Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments

Abstract

Adhesive shoulder capsulitis, or arthrofibrosis, describes a pathological process in which the body forms excessive scar tissue or adhesions across the glenohumeral joint, leading to pain, stiffness and dysfunction. It is a debilitating condition that can occur spontaneously (primary or idiopathic adhesive capsulitis) or following shoulder surgery or trauma (secondary adhesive capsulitis). Here, we review the pathophysiology of adhesive shoulder capsulitis, highlighting its clinical presentation, natural history, risk factors, pathoanatomy and pathogenesis. Both current non-operative and operative treatments for adhesive capsulitis are described, and evidence-based studies are presented in support for or against each corresponding treatment. Finally, the review also provides an update on the gene expression profile of adhesive capsulitis and how this new understanding can help facilitate development of novel pharmacological therapies.

Intraarticular injection of relaxin-2 alleviates shoulder arthrofibrosis

“…As these findings show, local delivery of relaxin-2 is an innovative treatment of shoulder arthrofibrosis. relaxin | fibrosis | frozen shoulder | arthrofibrosis A rthrofibrosis is an accumulation of fibrotic collagenous tissue within the joint, frequently occurring after trauma, surgical procedures, inflammation, prolonged joint immobilization, or idiopathically (1)(2)(3)(4)(5). It manifests as a painful and longstanding restriction of joint range of motion (ROM) (6).…”

“…The prevalence of arthrofibrosis following anterior cruciate ligament reconstruction is as high as 35%. The frequency of arthrofibrosis in the shoulder is up to 5% of the general population, increasing to 36% among those suffering from diabetes (5,(22)(23)(24)(25).…”

Patients with Axial Spondyloarthritis Are at Risk of Developing Adhesive Capsulitis: Real-World Evidence Database Study in Taiwan

“…Regarding the inflammatory cascade, the synovial cells and fibroblasts of the shoulder capsule were targets of inflammatory invasion [14]. The inflammatory cascade is related to fibroblastic hyperplasia induced by cytokines such as transforming growth factor-β, tumor necrosis factor-α, platelet-derived growth factor, interleukin 1 (IL-1), and IL-6 [15,16]. This can also be confirmed by observing the histologic presentation of fibroblast cell proliferation with increased matrix metalloproteinase and fibrogenic growth factors in patients with adhesive capsulitis [17].…”

Effects of Platelet Rich Plasma Injection on Adhesive Capsulitis: An Interventional Case Series

“…There is a limitation in daily living activities due to pain and stiffness, as well as impaired sleep quality due to night pain and fatigue, all of which result in significant impairment in the quality of life. Its incidence is approximately 3%-5% in the general population (1). Clinical presentation may progress with spontaneous remission within 2-4 years, but it is refractory in 40% of cases (2).…”