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Levine, MD, Christine P. Kashyap, MD, Sean F. Bak, MD, Christopher S. Ahmad, MD, Theodore A. Blaine, MD, and Louis U. Adhesive capsulitis of the shoulder is a common disorder, yet literature on its natural history is limited. Capdulite study examined patient characteristics, treatment patterns, and response to treatment of the disease in a large series of patients with this condition. Charts of 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 shoulders in 98 patients were identified with follow-up capeulite end point.
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 No significant difference was found for success of nonoperative treatment versus operative treatment or patient gender.
All patients received nonsteroidal antiinflammatory medications, Durationof treatmentin successfully nonoperativelytreatedpatientsaveraged3. Patientswho requiredsurgerywere treatedwith an averageof With supervisedtreatment,most patientswith adhesivecapsulitiswill experienceresolutionwith nonoperativemeasuresin a relativelyshort period. Only a small percentageof patientseventuallyrequireoperative treatment. J ShoulderElbow Surg ; Adhesive capsulitis is a common painful condition of the shoulder of unknown etiology.
It is a disorder frequently encountered by most orthopedic surgeons, but literature about its natural history is limited. First described by Duplay in and named frozen shoulder by Codman inadhesive capsulitis is characterized by pain and restriction of both passive and active range of motion.
Nonoperative treatment is typically prescribed initially.
This treatment includes benign neglect,10,23 oral nonsteroidalantiinflammatorydrugs NASIDs ,oralcorticosteroids,5,7 glenohumeral intraarticular corticosteroid injections,2,8,30 and physical therapy. Published reports on the natural history of patients with adhesive capsulitis are limited.
Griggs et adewiva reported that most patients with adhesive capsulitis can be treated successfully with a specific 4-direction shoulder-stretching exercise program. Diercks and Stevens10 showed that supervised benign neglect also yields better outcomes for adhesive capsulitis patients than intensive physical therapy.
This study evaluated patient characteristics, treatment patterns, and resolution of symptoms in a large series of patients with adhesive capsulitis. Reviewed were charts of patients with adhesive capsulitis treated between April and February From these charts, 98 patients shoulders were selected to be adesivx in this Institutional Review Board— approved retrospective study.
The criteria zdesiva inclusion in the study were 1 diagnosis of adhesive capsulitis and 2 treatment by 1 of 4 shoulder surgeons at our institution from to The exclusion criteria were 1 concomitant glenohumeral osteoarthritis, 2 concomitant rotator cuff. The average age of all patients was 5 years range, years. The average age of men was 58 years range, yearsand the average age of women was 54 years range, years. Sixteen patients 19 shoulders; At the initial evaluation, patient range of motion, function, and pain were assessed.
Health comorbidities, including diabetes mellitus, thyroid disorders, and cardiovascular disease, were determined, and a history of any previous shoulder disorders was ascertained. The patients were evaluated by 1 of 4 shoulder surgeons at the initial visit.
All patients had complete radiographic studies of the affected shoulder, including true anteroposterior, internal and external rotation, axillary, and scapular-Y views. Average length of treatment for all patients was capsulitf.
Capsulite adesiva – Artigo sobre capsulite adesiva do ombro, sua fisiopatologia,
All patients received treatment consisting of oral NSAIDs medications and a standardized physical therapy program. Operative indications included progressive worsening range of motion, failure to make progress after 3 consecutive visits, or residual functional impairment after 6 months or more of nonoperative treatment. This was compared with the initial evaluation of the same measurements.
Pain was also assessed using the Visual Analogue Scale pain score. Patients who could not or did not return for the final follow-up evaluation were contacted by telephone to determine their most recent status.
Statistical analysis was performed with the independent t test and the Pearson 2 test. A value of P. Symptoms resolved in 94 Patients were treated for an average of 3. Length of treatment for patients receiving physical therapy only was an average of 3. This difference was not significant P.
Patients who received surgical treatment for their adhesive capsulitis were treated nonoperatively acesiva an average of This was significantly different from the length of afesiva for the nonoperative group P.
