Conservative treatment of patients with secondary adhesive capsulitis

Abstract

Background. Secondary adhesive capsulitis, similar to idiopathic one, is accompanied by thickening of the glenohumeral joint capsule and loss of its elasticity. Nonoperative ma­nagement of secondary adhesive capsulitis associated with shoulder soft tissue injuries, impact of prolonged immobilization or surgical treatment still remains controversial. Capsular distension with steroids as in idiopathic adhesive capsulitis is often not used for one reason or another. The purpose: to compare the results of conservative treatment in patients with secondary adhesive capsulitis who underwent or not capsular distension with steroids during the treatment. Materials and methods. From 2015 to 2021 at the Department for Microsurgery and Reconstructive-Recovery Surgery of Upper Limb of the State Institution “Institute of Traumatology and Orthopaedics of the National Academy of Medical Sciences of Ukraine” (Kyiv) and Ivano-Frankivsk Regional Clinical Hospital, we have conduc­ted conservative treatment for 825 patients with various soft tissue pathology of the shoulder joint complicated by secondary adhesive capsulitis. All patients were divided into two groups: first one — conservative treatment, second one — conservative treatment with intraarticular injections (capsular distension) with steroids. In our study, we evaluated the function of the shoulder joint using the Constant Shoulder Score (CSS) and visual analog scale (VAS) before treatment and after 3 and 6 months. Results. Patients from first group (conservative treatment wi­thout distension intraarti­cular injections) had worse average functional results 3 month after starting treatment according to CSS (p = 0.13) and VAS (p = 0.24) compared to subjects of second group. Six months after the start of treatment, patients from first group had significantly worse results by CSS and VAS than those from group 2, where distension intraarticular injections were performed (p = 0.03 and p = 0.06, respectively). Conclusions. Conservative treatment of patients with secondary adhesive capsulitis of the shoulder joint should be comprehensive, differentiated and include both non-drug treatment methods and distension intraarticular injections with long-acting steroids.