Study Design

Observational: cross-sectional study.

Background

Idiopathic frozen shoulder is a common cause of severe and prolonged disability characterised by spontaneous onset of pain with progressive shoulder movement restriction. Although spontaneous recovery can be expected the average length of symptoms is 30 months. Chronic inflammation and various patterns of fibrosis and contracture of capsuloligamentous structures around the glenohumeral joint are considered to be responsible for the signs and symptoms associated with frozen shoulder, however, the pathoanatomy of this debilitating condition is not fully understood.

Objectives

To investigate the feasibility of a muscle guarding component to movement restriction in patients with idiopathic frozen shoulder.

Methods

Passive shoulder abduction and external rotation range of motion (ROM) were measured in patients scheduled for capsular release surgery for frozen shoulder before and after the administration of general anaesthesia.

Results

Five patients with painful, global restriction of passive shoulder movement volunteered for this study. Passive abduction ROM increased following anaesthesia in all participants, with increases ranging from approximately 55°–110° of pre-anaesthetic ROM. Three of these participants also demonstrated substantial increases in passive external rotation ROM following anaesthesia ranging from approximately 15°–40° of pre-anaesthetic ROM.

Conclusion

This case series of five patients with frozen shoulder demonstrates that active muscle guarding, and not capsular contracture, may be a major contributing factor to movement restriction in some patients who exhibit the classical clinical features of idiopathic frozen shoulder. These findings highlight the need to reconsider our understanding of the pathoanatomy of frozen shoulder.

Level of evidence

Level 4.

中文翻译：

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在肩周炎患者中，肌肉防护是否在运动减少范围中起作用？

学习规划

观察性：横断面研究。

背景

特发性肩周炎是导致严重和长期残疾的常见原因，其特征是自发性疼痛发作并伴有进行性肩关节活动受限。尽管可以自发恢复，但平均症状持续时间为30个月。慢性炎症和盂肱关节周围囊膜韧带结构的各种纤维化和挛缩的各种模式被认为是肩周炎相关的体征和症状的原因，但是，这种使人衰弱的病症的病理解剖学尚未得到充分了解。

目标

目的探讨特发性肩周炎患者肌肉保护组件限制运动的可行性。

方法

在全身麻醉之前和之后，对计划用于肩周炎的冷冻性肩囊松解术的患者，测量了其被动肩外展和外旋运动范围（ROM）。

结果

五名患有被动性肩关节疼痛疼痛，整体受限的患者自愿参加了本研究。麻醉后所有参与者的被动绑架ROM均增加，麻醉前ROM的范围大约在55°–110°。这些参与者中的三位还显示了麻醉后ROM的大约15°–40°范围内的麻醉后被动外旋转ROM的显着增加。

结论

该病例系列由5例肩周炎患者证明，在某些表现出特发性肩周炎经典临床特征的患者中，积极的肌肉保护而不是包膜挛缩可能是运动受限的主要因素。这些发现强调需要重新考虑我们对肩周炎的病理解剖学的理解。

证据水平

4级