Treatment of Adhesive Capsulitis of the Shoulder

Abstract

Adhesive capsulitis presents clinically as limited, active and passive range of motion caused by the formation of adhesions of the glenohumeral joint capsule. Radiographically, it is thickening of the capsule and rotator interval. The pathology of the disease, and its classification, relates to inflammation and formation of extensive scar tissue. Risk factors include diabetes, hyperthyroidism, and previous cervical spine surgery. Nonsurgical management includes physical therapy, corticosteroid injections, extracorporeal shock wave therapy, calcitonin, ultrasonography-guided hydrodissection, and hyaluronic acid injections. Most patients will see complete resolution of symptoms with nonsurgical management, and there appears to be a role of early corticosteroid injection in shortening the overall duration of symptoms. Surgical intervention, including manipulation under anesthesia, arthroscopic capsular release both limited and circumferential, and the authors' technique are described in this article. Complications include fracture, glenoid and labral injuries, neurapraxia, and rotator cuff pathology. Postoperative care should always include early physical therapy.

Current Concepts in the Treatment of adhesive capsulitis of the Shoulder

“…However, Loew et al 22 in a prospective trial, reported that arthroscopic assessment after MUA revealed multiple potential iatrogenic complications, such as superior labral tears, partial tears of the subscapularis, anterior labral detachments, and tears of the middle glenohumeral ligament 22 . Moreover, there have been reports of glenoid and proximal humerus fractures as well as axillary nerve neurapraxia 1 . In many institutions, arthroscopic capsular release has supplanted manipulation under anesthesia because arthroscopy allows complete inspection of the joint, diagnosis confirmation and a more precise capsulotomy without the risks of manipulation 23 .…”

“…Adhesive capsulitis (AC), is defined as "a condition of varying severity characterized by the gradual development of global limitation of active and passive shoulder motion where radiographic findings other than osteopenia are absent 1 ." AC can be classified as primary and secondary.…”

“…Secondary AC typically follows trauma or injuries to the shoulder such as fractures, surgery, or immobilization 2,3 . Most patients with primary AC are women aged 40 to 60 years 1,2 . The nondominant arm typically is most affected 1,2 .…”

“…Most patients with primary AC are women aged 40 to 60 years 1,2 . The nondominant arm typically is most affected 1,2 . AC is more common in persons in sedentary vocations than in persons who perform manual labor 1,2 .…”

“…The nondominant arm typically is most affected 1,2 . AC is more common in persons in sedentary vocations than in persons who perform manual labor 1,2 . Diabetes is associated with a significantly worse prognosis, greater need for surgery, and suboptimal results 4 .…”