There are many types of arthritis, but most often in the shoulder, it is triggered by an initial trauma. It can also involve “wear and tear” of the tissues of the joint, causing inflammation, swelling and pain. Often people will react by instinctively limiting their shoulder movements in order to lessen the pain. This can lead to a tightening or stiffening of the soft tissue parts of the joint, resulting in yet further pain and restriction of motion. In the worst cases, adhesive capsulitis occurs and the arm can not be moved.
Research reported in the February 2015 issue of International Orthopaedics focused on the effects of steroids on the tendons of patients undergoing rotator cuff surgery. The original goal of the study was to map the amount and density of blood vessels in different parts of the shoulder rotator cuff tendons. This is important because recent studies have shown that rotator cuff tears don’t heal well when the tendon has developed fewer blood vessels and has poor blood supply. While the study in International Orthopaedics showed a pattern of blood vessels that might be helpful to surgeons, the most startling finding was that patients who had shoulder steroid shots before the surgery had one-third fewer blood vessels than the patients who didn’t receive the shots.
The most common outcome following non-operative management of adhesive capsulitis with a stretching program is decreased range of motion compared to the contralateral side.
Adhesive capsulitis is defined as painful loss of motion of a shoulder without an underlying cause. While it is generally believed to be a self-limiting condition, numerous treatment methods have been suggested including benign neglect, steroid injections, physical therapy, manipulation, and arthroscopic or open capsular releases. Intra-articular steroid injections may provide an earlier return of shoulder range of motion, but have not shown a long-term difference. Non-operative management with a stretching program shows high rates of patient satisfaction, but it is commonly associated with decreased range of motion compared to the contralateral extremity.
Griggs et al. reviewed 75 patients with phase-2 adhesive capsulitis who were treated non-operatively with a stretching program. At an average follow-up of 22 months, forward flexion increased by 19 degrees, but still remained 36 degrees less than the unaffected shoulder.
Shaffer et al. reviewed 62 patients with adhesive capsulitis who were treated non-operatively with a stretching program. At an average follow-up of 7 years, 60% of patients had decreased range of motion in at least one plane when compared to a control-group of normal shoulders.
Answer 1: While continued pain is a frequent complication, it is usually much improved from the initial onset of the disease and does not affect quality of life.
Answer 3: Adhesive capsulitis is thought to have a low recurrence rate after it has resolved.
Answer 4: Surgical intervention following non-surgical management of adhesive capsulitis is rare since > 90% report satisfaction with non-operative treatment.
Answer 5: The association between rotator cuff arthropathy and adhesive capsulitis has not been studied.