ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.
-
Upload
eustace-bishop -
Category
Documents
-
view
220 -
download
2
Transcript of ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.
![Page 1: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/1.jpg)
ADHESIVE CAPSULITIS
THANATHEP TANPOWPONG ASSISTANT PROFESSOR
CHULALONGKORN UNIVERSITY
![Page 2: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/2.jpg)
“difficult to define difficult to treat
difficult to explain”
Codman
![Page 3: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/3.jpg)
• Codman first define “frozen shoulder”
• 1945 : Nevaiser describe pathological lesion of fibrosis, inflammation and capsular contracture
![Page 4: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/4.jpg)
Prevalence
• 2-3% of population (Female)• 40-60 year• Non-dominant hand• 20-30% involve opposite side
![Page 5: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/5.jpg)
Etilogy
• Unknown– Trauma– Inflammation (TGF-β)
– Associate with diabetes, thyroid dysfunction, Dupuytrens contracture, autoimmune disease, treatment of breast cancer, cerebrovascular accident, MI
![Page 6: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/6.jpg)
Diagnosis
• Primary : idiopathic process, global capsular inflammation and fibrosis
• Secondary : known injury or disesase prior to adhesion
![Page 7: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/7.jpg)
62% of idiopathic adhesive capsulitis were found to have partial thickness tear of supraspinatus
Yoo et al Orthapaedics. 2009;32(1):22
![Page 8: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/8.jpg)
Staging (Neviaser et al CORR 1987)
Symptom Sign Finding
1 pain Full ROM under GA synovitis
2 Severe night pain, early stiff
Stiff (external rotation) Christmas tree synovitis
3 Stiff, pain at end of motion
Significant loss motion Minimal synovitis,loss axillary fold
4 Profound stiff, minimal pain
Motion loss but start to improve
Difficult to identify joint
![Page 9: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/9.jpg)
• Stage 1– Pain, stiff – Gain full ROM after GA or intra-articular
anesthetic injection– Duration 3 month
![Page 10: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/10.jpg)
• Stage 2 (freezing)– Progressive capsular contracture– Limit ROM (not fully recovered)– “Christmas tree appearance”
![Page 11: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/11.jpg)
Acknowledgement to Neviaser AMJ Sport 2010;38:2346
![Page 12: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/12.jpg)
• Stage 3 (frozen)– Progressive loss of motion– Not improve after intraarticular anesthetic
injection – Duration 9-15month
![Page 13: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/13.jpg)
• Stage 4 (thawing)– Minimal pain– Gradual improve ROM– Fully mature adhesion– Difficult to identify intra-articular structure during
arthroscope
![Page 14: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/14.jpg)
Natural history
• No true study of natural history• Self-limiting• Grey: complete recovery in 2 years
• Miller: normal function and minimal pain after home therapy 4 year after home therapy
JBJS Am 1978;60(4):564
Orthopaedics 1996;19(10):849-853
![Page 15: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/15.jpg)
• 94% of idiopathic frozen shoulder recover to normal level, range of motion, function without treatment
Vastamaki et al CORR 2012;470(4):1133.43
![Page 16: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/16.jpg)
TREATMENT
• Address underlying pathology• Treatment according to clinical stage at
presentation
![Page 17: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/17.jpg)
NSAIDs
• Theoretical benefit• No level I or II study to prove effectiveness• Improve pain but not improve motion
• Cox-2 have comparable efficacy compare to Cox-1 ( better night pain control)
Rhind Rhumatol Rehabil 1982;21(1):51-53Duke Rhumatol Rehabil 1981;20(1):54-59
Otha et al. Mod Rhumatolol. Feb 2013
![Page 18: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/18.jpg)
Oral steroid
• Provide rapid relief of pain (similar to intraarticular steroid injection) but not sustain at long term
• Possible long term systemic effects• Not recommend
Buchbinder Ann Rhum Dis 2004;63(11):1460-1469
![Page 19: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/19.jpg)
Intra-articular steroid injection
• Rizk et al : transient (2-3 week) improvement of pain compare to placebo
• Bulgen et al : improve pain and motion in 4 weeks
Arch Phys Med Rehabil 1991;72(1):20-22
Ann Rheum Dis 1984;43(3):353-360
![Page 20: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/20.jpg)
• Van der Windt – 109 patient– 40 mg of triamcinolone vs physical therapy 2/wks– 2.2 injection/6 weeks– Passive joint motion, exercise, ice, hot, electrotherapy– 1 year follow up– Self-assessment and functional score– 77% success in injection group vs 46% in physical
