From the Guidelines
Adhesive capsulitis, or frozen shoulder, should be managed with a multimodal approach including pain management, physical therapy, and potentially corticosteroid injections, to improve range of motion and reduce pain, as there is no single most recent and highest quality study available, but general consensus and guidelines support this approach. When considering the management of adhesive capsulitis, it's crucial to understand that this condition can significantly impact the quality of life, especially in patients with a history of stroke, where shoulder pain can delay rehabilitation and functional recuperation 1.
Key Considerations
- Pain management using NSAIDs like ibuprofen or naproxen for 2-4 weeks is a common initial treatment.
- Physical therapy, including gentle stretching exercises such as pendulum exercises, wall climbing with fingers, and external/internal rotation stretches, is essential for maintaining and improving range of motion.
- Corticosteroid injections into the glenohumeral joint can provide significant pain relief during the painful freezing phase.
- For severe cases, more invasive options like hydrodilatation, manipulation under anesthesia, or arthroscopic capsular release may be considered.
Risk Factors and Prevention
- Risk factors for adhesive capsulitis include diabetes, thyroid disorders, prolonged immobilization, and age between 40-60 years, with women being affected more frequently than men.
- Early recognition and intervention can help prevent the progression of the disease and improve outcomes. Given the potential for significant morbidity and impact on quality of life, a proactive and multimodal treatment approach is recommended for managing adhesive capsulitis, especially in high-risk populations or those with complicating factors like stroke, as highlighted in guidelines such as those for the management of adult stroke rehabilitation care 1.
From the Research
Definition and Diagnosis of Adhesive Capsulitis
- Adhesive capsulitis, also known as frozen shoulder, is a common shoulder condition characterized by pain and decreased range of motion, especially in external rotation 2.
- The diagnosis is usually clinical, although imaging can help rule out other conditions, such as acromioclavicular arthropathy, autoimmune disease, biceps tendinopathy, glenohumeral osteoarthritis, neoplasm, rotator cuff tendinopathy or tear, and subacromial and subdeltoid bursitis 3.
- A finding of coracohumeral ligament thickening on noncontrast magnetic resonance imaging yields high specificity for adhesive capsulitis 2.
Treatment Options for Adhesive Capsulitis
- Nonsurgical treatments include analgesics, oral prednisone, and intra-articular corticosteroid injections, as well as home exercise regimens and physical therapy 3, 2.
- Combining suprascapular nerve block with physical therapy and/or intra-articular corticosteroid injection, and combining intra-articular corticosteroid injection with physical therapy have support in the literature for improving shoulder pain, range of motion, and function 4.
- Physiotherapy and corticosteroid injections combined may provide greater improvement than physiotherapy alone 2.
- Surgical treatment options for patients who have minimal improvement after six to 12 weeks of nonsurgical treatment include manipulation under anesthesia and arthroscopic capsule release 2.
Rehabilitative Treatments for Adhesive Capsulitis
- Conservative therapy is based on the use of multimodal techniques, including instrumental physical therapy, exercise, physiokinesitherapy, and anti-inflammatory drug therapy 5.
- Joint mobilizations, techniques adopting posterior glenohumeral approaches, and high-end mobilizations appear to be effective, both manual and instrumental techniques 5.
- Stretching is a mandatory implementation in rehabilitation programs, and supervised group or home therapeutic exercises in multimodal rehabilitation programs may be effective 5.
- Ultrasound therapy did not prove effective on the pathology, unlike radial shockwaves and cryotherapy 5.