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

• Authors: Joseph Lamplot, Emory University; Olivia Lillegraven, Washington University St. Louis; Robert H. Brophy, Washington University St. Louis
• Journal Title: Orthopaedic Journal of Sports Medicine
• Volume: Volume 6, Number 7
• Publisher: SAGE Publications Inc | 2018-07-12, Pages 2325967118785169-2325967118785169
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1177/2325967118785169
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Orthopedics; Sport Sciences; idiopathic adhesive capsulitis; frozen shoulder; conservative treatment; physical therapy; corticosteroid injection; RANDOMIZED CONTROLLED-TRIAL; PLACEBO-CONTROLLED TRIAL; FROZEN SHOULDER; CORTICOSTEROID INJECTIONS; GLENOHUMERAL JOINT; ACTIVITY LEVEL; INTRAARTICULAR CORTICOSTEROIDS; NATURAL-HISTORY; TRIPLE-BLIND; ACCURACY

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.