La capsulite adesiva della spalla post traumatica nello sciatore

Shoulder adhesive capsulitis is a pathological condition characterized by an involvement of the glenohumeral capsula and ligaments with a progressive and severe reduction of the range of motion. Frozen shoulder often comes on for seemingly no reason at all (primary type) but may follow a trauma or shoulder sugery (secondary type). There are three phases to frozen shoulder: - Freezing (painful phase, 1-8 months) - Frozen (stiff phase, 9-16 months) - Thawing (recovery of mobility, 12-40 months) Methods Authors refer their experience from 2002 to 2005 with 25 severe frozen shoulders. Fifteen patients (6 males and 9 females with a mean age of 57 years: range 26 to 68 years) underwent arthroscopic capsular release and closed manipulation (group A). A second group of 10 patients (6 females and 4 males with a mean age of 52 years, range 35 to 65 years) were treated with intra-articular corticosteroid injections and rehabilitation (Group B). In group A this syndrome followed a shoulder trauma in only two patients and a rotator cuff tear with progressive loss of motion in four patients; no etiologic cause was found in nine patients. Among these patients, authors report a case of a 37 years female who developed a frozen shoulder after a great tuberosity fracture occurred during alpine skiing. In group B one patient present a MRI with a partial supraspinatus tear and one snowboarder developed frozen shoulder after surgical treatment for a partial articular tear. All the patients were evaluated by international functional scoring scales (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form –ASES-, Constant and Murley, Simple Shoulder Test and UCLA). Results The pre-operative range of motion of the shoulder in group A was measured with goniometry (side to side); the mean abduction of the involved shoulder was 60°; the mean external rotation 20°, the mean flexion 75°; during the internal rotation patients were never able to reach the lumbo-sacral vertebra. Under general anesthesia, twelve patients underwent shoulder manipulation and arthroscopic capsular release, while in three patients authors performed a mobilization of the shoulder after the arthroscopic release. A subacromial bursectomy was executed in all cases; an acromioplasty was done only in three patients with subacromial impingement and a tenotomy of the long head of biceps was done in one patient because of sever tendinosis. All the patients with a rotator cuff tear (four) underwent an arthroscopic suture (in two cases delayed after recovery of full range of motion). At a mean follow-up of 15 months (range 3 to 45 months) were reviewed all the patients of group A. They all referred an improvement in range of motion and a decrease of pain. Post- operative physical examination showed a mean abduction of nearly 150°, a mean ER of 45° and a mean flexion of 165°; fourteen patients were able to reach the lumbo-sacral junction during the internal rotation. All the postop functional evaluation scales also showed relevant improvements. There was any case of fracture, dislocation or other complication. Results of group B are still under review because of their short follow up; however preliminary results are encouraging. Conclusion In patients with severe adhesive capsulitis, the goal of treatment is pain reduction and recovery of shoulder mobility. Patients with frozen shoulder unresponsive to traditional conservative treatment can be effectively treated with arthroscopic capsular release and closed manipulation. Anyway, the second group of patients treated by intra-articular corticosteroid injections seems to show encouraging preliminary results, resolving in some cases the frozen shoulder and avoiding surgical treatment. More detailed studies are necessary to establish if gleno-humeral infiltrations may represent first choice treatment in severe adhesive capsulitis of the shoulder.