Treatment of Adhesive Capsulitis of the Shoulder: A Critical Analysis Review.

Abstract

* Idiopathic adhesive capsulitis of the shoulder is a self-limiting condition with gradual improvement in symptoms over a variable period of time (1 to 3 years), although a small subset of patients can have permanent residual symptoms.* Nonoperative and operative treatments do not alter the long-term natural history of adhesive capsulitis, but they do provide short-term symptomatic relief of pain and improvement in shoulder range of motion.* There has been no consensus in scientific literature on a single treatment type, nonoperative, operative, or combined, which is more effective in the treatment of adhesive capsulitis.* There has been a general consensus that nonoperative management is the initial treatment of choice for adhesive capsulitis. Nonoperative treatments such as physical therapy, oral anti-inflammatory medications, corticosteroid injections, and hydrodilatation allow accelerated pain relief and/or improvement in range of motion compared with untreated controls, but these differences are short-term and there is no difference in final outcomes.* There has been insufficient evidence to support early operative treatment for adhesive capsulitis. However, there has been a general consensus that operative treatment (arthroscopic capsular release and/or manipulation under anesthesia) is an option if nonoperative treatment fails after a period of 6 months.* Arthroscopic capsular release with or without manipulation results in early relief of pain and improvement in motion compared with nonoperative treatment, but there is no difference in the final outcomes.* There has been insufficient evidence to make recommendations with regard to the indication for and timing of operative treatment or to the ideal surgical technique for arthroscopic capsular release.