Monday, 7 March 2011

Predictors of Outcome After Nonoperative and Operative Treatment of Adhesive Capsulitis

Predictors of Outcome After Nonoperative and Operative Treatment of Adhesive Capsulitis

  1. Brian K. Rill, MD*,
  2. Cassie M. Fleckenstein, MS,
  3. Martin S. Levy, PhD,
  4. Vinutha Nagesh, MS and
  5. Samer S. Hasan, MD, PhD§
+ Author Affiliations
  1. *Henry Ford Hospital, Sterling Heights, Michigan
  2. Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, Ohio
  3. University of Cincinnati, Cincinnati, Ohio
  4. Investigation performed at Cincinnati Sports Medicine Research and Education Foundation, Cincinnati, Ohio
  1. §Samer S. Hasan, MD, PhD, Cincinnati SportsMedicine Research and Education Foundation, 10663 Montgomery Road, First Floor, Cincinnati, OH 45242 (e-mail:


Background: Few studies regarding adhesive capsulitis have concurrently evaluated nonoperative and operative treatment.
Purpose: The objectives were to evaluate the efficacy of operative and nonoperative treatment of adhesive capsulitis and to determine predictors of clinical outcome.
Study Design: Cohort study; Level of evidence, 3.
Methods: At minimum 24 months’ follow-up, 85 patients underwent self-assessment using the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) score, including 24 patients treated operatively.
Results: Mean number of yes responses on the SST improved from 4.0 ± 2.7 at initial presentation to 9.9 ± 2.8 at final follow-up (P < .0001). Patients who received nonoperative treatment and patients who underwent surgery demonstrated similar improvements on the SST. For the entire cohort, forward elevation and external rotation at the side improved from 119° ± 20° to 152° ± 15° and from 29° ± 18° to 46° ± 11° (P < .0001), respectively, between initial presentation and discharge from treatment. Internal rotation to the back improved from the gluteal area to the thoracolumbar junction (P < .0001). Improvements in forward elevation and external rotation were greater for patients undergoing surgery. After nonoperative treatment, patients with diabetes had a lower final SST than patients without diabetes (P < .05). For the entire cohort, initial SST predicted final SST (P < .05), and a shorter duration of symptoms predicted a higher final ASES score (P < .05). Younger patients (P < .001) and those with a lower initial SST (P < .05) were more likely to undergo surgery.
Conclusions: A multimodal nonoperative treatment program is effective for most patients with adhesive capsulitis. Patients who do not improve, including those with diabetes, respond well to manipulation and arthroscopic release. Residual motion deficits at discharge from treatment do not appear to affect longer-term clinical outcome.

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