Abstract
BackgroundAdhesive capsulitis (AC) is a disabling and poorly understood pathological condition of the shoulder joint. The current study aims to increase our understanding of the pathogenesis, diagnosis and clinical outcomes of people with AC by investigating: 1) transcriptome-wide alterations in gene expression of the glenohumeral joint capsule in people with AC compared to people with non-inflammatory shoulder instability (controls); 2) serum and urine biomarkers to better understand diagnosis and staging of AC; and 3) clinical outcomes in people with AC compared to controls 12-months following arthroscopic capsular release or labral repair respectively.MethodsThe study is a prospective multi-centre longitudinal study investigating people undergoing arthroscopic capsulotomy for AC compared to people undergoing arthroscopic stabilization for shoulder instability. Tissue samples collected from the anterior glenohumeral joint capsule during surgery will undergo RNA-seq to determine differences in gene expression between the study groups. Gene Set Enrichment Analysis will be used to further understand the pathogenesis of AC as well as guide serum and urine biomarker analysis. Clinical outcomes regarding pain, function and quality of life will be assessed using the Oxford Shoulder Score, Oxford Shoulder Instability Score, Quick DASH, American Shoulder and Elbow Society Score, EQ-5D-5 L and active shoulder range of movement. Clinical outcomes will be collected pre-operatively and 12-months post-operatively and study groups will be compared for statistically significant differences using linear regression, adjusting for baseline demographic variables.DiscussionThis study will provide much needed information regarding the pathogenesis, diagnosis and staging of AC. It will evaluate clinical outcomes for people undergoing arthroscopic release of AC by comparing this group to people undergoing arthroscopic surgery for shoulder instability.Trial registrationACTRN12618000431224, retrospectively registered 26 March 2018.
Highlights
Adhesive capsulitis (AC) is a disabling and poorly understood pathological condition of the shoulder joint
Diagnosing AC is usually based on clinical findings [6]
External rotation is often the first reported movement restriction [1, 13], which is thought to be consequential to contraction of the coracohumeral ligament, one of the essential diagnostic findings in AC [1]
Summary
Adhesive capsulitis (AC) is a disabling and poorly understood pathological condition of the shoulder joint. Adhesive capsulitis (AC), or ‘frozen shoulder’ is a debilitating pathological condition of the glenohumeral joint, characterised by stiffness, pain and dysfunction [1, 2]. Patients usually report the onset of shoulder pain before loss of motion [11, 12]. External rotation is often the first reported movement restriction [1, 13], which is thought to be consequential to contraction of the coracohumeral ligament, one of the essential diagnostic findings in AC [1]. Blood tests are usually normal, though cholesterol, triglycerides and C-reactive protein might be elevated in the early stages [10]
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