The epidemiology and etiology of adhesive capsulitis in the U.S. Medicare population

Abstract

Background Adhesive capsulitis (AC) of the shoulder, also known as frozen shoulder, causes substantial pain and disability. In cases of secondary AC, the inflammation and fibrosis of the synovial joint can be triggered by trauma or surgery to the joint followed by extended immobility. However, for primary AC the inciting trigger is unknown. The burden of the disorder among the elderly is also unknown leading to this age group being left out of therapeutic research studies, potentially receiving delayed diagnoses, and unknown financial costs to the Medicare system. The purpose of this analysis was to describe the epidemiology of AC in individuals over the age of 65, an age group little studied for this disorder. The second purpose was to investigate whether specific medications, co-morbidities, infections, and traumas are risk factors or triggers for primary AC in this population. Methods We used Medicare claims data from 2010–2012 to investigate the prevalence of AC and assess comorbid risk factors and seasonality. Selected medications, distal trauma, and classes of infections as potential inflammatory triggers for primary AC were investigated using a case–control study design with patients with rotator cuff tears as the comparison group. Medications were identified from National Drug codes and translated to World Health Organization ATC codes for analysis. Health conditions were identified using ICD9-CM codes. Results We found a one-year prevalence rate of AC of approximately 0.35% among adults aged 65 years and older which translates to approximately 142,000 older adults in the United States having frozen shoulder syndrome. Diabetes and Parkinson’s disease were significantly associated with the diagnosis of AC in the elderly. Cases were somewhat more common from August through December, although a clear seasonal trend was not observed. Medications, traumas, and infections were similar for cases and controls. Conclusions This investigation identified the burden of AC in the US elderly population and applied case–control methodology to identify triggers for its onset in this population. Efforts to reduce chronic health conditions such as diabetes may reduce seemingly unrelated conditions such as AC. The inciting trigger for this idiopathic condition remains elusive.

Genome-Wide Association Study of Adhesive Capsulitis Suggests Significant Genetic Risk Factors

“…n Scott Kulm, PhD 1 Mark T. Langhans, MD, PhD 2 Tony S. Shen, MD 2 David A. Kolin, BS 1 Olivier Elemento, PhD 1 Scott A. Rodeo, MD 2…”

“…Adhesive capsulitis, or frozen shoulder, is a loss of range of motion with associated pain occurring in the glenohumeral joint of the shoulder, which can develop spontaneously, with no obvious injury or inciting event 1 . It is most common in females 40 to 60 years of age, but has a 1-year prevalence as high as 0.35% 2 and a lifetime prevalence of 10% 3 , making it one of the most common shoulder pathologies. Treatment of adhesive capsulitis can include intra-articular corticosteroid injections, physical therapy, and surgery 4 .…”

“…Weill Cornell Medicine, New York, NY2 Hospital for Special Surgery, New York, NY Email for corresponding author: langhans.1@gmail.com…”

Risk Factors for the Onset of Frozen Shoulder in Middle-Aged and Elderly Subjects Within 1 Year of Discharge From a Hospitalization That Involved Intravenous Infusion: A Prospective Cohort Study

“…The incidence of frozen shoulder among the middle-aged and elderly subjects included in this study was higher than previously reported for the general population. In Europe and the US, frozen shoulder affects an estimated 2% of the general population, with a cumulative incidence of 2.4 cases per 1,000 person-years ( 17 ); in the UK, the annual incidence of frozen shoulder in the general population is ~1.4 per 1,000 individuals ( 18 ); and in the US, the 1-year prevalence of frozen shoulder in individuals aged >65 years is 0.35% ( 19 ). In China, intravenous infusion is the most common mode of administration of medications, nutrients and fluids in inpatients; in 2016, 93.1% of inpatients in urban hospitals in China received intravenous medication administration ( 20 ).…”

Ultrasound-guided glenohumeral joint injections for shoulder pain in ALS: A Case Series

“…Similar pathology has been reported in both stroke and Parkinson's disease where there is motor dysfunction involving the shoulder. 18,19 Motion is critical to maintain and restore ROM. 13,16 For PALS with shoulder pain, stretching and range of motion exercises are recommended, and strategies to increase compliance can be helpful.…”