Identification of prognostic factors for the nonoperative treatment of stiff shoulder

Abstract

Purpose This study evaluated prognostic factors for the nonoperative treatment of stiff shoulder. Methods Between June 2005 and May 2010, 497 stiff shoulders treated at our institute were included in this study. Multivariable analysis for recovery with Cox proportional hazard model was performed. The chief determining variable was pathogenesis (idiopathic, diabetic, post-traumatic) and confounding variables were age (49 or less, 50-59, 60 and above), sex, onset to visit interval (three months or less, four months or more), and external rotation (under 0°, 0°or more) or forward flexion (less than 90°, 90°or more) or internal rotation on the first visit. Results There were 356 idiopathic, 61 diabetic, and 80 posttraumatic stiff shoulders. Hazard ratio (HR) and 95 % confidence interval (CI) for recovery (lower HR means poor prognosis) was 0.54 (0.36-0.96) in the diabetic group (p=0.007), and 0.92 (0.67-1.25) in the post-traumatic group (p=0.58) compared with the idiopathic group. A positive correlation was observed in ages of 60 or over (HR 1.46, 95 % CI 0.86-1.65, p-value 0.02) and external rotation under 0°on the first visit (0.71, 0.53-0.96, 0.03). No correlations were observed in sex (p=0.78) or onset to visit interval (p=0.99). Similar results were obtained when forward flexion or internal rotation was used as a confounding variable. Conclusions Diabetes mellitus and severely restricted joint motion on the first visit were poor prognostic factors and ages of 60 or over was a better prognostic factor.

Early Intra‐articular Corticosteroid Injection Improves Pain and Function in Adhesive Capsulitis of the Shoulder: 1‐Year Retrospective Longitudinal Study

“…Primary adhesive capsulitis is caused by global capsular inflammation and fibrosis, which results in a global limitation of range of motion. Recent studies have, however, argued that an anterosuperior or anteroinferior capsular tightening is another characteristic [6], and have included a limitation of external rotation in the diagnostic criteria for adhesive capsulitis, namely, external rotation to less than one‐half of normal [28] or less than 20° of external rotation [13,41]. Considering these changes, it would be more nearly ideal to use diagnostic criteria that would include the limitation of external rotation in future studies on adhesive capsulitis.…”

Alterations of tendons in diabetes mellitus: what are the current findings?

“…The prevalence of connective tissue diseases, such as Dupuytren's disease, trigger finger, carpal tunnel syndrome, rotator cuff tears and shoulder adhesive capsulitis (frozen shoulder), were increased in both patients with type 1 and type 2 diabetes [9,12,13]. These diabetic patients with stiff shoulder have poor prognosis of nonoperative treatment [14].…”

Hydrodilatation With Corticosteroid for the Treatment of Adhesive Capsulitis: A Systematic Review

“…Adhesive capsulitis affects 2%‐5% of the population [1] and is a difficult condition to treat, resulting in significant patient morbidity [2,3]. Adhesive capsulitis is characterized by severe pain that is associated with both active and passive reduction in passive range of motion (ROM) of the glenohumeral joint [2].…”