Outcomes From Conservative Treatment of Shoulder Idiopathic Adhesive Capsulitis and Factors Associated With Developing Contralateral Disease

Abstract

Background:Idiopathic adhesive capsulitis is a common condition resulting in painful multidirectional restriction of motion without other identifiable shoulder abnormality. First-line therapies for this condition are nonoperative, but limited data are available regarding which treatments are most effective. Factors associated with contralateral disease are not well established.Hypothesis:Younger patients will have a better response to treatments, and older patients and patients with diabetes will be more likely to develop contralateral disease.Study Design:Cohort study; Level of evidence, 3.Methods:Patients diagnosed with idiopathic adhesive capsulitis were treated with a single intra-articular glenohumeral injection of local anesthetic and corticosteroid as well as 4 weeks of supervised physical therapy (PT). Patients were re-evaluated monthly and received additional conservative treatment based on failure to restore normal motion. Patient-reported outcome scores and range of motion were used to assess treatment efficacy.Results:Minimum 2-year follow-up data (mean, 3.4 years) were available for 60 of 75 eligible patients (80%). Patients who did not attend supervised PT as prescribed were more likely to undergo repeat injection due to a lack of adequate range of motion at follow-up (P = .003). Conservative therapy failed in 2 patients (3.3%), and they underwent arthroscopic release and manipulation under anesthesia. Twenty-two patients (36.7%) were subsequently diagnosed with contralateral idiopathic adhesive capsulitis, with a higher incidence in patients with diabetes (P = .009) and patients younger than 50 years (P = .005). American Shoulder and Elbow Surgeons score improved from 41.2 (95% CI, 33.0-49.4) at baseline to 92.0 (95% CI, 88.4-95.6) at final follow-up (P < .0001). Patients with diabetes had a decrease in Shoulder Activity Scale score at final follow-up (P = .049).Conclusion:Conservative treatment for idiopathic adhesive capsulitis resulted in good clinical outcomes with a low incidence of surgical intervention. Physical therapy reduced the use of a second injection as part of treatment in this treatment algorithm. Young patients and patients with diabetes may be more likely to develop contralateral disease.

Adhesive Capsulitis: Demographics and Predictive Factors for Success Following Steroid Injections and Surgical Intervention

“…Prior studies have shown ADHESIVE CAPSULITIS TREATMENT e37 efficacy in physical therapy, as well as corticosteroid injections in the treatment of adhesive capsulitis, although little data exist on the ideal number of corticosteroid injections. 6,13 One of the interesting demographic findings from this study was the higher percentage of men with diabetes (24.8% vs 17.3% [P ¼ .001]), and a higher percentage of women with hypothyroidism (13.4% vs 5.6% [P ¼ .001]) presenting with adhesive capsulitis. Prior studies have shown a higher prevalence of hypothyroidism among women in the general population, with a prevalence of approximately 8% in women compared with just 1% in men, but the percentages of patients with adhesive capsulitis and hypothyroidism far exceeded this for both sexes.…”

“…4,5 Once the diagnosis of adhesive capsulitis is correctly made (which can be difficult at times), initial treatment commonly involves a course of physical therapy (PT) focusing on gentle, progressive stretching with or without a glenohumeral corticosteroid injection. 6 Supplemental treatments to physical therapy are numerous and include corticosteroid injections, antiinflammatory medications, hydrodilation, and capsular release with manipulation under anesthesia. Intraarticular corticosteroid injections have been shown to be effective in treating adhesive capsulitis, with improvements in pain and range of motion (ROM), whereas treatment with oral antiinflammatory medications has not generally produced effective results.…”

Feasibility of Ultrasound-Guided Trigger Point Injection in Patients with Myofascial Pain Syndrome

“…It remains uncertain, however, whether there is an appropriate placement or misplacement of injected treatment agents at the MTrPs [35]. Thus, a blind technique would cause residual or earlier recurrence of symptoms [36]. To resolve this, US-guided injections of treatment agents have been attempted, whose accuracy has been well described in the literature [37].…”

Concordancia diagnóstica de capsulitis adhesiva por resonancia magnética entre centros de imagenología y una clínica de reconstrucción articular con correlación quirúrgica

“…Actualmente su prevalencia real se desconoce, pero se estima que se presenta en 5.3% de la población 1 en el rango de 40 a 65 años de edad, 5 afecta al género femenino en 70% de los casos 1 y hasta en 20% de la población con diabetes, en particular en la extremidad no dominante se manifiesta entre 40 y 50% de los casos de forma bilateral, 1 condición que afecta sobre todo a la población diabética y a los que muestran el primer cuadro antes de los 50 años. 5 Es una patología autolimitada, con una duración entre 1 y 3.5 años, con un promedio de 30.5 meses. El diagnóstico diferencial debe realizarse con lesiones del manguito de los rotadores, tendinitis o bursitis calcificada o con un proceso degenerativo glenohumeral.…”