This retrospective study examined 105 shoulders in 98 patients with idiopathic adhesive capsulitis treated at a single institution. It asked: what proportion resolve with nonoperative care, how long does it take, and who is likely to fail? All patients received NSAIDs and standardized physical therapy; corticosteroid injection was added at surgeon discretion.
When a patient presents with adhesive capsulitis, reassure them that 9 in 10 will resolve without surgery — but set the clock at 4 months.
If a patient is not making progress by that mark, the data here support moving toward operative intervention rather than continuing months of ineffective nonoperative care. The surgical group in this series waited an average of 12.4 months before getting the OR, which is longer than necessary.
Younger patients with severely limited motion at first visit warrant closer follow-up — they are the group most likely to need arthroscopic capsular release or manipulation under anesthesia.
The finding on diabetes is worth knowing for boards and for clinic: contrary to widely cited dogma, diabetic patients in this series resolved nonoperatively at the same rate as everyone else. Diabetes should raise your vigilance, not automatically lower your threshold for surgery.
This retrospective study examined 105 shoulders in 98 patients with idiopathic adhesive capsulitis treated at a single institution. It asked: what proportion resolve with nonoperative care, how long does it take, and who is likely to fail? All patients received NSAIDs and standardized physical therapy; corticosteroid injection was added at surgeon discretion.
When a patient presents with adhesive capsulitis, reassure them that 9 in 10 will resolve without surgery — but set the clock at 4 months.
If a patient is not making progress by that mark, the data here support moving toward operative intervention rather than continuing months of ineffective nonoperative care. The surgical group in this series waited an average of 12.4 months before getting the OR, which is longer than necessary.
Younger patients with severely limited motion at first visit warrant closer follow-up — they are the group most likely to need arthroscopic capsular release or manipulation under anesthesia.
The finding on diabetes is worth knowing for boards and for clinic: contrary to widely cited dogma, diabetic patients in this series resolved nonoperatively at the same rate as everyone else. Diabetes should raise your vigilance, not automatically lower your threshold for surgery.