If non-surgical treatments do not ease symptoms or the shoulder joint is severely worn causing parts of the joint to become loose, a procedure called an arthroplasty may be recommended. This is a joint replacement treatment which involves replacing the ball with a synthetic ball and placing a cap for the scapula (known as a glenoid). After surgery passive shoulder exercises will be carried out and involve another person moving the joint. After 3-6 weeks patients are advised to start exercising the joint independently. Exercises and stretches are an important part of recovery and help to increase strength, flexibility and mobility in the joint. The success of surgery is dependent on the state of the rotator cuff muscles before surgery and the patient’s commitment to the exercise regime.
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.
As with any medication, there are possible side effects or risks involved. Common risks from steroid injections include pain at the injection site, bruising due to broken blood vessels, skin discolouration and aggravation of inflammation. Rarer risks include allergic reactions, infection, tendon rupture and serious injury to bones called necrosis. Long term side effects (depending on frequency and dose) include thinning of skin, easy bruising, weight gain, puffiness in the face, higher blood pressure, cataract formation, and osteoporosis (reduced bone density). Steroid injections may be given every 3-4 months but frequent injections may lead to tissue weakening at the injection site and is not recommended. Side effects do not happen in everyone and vary from person to person.