Introduction
Incidence
Adhesive capsulitis classification
Clinical phases
Pathology
Evaluation
Non-operative treatment
Anti-inflammatories
Study and date published | Number of shoulders | Active intervention | Control intervention | Results |
---|---|---|---|---|
Blockey and Wright [62], 1954 | 32 | Cortisone acetate (200 mg daily for 3 days, then 100 mg daily for 11 days, then dose tapered off in decrements of 12.5 mg every 2 days, total dose = 2.5 g over 4 weeks. If unsatisfactory progress after 4 weeks, manipulation under general anaesthesia; followed by a second 4 week course of cortisone acetate | Placebo | No statistical analysis of between-group differences reported, although an earlier clinically important improvement in both pain and range of motion was noted in the oral steroid group: mean pain scores (measured on a 4-point categorical scale converted into an interval scale, where none = 0, slight = 1, moderated = 2, severe = 3) at baseline, 1, 4, and 18 weeks were 1.4, 0.9, 0.5, 0.6 in the steroid group, and 1.4, 1.3, 0.8, 0.5 in the control group; total shoulder abduction was 82, 103, 125, 153° in the steroid groups and 75, 89, 106, 154° in the control group. The number of participants requiring manipulation after 4 weeks was 6/15 (40%) and 11/16(68.8%) in the steroid and placebo groups, respectively (RR = 0.58 (0.29–1.17)) |
Kessel et al. [63], 1981 | 32 | Prednisolone (15 mg daily for 4 weeks) and manipulation (after 2 weeks of oral steroids) | Manipulation | No statistical analysis was done but “dramatic response” to manipulation in 7/12 (58.3%) participants taking oral steroids compared with 5/16 (31.25%) taking placebo. Effect of manipulation on final range of motion at 6, 12, and 18 weeks following the procedure also favored the steroid group but again the differences between groups were normally not formally analyzed |
Binder et al. [23], 1986 | 40 | Prednisolone (10 mg daily for 4 weeks, then 5 mg daily for 2 weeks | No treatment | The pattern of improvement in pain at night over 8 weeks showed a significant difference in favor of oral prednisolone with a more rapid initial recovery, although by 5 months the difference between the groups was negligible. Improvement in pain at rest and with movement, range of motion, and a cumulative recovery curve were not significantly different between groups over 8 months |
Buchbinder et al. [64], 2004 | 50 | Prednisolone (30 mg daily for 3 weeks) | Placebo | Greater improvement in overall pain in oral steroid group than in placebo group at 3 weeks. There was also greater improvement in disability, range of motion and participant rated improvement in 22/23 (96%) oral steroid, vs. 11/23 (48%) in placebo group. At 6 weeks, analysis favored the oral steroid group for most outcomes but none of the differences was significant. At 12 weeks, the analysis tended to favor the placebo group. A 3 week course of 30 mg prednisolone daily is of significant short-term benefit in adhesive capsulitis but benefits are not maintained beyond 6 weeks |
Intra-articular corticosteroid injections
Study and date | Number of shoulders | Duration of symptoms | Interventions and number of treatments | Outcomes measured | Follow-up | Findings |
---|---|---|---|---|---|---|
Randomized clinical trials
| ||||||
Bulgen et al. [21], 1984 | 42 | ∼5 months | Sub acromial corticosteroid injections—11; mobilization—11; ice therapy—12; and control—8 | Pain ROM | 8 months | At 4 weeks improvements in ROM occurred in the group treated with steroids. At 6 months no significant differences were seen between groups |
Carette et al. [65], 2003 | 93 | <12 months | SA Injection + 12 PT—21 | Function | 6 weeks | At 6 weeks score improved more in groups receiving steroid. Range of motion improved in all groups but with steroid and PT. No difference in saline groups at follow-up sessions. At 12 months all groups improved |
SA injection alone—23 | 3 months | |||||
Saline injection + 12 PT—26 | 6 months | |||||
Saline injection alone—23 | 1 year | |||||
Ryans et al. [66], 2005 | 80 | <6 months | Injection + 8 PT—20 | Pain Function | 6 weeks | Function improved more in group with injection at 6 weeks. PT improved ER range of motion at 6 weeks. Injection improved function (global) at 6 weeks. At 16 weeks all groups had improved to similar degree with respect to outcomes |
Injection alone—20 | 16 weeks | |||||
Placebo injection + 8 PT—20 | ||||||
Placebo injection alone—20 | ||||||
van der Windt et al. [60], 1998 | 108 | 5 months | Physical therapy—12 treatments vs. 3 corticosteroid intra- articular injections | Pain ROM Function | 52 weeks | At 7 weeks 77% treated with injections were considered successes compared with 46% treated with physical therapy. At 26 and 52 weeks these differences in outcome measures were small |
Winters et al. [59], 1997 | 114 | 18 months | Physical therapy 20 treatments vs. manipulation vs. corticosteroid injections. Injections in either joint capsule, sub acromial space, or AC joint | Pain | 11 weeks | Patients placed into one of two groups—shoulder group and synovial group. Shoulder girdle group divided into manipulation or physiotherapy, patients in the synovial group divided into corticosteroid injection, manipulation physiotherapy. In shoulder girdle group—manipulation less duration of pain than physiotherapy. In synovial group duration of complaints shortest after corticosteroid injection, followed by manipulation and physiotherapy |
