Specialists

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Open Capsular Release for Adhesive Capsulitis

Open surgical release of the glenohumeral capsule was more commonly utilized to treat patients with severe and refractory adhesive capsulitis prior to the advancement of arthroscopic techniques to treat this difficult patient population. Although the peri-operative morbidity of this open approach to treatment is now accepted to be somewhat greater than its arthroscopic counterpart, use […]

Arthroscopic Capsular Release for Adhesive Capsulitis

Because adhesive capsulitis of the shoulder, by definition, is due only to a tight and thickened glenohumeral capsule, arthroscopic surgery seems ideal for the treatment of this problem. The capsule is best viewed, and more directly surgically addressed, by an intra-articular approach rather than an extra-articular, open surgical approach. Arthroscopy allows circumferential capsular release as […]

Operative Treatment for Adhesive Capsulitis

Manipulation Under Anesthesia

Manipulation under anesthesia (MUA) has been used to treat adhesive capsulitis for many years. This treatment has commonly been described to prospective patients as “stretching the tight capsule” or “breaking up adhesions” within the shoulder joint. Arthroscopic visualization of the glenohumeral joint after this procedure, however, reveals that a MUA does not […]

Nonsurgical Treatment for Adhesive Capsulitis

Nonoperative treatment commonly begins with measures to reduce shoulder pain and inflammation including topical treatments of heat, ice, transcutaneous electric stimulation, transcutaneous salves and balms, acupuncture, massage and systemic medications [nonsteriodal anti-inflammatory drug (NSAID) class medicines and oral corticosteroids]. The relative contribution to recovery that any of these treatment measures provide remains unclear and their […]

Imaging Studies for Adhesive Capsulitis

The evaluation of a patient with adhesive capsulitis is not complete without an appropriate series of plain radiographs. True glenohumeral anterior-posterior views, along with axillary, scapular outlet and acromioclavicular views are considered necessary to exclude other shoulder girdle conditions which result in pain and stiffness. These films may often reveal osteopenia, but should not show […]

Physical Findings of Adhesive Capsulitis

The physical examination of patients with adhesive capsulitis reveals a global reduction in range of motion with a marked decrease in glenohumeral translation also present. Examination of the opposite shoulder (if normal) is performed to identify the patient’s expected normal range of motion for comparison. Evaluation for limitation of pure glenohumeral motion (best measured in […]

Clinical History and Classification of Adhesive capsulitis

Adhesive capsulitis is a disease that typically progresses through three clinical phases. Patients with this condition will have varying clinical complaints depending upon the phase they are experiencing at the time of interview. The initial inflammatory “painful” phase begins with a spontaneous onset of aching discomfort at rest and the development of pain with use. […]

Adhesive Capsulitis

Key Points

True shoulder stiffness is the loss of passive range of motion in the shoulder. Many patients who complain of stiffness do not have true shoulder stiffness. Rather, they have pain and inflammation, and because movement results in discomfort, they guard against painful movement and appear to have lost range of motion. Stiffness arising […]

Treatment

Many treatment methods have been described through the years. In general, the choice of the treatment for a proximal humerus fracture should be based on the type of the fracture, presence of concurrent injuries, age and activity level of the patient, the presence and nature of comorbid medical conditions, and potential outcomes of specific treatment […]

Clinical Evaluation-Radiographic Evaluation

Accurate radiographic evaluation of the fracture of the proximal humerus is essential for diagnosis and treatment. The trauma series is still the standard initial method for evaluating proximal humeral fracture. This consists of anteroposterior (AP) view of the scapula, a lateral, Y-view of the scapula, and axillary view. This series allows evaluation of the fracture […]