Adhesive Capsulitis of the Shoulder. Is there Consensus Regarding the Treatment? A Comprehensive Review.
Adhesive Capsulitis of the Shoulder. Is there Consensus Regarding the Treatment? A Comprehensive Review.
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DOI：
10.2174/1874325001711010065
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Bisbinas I
中科院分区：
文献类型：
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作者：
Georgiannos D;Markopoulos G;Devetzi E;Bisbinas I
粘连性肩关节囊炎（ACS）是一种常见的自限性疾病，其特征是致残性疼痛和活动受限。它的病理生理学知之甚少，临床上它的特点是疼痛和僵硬的阶段，最后往往病人永远不会完全恢复。然而，关于ACS的可用治疗方法尚未达成共识。本文的目的是讨论和发展有关的问题，在ACS的管理方法的各个阶段，它进行了文献回顾和指导方针，为医生和医疗保健专业人员的临床实体的治疗。抗炎药物、类固醇和/或透明质酸盐注射和物理治疗是保守治疗的主要手段，在第一阶段单独使用或在后期与其他治疗方式联合使用。下一步的治疗，包括轻微到中度的干预，包括肩胛上神经阻滞，扩张关节造影和麻醉下的操作。为了避免“盲目干预”的并发症，关节镜下关节囊松解术逐渐得到更广泛的应用，在关节炎严重的病例中，开放松解术是一种有用的选择。各种形式的保守治疗和逐渐更多的手术释放应用。然而，临床医生通常根据个人经验和培训而不是已发表的证据进行选择。
Adhesive capsulitis of the shoulder (ACS) is a common self-limiting condition characterized by disabling pain and restricted movements. Its pathophysiology is poorly understood, clinically it is characterized by stages of pain and stiffness, and finally often patients never recover fully. However, there is no consensus about available methods of treatment for ACS. The aims of this paper are to discuss and develop issues regarding approaches to management in ACS in the stages of it. A review of the literature was performed and guidelines for the treatment of that clinical entity for doctors and health care professionals are provided. Anti-inflammatory medications, steroid and/or hyaluronate injections and physiotherapy is the mainstay of conservative management either alone in the first stages or in combination with other treatment modalities in the later stages. Next line of treatment, involving minor to moderate intervention, includes suprascapular nerve block, distension arthrography and manipulation under anaesthesia. In order to avoid complications of “blind intervention”, arthroscopic capsular release is gradually more commonly applied, and in recalcitrant severe cases open release is a useful option. Various modalities of conservative management and gradually more surgical release are applied. However, often clinicians choose on personal experience and training rather than on published evidence.