Griggs and colleagues measured outcomes after a four‑direction stretching program in phase‑II idiopathic adhesive capsulitis.
Prospective study of 75 consecutive patients (77 shoulders) at Rhode Island Hospital, Providence, followed a mean of 22 months (range 12 to 41).
Methods
Design
Prospective outcome study
Consecutive patients
Data source
Shoulder Service, Rhode Island Hospital, Providence
Patients
75 patients (77 shoulders)
Phase‑II idiopathic adhesive capsulitis
Phase II: pain with globally limited motion and over 50% loss of external rotation
Mean age 53, 77% women
46 shoulders (60%) had failed earlier treatment
Exposure
Passive stretching in forward elevation, external rotation, horizontal adduction and internal rotation
Stretch to tolerable discomfort 5 times daily
Formal physical therapy in 68 patients (91%)
Follow-up
Mean 22 months (range 12 to 41)
1 patient died before final evaluation
3 patients lost to follow‑up
Outcomes
Patient satisfaction
Pain at rest and with activity
Range of motion
Simple Shoulder Test
DASH Questionnaire
SF‑36 Health Survey
Key Findings
64 of 71 patients (90%) were satisfied with the stretching program, and 5 (7%) went on to manipulation, arthroscopic capsular release or both.
In patients treated without a procedure, mean pain with activity fell from 4.12 to 1.33 on a 5‑point scale (p < 0.0001).
Gains in motion were not associated with final pain, Simple Shoulder Test or DASH scores, whereas initial pain with activity was associated with a worse final DASH score (p = 0.0235).
Pain and motion in the treated shoulder still differed significantly from the unaffected opposite shoulder at final evaluation (p < 0.00001).
Nearly 40% of patients treated without a procedure had an abnormal DASH score above 6 points, and the authors concluded that normal function is not required for satisfaction.
Diabetes mellitus and male gender were the only factors linked to more limited final motion (p < 0.01).
Board pearl
Prior physical therapy (p = 0.028) and a Workers' Compensation claim or litigation (p < 0.001) were the only factors associated with failure of the stretching program or later manipulation or release.
Authors' conclusion
The vast majority of patients who have phase-II idiopathic adhesive capsulitis can be successfully treated with a specific four-direction shoulder-stretching exercise program. Although measurable limitations and deficiencies were noted at the outcome evaluation, these appeared to be acceptable to most of the patients and did not affect their general health status. Patients with more severe pain and functional limitations before treatment had relatively worse outcomes. More aggressive treatment such as manipulation or capsular release was rarely necessary, and the efficacy of early use of these treatments should be further studied.
Griggs and colleagues measured outcomes after a four‑direction stretching program in phase‑II idiopathic adhesive capsulitis.
Prospective study of 75 consecutive patients (77 shoulders) at Rhode Island Hospital, Providence, followed a mean of 22 months (range 12 to 41).
Methods
Design
Prospective outcome study
Consecutive patients
Data source
Shoulder Service, Rhode Island Hospital, Providence
Patients
75 patients (77 shoulders)
Phase‑II idiopathic adhesive capsulitis
Phase II: pain with globally limited motion and over 50% loss of external rotation
Mean age 53, 77% women
46 shoulders (60%) had failed earlier treatment
Exposure
Passive stretching in forward elevation, external rotation, horizontal adduction and internal rotation
Stretch to tolerable discomfort 5 times daily
Formal physical therapy in 68 patients (91%)
Follow-up
Mean 22 months (range 12 to 41)
1 patient died before final evaluation
3 patients lost to follow‑up
Outcomes
Patient satisfaction
Pain at rest and with activity
Range of motion
Simple Shoulder Test
DASH Questionnaire
SF‑36 Health Survey
Key Findings
64 of 71 patients (90%) were satisfied with the stretching program, and 5 (7%) went on to manipulation, arthroscopic capsular release or both.
In patients treated without a procedure, mean pain with activity fell from 4.12 to 1.33 on a 5‑point scale (p < 0.0001).
Gains in motion were not associated with final pain, Simple Shoulder Test or DASH scores, whereas initial pain with activity was associated with a worse final DASH score (p = 0.0235).
Pain and motion in the treated shoulder still differed significantly from the unaffected opposite shoulder at final evaluation (p < 0.00001).
Nearly 40% of patients treated without a procedure had an abnormal DASH score above 6 points, and the authors concluded that normal function is not required for satisfaction.
Diabetes mellitus and male gender were the only factors linked to more limited final motion (p < 0.01).
Board pearl
Prior physical therapy (p = 0.028) and a Workers' Compensation claim or litigation (p < 0.001) were the only factors associated with failure of the stretching program or later manipulation or release.
Authors' conclusion
The vast majority of patients who have phase-II idiopathic adhesive capsulitis can be successfully treated with a specific four-direction shoulder-stretching exercise program. Although measurable limitations and deficiencies were noted at the outcome evaluation, these appeared to be acceptable to most of the patients and did not affect their general health status. Patients with more severe pain and functional limitations before treatment had relatively worse outcomes. More aggressive treatment such as manipulation or capsular release was rarely necessary, and the efficacy of early use of these treatments should be further studied.