Arthrofibrosis Awareness Day 2023 - Expert Interview with Prof. Dr. Neal Millar
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- Опубликовано: 18 сен 2024
- Dr. Kayley Usher interviews Prof. Dr. Neal Millar about frozen shoulder (shoulder arthrofibrosis).
Professor Neal Millar is an Academic Consultant Orthopaedic Surgeon specialising in shoulder surgery, having completed shoulder fellowships in Sydney and New York.
His research interest lies in investigating the molecular pathophysiology of tendinopathy; an overuse injury, characterised by tendon pain and weakness with a significant burden of disease.
Past work has highlighted the role of inflammation and cytokines in tendon disease and is currently focused on understanding the role of microRNA in the post transcriptional regulation of collagen synthesis and immediate tissue repair processes implicated in tendinopathy.
Interesting that he is based in Glasgow. His colleagues from Royal Glasgow Infirmary rejected me as a new patient because I have arthrofibrosis, perhaps he could educate the sarcoma team about AF.
Why does knee capsulitis not 'thaw' after 2 years as frozen shoulder does?
I suffered bilateral frozen shoulder 10 years ago, which gradually thawed and resolved over the course of 2 years. In 2018, I developed adhesive capsulitis in the knee with extension contracture after knee surgery. If they're the same thing physically, why does knee capsulitis not resolve on its own over 2 years n the way that frozen shoulder does?
There isn't much known about why arthrofibrosis is more likely to resolve in shoulders than knees. Some researchers have suggested that there are different tissue-resident immune cells (macrophages) in the two joints that affect the outcome. It might also be due to the Hoffa's fat pad (IFP) in knees that becomes inflamed and swollen and gets pinched between the bones of the knee during activity, and even when standing. The IFP is full of immune cells, nerves and other cells that create more inflammation and fibrosis, and it can feel like a finger continually being slammed in a door when walking up steps etc. Because it's not easy to rest knees during daily life, the IFP continues to be injured and sets up a viscous feedback. The IFP is frequently cut during knee surgeries so this sets up inflammation from the start.
I wish it would 😭😭 Also it's a lot easier to find a surgeon to treat frozen shoulder than a frozen knee.