Adhesive capsulitis: a review of current clinical treatments

Abstract

Adhesive Capsulitis of the shoulder or arthrofibrosis describes a pathological process in which the body forms excessive scar tissue or adhesions across the glenohumeral joint, leading to pain, stiffness, and dysfunction. It is a debilitating condition that can occur spontaneously (primary or idiopathic adhesive capsulitis) or following shoulder surgery or trauma (secondary adhesive capsulitis). Here we review the pathophysiology of adhesive capsulitis of the shoulder, highlighting its clinical presentation, natural history, risk factors, pathoanatomy, and pathogenesis. Both current non-operative and operative treatments for adhesive capsulitis are discussed and evidence-based studies are presented in support of or against each corresponding treatment. Research carried out in the MEDLINE/ PubMed / Research gate/ Google scholars using Mesh Terms: “adhesive capsulitis”, “frozen shoulder”, and “treatment”. The articles in English published were selected, after which non-relevant articles were excluded based on the title, reading of the abstract, and full article. Physical therapy along with medication has proven to be beneficial either isolated or concomitantly with other therapeutic approaches. Alternate options like capsular distension, manipulation under anesthesia, and arthroscopic surgery have reported good results, especially in refractory cases. No significant benefits were found with the use of oral corticosteroids, NSAIDs, or acupuncture. New treatment options are currently being tested with promising results. There are several effective options for the treatment of Adhesive capsulitis. In the early stages, conservative measures should be chosen with special emphasis on physical therapy within the limits of pain associated with low-dose intra-articular injection of corticosteroids. More invasive treatment options should be suggested namely capsular distention and manipulation under anesthesia.