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: cfleckenstein@csmref.org).

Abstract

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.

Shaping the Future of Musculoskeletal Services Wednesday 8 June 2011 - London

Shaping the Future of Musculoskeletal Services


A conference for primary care musculoskeletal practitioners

These are challenging times for those involved in the delivery of musculoskeletal care in the UK. But new challenges also present opportunities to improve the care we deliver to our patients.



Arthritis Research UK is keen to continue its support for clinicians working in musculoskeletal ‘special interest’ roles and musculoskeletal interface clinics and would like to invite you to shape the future of musculoskeletal services. We hope this one-day conference will serve as a forum to share ideas and best practice and also develop networks for peer support.



Key themes Commissioning and pathways, education, continuing professional development and appraisal.



Target audience GPwSIs, PwSIs, AHPs and specialist nurses working in musculoskeletal interface services.



Date Wednesday 8 June 2011



Venue Skinner’s Hall, Dowgate Hill, London



The full price will be £70 but we are offering a reduced rate of £50 for those who book before Monday 28th March. To reserve your place please complete an application form and return to Donna Lakin. A full programme and further details will be published in due course.

BASEM Education Diploma Revision Course

 A weekend exam preparation course for the Intercollegiate Faculty of Sport & Exercise Medicine's (FSEM) Diploma in SEM

Dates: Saturday 5th & Sunday 6th March, 2011


Venue: Bisham Abbey National Sports Centre, Buckinghamshire

BASEM is running a weekend preparation course covering parts one and two of the Faculty of Sport and Exercise Medicine (FSEM) Diploma exam in SEM. The course will feature, focused lectures and tutorials on key topics; practical sessions covering joint examination, basic life support, advanced trauma life support and communication skills; practice written paper (day 1) and OSCE (day 2); advice on exam technique and some pre course material including reading list, lecture notes and practice written questions for part 1. It is possible to attend day 1 (part 1) and/or day 2(part 2) as required.

More information including pricing and a booking facility for this course is available on the BASEM web site, www.basem.co.uk or by clicking here 

Spinal Injections in Sports Medicine: Practical Fluoroscopic Cadaver Course Venue: University College London Hospital. Date: March 28th 2011

Spinal Injections in Sports Medicine
28th March 2011

PROGRAMME
0815-0900 Registration
0900-0915 Introduction RC
0915-0950 Lecture: Overview of Lumbo-sacral anatomy including imaging JT
0950-1020 Lecture: Role of Spinal Injections in Sports Medicine RC
Break
1040-1210
Delegates break up into 4 groups and rotate between Tutors for 20 minute Mini-tutorials
Group 1 Prolotherapy – lumbar and sacroiliac/ blind and fluoroscopic SP
Group 2 Intra-articular facet, sacroiliac joint and hip injections JT
Group 3 Nerve root blocks UJ
Group 4 Caudal epidural (including palpation of sacral hiatus) RC
1210 – 1230 Panel Discussion (Q and A) - Picking the right patient for the right procedure
(all tutors – RC to chair)
Lunch
1315-1630 Cadaver lab
Delegates break up into 3 groups and rotate between Tutors for 1 hour practicals
There will be 3 prone and one supine cadaver with at least 2 fluoroscopes
Group 1 Prolotherapy (delegates practice with and without fluoroscope) SP
Group 2 Facet and Sacroiliac (with and without fluoroscope) JT
Group 3 Caudal Epidural UJ
Coffee break as required during afternoon
There will be a further cadaver in supine position where may be opportunity to try hip
injections whilst awaiting their turn elsewhere (RC)
TUTORS:
RC Robin Chakraverty
SP Simon Petrides
JT John Tanner
UJ Usamah Jannoun
Venues: UCH Education Centre, Euston Road & Rockefeller Building, University Street, London

Course Leader:
Dr. Robin Chakraverty MSc DipSEM DipMSMed MLCOM FFSEM (Ire)
Musculoskeletal & Sports physician, Medical Officer, UK Athletics.
Tutors:
Dr. John Tanner DM-SMed Dip.Sports.Med FFSEM (UK) Musculoskeletal & Sports physician
Dr. Simon Petrides DO Dip.Sports.Med. FFSEM (UK) DM-SMed Musculoskeletal & Sports physician
Dr. Usamah Jannoun DM-SMed MFSEM Dman Med DNeural Med Musculoskeletal & Sports physician
The Course will provide an overview of the use of spinal injections in musculoskeletal
and sports medicine, including: Caudal Epidural, Prolotherapy, Facet and Sacroiliac
Joint Injections.

There is a significant practical element to the course with demonstrations and handson
practical experience, aiming to teach safest practice using fluoroscopic control. In
addition there will be the opportunity to practice blind techniques with emphasis on
potential pitfalls and managing acute complications.

Cost: BIMM Members £400 NON Members £450.

For a booking form please contact Deena Harris
Phone: 0208 421 9910 Fax: 0208 386 4183
e-mail: info@bimm.org.uk Web: www.bimm.org.uk