The average capsulitd of these patients was 51 years range, years. Six women and 4 men required surgery, none of which were smokers. In addition, only 2 Fifteen of the 98 patients required telephone contact to assess final outcome. These phone calls occurred between 15 and months after they were initially evaluated by the physicians in this study. One of the 15 received surgical treatment with an outside physician; the remaining 14 were successfully treated nonoperatively.
None casulite them reported recurrent symptoms of adhesive capsulitis at the time of the follow-up phone call. The initial and final range-of-motion values for the nonoperative and surgical groups are summarized in Table I. There was a significant difference P. A significant change occurred between the initial and final range of motion for forward elevation and external rotation, but not internal rotation, in the 2 nonoperative treatment groups.
Average range of motion decreased from the initial evaluation to the preoperative evaluation for the surgical patient group. The decrease in forward elevation was identified in 8 The end range of motion for patients treated nonoperatively is listed in Table I and compared with the initial range of motion of the unaffected shoulder.
There was a significant difference between the end range of motion of the affected shoulder and the contralateral shoulder range of motion for forward elevation, external rotation, and internal rotation P. Adhesive capsulitis is a wdesiva disorder in which definitive treatment is still uncertain. The current study identified several factors associated with failure of capsuliet management, including young age and more severe initial range of motion.
Patients were significantly younger in capsklite surgical group, with the average age of 51 years compared with an average of 56 years in the patients in the nonsurgical groups.
It is unclear from this study whether this is due to a possible bias toward treating younger patients more aggressively or if younger age at initial presentation is a factor in poor prognosis. Younger patients may have higher expectations of function for their affected shoulder after treatment completion and may hope to regain more range of motion than older patients.
Additional studies should be conducted capulite evaluate this factor further. Patients who were initially evaluated with more limited range of motion of their shoulders were more likely to require surgical treatment.
There was a significant difference between initial forward elevation and external rotation between the nonoperative and operative groups.
Furthermore, most patients in the surgical group experienced a decrease in forward elevation range of motion from the initial presentation to the final preoperative evaluation. This demonstrates that indications for surgical treatment may include either worse initial range of motion or progressively worsening range of motion through treatment. Traditionally, nonoperative management of adhesive capsulitis is recommended for a minimum of 6 months before operative intervention.
Table I Average end range of motion of affected shoulder compared with initial range of motion of unaffected shoulder. Patients in the surgical group were treated for an average of On the basis of these results, consideration should be given to operative intervention in patients who fail to respond within the first 4 months of treatment. The group successfully treated nonoperatively had an average of 5. Patients treated operatively averaged 9. In addition, the youngestpatient in this study had type 1 diabetesmellitus and was affected bilaterally.
This study did not show, however,that diabeticpatientswere more likely toneedsurgicalmanagement. Only2ofthe19diabetic shoulders in this study required surgical management. Of the 17 shoulders treated nonoperatively, 8 were effectively treated with physical therapy alone, and 9 were treated with physical therapy and 1 or more intraarticularcorticosteroidinjections.
Parte 1 de 2 Nonoperative management of idiopathic adhesive capsulitis William N. The exclusion criteria were 1 concomitant glenohumeral osteoarthritis, 2 concomitant rotator cuff Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center.
Patient demographics Sixty-eight patients Evaluation At the initial evaluation, patient range of motion, function, and pain were assessed.
Study protocol and determination of failure Average length of treatment for all patients was 4. Statistical analysis Statistical analysis was performed with the independent t test and the Pearson 2 test. Nonoperative group Symptoms resolved in 94 Operative group Patients who received surgical treatment for their adhesive capsulitis were treated nonoperatively for an average of Final outcome with telephone call Fifteen of the 98 patients required telephone contact to assess final outcome.
Tags capsulite adesiva ombro. Arquivos Semelhantes Tratamento osteopatico no ombro rigido Fundamento osteopatico no tto do ombro rigido.