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What is a Frozen Shoulder?
Various triggers have been associated with adhesive capsulitis. The condition often has no clear cause, or is idiopathic, but has been associated with systemic conditions such as diabetes mellitus and hypothyroidism [Ramirez, 2019; Navarro-Ledesma et al, 2024].
Risk factors for adhesive capsulitis are multifactorial, involving metabolic, genetic, and lifestyle components:
Diabetes Mellitus: Multiple studies have consistently identified diabetes as a significant risk factor for adhesive capsulitis. Patients with diabetes have a higher prevalence of this condition compared to the general population. Approximately 10-20% of patients with diabetes develop adhesive capsulitis [Cao et al, 2022; Kingston et al, 2018; Abudula et al, 2024].
Female Gender: Females are more likely to develop adhesive capsulitis than males. This has been supported by various studies and is considered an independent risk factor. Females are 1.5 to 2 times more likely to develop adhesive capsulitis than males [Wang et al, 2013; Kingston et al, 2018; Abudula et al, 2024].
Age: The condition is more common in individuals aged 40-70 years, with a peak incidence in the 50-60 year age group [Cao et al, 2022; Kingston et al, 2018].
Obesity: Higher body mass index (BMI) is associated with an increased risk of developing adhesive capsulitis with 27-30% of patients with adhesive capsulitis are classified as obese [Cao et al, 2022; Kingston et al, 2018].
Thyroid Disorders: Hypothyroidism and hyperthyroidism have been linked to an increased risk of adhesive capsulitis. Hypothyroidism is present in approximately 10-20% of patients with adhesive capsulitis [Wang et al, 2013; Kulm et al, 2022].
Previous Shoulder Injuries or Surgeries:
History of shoulder trauma, surgeries, or conditions such as rotator
cuff disease, biceps tendinitis, and calcific tendinitis are associated
with a higher risk. Frozen shoulder was identified in 11% of the patients after shoulder surgery and was more common in females (15%) than in males (8%) [Koorevaar et al, 2011].
Genetic Factors:
Genetic predisposition has been suggested, with specific loci
identified that may increase susceptibility to adhesive capsulitis [Kulm et al, 2022].
Other Comorbidities: Conditions such as hyperlipidemia, cervical spondylosis, and cardiovascular diseases have also been associated with an increased risk [Wang et al, 2013; Sun et al, 2024].
Conservative Treatment
Early intervention strategies for patients at high risk of developing adhesive capsulitis (frozen shoulder) include:
Intra-articular corticosteroid injections: These are effective in reducing pain and improving shoulder function, particularly in the early stages of the condition. The American Academy of Orthopaedic Surgeons highlights the role of early corticosteroid injections in shortening the duration of symptoms [Redler & Dennis, 2019].
Physical therapy: This includes joint mobilization and stretching exercises, which are crucial for maintaining range of motion and preventing stiffness. Combining physical therapy with corticosteroid injections may provide greater improvement than physical therapy alone [Ramirez, 2019].
A study by Nicholson et al. evaluated the efficacy of distension arthrography in treating adhesive capsulitis. All procedures were performed with a combination of steroid, local anaesthetic, and a distention volume of 10 ml, 30 ml, or 50 ml. This study found that higher volumes of distension (50 ml) were associated with significantly lower recurrence rates compared to lower volumes (30 ml). This suggests a dose-dependent advantage of higher volume distention in reducing symptom recurrence [Nicholson et al, 2020].
Lin et al. conducted a systematic review and network meta-analysis, which found that capsular distension was superior to intra-articular steroid injection in improving external rotation. Sixteen RCTs and 1 observational study were enrolled in meta-analysis. This highlights the potential benefit of distension in addressing the functional limitations associated with frozen shoulder [Lin et al, 2018].
In a recent study by Gallacher et al, high volume shoulder dilation ha similar outcomes to surgical management. In this study, patients with severe idiopathic frozen shoulder deemed suitable for surgical intervention were enrolled. 50 patients were randomized to either a high-volume distention or arthroscopic capsular release. Both groups showed a significant improvement in pain and function with 75% of improvement in function at 6 weeks after procedure in both groups [Gallacher et al, 2018].
A systematic review and meta-analysis published in the Archives of Physical Medicine and Rehabilitation found that PRP injections significantly improved passive abduction, passive flexion, pain, and disability at 1, 3, and 6 months post intervention [Lin et al, 2023]. These findings suggest that PRP not only provides short-term relief but also confers sustained therapeutic benefits over time.
A study by Dr. Lee et al. reported substantial improvements in both pain intensity and shoulder range of motion at the 6-month follow-up in patients receiving PRP compared to those treated with corticosteroid injections [Lee et al, 2021]. The authors attributed these outcomes in part to the anti-inflammatory and regenerative properties of PRP, which may help to restore normal shoulder function more effectively than conventional treatments.
A systematic review published in Arthroscopy found that PRP injections were at least as effective as corticosteroid or saline solution injections, with many studies demonstrating superior outcomes in terms of pain relief, mobility, and overall functional scores at follow-ups ranging from 3 to 6 months [Nudelman et al, 2023]. These findings further support the use of PRP as a viable and potentially superior treatment option for adhesive capsulitis.
Surgical Management
References
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