pooled. Subgroup analysis was performed on the different manifestations of thyroid disease. We explored heterogeneity with sensitivity analyses and publication bias with funnel plots and Egger's tests. A trim and fill analysis was conducted if publication bias was found.
Results: In total, 10 case-control studies comprising a total of 127,967 patients were included. The prevalence of thyroid disease was significantly higher in patients with AC (odds ratio [OR] = 1.87, 95% CI: 1.37-2.57, P < .0001) than in patients without AC. The results of subgroup analysis indicated significantly higher rates of hypothyroidism (OR = 1.92, 95% CI: 1.09-3.39, P = .02) and subclinical hypothyroidism (OR = 2.56, 95% CI: 1.81-3.63, P < .00001), but not hyperthyroidism (OR = 1.42, 95% CI: 0.63-3.22, P = .40), among patients with AC than among those without AC.
Our meta-analysis demonstrated that thyroid disease, especially when presenting as hypothyroidism or subclinical hypothyroidism, is associated with an increased risk of AC. Evidence for an association between hyperthyroidism and AC was not found, although this may be due to the lack of related studies. Further research on the pathogeneses of and relationship between these two diseases is warranted.
Is there evidence to recommend transcatheter arterial embolisation in adhesive capsulitis: A review of literature
2022, Journal of Orthopaedics
Hypervascularity of the rotator interval with increased expression of the vascular endothelial growth factor may be the causative factor of conventionally managed adhesive capsulitis. Hence, transcatheter arterial embolisation(TAE) has emerged as an alternative treatment option to occlude the target neovessels by infusing an embolic agent. The present study reviews the literature regarding the efficacy of the TAE for adhesive capsulitis.
The systematic review was performed following PRISMA guidelines. MEDLINE, Google Scholar, Scopus and Cochrane database of systemic reviews (CDSR) were searched for relevant publication (from 1960 to 2021). The search algorithm used was Transcatheter arterial embolisation and resistant adhesive capsulitis or refractory adhesive capsulitis or vascular adhesive capsulitis. The database search produced a total of 12026 publications. After exclusion of the non relevant titles, 113 abstracts were reviewed. From these abstracts, three full-text articles were obtained for final review.
All the studies were analyzed in depth. Patients with no or minimal improvement with conservative treatment for at least 3 months underwent TAE. Pre and post embolisation visual analog score(VAS), shoulder range of motion(ROM) were noted. Any additional therapy was also taken into account. Significant improvement of the VAS score and shoulder ROM was noted immediately after surgery and maintained till final follow up at 24.5 months.
Resistant cases of adhesive capsulitis can be managed successfully with TAE. But ample evidence is lacking regarding the appropriate patient selection and efficacy of TAE as a sole management option of resistant AC.
Effect of diabetes and corticosteroid injection on glenohumeral joint capsule in a rat stiffness model
2021, Journal of Shoulder and Elbow Surgery
To evaluate the effects of diabetes and corticosteroid injected in the joints on the shoulder motion, gait, and joint capsular properties in a rat stiffness model.
A total of 27 rats were randomly distributed into 3 groups—nondiabetes group (group A), diabetes group (group B), and diabetes plus steroid injection group (group C). The diabetes model was developed by inducing hyperglycemia with a submaximal dose of streptozotocin and the stiffness model by completely immobilizing the right shoulder of each animal in all groups with sutures passed between the scapula and humeral shaft. The left shoulder was used as an untreated control in all groups. Three weeks after immobilization, the sutures were removed in all groups, and a single dose of triamcinolone acetonide (0.5 mg/kg) was injected into the glenohumeral joint in group C. After 3 weeks of free activity, range of motion (ROM) evaluation, gait analysis by stride length, and capsular area measurement were performed in all rats.
