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Inflammation and fibrosis: CausEs in adhesive CAPsulitis

What is a frozen shoulder?

Frozen shoulder is a common joint disease affecting 10% of the working population. The condition causes significant shoulder pain, disability and social isolation and predominantly affects patients between 40-60 years old.

Frozen shoulder is poorly understood and currently there are no effective treatments. During disease, the joint capsule, an envelope surrounding the shoulder joint becomes inflamed and thickened, causing severe stiffness, which significantly impacts day-to-day life. 

Patients typically have symptoms for 2-5 years, yet interestingly the condition is self-limiting: it almost always resolves during this time.  In contrast many other forms of inflammatory joint disease including arthritis never resolve. Therefore, frozen shoulder is a unique condition whereby chronic inflammation and thickening of the shoulder joint capsule spontaneously resolves over time, as shown in the figure below. 

 Frozenshoulderfigure.pngAnimal models of frozen shoulder do not accurately represent the condition affecting patients. Therefore, access to patient tissue is vital to advance our understanding of disease. We have established an ethically approved national clinical study called ‘ICECAP’ to collect tissue from the joint capsule of patients undergoing shoulder surgery. 

Preliminary findings

Our preliminary findings from studying frozen shoulder patient tissue samples suggest that cells in the shoulder capsule are enriched to resolve inflammation. Read more about it here.

What is the ICECAP study?

Inflammation and fibrosis: CausEs in adhesive CAPsulitis

The ICECAP study is comprised of 3 patient groups. The Frozen Shoulder Group will comprise patients with frozen shoulder undergoing elective surgery for arthroscopic capsular release. We will compare frozen shoulder patient tissues with 2 other groups of patients undergoing shoulder surgery. The Instability Comparator Group will comprise patients with shoulder instability undergoing elective surgery for anterior stabilisation of the shoulder joint. The Fracture Comparator Group will comprise patients with displaced proximal humeral fractures undergoing surgical repair.

We will use these patient tissues to:

  1. Discover the cell types in inflamed joint capsules and construct a ‘cellular atlas’ of frozen shoulder
  2. Identify the biological processes that lead inflammation and fibrosis to ultimately resolve in frozen shoulder
  3. Identify new therapies to ‘kick-start’ resolution of frozen shoulder 

Our findings will help to identify new treatments to accelerate resolution of frozen shoulder, thereby improving the life quality of affected patients.

ICECAP Study Design

Male and female patients aged between 18-80 years of age are eligible for inclusion to the study. We aim to collect tissues from 40 frozen shoulder patients undergoing adhesive capsular release surgery, 30 fracture patients undergoing surgical repair and 15 patients undergoing shoulder instability surgery. Patients with immune mediated disease affecting the joint including Rheumatoid Arthritis cannot be included into this study.

Meet the team

Kim Wheway

Kim Wheway 

Research Nurse

Bridget Watkins

Bridget Watkins 

Research Nurse

Debra Beazley

Debra Beazley 

Research Nurse

Tissue Collection 

Louise Appleton

Louise Appleton 

Lab Manager

Sample tracking & transport 

Andrew Carr

Prof Andrew Carr

Chief Investigator 

Stephanie Dakin

Prof Stephanie Dakin 

Principle Investigator

Amar Rangan

Prof Amar Rangan 

Co-Investigator 

DrLucksyKottam.png

Dr Lucksy Kottam

Co-Investigator 

Christopher Buckley

Prof Christopher Buckley 

Co-Investigator 

Hamez Gacaferi

Dr Hamez Gacaferi 

Clinical Fellow & DPhil student