engleski

Pathology of the primary contracted shoulder – primary frozen shoulder syndrome

Primary frozen shoulder (FS) is self-limiting condition characterised by onset of shoulder pain and restriction of active and pasive shoulder motion. Matsen defined it as idiopathic global limitation of humeroscapular motion resulting from contracture and loss of compliance of the glenohumeral joint capsule. It affects 2% of general population, mostly women after age of 40 years. Diabetes is strongly correlated with idiopathic FS. Chromosome abnormalities in patient with FS are similar to those found in Dupuytren dissease and serum lipid levels are elevated in both disseases. Other disorders as hipothyroidism, cardiac disorders, epilepsy, thoracic surgery or usage of some medications can also be found with FS, but are not in strong correlation. Basic pathogenesis of FS is still poorly understood. There is a progression from inflamation to fibrosis mediated with PDGF and TGB- . Colagen turnover is stimulated with decrease in metalloproteinases activity. Sinovitis in rotator interval with thickening and contracture of the coracohumeral ligament are primary pathology. Affection of middle glenohumeral ligament and capsular thickening progresively reduces joint volume. Typical clinical picture of the dissease goes through three stages ; painful „freezing“ stage lasts between 2, 5 and 9 months and is followed with „frozen“ stage characterised by stiff shoulder with severely limited range of motion. It lasts for 4 to 12 months. „Thawing“ is recovery stage that lasts for 5 to more than 25 months. Range of motion often remains slightly diminished. There are no specific laboratory tests or markers for diagnosing FS. Radiographs are usually normal, although reduced bone mineral density due to arm disuse can be observed. Sonography or MRI are helpful to exclude other pathology (rotator cuff lesion, tumours, calcific tendonitis). Also osteoarthritis, fractures and locked posterior shoulder dislocation should always be excluded. Diagnosis of primary frozen shoulder is always determined by exclusion of secondary shoulder stiffness.

frozen shoulder; primary contracted shoulder; pathology

nije evidentirano