Donuk Omuzda Rehabilitasyon
Özet
Donuk omuz (adeziv kapsülit), glenohumeral eklem etrafındaki patolojik kontraktürler sonucu oluşan eklem sertliği, ağrı ve disfonksiyonla karakterize, yaşam kalitesini düşüren bir tablodur. Tarihsel olarak Duplay, Codman ve Nevasier tarafından tanımlanan bu hastalık, primer veya sekonder olarak ortaya çıkabilir ve insansı %3-5 arasında değişirken diyabetlilerde, kadınlarda, hipertiroidizm hastalarında ve cerrahi geçmişi olanlarda risk artar. Etiyolojisi tam bilinmemekle birlikte temel patoloji, inflamatuar sitokinlerin ve makrofajların rol oynadığı eklem kapsülü kontraktürü ile fibroblastik transformasyondur. Klinik olarak tüm yönlerde ağrılı hareket kısıtlılığı (ROM) görülür ve histolojik/artroskopik olarak 4 evreye ayrılır. Konvansiyonel radyografiler genellikle normalken MR'da ligament kalınlaşması ve ödem izlenir. Tedavinin amacı ağrısız ve fonksiyonel bir eklem sağlamaktır; hastanın irritabilite düzeyine göre (ciddi, orta, hafif) stratejiler belirlenir. İlk basamakta hasta eğitimi ve sıcak/soğuk, TENS gibi fizik tedavi modaliteleri egzersiz öncesi kas uzayabilirliğini artırmak için kullanılır. Erken evrelerde tolere edilebilen aktif/pasif egzersizler, ilerleyen evrelerde ise doku remodelizasyonunu hızlandıran kontrollü germe hareketleri ve manuel terapi uygulanır.
Frozen shoulder (adhesive capsulitis) is a clinical condition characterized by joint stiffness, pain, and dysfunction resulting from pathological contractures around the glenohumeral joint, which significantly reduces the patient's quality of life. Historically defined by Duplay, Codman, and Nevasier, this disease can present as primary or secondary; its incidence ranges between 3-5%, with an increased risk observed in females, diabetic individuals, hyperthyroidism patients, and those with a history of shoulder or breast surgery. Although its precise etiology remains fully unelucidated, the core pathology involves joint capsule contracture and fibroblastic transformation driven by inflammatory cytokines and macrophages. Clinically, it manifests as painful restriction of motion (ROM) in all directions and is categorized into four arthroscopic and histological stages. While conventional radiographs are typically normal, magnetic resonance imaging reveals ligament thickening and edema. The objective of treatment is to achieve a painless and functional joint, utilizing specific management strategies tailored to the patient's level of irritability (high, moderate, low). Initial management consists of patient education combined with physical therapy modalities such as hot/cold packs and TENS to enhance muscle extensibility prior to exercise. Active or passive exercises within tolerable limits are recommended in the early stages, whereas controlled stretching exercises and manual therapy are implemented in later stages to accelerate tissue remodeling.
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