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Treatment of Adhesive Capsulitis of the Shoulder: A Critical Analysis Review

Idiopathic adhesive capsulitis of the shoulder is a self-limiting condition with gradual improvement in symptoms over a variable period of time (1 to 3 years), although a small subset of patients can have permanent residual symptoms.Nonoperative and operative treatments do not alter the long-term natural history of adhesive capsulitis, but they do provide short-term symptomatic relief of pain and improvement in shoulder range of motion.There has been no consensus in scientific literature on a single treatment type, nonoperative, operative, or combined, which is more effective in the treatment of adhesive capsulitis.There has been a general consensus that nonoperative management is the initial treatment of choice for adhesive capsulitis. Nonoperative treatments such as physical therapy, oral anti-inflammatory medications, corticosteroid injections, and hydrodilatation allow accelerated pain relief and/or improvement in range of motion compared with untreated controls, but these differences are short-term and there is no difference in final outcomes.There has been insufficient evidence to support early operative treatment for adhesive capsulitis. However, there has been a general consensus that operative treatment (arthroscopic capsular release and/or manipulation under anesthesia) is an option if nonoperative treatment fails after a period of 6 months.Arthroscopic capsular release with or without manipulation results in early relief of pain and improvement in motion compared with nonoperative treatment, but there is no difference in the final outcomes.There has been insufficient evidence to make recommendations with regard to the indication for and timing of operative treatment or to the ideal surgical technique for arthroscopic capsular release.