Adhesive Capsulitis Treatment: What is a Myofibroblast?
Adhesive capsulitis is a problem also known as “frozen shoulder”. This is a difficult problem to fix, because it’s cause is poorly understood. All adhesive capsulitis treatment to date has been focused on the macro problem of a tight shoulder, however, recent research shows involvement at a cellular level by a strange cell called a myofibroblast.
A frozen shoulder is when the joint locks down causing almost no movement and often begins after shoulder surgery. It’s horrible for the patient, as things like getting dressed or reaching become almost impossible. It’s a serious issue, not only because the joint doesn’t move well and this limits function, but also because it places more wear and tear on certain parts of the joint, which can lead to arthritis.
The cause of this horrible problem has not been well understood. In fact, we only know a few things about the disease. First, it’s much more common in adult onset diabetics. It’s also more common in patients with poor blood sugar control who aren’t yet diabetics (metabolic syndrome). We also know that patients with diabetes don’t respond as well to traditional treatments. What is the number one adhesive capsulitis treatment? Yanking on the shoulder with force during surgery to break up the adhesions in the shoulder capsule. This is known as “Manipulation Under Anesthesia”.
This past decade has yielded some more information on what causes this shoulder problem, which is now widely thought to be due to chronic inflammation. This problem of too much whole body swelling is a huge problem in modern society. However, the real cause may be how the inflammation interacts with a very interesting and often ignored cell type called a myofibroblast. What’s that?
A myofibroblast is a cross between a muscle cell (myocyte) and a fibrous tissue (like ligament and tendon) cell. It’s a hybrid cell involved in healing because it can both anchor in the foundation material of cells (extra-cellular matrix) and contract. These myofibroblasts manage a key job of healing torn tissue-contracting the two ends of the wound. This approximation part is necessary for big cuts or tears in ligaments to heal because repair cells can only bridge a small gap. Myofibroblasts are so important in healing, that stem cells can also turn into this cell type when there aren’t enough.
What does this cell have to do with a frozen shoulder? While these cells are critical for healing an injury, like many repair cells, they’re activated by inflammation. For an acute or recent injury, inflammation is what causes the dance of cells to spring into action and do their jobs. When the injury is healed, the inflammation stops and the various repair cells are deactivated. However, chronic inflammation is a low level signal that provides a constant “on” signal for many cells, including myofibroblasts. In adhesive capsulitis, this stimulation causes these cells inside the main shoulder lubricating sac to contract like a muscle. Since this portion of the shoulder allows free movement by allowing structures to freely and easily slide past one another, it’s tightening leads to a shoulder that doesn’t move.
The upshot? Adhesive capsulitis of the shoulder is what happens when chronic inflammation interacts with a cell type normally designed for contracting tissue tears to maximize healing. These cells are supposed to get a temporary chemical signal to contract from local inflammation caused by an acute injury. However, in the presence of chronic inflammation, they get a constant “on” signal that causes the shoulder bursa and capsule to contract. To prevent this horrible problem from happening to you, you’ve got to get on top of chronic inflammation. Read more here how you can help reduce chronic inflammation with supplements. To treat frozen shoulders, we’ve successfully used our third generation platelet lysate injected to expand these bound down myofibroblasts in the shoulder bursa and capsule.