Frozen shoulder and calcific tendonitis

Frozen shoulder represents a group of conditions with several different etiologies. Despite several recent studies, the underlying cause of primary or idiopathic frozen shoulder remains largely unknown. Recent studies have suggested that immunologic factors may play a significant role in the development of this disorder. Primary frozen shoulder can most often be successfully managed by nonoperative means, consisting of a supervised rehabilitation program or manipulation under anesthesia. Secondary shoulder stiffness due to previous surgery or trauma is usually resistant to nonoperative treatment and, consequently, warrants a more aggressive approach. Recently several clinical studies have documented the effectiveness of arthroscopic capsular release in restoring glenohumeral motion in patients with recalcitrant frozen shoulder or postsurgical or posttraumatic stiffness. When arthroscopic release fails to restore motion or is contraindicated, such as in cases in which there is a known extraarticular contracture, an open capsular release may be performed. Calcifying tendonitis of the rotator cuff is a relatively common condition that usually resolves with conservative care. In patients with severe acute symptoms in the resorptive phase, needling and lavage can provide immediate relief. Chronic symptoms may necessitate more invasive care. Recent studies have demonstrated some efficacy with extracorporeal shock wave therapy. Surgical intervention remains effective when a distinct deposit can be identified. Depending on the surgeon's skill and comfort, open or arthroscopic techniques may be used.Curr Opin Orthop 1999, 10:294–304 © 1999 Lippincott Williams & Wilkins, Inc.