A large-scale assessment of the healthcare burden of adhesive capsulitis of the shoulder joint

Abstract

BACKGROUND AND AIM: Frozen shoulder is a poorly understood pathological entity that is characterised by a painful and stiff shoulder. To analyse the socioeconomic impact of frozen shoulder in terms of cost generation and prolonged absence from work, we conducted a retrospective cohort study based on shoulder injuries through accidents in Switzerland. METHODS: Data were obtained from the comprehensive database of the Statistical Service for the Swiss National Accident Insurances (SSUV). Cases with shoulder injuries (ICD-10 codes S4* and M84.3*) and/or an additional code of adhesive capsulitis (M75.0) were extracted. Outcomes were work incapacity, with long-term work incapacity defined as absence from work for >90 days and very-longterm cases with >360 days lost. Healthcare and treatment costs as well as total insurance expenses were measured over a 5-year follow-up. Multivariate statistical analyses were used to quantify the effect of the frozen shoulder complication.RESULTS: Among all 456,926 patients with a shoulder injury, 5% or a total of 22,228 posttraumatic frozen shoulder cases were observed over the 8-year period. Patients suffering from a frozen shoulder after shoulder injury showed significantly longer sick leave periods with 30.8% longterm and 9.7% very-long-term cases compared with 9.4% and 1.3%, respectively, in the non-frozen shoulder cohort. Overall costs per case for an injured shoulder without developing a frozen shoulder was roughly CHF 8000, whereas expenses for cases with posttraumatic and postoperative frozen shoulder were CHF 34,000 per case. CONCLUSION: Developing a frozen shoulder after a shoulder injury is associated with significant longer work incapacities (3.3-7.5 times) and is responsible for costs of CHF 78 million every year. The presented numbers are for cases covered by the compulsory accident insurance only and do not include the even more frequent idiopathic frozen shoulder cases.

Non-adherence to pain medication increases risk of postoperative frozen shoulder

“…Further, it has a relevant impact on healthcare system. [ 7 ] In the current study, presence of FS did prolong shoulder restriction by a factor 2 (11 months vs 6.5 months). This is remarkable, since small arthroscopic procedures are usually uneventful and a rapid recovery is usually expected both by the patient and the physician.…”

“…Since small arthroscopic shoulder interventions are frequently performed, this complication imposes a relevant burden on the healthcare system due to (unexpectedly) long inability to work. [ 7 ] Identification of patients a risk, besides the ones known for idiopathic FS, would be advantageous to apply prophylactic measures and to improve preoperative information on possible duration of inability to work.…”

Translational targeting of inflammation and fibrosis in frozen shoulder: Molecular dissection of the T cell/IL-17A axis

“…Frozen shoulder is more prevalent in women, mainly affecting those in the fifth and sixth decades of life, and is the third most common cause of musculoskeletal disability in the United States and European Union ( 3 ). While often thought of as a self-limiting disease, the majority of patients suffer permanent disability at long-term follow up, with some patients reporting painful symptoms at 6-y postdisease onset ( 4 ), costing the US healthcare system in excess of $85 million per annum ( 5 ). Numerous rehabilitative, medical, and surgical therapies are available ( 2 ); however, current research does not support a clear treatment strategy, and none are derived from an understanding of the molecular mechanisms underpinning disease pathology.…”

Behandlung bei Erwachsenen mit primärer Frozen Shoulder in der Sekundärversorgung (UK FROST): eine multizentrische, pragmatische, dreiarmige, randomisierte klinische Überlegenheitsstudie

“…In der Schweiz verursacht die posttraumatische, sekundäre FS enorme Gesundheitskosten [5]. Ein internationaler Vergleich wäre daher interessant, war jedoch zwischen der Studie von Rangan et al [2] in UK und der Schweizer Studie [5] aufgrund der untersuchten Fragestellung (direkte vs. indirekte Gesundheitskosten), der Art der FS (primär vs. sekundär) sowie der unterschiedlichen Einheiten der Ergebnisse (QALY vs. Betrag in Schweizer Franken) nicht möglich. Die Hauptstudie Rangan et al [2] weist gemäß den Kriterien des Oxford Centre for Evidence-Based Medicine [6]…”