Concept: Adhesive capsulitis of shoulder
Frozen shoulder is a poorly understood condition that typically involves substantial pain, movement restriction, and considerable morbidity. Although function improves overtime, full and pain free range, may not be restored in everyone. Frozen shoulder is also known as adhesive capsulitis, however the evidence for capsular adhesions is refuted and arguably, this term should be abandoned. The aim of this Masterclass is to synthesise evidence to provide a framework for assessment and management for Frozen Shoulder. Although used in the treatment of this condition, manipulation under anaesthetic has been associated with joint damage and may be no more effective than physiotherapy. Capsular release is another surgical procedure that is supported by expert opinion and published case series, but currently high quality research is not available. Recommendations that supervised neglect is preferable to physiotherapy have been based on a quasi-experimental study associated with a high risk of bias. Physiotherapists in the United Kingdom have developed dedicated care pathways that provide; assessment, referral for imaging, education, health screening, ultrasound guided corticosteroid and hydro-distension injections, embedded within physiotherapy rehabilitation. The entire pathway is provided by physiotherapists and evidence exists to support each stage of the pathway. Substantial on-going research is required to better understand; epidemiology, patho-aetiology, assessment, best management, health economics, patient satisfaction and if possible prevention.
To compare 2 different treatment approaches, physical therapy modalities, and joint mobilization versus whole-body cryotherapy (WBC) combined with physical therapy modalities and joint mobilization, for symptoms of adhesive capsulitis (AC) of the shoulder.
To describe and evaluate ultrasound-guided hydrodilatation via the rotator interval for the treatment of adhesive capsulitis.
The treatment and evaluation of a stiff and painful shoulder, characteristic of adhesive capsulitis and “frozen” shoulders, is a dilemma for orthopedic rehabilitation specialists. A stiff and painful shoulder is all-inclusive of Adhesive capsulitis and Frozen Shoulder diagnoses. Adhesive capsulitis and frozen shoulder will be referred to as a stiff and painful shoulder, throughout this paper. Shoulder motion occurs in multiple planes of movement. Loss of shoulder mobility can result in significant functional impairment. The traditional treatment approach to restore shoulder mobility emphasizes mobilization of the shoulder overhead. Forced elevation in a stiff and painful shoulder can be painful and potentially destructive to the glenohumeral joint. This manuscript will introduce a new biomechanical approach to evaluate and treat patients with stiff and painful shoulders.
This study determined in a prospective manner if arthroscopic shoulder capsular release can decrease the duration of adhesive capsulitis symptoms when compared with a nonoperative home therapy program. Patients randomized to the operative group underwent arthroscopic capsular release and manipulation of the shoulder. Immediately after surgery they began the same stretching program as the nonoperative group, which consisted of terminal range of motion low-grade stretches twice daily for at least 15 minutes per session for 3 months. Twenty-six patients granted consent for the study (final analyses included 10 operative and 7 nonoperative). There were no statistical differences between the groups regarding gender, age (operative mean age, 51.5 ± 11.1 years; nonoperative mean age, 52.0 ± 6.8 years) or treatment outcome. This prospective, randomized study, which compared arthroscopic capsular release to a gentle home stretching program, demonstrated both treatment options to be effective treatment modalities.
Adhesive capsulitis (frozen shoulder) is a common cause of shoulder pain and disability. Previous studies have reported that intra-articular corticosteroid injections are of benefit compared with placebo up to six weeks. It has been suggested that the structures primarily involved in adhesive capsulitis are the capsule and the rotator interval. Systematic reviews have concluded that there is limited evidence of the treatment effectiveness of intra-articular corticosteroid injections and that high quality primary research is required. The aim of this study was to compare ultrasound guided intra-articular corticosteroid injection and combined intra-articular and rotator interval injection in a double blind, sham controlled randomized clinical trial. The main outcome measure was the group difference in change in shoulder pain (0-10) at six weeks. One hundred and twenty-two patients were randomized (42 to intra-articular injection, 40 to combined intra-articular/interval injection, 40 to sham injection). For both corticosteroid injection groups there was a significant difference compared to sham injection at week 6. The mean group difference (adjusted for gender, age, dominant arm and duration) in change in shoulder pain for intra-articular versus sham injection was -1.7 (95% confidence interval -2.7 to -0.6, p=0.002) and -2.1 (95% CI -3.2 to -1.1, p=0.0001) for the combined injection versus sham injection. The significant group differences were maintained at week 12 but not at week 26. Similar results were found for the secondary outcome measures (night pain, shoulder pain and disability index). Differences between the corticosteroid groups were not significant at any time.
- PM & R : the journal of injury, function, and rehabilitation
- Published over 3 years ago
Maintaining the integrity of the capsule along with infusing a sufficient amount of fluid is one of the therapeutic concept in intra-articular hydraulic distension (IHD) for adhesive capsulitis. It has been known that hypertonic saline decreases tissue edema and increases the fluid volume within the epidural space, causing microdissection, in epidural adhesiolysis.
Axillary Ultrasound and Laser Combined with Postisometric Facilitation in Treatment of Shoulder Adhesive Capsulitis: A Randomized Clinical Trial
- Journal of manipulative and physiological therapeutics
- Published over 2 years ago
The purpose of this study was to compare axillary ultrasound, laser, and postisometric facilitation technique with standard care in the management of shoulder adhesive capsulitis.
Primary adhesive capsulitis is mainly characterized by spontaneous chronic shoulder pain and the gradual loss of shoulder motion. The main treatment for adhesive capsulitis is a trial of conservative therapies, including analgesia, exercise, physiotherapy, oral nonsteroidal anti-inflammation drugs, and intra-articular corticosteroid injections. Previously, it was reported that intra-articular corticosteroid lead to fast pain relief and improvement of range of motion (ROM). The objective of this study was to determine whether corticosteroid injections would lead to better pain relief and greater improvement in ROM.
United Kingdom Frozen Shoulder Trial (UK FROST), multi-centre, randomised, 12 month, parallel group, superiority study to compare the clinical and cost-effectiveness of Early Structured Physiotherapy versus manipulation under anaesthesia versus arthroscopic capsular release for patients referred to secondary care with a primary frozen shoulder: study protocol for a randomised controlled trial
Frozen shoulder (also known as adhesive capsulitis) occurs when the capsule, or the soft tissue envelope around the ball and socket shoulder joint, becomes scarred and contracted, making the shoulder tight, painful and stiff. It affects around 1 in 12 men and 1 in 10 women of working age. Although this condition can settle with time (typically taking 1 to 3 years), for some people it causes severe symptoms and needs referral to hospital. Our aim is to evaluate the clinical and cost-effectiveness of two invasive and costly surgical interventions that are commonly used in secondary care in the National Health Service (NHS) compared with a non-surgical comparator of Early Structured Physiotherapy.