SCAPULOHUMERAL PERIARTHRITIS (Adhesive Capsulitis, Frozen Shoulder)Periarthritis of the shoulder joint is an inflammatory disorder primarily involving the soft tissues. The condition may be divided into a primary type, in which no obvious cause can be identified, and a secondary type associated with an organic lesion (eg, rheumatoid arthritis, osteoarthritis, fracture or dislocation). The primary type is most common in the minor shoulder among women after the fourth decade. It may be manifested as inflammation of the articular synovia, the tendons around the joint, the intrinsic ligamentous capsular bands, the paratendinous bursae (especially the subacromial), or the bicipital tendon sheath. Calcareous tendinitis and attritional disease of the rotator cuff, with or without tears, are incidental lesions. The onset of pain, which is aggravated by extremes of shoulder joint motion, may be acute or insidious. Pain may be most annoying at night and may be intensified by pressure on the involved extremity when the patient sleeps in the lateral decubitus position. Tenderness upon palpation is often noted near the tendinous insertions into the greater tubcrosity or over the bicipital groove. Although a sensation ofstiffness may be noted only at onset, restriction of shoulder joint motion soon becomes apparent and is likely to progress unless effective treatment is instituted. Pain can usually be controlled with nonsteroidal anti-inflammatory agents. Passive exercise of the shoulder by an overhead pulley mechanism should be repeated slowly for about 2 minutes 4 times daily. Forceful manipulation of the shoulder joint during this exercise should be avoided. Injection of tender areas with corticosteroids gives transitory relief. Operative treatment should be reserved for the occasional refractory case. |
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