Outcomes From Conservative Treatment of Shoulder Idiopathic Adhesive Capsulitis and Factors Associated With Developing Contralateral Disease.

BACKGROUND: Idiopathic adhesive capsulitis is a common condition resulting in painful multidirectional restriction of motion without other identifiable shoulder abnormality. First-line therapies for this condition are nonoperative, but limited data are available regarding which treatments are most effective. Factors associated with contralateral disease are not well established.

HYPOTHESIS: Younger patients will have a better response to treatments, and older patients and patients with diabetes will be more likely to develop contralateral disease.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Patients diagnosed with idiopathic adhesive capsulitis were treated with a single intra-articular glenohumeral injection of local anesthetic and corticosteroid as well as 4 weeks of supervised physical therapy (PT). Patients were re-evaluated monthly and received additional conservative treatment based on failure to restore normal motion. Patient-reported outcome scores and range of motion were used to assess treatment efficacy.

RESULTS: Minimum 2-year follow-up data (mean, 3.4 years) were available for 60 of 75 eligible patients (80%). Patients who did not attend supervised PT as prescribed were more likely to undergo repeat injection due to a lack of adequate range of motion at follow-up ( P = .003). Conservative therapy failed in 2 patients (3.3%), and they underwent arthroscopic release and manipulation under anesthesia. Twenty-two patients (36.7%) were subsequently diagnosed with contralateral idiopathic adhesive capsulitis, with a higher incidence in patients with diabetes ( P = .009) and patients younger than 50 years ( P = .005). American Shoulder and Elbow Surgeons score improved from 41.2 (95% CI, 33.0-49.4) at baseline to 92.0 (95% CI, 88.4-95.6) at final follow-up ( P < .0001). Patients with diabetes had a decrease in Shoulder Activity Scale score at final follow-up ( P = .049).

CONCLUSION: Conservative treatment for idiopathic adhesive capsulitis resulted in good clinical outcomes with a low incidence of surgical intervention. Physical therapy reduced the use of a second injection as part of treatment in this treatment algorithm. Young patients and patients with diabetes may be more likely to develop contralateral disease.