Rizk et al. [74], 1991 | 48 | 13 weeks | Intra-articular steroid and lidocaine; intrabursal steroid and lidocaine; intra-articular lidocaine; and intra-busal lidocaine | Pain ROM | 15 weeks | No difference noted in outcome between intrabursal and intra-articular injections. Injection of steroid lidocaine had no advantage over lidocaine alone in restoring motion, but partial, transient pain relief occurred in two-thirds of the steroid- treated patients |
6 months | ||||||
Jacobs et al. [75], 1991 | 47 | Not reported | Three intra-articular injections given over 6 week intervals. Distension vs. distension with steroid | ROM Strength | 1st visit | All reported improvement. ROM greater in steroid with distension group. Strength did not differ between groups |
6 weeks | ||||||
12 weeks | ||||||
Dacre et al. [76], 1989 | 66 | 4 weeks | Steroid injection (22) Physiotherapy (20) Both (20) | Pain ROM | 6 weeks | All groups showed significant improvements by 6 weeks with ER. No further improvement at 6 months. The seen improvements were identical in all groups. Local steroid injections may be as effective as physical therapy alone or a combination of both |
6 months |
Capsular distension injections
Surgical treatment
Manipulation under anesthesia
Arthroscopic release and repair
Rehabilitation
Study and date | Number of shoulders | Duration of symptoms | Interventions and number of treatments | Outcomes measured | Follow-up | Findings |
---|---|---|---|---|---|---|
Shaffer et al. [24], 1992 | 62 | 2 weeks to 48 months | Physical therapy Treatment number not reported | ROM Function | Ave. 7 years | 50% of patients still had mild pain, stiffness, or both. 60% demonstrated restricted motion in elevation. Marked restriction only occurred in external rotation. Neither subjective nor objective outcomes were related to age, whether dominant or non-dominant extremity was affected, left vs. right, nature of onset, etiology, method of treatment, bilateral involvement or associated medical conditions |
Diercks et al. [67], 2004 | 77 | 5 months | Intensive physical therapy vs. super vised neglect | ROM Function | 24 months | Patients treated with supervised neglect, 89% had normal or near normal painless shoulder function as rated by Constant Score >80. Intensive physical therapy group 63% reached Constant Score >80. Constant Score at end of study and moment Constant Score reached >80 seem to indicate supervised neglect yields better outcomes than intensive physical therapy |
Ekelund and Rydell [68], 1992 | 23 | 15 months | Distension arthrography and manipulation with physical therapy. Treatment number not reported | ROM Pain | 48 months | Following treatment rapid improvement seen at 4–6 weeks. 91% of patients had no or slight pain while 83% had normal or near normal range of motion |
Griggs et al. [69], 2000 | 77 | 9 months | Physical therapy passive stretching Treatment number not reported | Pain ROM Function | 22 months | 90% of patients reported successful outcomes. 10% were not satisfied. Active forward elevation increased 43°, external rotation increased 25°, internal rotation increased 8 vertebral levels, abduction increased 72°. Prior treatment with physical therapy and Workers Compensation claim or pending litigation were associated with need for manipulation or capsular release |
Mao et al. [70], 1997 | 12 | 2–12 months | Physical therapy 12–18 treatments | ROM | 2 weeks following arthrogram | In acute patients joint space assessed via arthrography increased significantly after treatment of exercise intervention physical modalities. Joint space most correlated with external rotation and abduction, with less correlation in flexion. In patients no obvious increase in joint space despite increase in shoulder motion |
Melzer et al. [10], 1995 | 110 | 18 months | Physical therapy (89) vs. manipulation (21) | Pain ROM Function | 3.8 years | In those treated with physical therapy abduction increased 78% and anteversion 81%. Least improvement seen in adduction. Subjective personal rating increased 78 points. In the manipulation under anesthesia group range improved greatest in anteversion 73% followed by adduction 62%. Subjective scores only 40 points |
Placzak et al. [71], 1998 | 31 | 7 months | Manipulation and 14 physical therapy treatments | Pain ROM Function | 14 months | Passive range of motion increased significantly for flexion, abduction, external rotation and internal rotation. Translational manipulation provides a safe, effective treatment option for adhesive capsulitis |
Roubal et al. [72], 1996 | 8 | 7 months | Manipulation and physical therapy 16 treatments | ROM | 4 weeks | Following manipulation and physical therapy all active and passive motions increased. Additionally all patients increased in function such as overhead activities, hair care and dressing |
Sharma et al. [25], 1993 | 32 | 9 months | Hydraulic distension and manipulation with 8 weeks of physical therapy | ROM | 44 months | Abduction ROM improved by 46.6° on average, but in 4 patients there was no improvement. Most patients lost some ROM between the 3rd and 5th week |
Vermeulen et al. [73], 2000 | 7 | 8 months | Physical therapy with end-range mobilization Techniques 2×/week × 3 months | Pain ROM | 9 months | After 3 months there were increases in active range of motion. Mean abduction increased from 96 to 159. Mean flexion increased from 113 to 147. Lateral rotation increased from 13 to 31. Passive range of motion increases included mean abduction from 96 to 159. Mean flexion from 120 to 154. Mean lateral rotation from 21 to 41. Mean capsule capacity increased from 10 cc to 15 cc. Four patients rated shoulder as excellent, two as good and one moderate. All patients maintained joint mobility at the 9 month follow-up |