06/03/2023
The onset of arthrofibrosis in adhesive capsulitis 💡
Shoulder arthrofibrosis, also known as adhesive capsulitis (AC), develops in four stages (Figure) [https://pubmed.ncbi.nlm.nih.gov/33795150/39]:
👉 Stage I begins with the invasion of inflammatory cells into the joint space, leading to synovitis and pain, but without stiffness or loss of ROM.
👉 In Stage II, cytokines secreted by immune cells recruit matrix-producing fibroblasts to the synovium, while synovitis persists. Synovial hyperplasia follows and contributes to early joint stiffness, indicative of capsule thickening.
👉 Stage III is defined by increasing joint stiffness and loss of range of motion (ROM), accompanied by significant pain, especially at the extremes of motion due to significant extracellular matrix (ECM) deposition in the synovium.
👉 Lastly, Stage IV presents as a persistent loss of ROM after synovitis, where pain varies by patient.
Note: inflammation does not always subside by Stage IV.
Illustration: https://pubmed.ncbi.nlm.nih.gov/33795150/