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1.8.

2016

AdhesiveCapsulitisManagement

AdhesiveCapsulitisManagement
Sooncewehavediagnosedadhesivecapsulitis...howdowemanageit?
MedicalManagement
NSAID'snodifferencesinfunctionorpaincomparedtoplacebo
Oralcorticosteroids(prednisone)canimprovenightpain&pain/functionintheshortterm(usually
6/52)buthasnoeffectonthedurationofinjury
Intraarticularcorticosteroidinjectionbetterpainrelief&improvedfunctioninshortterm(6/52),
evidencethatapatientcanreceiveuptothreeinjectionsoverfourmonthswithoutsignificant
complications
SodiumhyaluronateinjectionsignificantlyimprovedshoulderROMandpainwithequivalentresultsto
corticosteroidinjectionsbutlessharmful,howeverallstudieslookedatusedrepeatedinjections(weekly
upto5xinjections)
Hydrodilatationalargeamountofsalinesolution&corticosteroidisinjectedintotheglenohumeraljoint
tostretchthecapsule
Bellandcolleagues(2003)performed109hydrodilatations,with67%ofpatientshavingnopainat3
monthsandtheremaininghavingmildtomoderatepainat3months.Ithasbeenshownaseffectiveat
earlyorlatestageandinthosewithmildtoseverepain.
Previouslyahydrodilatationwasperformeduntilrupture,howeverKoh(2012)measuredpressureand
volumeinthejointandfoundincreasedvolumeandabetterresultiftheypreventedthecapsulerupture.If
thecapsuleisallowedtograduallystretch,withoutrupture,itpreventsfurthercomplicationstothetendon
sheathsandallowsforrepeathydrodilatations.TheirstudyfoundthosewithimprovedROMandreduced
painhadassociatedbiomechanicalchangesinthejointofincreasedvolumecapacityandreduced
capsularstiffness.Thisstudyhighlightsphysiologicalchanges,aswellaspainrelief,occurwhena
hydrodilatationisperformed.

SurgicalManagement
ManipulationUnderAnaesthetic(MUA)onlyconsideredafter6/12,glenohumeraljointstretchedinto
flexion/abduction/ERorIRuntilcapsulartearingoccurs,ithasgoodresultsbutisequivalenttoless
invasivemethods,complicationsincludefractures,RCuff/labraltears,dislocation,brachialplexusinjuries,
haematomasetc.
ArthroscopicReleaseremovescartissuefromsubscapularis&inferiorcapsuleallowinginferiorand
lateraltranslationofheadofhumerus
OpenReleaseonlyafterfailedMUA,rarenowduetoarthroscopeavailability
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1.8.2016

AdhesiveCapsulitisManagement

Physiotherapy
Thereislimitedevidenceforphysiotherapyalone,mostarticlesagreethatacombinationofmedical,
physiotherapyandhomeexerciseprogramisthemosteffective.Caretteandassociates(2003)found
cortisoneinjectionsandahomeexerciseprogramwereeffectiveinreducingpain,butaddingsupervised
physiotherapyhadafasterimprovementinrangeofmotion.Althoughphysiotherapyalonewasno
better.AsystematicreviewbyBlanchard(2010)foundcorticosteroidsarebetteratimprovingpain,passive
externalrotationandshoulderdisabilityinthefirst6weekspostinjection.However,physiotherapywas
morebeneficialat12weeksinreducingpainanddisability,withbothinjectionsandphysiotherapymore
beneficialthanplacebo.Soshouldwewaitforitto"burnout"?
Techniques
Patienteducationthereismoderateevidencethat"supervisedneglect",consistingofknowledgeof
pathology,gradualstretchingandreturntoADL'saspainallows,issuperiortointensiveandaggressive
physiotherapy(Diercks&Stevens,2004)
JointmobilisationalthoughmobilisationgroupsshowimprovedrangeandpaininRCT's,thereisno
significantdifferencecomparedtocontrol,GradeI&IImobilisationsmayassistinpainreliefbuthave
minimaleffectonrange
StretchingthereisniltominimalimprovementsinROMandpainfollowinghomestretching,however
mostarticlesemploystretchingintheircontrolgroups
ClinicalPracticeGuidelinesFormoreinformation,arecentarticlebyKelleyetal(2013),providesa
comprehensiveoverviewofphysiotherapy,medicalandsurgicalinterventions.
Alicia
References
Bell,S.,Coghlan,J.,&Richardson,M.(2003).Hydrodilatationinthemanagementofshouldercapsulitis.
Australasianradiology,47(3),247251.
Blanchard,V.,Barr,S.,&Cerisola,F.L.(2010).Theeffectivenessofcorticosteroidinjectionscomparedwith
physiotherapeuticinterventionsforadhesivecapsulitis:asystematicreview.Physiotherapy,96(2),95107.
Carette,S.,Moffet,H.,Tardif,J.,Bessette,L.,Morin,F.,Fremont,P.,...Blanchette,C.(2003).Intraarticular
corticosteroids,supervisedphysiotherapy,oracombinationofthetwointhetreatmentofadhesivecapsulitis
oftheshoulder:aplacebocontrolledtrial.Arthritisandrheumatism,48(3),829838.
Kelley,M.J.,Shaffer,M.A.,Kuhn,J.E.,Michener,L.A.,Seitz,A.L.,Uhl,T.L.,...McClure,P.W.(2013).
Shoulderpainandmobilitydeficits:adhesivecapsulitis.TheJournaloforthopaedicandsportsphysical
therapy,43(5),A131.
Koh,E.S.,Chung,S.G.,Kim,T.U.,&Kim,H.C.(2012).Changesinbiomechanicalpropertiesof
glenohumeraljointcapsuleswithadhesivecapsulitisbyrepeatedcapsulepreservinghydraulicdistensions
withsalinesolutionandcorticosteroid.PM&R:thejournalofinjury,function,andrehabilitation,4(12),976
984.

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