before introducing the treatment, let me clarify the terminology of the frozen shoulder first.
Since Codman described the frozen shoulder in 1934, the frozen shoulder has been named variably for the past 70 years.
Bunker describes it as a shoulder condition of a painful incomplete active elevation and external rotation, the restriction of passive movement, and normal radiographic findings.
A history of atraumatic shoulder pain, absence of glenohumeral arthritis, and a positive external rotation test are one of the strong diagnostic clues for the frozen shoulder.
In some countries, Most doctors still stick to using the original terminology and follow Zuckerman's proposal: Primary and secondary type of frozen shoulder.
Furthermore, the primary frozen shoulder has been described as an idiopathic frozen shoulder.
As you know, An idiopathic or primary disease is any disease with an unknown cause or mechanism of apparent spontaneous origin.
Science has solved many questions.
Many researchers have demonstrated many pathologic findings of previous frozen shoulder. So, It is time to change the frozen shoulder.
Luckily, some doctors had begun to criticize the terminology of frozen shoulder.
Look at the trends of the description. The adhesive capsulitis has grown in popularity since 1980.
Let me talk about my perspectives about the frozen shoulder.
Let's forget the terminology for a moment. We are dealing with patients with painful restricted shoulder joint movement.
I will show you two videos conducting the passive shoulder joint movement test.
She and I showed normal radiographs and a capsular pattern of limitation.
According to Zuckerman's classification, She and I have the same idiopathic frozen shoulders.
Let's observe her T2 weighted multiplanar MR images. It shows high signal intensity in the coracohumeral ligament, and the inferior joint capsule and extracapsular tissue.
It's mine. I don't have any high signal intensity in the coracohumeral ligament and inferior capsule. Instead, I have an anterior superior labral tear with small ganglion formation.
Here is my point. There is no more idiopathic frozen shoulder. It is antique terminology. All the frozen shoulders always have pathologies to explain the pain and limitations.
I prefer to use the terminology of adhesive capsulitis
I will show you one more case of adhesive capsulitis. It shows high signal intensity in the coracohumeral ligament and sub-capsular tissue of the inferior capsule.
But also showed insertional tears of the supraspinatus and subscapular tendons.
Do you think it is a secondary type of adhesive capsulitis?
Is the adhesion the result of cuff tears?
The terminology "secondary" may cause misunderstanding and mistakingly prejudice the" frozen" result generated by the cuff tears.
It is not a relation between cause and result.
I believe that the two pathologies are separate entities and innocent bystanders.
So, I will treat the adhesive capsulitis if the symptom is a painful capsular limitation.
It is my summary. I will classify clinical frozen shoulder into the name of adhesive capsulitis and pseudo-adhesive capsulitis.
Usually, I finalize the decision according to the MRI findings.
The coracohumeral ligament could be a critical key factor and could be a game-changer.
So, the pathologies of adhesive capsulitis are not confined to the joint capsule but rotator cuff interval, subcoracoid fat triangle, coracohumeral ligament, a sub-synovial layer of the inferior joint capsule.
It is why I am not satisfied with the title of adhesive capsulitis.
It is a disease of inflammation and fibrosis in the capsule and extracapsular fibrous tissue, especially the coracohumeral ligament.
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