背景:关于冻结肩(FS)的临床病程存在矛盾的证据。
目的:探讨残疾患者的临床病程,疼痛,运动范围(ROM),肌肉力量,肩胛骨向上旋转,和本体感受,并建立这些变量之间的纵向相关性。
方法:对FS患者进行为期3个月的前瞻性随访9个月。评估包括手臂的残疾,肩和手问卷;疼痛视觉模拟量表;肩外旋转倾角计(ER),内部旋转(IR),屈曲,绑架ROM,肩胛骨向上旋转和本体感觉,以及手持测力测量肩部外展的肌肉力量,ER,和IR。
结果:最初,包括149例患者(98例女性;平均(SD)年龄53(9)岁),88完成所有后续评估。大多数变量在FS的临床过程中显示出早期改善,特别是90°外展时的ER和IR,从6到9个月的随访持续改善。观察到残疾和疼痛之间的关联(r=0.61),残疾/疼痛和ROM(分别为r=-0.62至-0.59和r=-0.47至-0.39),残疾/疼痛和肌肉力量(分别为r=-0.24至-0.35和r=-0.36至-0.17),以及残疾/疼痛和肩胛骨向上旋转低于肩部水平(分别为r=0.23至0.38和r=0.24至0.30)。ROM与肌肉力量相关(r=0.14至0.44),而ROM和ER肌肉力量均与肩胛骨向上旋转相关,低于肩部水平(分别为r=-0.37至-0.23和r=-0.17至-0.12)。肌肉力量与肩cap骨向上旋转相关(r=0.28至0.38),而提离肌肉力量与关节重新定位相关(r=-0.17至-0.15)。
结论:基线评估后,几乎所有因素都在早期(3-6个月)得到改善,而肩部水平的ER和IRROM长期持续改善。
BACKGROUND: Contradictory evidence exists regarding the clinical course of frozen shoulder (FS).
OBJECTIVE: To explore the clinical course of FS regarding disabilities, pain, range of motion (ROM), muscle strength, scapular upward rotation, and proprioception and to establish longitudinal correlations between these variables.
METHODS: Patients with FS were prospectively followed for 9 months at 3-month intervals. Assessment included the Disabilities of the Arm, Shoulder and Hand questionnaire; visual analogue scale for pain; an inclinometer for shoulder external rotation (ER), internal rotation (IR), flexion, and abduction ROM, and scapular upward rotation and proprioception, as well as handheld dynamometry for muscle strength in shoulder abduction, ER, and IR.
RESULTS: Initially, 149 patients (98 females; mean (SD) age 53 (9) years) were included, with 88 completing all follow-up assessments. Most variables showed early improvement in the clinical course of FS, particularly ER and IR at 90° abduction, which continued to improve from 6 to 9 months of follow-up. Associations were observed between disabilities and pain (r = 0.61), disabilities/pain and ROM (r=-0.62 to -0.59 and r=-0.47 to -0.39, respectively), disabilities/pain and muscle strength (r=-0.24 to -0.35 and r=-0.36 to -0.17, respectively), and between disabilities/pain and scapular upward rotation below shoulder level (r = 0.23 to 0.38 and r = 0.24 to 0.30, respectively). ROM correlated with muscle strength (r = 0.14 to 0.44), while both ROM and ER muscle strength correlated with scapular upward rotation below shoulder level (r=-0.37 to -0.23 and r=-0.17 to -0.12, respectively). Muscle strength correlated with scapular upward rotation above shoulder level (r = 0.28 to 0.38) and lift-off muscle strength correlated with joint repositioning (r=-0.17 to -0.15).
CONCLUSIONS: Almost all factors improved in the early phase (3-6 months) after baseline assessment, while ER and IR ROM at shoulder level continued to improve long term.