來源：jxradiology

譯者：HW ZHAO譯

腋隱窩解剖示意圖：

腋囊的增厚和水腫：

肩袖間隙異常軟組織信號（細箭）：

腋囊增厚和水腫(細箭)：

腋囊增厚纖維化（T1/T2均為低信號）：

MRI關(guān)節(jié)囊造影提示腋囊體積縮?。?/span>

原文：https:///articles/adhesive-capsulitis-of-the-shoulder

Adhesive capsulitis of the shoulder, also known as frozen shoulder, is a condition characterised by thickening and contraction of the shoulder joint capsule and surrounding synovium. Adhesive capsulitis can rarely affect other sites such as the ankle .

粘連性肩關(guān)節(jié)囊炎 ，也稱凍結(jié)肩，其特征是肩關(guān)節(jié)囊和周圍滑膜的增厚和攣縮。粘連性關(guān)節(jié)囊炎很少影響其他部位，如踝關(guān)節(jié)。

Epidemiology

The incidence in the general population is thought to be 3-5%. Adhesive capsulitis typically affects women in the 5th to 6th decades of life, although patients with co-morbidities such as diabetes may develop the condition at earlier ages. The incidence in patients with diabetes is reported to be 2 to 4 times higher than in the general population.

流行病學

一般人群的發(fā)病率為3-5％。粘連性關(guān)節(jié)囊炎通常見于50-60歲的女性，患有糖尿病等并發(fā)癥的患者發(fā)病年齡可能會提前。糖尿病患者的發(fā)病率高于普通人群的2?4倍。

Clinical presentation

Adhesive capsulitis presentation can be broken into three distinct stages:

• freezing: painful stage 

• patients may not present during this stage because they think that eventually, the pain will resolve if self-treated.

• as the symptoms progress, pain worsens and both active and passive range of motion (ROM) becomes more restricted

• this can eventually result in the patient seeking medical consultation

• typically lasts between 3 and 9 months and is characterised by an acute synovitis of the glenohumeral joint

• frozen: transitional stage

• most patients will progress to the second stage

• during this stage, shoulder pain does not necessarily worsen

• because of pain at end ROM, use of the arm may be limited causing muscular disuse

• can last between 4 to 12 months

• the common capsular pattern of limitation has historically been described as diminishing motions with external shoulder rotation being the most limited, followed closely by shoulder flexion, and internal rotation

• there eventually becomes a point in the frozen stage that pain does not occur at the end of ROM

• thawing stage

• begins when ROM begins to improve

• lasts anywhere from 12 to 42 months and is defined by a gradual return of shoulder mobility

臨床癥狀：

粘連性關(guān)節(jié)囊炎分為三個階段：

凝結(jié)期：疼痛期

• 患者在這個階段可能不會出現(xiàn)，因為他們認為最終，如果自我治療，疼痛就會解決。

• 隨著癥狀的進展，疼痛惡化，主動和被動的運動范圍（ROM）變得更加受限制

• 這可能最終導致病人尋求醫(yī)療咨詢

• 通常持續(xù)3至9個月，其特征是盂肱關(guān)節(jié)的急性滑膜炎

凍結(jié)期：過渡期

• 大多數(shù)患者將進入此階段

• 在這個階段，疼痛并不一定會惡化

• 由于運動時的疼痛，手臂功能可能會受到限制，導致肌肉廢用

• 可持續(xù)4至12個月

• 常見的限制模式歷史上被描述為減少運動，外肩旋轉(zhuǎn)是最受限的，其次是肩部屈曲和內(nèi)旋

• 最終在慢性期運動受限成為一個點，在運動范圍結(jié)束時不會發(fā)生疼痛

解凍期

• 開始時運動范圍開始改善

• 持續(xù)12至42個月，肩關(guān)節(jié)運動逐步恢復

Pathology

Adhesive capsulitis is divided into two main types: 

• primary or idiopathic

• absence of preceding trauma

• secondary 

• major or minor repetitive trauma

• shoulder or thoracic surgery

• endocrine, e.g. diabetes, hyperthyroidism 

• rheumatological conditions

病理

粘連性關(guān)節(jié)囊炎分為兩大類：

原發(fā)性或特發(fā)性

•   無外傷病史

繼發(fā)性

• 重大或輕微的重復創(chuàng)傷

• 肩部或胸部手術(shù)

• 內(nèi)分泌，例如糖尿病，甲狀腺功能亢進

• 風濕病

Radiographic features

MRI/MR arthrography

• normal inferior glenohumeral ligament measures <4 mm and is best seen on coronal oblique images at the mid glenoid level; in adhesive capsulitis, the axillary recess may show thickening ≥1.3 cm

• joint capsule thickening 

• abnormal soft tissue thickening within the rotator interval with signal alteration

• abnormal soft tissue encasing the biceps anchor

• variable enhancement of the capsule and synovium within the axillary recess and rotator interval

Other MR arthrography features include

• thickening of the coracohumeral ligament (CHL) 

• subcoracoid triangle sign 

影像學表現(xiàn)

MRI / MRI關(guān)節(jié)造影

• 正常下盂肱韌帶測量值<4毫米，在斜冠位上關(guān)節(jié)囊中間層面顯示最好；在粘連性關(guān)節(jié)囊炎患者中，腋隱窩軟組織增厚≥1.3厘米

• 關(guān)節(jié)囊增厚

• 肩袖間隙異常軟組織增厚伴信號異常

• 異常軟組織包繞肱二頭肌腱

• 增強后腋隱窩和肩袖間隙的關(guān)節(jié)囊或滑囊強化

其他MR關(guān)節(jié)造影包括

• 喙肱韌帶（CHL）增厚

• 喙突下三角征

• 腋囊正常容量15-18ml，本病小于10ml，多數(shù)小于5ml（文獻上）

Treatment and prognosis

Adhesive capsulitis is typically a self-limiting disease that improves over 1-2 years. Treatment options include:

• physiotherapy

• corticosteroid injections

• glenohumeral hydrodilatation

• closed manipulation under anaesthesia

• arthroscopic capsular release with lysis of adhesions