Abstract
BackgroundNo consensus exists among orthopedic surgeons regarding the optimal intervention for adhesive capsulitis. The purpose of this study was to determine which treatment provides the best objective outcome following manipulation under anesthesia (MUA), MUA + arthroscopic capsular release (CR), or CR alone.MethodsBetween 2011 and 2015, 97 shoulders were treated for adhesive capsulitis (MUA, MUA+CR, CR) and followed for three months or until achieving full range of motion (ROM). Patients' charts were reviewed for demographic information, diabetes, pre/post-operative ROM, and complications.ResultsThe average age at surgery was 57 years (range: 31-80 years) with a mean follow-up of 6.2 months (range: 2-43 months). ROM improved significantly regardless of treatment modality (p < 0.001). MUA had significantly more external rotation at follow-up than MUA+CR and CR alone (62 vs 49 vs 48, p = 0.02). Groups were similar in regards to post-operative elevation and internal rotation. Loss of external rotation following surgery was significantly more common in the MUA+CR group (p = 0.03). In diabetics, no treatment option was superior to another in regards to final ROM.ConclusionOperative treatment of idiopathic adhesive capsulitis is efficacious and safe for improving shoulder ROM across treatment modalities. Surgeon preference may effectively guide treatment independent of diabetic status.
Highlights
Adhesive capsulitis, known as frozen shoulder, is stiffening of the shoulder due to scar tissue and is a common cause of shoulder pain affecting 2-5% of the population [1, 2]
Between 2011 and 2015, 97 shoulders were treated for adhesive capsulitis (MUA, manipulation under anesthesia (MUA)+capsular release (CR), CR) and followed for three months or until achieving full range of motion (ROM)
The pathologic process of adhesive capsulitis goes through a three-stage progression from initial inflammation and synovitis to fibrosis of the capsule and synovium, leaving patients with restricted active and passive shoulder range of motion without a clear underlying cause, to resolution in upwards of 24 months [3, 4]
Summary
Known as frozen shoulder, is stiffening of the shoulder due to scar tissue and is a common cause of shoulder pain affecting 2-5% of the population [1, 2]. This can be managed with over the counter analgesics, intraarticular cortisone injections, and rarely narcotics. Stiffness is managed with a four-quadrant gentle stretching program that can be performed at home or under the supervision of a physical therapist depending on the patient/surgeon preference. This combination has been shown to be effective in 60-95% of patients [5,6,7,8]. The purpose of this study was to determine which treatment provides the best objective outcome following manipulation under anesthesia (MUA), MUA + arthroscopic capsular release (CR), or CR alone
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