From the Guidelines
Adhesive capsulitis, or frozen shoulder, should be managed with a focus on pain relief and preservation of range of motion, using interventions such as gentle stretching exercises, NSAIDs, and corticosteroid injections, as these approaches have been shown to improve outcomes in terms of morbidity, mortality, and quality of life. The condition is characterized by stiffness and pain in the shoulder joint, typically developing gradually with three phases: freezing, frozen, and thawing. According to the most recent and highest quality study, the Canadian Stroke Best Practice Recommendations from 2016 1, treatment of hemiplegic shoulder pain related to limitations in range of motion includes gentle stretching and mobilization techniques. Some key points to consider in the management of adhesive capsulitis include:
- Gentle stretching exercises performed daily to preserve range of motion
- Use of NSAIDs like ibuprofen or naproxen for pain relief, as recommended by the Canadian Stroke Best Practice Recommendations 1
- Consideration of corticosteroid injections into the shoulder joint for significant relief during the painful phase, as suggested by the management of adult stroke rehabilitation care guideline 1
- Heat application before exercises and ice afterward to help manage pain
- Potential use of botulinum toxin injections or subacromial corticosteroid injections in specific cases, as outlined in the Canadian Stroke Best Practice Recommendations 1. Recovery from adhesive capsulitis typically takes 1-3 years, with most patients seeing significant improvement within 12-18 months with appropriate treatment, highlighting the importance of a comprehensive and multidisciplinary approach to management.
From the Research
Definition and Characteristics 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.
- It is predominantly an idiopathic condition and has an increased prevalence in patients with diabetes mellitus and hypothyroidism 2.
- The condition is characterized by fibrosis and contracture of the glenohumeral joint capsule, resulting in progressive stiffness, pain, and restriction of motion of the shoulder 3.
Diagnosis of Adhesive Capsulitis
- Although imaging is not necessary to make the diagnosis, a finding of coracohumeral ligament thickening on noncontrast magnetic resonance imaging yields high specificity for adhesive capsulitis 2.
- The diagnosis is often based on clinical presentation, including pain and limited range of motion, especially in external rotation 2, 3.
Treatment Options for Adhesive Capsulitis
- Nonsurgical treatments include nonsteroidal anti-inflammatory drugs, short-term oral corticosteroids, intra-articular corticosteroid injections, physiotherapy, acupuncture, and hydrodilatation 2.
- Physiotherapy and corticosteroid injections combined may provide greater improvement than physiotherapy alone 2.
- Corticosteroid injection is superior to placebo and physiotherapy in the short-term (up to 12 weeks) 4.
- Dosages of intra-articular triamcinolone 20 mg and 40 mg showed identical outcomes, while subacromial and glenohumeral corticosteroid injections had similar efficacy 4, 5.
- 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.
Effectiveness of Treatment Options
- There is currently no consensus on the most effective treatment for adhesive capsulitis 3.
- A randomized controlled trial found that four injections with corticosteroid with or without distension, given with increasing intervals during 8 weeks, were better than treatment-as-usual in the short-term, but no difference was found between any of the groups in the long run 6.
- Injection of 20 mg of triamcinolone acetonide is sufficient to elicit symptom relief in patients with severe adhesive capsulitis 5.