Hyperglycemia was successfully induced with a mean blood glucose level of 448.9±55.9 mg/dL in group B and 431.6±17.8 mg/dL in group C, which were significantly higher than 136.5±13.4 mg/dL in group A (P < .001). A significantly smaller ROM and stride length were found in the right (stiffness-induced) shoulder than that in the left (control) shoulder only in group B, and significantly larger capsular area in the right shoulder than that in the left shoulder in groups A and B (all P < .05). However, in group C, there were no differences between the right and left shoulders in all measurements (all P > .05). In case of the right shoulders in each group, group C showed significantly larger ROM (68° ± 11° vs. 42° ± 7°) and smaller capsular area (3934.4 ± 537.1 pixels vs. 7402.3 ± 1840.3 pixels) than group B (all P < .0167).
The diabetic model had a detrimental effect on the development of stiffness by thickening the joint capsule, and an intra-articular steroid injection resolved the thickened joint capsule and restored shoulder motion.
Association between subscapularis trigger point and frozen shoulder: A cross sectional study
2021, Journal of Bodywork and Movement Therapies
Frozen shoulder (FS) is one of the most common shoulder conditions characterized by pain, restricted range of motion and high morbidity. Though FS is known as adhesive capsulitis, presence of capsular adhesions has been rebutted and the nomenclature adhesive capsulitis is debated. It has been proposed that FS is a condition of cytokine driven capsular, ligamentous fibrosis and contracture. Despite extensive research on it, still it is unclear that how far the capsular contracture contribute to range of motion restriction in FS. Evidence also suggested that myofascial trigger points play a role in restricted range of motion.
To find an association between subscapularis trigger point and frozen shoulder.
Cross-sectional study.
143 Patients were screened for inclusion and exclusion criteria, out of which 100 patients, were selected for the study. Manual palpation was performed to look for subscapularis muscle trigger points via axillary approach on both the affected and unaffected side. Trigger point diagnosing criteria was used to diagnose subscapularis trigger points.
Results have shown that there was an association between subscapularis trigger point and frozen shoulder (X 2 = 32.151 P < 0.0001) on the affected side. We used Phi coefficient to measure the degree of association which denotes (Phi = 0.567 P < 0.0001) strong association between frozen shoulder and subscapularis trigger point on the affected side compared to unaffected side (X 2 9.157; P < 0.002: Phi:0.303: P < 0.002).
This study concluded that there appears to be a strong association between subscapularis trigger point and frozen shoulder.
Adhesive Capsulitis Embolization: A Case of Particle Embolization for Refractory Shoulder Pain Secondary to Adhesive Capsulitis
2021, Journal of Radiology Nursing
Citation Excerpt :
AC is primarily a clinical diagnosis, but imaging studies can be used to exclude other causes of shoulder pain such as glenohumeral osteoarthritis, neoplasm, rotator cuff tendinopathy or tear, cervical disk degeneration, and bursitis (Fields et al., 2019). The pathophysiology of AC involves inflammation within the joint capsule, leading to reactive fibrosis and adhesion formation in the synovial lining of the joint (Song et al., 2011; Wiley, 1991). Pain in AC has been linked to upregulated inflammatory growth factors that promote angiogenesis and the accompanying nerve fiber growth (Costa et al., 2007; Xu et al., 2012).
Adhesive capsulitis (AC) is an inflammatory process characterized by limited shoulder mobility and pain. The prevalence of AC is as high as 5% in the general population but increases up to 20% in patients with diabetes. The current management algorithm for AC consists of physical therapy followed by pharmacological treatment. Surgical options are reserved for those with refractory pain. Adhesive capsulitis embolization (ACE) is a new minimally invasive procedure that involves particle embolization of the inflammatory vessels linked to chronic shoulder pain. Early studies show promising results with significant improvement in shoulder pain and mobility. The present case describes a 40-year-old woman who underwent ACE for refractory shoulder pain and discusses the postoperative management of ACE.

View all citing articles on Scopus

View full text

Arthroscopic appearance of frozen shoulder

Abstract

Arthroscopy

Arthroscopic surgery

Arthroscopic reconstruction for anterior shoulder instability

Tech. Orthop

The arthroscopic treatment of glenoid labrum tears in the throwing athlete

Orthop Trans

Arthroscopic evaluation and surgery for rotator cuff disease

Tech Orthop

Time for a new name for “frozen shoulder” [Editorial]

Br Med J

The shoulder

On “frozen” shoulder

Bull Hosp Jt Dis

Periarthritis of the shoulder

Postgrad Med J