Adhesive capsulitis

Adhesive capsulitis affects 2% to 5% of the population. It is slightly more common in women than in men, and is most common in people between 40 and 70 years of age.

Recent history of traumatic shoulder injury, prior surgery to affected shoulder, diabetes mellitus, thyroid disease, and previous history of adhesive capsulitis are all risk factors for developing adhesive capsulitis.

Mainstay of treatment is physical therapy and observation. Evidence shows that nonsteroidal anti-inflammatory drugs and injected corticosteroids may also be beneficial.

Refractory cases may require a surgical capsular release. This can be performed reliably and satisfactorily with arthroscopic techniques.

Adhesive capsulitis is a chronic fibrosing condition characterized by insidious and progressive severe restriction of both active and passive shoulder range of motion, in the absence of a known intrinsic disorder of the shoulder. It is generally regarded as a self-limited condition that usually resolves within 18 to 24 months. However, some reports have indicated that many patients can have residual pain and limited range of motion lasting several years.[1]Griggs SM, Ahn A, Green A. Idiopathic adhesive capsulitis: a prospective functional outcome study of nonoperative treatment. J Bone Joint Surg Am. 2000 Oct;82(10):1398-407. http://www.ncbi.nlm.nih.gov/pubmed/11057467?tool=bestpractice.com [2]Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder: a long-term follow-up. J Bone Joint Surg Am. 1992 Jun;74(5):738-46. http://www.ncbi.nlm.nih.gov/pubmed/1624489?tool=bestpractice.com [3]Wong CK, Levine WN, Deo K, et al. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. 2017 Mar;103(1):40-7. http://www.ncbi.nlm.nih.gov/pubmed/27641499?tool=bestpractice.com

A poor understanding of the pathogenesis of adhesive capsulitis underpins the continued debate regarding the best treatment strategies.[3]Wong CK, Levine WN, Deo K, et al. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy. 2017 Mar;103(1):40-7. http://www.ncbi.nlm.nih.gov/pubmed/27641499?tool=bestpractice.com There is a paucity of good-quality randomized controlled trials that help guide clinicians by providing a stepwise and systematic treatment algorithm.[4]Lowe CM, Barrett E, McCreesh K, et al. Clinical effectiveness of non-surgical interventions for primary frozen shoulder: a systematic review. J Rehabil Med. 2019 Sep 3;51(8):539-56. https://www.medicaljournals.se/jrm/content/html/10.2340/16501977-2578 http://www.ncbi.nlm.nih.gov/pubmed/31233183?tool=bestpractice.com However, one critical review of available evidence found that most interventions, including nonoperative treatments, are designed to mitigate or alleviate symptoms, speed up recovery, and reduce the duration of painful symptoms and limited range of motion.[5]Rookmoneea M, Dennis L, Brealey S, et al. The effectiveness of interventions in the management of patients with primary frozen shoulder. J Bone Joint Surg Br. 2010 Sep;92(9):1267-72. http://www.ncbi.nlm.nih.gov/pubmed/20798446?tool=bestpractice.com