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Research in Focus – Uncovering the pathways to a frozen shoulder

Wednesday, 19 August 2020

Adhesive capsulitis (AC), also called frozen shoulder, causes pain and stiffness in the shoulder. Over time, the shoulder becomes very hard to move. AC affects up to 5% of the population, most commonly between the ages of 30 and 70, and occurs in women more often than men. It creates a high burden on individuals and the community, affecting employment, lifestyle, and care-giving.

While studies suggest that inflammation (the body’s natural response to infection, disease and tissue damage) is a major driver of AC, the cause of the disease is not well understood.  As part of a program of work investigating gene expression in a range of shoulder and painful musculoskeletal conditions, B-CORE researchers at Barwon Health sought to learn more about the cause of adhesive capsulitis, to enable the development of better diagnostic tests and treatment strategies.

Our researchers analysed samples of shoulder capsule tissue collected from patients who underwent shoulder surgery to relieve AC, and compared them to the same type of tissue collected from patients who did not suffer from AC who underwent shoulder surgery.  

Gene sequencing of the capsule tissue revealed 545 genes that were expressed differently between the AC and the control group. 101 enriched biological processes were also identified in the AC group. The top 50 biological processes included remodelling of the extracellular matrix, the structural scaffolding that supports the cells, as well as inflammation and regulation of immune cell function.

These findings provide a unique view of gene changes in the shoulder capsule associated with adhesive capsulitis. These changes provide a useful insight into the cause of the disease and could lead to new targets to better diagnose and treat this condition.

The B-CORE team are extending their research into other conditions, with analysis of a cohort of patients with rotator cuff tears who have undergone surgery, and recruitment of patients with osteoarthritis of the shoulder who require shoulder replacement surgery currently underway.

Authors: Nima Kamal, Sean L. McGee, Kevin Eng, Graeme Brown, Sally Beattie, Fiona Collier, Stephen Gill, Richard S. Page

Citation: Journal of Orthopaedic Research 2020;1–10

Department: Orthopaedics - B-CORE

More information: Shouldering the burden: A new approach to shoulder pain