para>Indications for more invasive options remain highly subjective and need to be individualized to each patient.
SURGERY/OTHER PROCEDURES
- Arthroscopic capsular release: most common surgical method for treating recalcitrant AC
- Short-term benefits: improved pain and function
- Long-term benefits: superior to conservative therapies in recalcitrant cases (5)[A]
- MUA: Outcomes are similar to those with conservative, noninvasive therapies; contraindicated in posttraumatic/postsurgical AC (5)[A]
- Transcatheter arterial embolization: Early evidence suggests benefit (7)[B].
COMPLEMENTARY & ALTERNATIVE MEDICINE
- Acupuncture: Insufficient evidence exists regarding the effectiveness of acupuncture for AC.
- Osteopathic manipulative technique: Evidence is equivocal.
INPATIENT CONSIDERATIONS
Admission Criteria/Initial Stabilization
Outpatient care
ONGOING CARE
FOLLOW-UP RECOMMENDATIONS
Reinforce the natural course of the disease. Many patients are more likely to request invasive procedures (injections, capsular distension, MUA, surgery) when stiffness starts to affect ADLs.
Patient Monitoring
A multidisciplinary team approach helps reinforce the natural history of AC and provides patient encouragement.
DIET
No restrictions
PATIENT EDUCATION
Long-term course of treatment until resolution of symptoms; stretching and ROM exercises daily during and after improvement
PROGNOSIS
- Although AC is considered self-limiting, up to 50% of patients will have permanent restrictions of ROM (usually external rotation).
- Rare functional disability results
COMPLICATIONS
Surgical complications and complications due to MUA can be disabling but are uncommon.
REFERENCES
11 Jain TK, Sharma NK. The effectiveness of physiotherapeutic interventions in treatment of frozen shoulder/adhesive capsulitis: a systematic review. J Back Musculoskelet Rehabil. 2014;27(3):247-273.22 Russel S, Jariwala A, Conlon R, et al. A blinded, randomized, controlled trial assessing conservative management strategies for frozen shoulder. J Shoulder Elbow Surg. 2014;23(4):500-507.33 Prestgaard T, Wormgoor ME, Haugen S, et al. Ultrasound-guided intra-articular and rotator interval corticosteroid injections in adhesive capsulitis of the shoulder: a double-blind, sham-controlled randomized study. Pain. 2015;156(9):1683-1691.44 Dehghan A, Pishgooei N, Salami MA, et al. Comparison between NSAID and intra-articular corticosteroid injection in frozen shoulder of diabetic patients; a randomized clinical trial. Exp Clin Endocrinol Diabetes. 2013;121(2):75-79.55 Uppal HS, Evans JP, Smith C. Frozen shoulder: a systematic review of therapeutic options. World J Orthop. 2015;6(2):263-268.66 Lee LC, Lieu FK, Lee HL, et al. Effectiveness of hyaluronic acid administration in treating adhesive capsulitis of the shoulder: a systematic review of randomized controlled trials. Biomed Res Int. 2015;2015:314120.77 Okuno Y, Oguro S, Iwamoto W, et al. Short-term results of transcatheter arterial embolization of abnormal neovessels in patients with adhesive capsulitis: a pilot study. J Shoulder Elbow Surg. 2014;23(9):e199-e206.
ADDITIONAL READING
- Ewald A. Adhesive capsulitis: a review. Am Fam Physician. 2011;83(4):417-422.
- Maund E, Craig D, Suekarran S, et al. Management of frozen shoulder: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2012;16(11):1-264.
- Rill BK, Fleckenstein CM, Levy MS, et al. Predictors of outcome after nonoperative and operative treatment of adhesive capsulitis. Am J Sports Med. 2011;39(3):567-574.
- Smith CD, Hamer P, Bunker TD. Arthroscopic capsular release for idiopathic frozen shoulder with intra-articular injection and a controlled manipulation. Ann R Coll Surg Engl. 2014;96(1):55-60.
CODES
ICD10
- M75.00 Adhesive capsulitis of unspecified shoulder
- M75.01 Adhesive capsulitis of right shoulder
- M75.02 Adhesive capsulitis of left shoulder
ICD9
- 726.0 Adhesive capsulitis of shoulder
SNOMED
- 399114005 adhesive capsulitis of shoulder (disorder)
- 301971000119109 Adhesive capsulitis of right shoulder (disorder)
- 301981000119107 Adhesive capsulitis of left shoulder (disorder)
- 15635961000119100 Bilateral adhesive capsulitis of shoulders (disorder)
- 430474001 Secondary adhesive capsulitis (disorder)
CLINICAL PEARLS
- Early-stage AC is difficult to distinguish from rotator cuff pathology. Restriction of external ROM suggests AC.
- Diagnostic subacromial bursa injection may help differentiate early AC from impingement syndrome. In AC, ROM deficits persist and strength is intact after injection.
- Normal radiographs in the setting of progressive restriction of motion in >1 plane confirms AC.
- Initial AC treatment is conservative.
- Invasive treatment options (capsular distention, MUA, and arthroscopy) can be considered after 4 to 6 months of conservative therapy. This is necessary in only about 10% of cases.