Nonoperative management of idiopathic adhesive capsulitis

Adhesive capsulitis of the shoulder is a common disorder, yet literature on its natural history is limited. This study examined patient characteristics, treatment patterns, and response to treatment of the disease in a large series of patients with this condition. Charts of 234 patients treated at our institution for adhesive capsulitis were reviewed retrospectively. The end points for the study were defined as resolution of symptoms with nonoperative treatment or operative treatment. A total of 105 shoulders in 98 patients were identified with follow-up to end point. Of these, 89.5% resolved with nonoperative treatment, including 17 (89.5%) of 19 diabetic shoulders. The average age of patients who went on to surgery was 51 years, whereas the average age of patients treated nonoperatively was significantly higher at 56. No significant difference was found for success of nonoperative treatment versus operative treatment or patient gender. All patients received nonsteroidal antiinflammatory medications, 52.4% received physical therapy without cortisone injection, and 37.1% received therapy with at least 1 corticosteroid injection. Duration of treatment in successfully nonoperatively treated patients averaged 3.8 +/- 3.6 months. Patients who required surgery were treated with an average of 12.4 +/- 12.1 months of nonoperative treatment. Initial forward elevation averaged 118 degrees +/- 22 degrees with average forward elevation at resolution of 164 degrees +/- 17 degrees. External rotation improved from an average of 26 degrees +/- 16 degrees pretreatment to 59 degrees +/- 18 degrees posttreatment. With supervised treatment, most patients with adhesive capsulitis will experience resolution with nonoperative measures in a relatively short period. Only a small percentage of patients eventually require operative treatment.