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      Diagnosis and management of adhesive capsulitis

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          Abstract

          Adhesive capsulitis is a musculoskeletal condition that has a disabling capability. This review discusses the diagnosis and both operative and nonoperative management of this shoulder condition that causes significant morbidity. Issues related to medications, rehabilitation, and post surgical considerations are discussed.

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          The pathology of frozen shoulder. A Dupuytren-like disease.

          T D Bunker, P P Anthony (1995)
          Of 935 consecutive patients referred with shoulder pain, 50 fitted the criteria for primary frozen shoulder. Twelve patients who failed to improve after conservative treatment and manipulation had excision of the coracohumeral ligament and the rotator interval of the capsule. The specimens were examined histologically, using special stains for collagen. Immunocytochemistry was performed with monoclonal antibodies against leucocyte common antigen (LCA, CD45) and a macrophage/synovial antigen (PGMI, CD68) to assess the inflammatory component, and vimentin and smooth-muscle actin to evaluate fibroblasts and myofibroblasts. Our histological and immunocytochemical findings show that the pathological process is active fibroblastic proliferation, accompanied by some transformation to a smooth muscle phenotype (myofibroblasts). The fibroblasts lay down collagen which appears as a thick nodular band or fleshy mass. These appearances are very similar to those in Dupuytren's disease of the hand, with no inflammation and no synovial involvement. The contracture acts as a check-rein against external rotation, causing loss of both active and passive movement.
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            Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial.

            Vivian Bykerk, Hélène Moffet, J Tardif … (2003)
            To compare the efficacy of a single intraarticular corticosteroid injection, a supervised physiotherapy program, a combination of the two, and placebo in the treatment of adhesive capsulitis of the shoulder. Ninety-three subjects with adhesive capsulitis of <1 year's duration were randomized to 1 of 4 treatment groups: group 1, corticosteroid injection (triamcinolone hexacetonide 40 mg) performed under fluoroscopic guidance followed by 12 sessions of supervised physiotherapy; group 2, corticosteroid injection alone; group 3, saline injection followed by supervised physiotherapy; or group 4, saline injection alone (placebo group). All subjects were taught a simple home exercise program. Subjects were reassessed after 6 weeks, 3 months, 6 months, and 1 year. The primary outcome measure was improvement in the Shoulder Pain and Disability Index (SPADI) score. At 6 weeks, the total SPADI scores had improved significantly more in groups 1 and 2 compared with groups 3 and 4 (P = 0.0004). The total range of active and passive motion increased in all groups, with group 1 having significantly greater improvement than the other 3 groups. At 3 months, groups 1 and 2 still showed significantly greater improvement in SPADI scores than group 4. There was no difference between groups 3 and 4 at any of the followup assessments except for greater improvement in the range of shoulder flexion in group 3 at 3 months. At 12 months, all groups had improved to a similar degree with respect to all outcome measures. A single intraarticular injection of corticosteroid administered under fluoroscopy combined with a simple home exercise program is effective in improving shoulder pain and disability in patients with adhesive capsulitis. Adding supervised physiotherapy provides faster improvement in shoulder range of motion. When used alone, supervised physiotherapy is of limited efficacy in the management of adhesive capsulitis.
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              Frozen shoulder. A long-term follow-up.

              R Kerlan, Joseph Shaffer, J Tibone (1992)
              Sixty-two patients (sixty-eight shoulders) who had been treated non-operatively for idiopathic frozen shoulder were evaluated subjectively and objectively at two years and two months to eleven years and nine months of follow-up (average, seven years). Thirty-one (50 per cent) of these patients still had either mild pain or stiffness of the shoulder, or both. The range of motion averaged 161 degrees of forward flexion, 157 degrees of forward elevation, 149 degrees of abduction, 65 degrees of external rotation, and internal rotation to the level of the fifth thoracic spinous process. Thirty-seven (60 per cent) of the sixty-two patients still demonstrated some restriction of motion as compared with study-generated control values (calculated as the average motion, in each plane, for the thirty-seven unaffected shoulders of the patients who had unilateral disease). Ten patients had restriction of forward flexion; eight, of forward elevation; seventeen, of abduction; twenty-nine, of external rotation; and ten, of internal rotation. However, when the motion of each affected shoulder of thirty-seven patients who had unilateral involvement was compared with that of the unaffected contralateral shoulder, eleven (30 per cent) demonstrated some restriction. None of these patients had restriction of forward flexion; two had restriction of forward elevation; two, of abduction; seven, of external rotation; and seven, of internal rotation. The patients who had substantial restriction in three planes or more were thirteen times more likely to be men (p greater than 0.05). Marked restriction, when it was present, was most commonly in external rotation. Only seven patients (11 per cent) reported mild functional limitation.(ABSTRACT TRUNCATED AT 250 WORDS)
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                Author and article information

                Contributors
                : +316-978-3702 , +316-978-3025 , Robert.manske@wichita.edu
                : dprohaska@kumc.edu
                Journal
                Journal ID (nlm-ta): Curr Rev Musculoskelet Med
                Title: Current Reviews in Musculoskeletal Medicine
                Publisher: Humana Press Inc (New York )
                ISSN (Print): 1935-973X
                ISSN (Electronic): 1935-9748
                Publication date (Electronic): 23 May 2008
                Publication date PMC-release: 23 May 2008
                Publication date Collection: December 2008
                Volume: 1
                Issue: 3-4
                Pages: 180-189
                Affiliations
                [1 ]Department of Physical Therapy, Wichita State University, 1845 North Fairmount, Wichita, KS 67260-0043 USA
                [2 ]Department of Family Medicine, Sports Medicine Fellowship Program, University of Kansas School of Medicine, Wichita, KS USA
                [3 ]Department of Orthopaedics, Advanced Orthopaedic Associates, University of Kansas School of Medicine-Wichita, 2778 N. Webb Rd., Wichita, KS 67226 USA
                Article
                Publisher ID: 9031
                DOI: 10.1007/s12178-008-9031-6
                PMC ID: 2682415
                PubMed ID: 19468904
                SO-VID: eda93519-d386-4677-9add-42dffecccba1
                Copyright © © The Author(s) 2008
                History
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                Subject: Article
                Custom metadata
                issue-copyright-statement © Humana Press 2008

                ScienceOpen disciplines: Orthopedics
                Keywords: surgery,adhesive capsulitis,shoulder pain
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: surgery, adhesive capsulitis, shoulder pain

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