A PROSPECTIVE COMPARATIVE

STUDY OF THREE TREATMENT

MODALITIES FOR IDIOPATHIC

ADHESIVE

CAPSULITIS OF SHOULDER

Dr. Hemant Kumar Pippal

Dr. Manoj Kumar

Department of Orthopaedic Surgery

MAULANA AZAD MEDICAL COLLEGE

In this study no funding from any pharmaceutical

company nor any conflicts of interests were involved.

INTRODUCTION

DEFINITION

“A condition of uncertain etiology characterized by

significant restriction of both active and passive shoulder

motion that occurs in the absence of a known intrinsic

shoulder disorder”1.

IDIOPATHIC ADHESIVE

CAPSULITIS

TREATMENT OPTIONS

Treatment options:

1. supervised physical rehabilitation3

2. nonsteroidal anti-inflammatory medications4

3. oral corticosteroid3

4. intra-articular corticosteroid injection3

5. Intra- articular hydrodistension therapy3

6. closed manipulation5

7. open surgical release6

8. arthroscopic capsular release7

BEST TREATMENT MODALITY?

Ogilvie-Harris DJ et al7(1997)

• arthroscopic capsular release shortens the natural history of this condition.

Neviaser15 (1987) did not found similar effectiveness of surgical treatments.

Callinan et al41 (2003)

• Support hydrodilatation and nerve blockade.

Farrell CM et al45 (2005)

• Excellent results from manipulation

Maund et al8 in Health Technology Assessment (March 2012),

• concluded that there was limited clinical evidence on the effectiveness of treatments for

primary frozen shoulder.

NO

CONSENSUS

AIMS AND OBJECTIVES

Study the relative efficacy of Arthroscopic capsular release and

Intra-articular steroid injection matched to a control group of

patients receiving standard conservative treatment for Idiopathic

Adhesive Capsulitis of shoulder.

MATERIALS AND METHODS

STUDY DESIGN

• Prospective comparative study.

• Conducted from September 2012 to April 2014.

SAMPLE SIZE

• 30 consecutive patients of both sexes, 40 to 75 years of age.

1. Control/Conservative group of patients receiving Standard treatment i.e. Analgesics +

hot water fomentation + shortwave diathermy + supervised physiotherapy followed by

home exercises program.

2. Intra-articular steroids injections plus distension + supervised physiotherapy followed by

home exercises program.

3. Arthroscopic Capsular Release + supervised physiotherapy followed by home exercises program.

MATERIALS AND METHODS CONTD.

INCLUSION CRITERIA:

Binder & Bulgen3, Lundberg B.J5 and Codman9.

1. Shoulder Pain around Deltoid insertion for at least one month.

2. Restriction of movements, both active and passive.

3. normal radiographs of the shoulder.

EXCLUSION CRITERIA:

1. Injury to ipsilateral shoulder or arm.

2. Surgical procedure on ipsilateral shoulder, cervical spine, thorax and breast

within past 2 yrs.

3. uncontrolled diabetes10.

PARAMETERS ASSESED

ROM Measurements

1. Passive glenohumeral abduction

2. Passive external rotation

3. Passive internal rotation

4. Active overhead elevation

Shoulder Rating Questionnaire11

• no significant difference in the

pretreatment SRQ scores

OBSERVATIONS AND RESULTS

56.6% patients belonged to 40-50 years of age

Demographics

12 males and 18 females

DIABETES

• Diabetes was found to be

associated with adhesive capsulitis in

a very high percentage of patients

(66%) in the present study.

• 8 out of 30 patients were already on

treatment.

• 12 patients however, were

diagnosed to have impaired glucose

tolerance .

OBSERVATIONS AND RESULTS

The improvement gained in external rotation ROM was

statistically significant in Arthroscopic capsular release group as

compared to Conservative group at 6 months of follow-up

(p value 0.044; 95% C.I.)

DISCUSSION

Patients in the ACR groups achieved maximum gain in ROM in absolute values in all

the four movements. (p value >0.05)

The gain in external rotation, in ACR group was significantly better (p value <0.44)

However, in actual terms it did not translate into the SRQ scores.

This can be attributed to the fact that in the vast majority of patients it is the end

range of motion which is affected and it might not be necessarily needed for

patients in 50+ age groups and so overall functional outcome might still be sufficient

despite the fact there is still residual stiffness and pain.

CONCLUSION

Conservative management is usually the first line of management offered

for adhesive capsulitis.

Observations of our study make us believe that it is still an effective

treatment modality with consistent results and devoid of any iatrogenic

complications.

We were not able to draw any superiority of ACR and

steroid injection over conservative treatment except for

a finding of significantly improved external rotation in

ACR at six months of follow-up.

REFERENCES

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regimens. Ann Rheum Dis. 1984 Jun 43(3):353–360.

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