A comparative study on the association of hypothyroidism with adhesive capsulitis of shoulder

Abstract

Objective: Adhesive capsulitis (AC) is a pathologic condition characterized by pain and limitation of shoulder movements. Thyroid dysfunction often accompanies musculoskeletal disorders, and undiagnosed hypothyroidism can delay response to treatment outcomes. Early diagnosis and treatment of hypothyroidism in patients with AC of shoulder could help to improve pain and disability. This study was done to assess the association of hypothyroidism with AC of shoulder and to find the correlation of severity of pain and disability in AC with hypothyroidism. Materials and Methods: In this case–control study, patients who attended PMR OPD during a period of 2 years with pain and limitation of shoulder movements satisfying the inclusion and exclusion criteria were included as cases and patients without AC as controls. Fifty-seven patients were selected as cases and 114 patients as controls. Serum thyroid-stimulating hormone (TSH) level and free tetraiodothyronine level were estimated. Shoulder range of motion (ROM) measurement and radiographs were performed in cases, and the TSH values obtained were compared with the severity of ROM restriction, Visual Analog Scale score, and Shoulder Pain and Disability Index Scale (SPADI) score. Statistical analysis was done using IBM SPSS 20 (SPSS Inc., Chicago, IL, USA). Results: Among cases, 8 (14%) patients had hypothyroidism and 16 (28.1%) had subclinical hypothyroidism, and among controls, 4 (3.5%) had hypothyroidism and 9 (7.9%) had subclinical hypothyroidism. Among the 24 patients with elevated TSH, 16 (66.6%) had mild-to-moderate pain and 8 (33.3%) had severe pain. Mean TSH was elevated in patients with severe pain compared with those with mild-to-moderate pain (5.43 ± 2.31 vs. 3.35 ± 2.48 µIU/mL, P = 0.031). TSH levels showed a positive correlation with SPADI pain score (r =0.335, P = 0.011) and SPADI disability score (r = 0.375, P = 0.004), respectively. There was significant restriction in ROM in patients with higher TSH levels (P < 0.001). Conclusion: Patients with AC have higher prevalence of hypothyroidism and subclinical hypothyroidism compared with those who did not. Patients with higher TSH levels had more severe pain, restriction of movement, and overall disability when compared with euthyroid patients. Proper management of hypothyroidism along with the standard measures of management may result in more speedy relief from symptoms and recovery of function in these patients.