Adhesive Capsule

Frozen shoulder syndrome or adhesive capsule are two words that describe a variety of clinical conditions including subacromiala bursitis, tendinitis and cracks cape calcified cuff. Despite nomencalaturii used to describe various frozen shoulder syndrome, all these terms denote different clinical conditions that can cause painful restriction of active and passive glenohumeral motion and movements of the shoulder periscapulare.
Condition of signs and symptoms include slow onset of shoulder pain, discomfort, located near the deltoid insertion, inability to sleep on the affected side, lift limitations can change based glenohumeral external rotation and normal radiological appearance. Diagnostic criteria for frozen shoulder syndrome include painful restriction of active and passive glenohumeral movements and movements periscapulare. Despite these criteria adhesive capsule diagnosis can be difficult because there are many controversies over specific restriction glenohumeral motion and the time needed to classify a patient with frozen shoulder.
Treatment can be painful and overworked and consists of physical therapy, medication, massage therapy, or surgery hidrodilatare. It can perform shoulder manipulation under anesthesia, a process that breaks the adhesion and fibrous tissues around the joint to help restore a few moves.Physical therapy is very important in all stages of the disease, despite worsening pain and inflammation because it prevents painful contractions. Pain and inflammation can be controlled with analgesics and NSAIDs. If manual therapy and stretching are applied progressively to shrink the shoulder capsule, leaving the shoulder with severe restriction of movement.
Pathogenesis and causes
Scapulotoracice movements appear simultaneously glenohumeral abduction and arm. In a healthy third of arm elevation is attributed scapulotoracice movements, while two thirds is provided by glenohumeral movement. Glenohumeral joint is covered with articular capsule and surrounded by two muscle sleeves. Normal capsule is a free structure with an area more than twice that of the humeral head. Capa cuff tendons and the capsule adjacent to harden the capsule anterior, posterior and superior glenohumeral ligaments are while also strengthening areas of the capsule. The capsule is composed of type I collagen fibers and lined with synovial cells.
Risk factors that may trigger capsulated adhesive include:-Trauma, surgery on shoulderInflammatory-disease, diabetesRegional-pathological conditions, various diseases of the shoulder.
Pathogenic theories proposed include: autoimmune theory with high C-reactive protein and incidence of histocompatibilitatii HLA-B27 in patients with frozen shoulder, muscle inactivity theory that the major etiological factor and association with cervical disease, hyperthyroidism and ischemic heart disease.Most patients have periods of immobilization of the shoulder.Immobilization can be various reasons.
Signs and symptoms
Adhesive capsule usually affects patients between 40-70 years.The incidence is not precisely known but is estimated at 3% of the population. Men tend to be affected more frequently than women and there is no racial predilection. Menopause in women is a trigger. The disease is associated with several conditions. A high incidence of the condition exist among patients with diabetes from the general population. The incidence among patients with insulin-dependent diabetes is even higher.
Patient history should include information about the following:-Onset of symptoms, history of trauma or surgery-Duration of symptoms, concomitant diabetes, hyperthyroidism, the ischemic acardiopatieiAssociation with other conditions of shoulder--Administration of drugs, the neurological upper limb complaints.
Adhesive capsule is divided into two categories: primary and secondary. Patients with primary adhesive capsulated shows no significant elements of history, physical examination or radiographic evaluation to explain loss of movement and pain.Classic symptoms are divided into three adhesive capsulitei phases: painful, phase stiffness and the thawing phase. The initial painful phase is gradual onset of diffuse pain that persists for weeks before the shoulder months. Phase stiffness is characterized by progressive loss of movement and lasts up to one year. Most patients lose their movements glenohumeral external rotation, internal rotation and abduction in this phase. The final phase is maintained for several months and thawing is a gradual improvement during the movement. In this phase the patient may require up to 9 months to earn shoulder movements.Instead adhesive capsule patients describe an event that precedes secondary symptoms such as shoulder trauma or surgery on the affected upper extremity.
Shoulder Pain:Patients describe the gradual onset of pain in a few weeks. Report initial pain during the night associated with shoulder movements (combing, lifting your arm over your head). Combined movements of abduction and external rotation or extension and internal rotation is painful. Phase progresses to constant pain at rest and aggravated by shoulder movements worsened by repetitive arm movements, psychological stress, exposure to cold or vibration and weather changes. This pain lasts 1-2 years.
Joint contracture:The second main feature is progressive loss of frozen shoulder passive and active movements of the shoulder. Movements are more affected first external rotation, followed by abduction, internal rotation and flexion. Adductia horizontal extension and the later tend to be affected. Glenohumeral movements are lost in a few months.
Disease progression:In the past capsulated adhesive was considered a self-limiting condition that could be treated with physical therapy and resolve within 1-3 years. Several studies have demonstrated the presence of long-term pain and shoulder stiffness after conservative therapy.Some studies show improvement of symptoms after arthroscopic capsular release.