АДГЕЗИВНЫЙ КАПСУЛИТ ПЛЕЧЕВОГО СУСТАВА

Abstract

The article presents a current view of the etiology and pathogenesis of, adhesive capsulitis of the shoulder joint and the basic principles of conservative and surgical treatmen. Idiopathic adhesive shoulder capsulitis is a self-limiting disease with gradual improvement in symptoms, sometimes demanding surgical treatment. Currently, the role of both inflammatory and fibrotizing processes in the pathogenesis of adhesive capsulitis is generally recognized, when the inflammatory process ultimately leads to fibrotic changes. The disease is associated with diabetes mellitus, thyroid disease, cerebrovascular disease, coronary heart disease, autoimmune diseases, and Dupuytren’s contracture. In theliterature there isno consensus on the unified treatment modality for adhesive capsulitis: conservative, operative, or combined. In a number of patients, improvement is achieved spontaneously, the recommended methods of treatment range from follow-up to invasive open capsulotomy. There is no universal treatment algorithm, so treatment should be individualized. By all accounts, conservative treatment is the first treatment of choice for adhesive capsulitis and includes physical therapy in combination with physiotherapy, anti-inflammatory drugs, corticosteroid injection, and hydrodilation. Surgical treatment of adhesive capsulitis is indicated for patients with persistent symptoms of the disease and ineffectiveness of conservative treatment. Surgical treatment includes manipulation under anesthesia and / or shoulder capsulotomy (arthroscopic or open). Treatment of adhesive shoulder capsulitis remains an unresolved clinical problem. The existing treatment regimens are not universal and further studies with long-term outcomes are needed to develop more effective treatment modality.