therapy group
BMJ 1998;317(7168):1292-1296
![Page 21: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/21.jpg)
• Intraarticular steroid injection gives better result in early stage of disease
• Stage 1recover in 6 weeks • Stage 2 recover in 7 months
Marx HHS J 2007;3(2):202-207
![Page 22: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/22.jpg)
Physical therapy
• Most consistently prescribe for latter stage
• Cochrane database review– Little overall evidence (4/26)– No evidence that physiotherapy alone is of benefit
in adhesive capsulitis
Cochrane Database Syst Rev 2003;(2):CD004258
![Page 23: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/23.jpg)
• Carette and Bulgen found no difference between physiotherapy and no treatment (control group)—level I study– Low number of participants
Arthritis Rheum 2003;48(3):829-838Ann Rhum Dis 1984;43(3):353-360
![Page 24: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/24.jpg)
• Level I study by Vermeulen– Low grade mobilization have little difference
compare with high grade technique
– Low grade : movement with in pain free zone – High grade: movement into stiff and painful range – “reflex muscle acivity”
Phys Ther 2006;86(3):355-368
![Page 25: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/25.jpg)
Surgical intervention
In most series 10% of patients do not respond to non-operative treatment
![Page 26: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/26.jpg)
Surgical intervention1. Suprascapular nerve blocks2. Hydrodilation3. Manipulation under
anesthesia4. Arthroscopic release5. Open release
![Page 27: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/27.jpg)
• Suprascapular nerve block– Unclear therapeutic mechanism– Disruption of efferent and afferent pain signaling– May normalization pathological and neurological
process
– Insufficient data to prove it’s efficacy
![Page 28: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/28.jpg)
• Hydrodilation (Brisement)– Increase intracapsular pressure until rupture– Compare hydrodilation with MUA
• No diiference in ROM• Better Constant and VAS score
– Small number of trials to proof it’s efficacy
Quraishi JBJS Br. 2007;89(9):1197-1200
![Page 29: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/29.jpg)
Manipulation (MUA)
• MUA vs home exercise (level II)– Slight better moblility at 3 month– No difference in 6 and 12 month
• MUA have effect of improve motion and pain relief for approx 23 years
Kivimaki J Shoulder Elbow Surg 2007;16(6):722-726
CORR 2013;471(4):1245-50
![Page 30: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/30.jpg)
Arthroscopic release
• Advantage– Accurate and complete– Ability to perform synovectomy– Improve mobility of musculotendinous unit
compare with open surgery– Minimal pain– Identify intrinsic pathology– Post operative motion can be done immidiately
![Page 31: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/31.jpg)
• Contraindication – Unable to cooperate postoperative program– Pateint cannot tolerate stress from fluid challenge
(renal or cardiac failure)
![Page 32: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/32.jpg)
Surgical technique
Release rotator interval , SGHL
![Page 33: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/33.jpg)
MGHL
![Page 34: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/34.jpg)
Posterior capsular release
![Page 35: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/35.jpg)
Release axillary pouch and IGHL (multiple perforation or direct cut)
![Page 36: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/36.jpg)
My practice
• Stage 3 or 4 • No intraarticular steroid are injected• Jackin’s exercise (low grade) • Nsaids prior and ice after• If 3-6 month not improve MUA or scope
release
![Page 37: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/37.jpg)
Jackin’s exercise program
• Each 4 position are perform 10 times/round• 5 round/day
![Page 38: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/38.jpg)
![Page 39: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/39.jpg)
![Page 40: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/40.jpg)
![Page 41: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/41.jpg)
• Post operative protocol– Regional nerve block ( interscalene, SSN, brachial) – Immediate post-op : pendulum exercise– Passive stretching ( Forward flexion, IR, ER, ABD)– 2 times/day, 15 minutes/session– Follow up: post-op week 1,2,4,6,8
![Page 42: ADHESIVE CAPSULITIS THANATHEP TANPOWPONG ASSISTANT PROFESSOR CHULALONGKORN UNIVERSITY.](https://reader036.fdocuments.in/reader036/viewer/2022062421/56649ccc5503460f94996950/html5/thumbnails/42.jpg)
Thank you