a prospective comparative study of three treatment
TRANSCRIPT
A PROSPECTIVE COMPARATIVE
STUDY OF THREE TREATMENT
MODALITIES FOR IDIOPATHIC
ADHESIVE
CAPSULITIS OF SHOULDER
Dr. Hemant Kumar Pippal
Dr. Manoj Kumar
Department of Orthopaedic Surgery
MAULANA AZAD MEDICAL COLLEGE
In this study no funding from any pharmaceutical
company nor any conflicts of interests were involved.
INTRODUCTION
DEFINITION
“A condition of uncertain etiology characterized by
significant restriction of both active and passive shoulder
motion that occurs in the absence of a known intrinsic
shoulder disorder”1.
IDIOPATHIC ADHESIVE
CAPSULITIS
TREATMENT OPTIONS
Treatment options:
1. supervised physical rehabilitation3
2. nonsteroidal anti-inflammatory medications4
3. oral corticosteroid3
4. intra-articular corticosteroid injection3
5. Intra- articular hydrodistension therapy3
6. closed manipulation5
7. open surgical release6
8. arthroscopic capsular release7
BEST TREATMENT MODALITY?
Ogilvie-Harris DJ et al7(1997)
• arthroscopic capsular release shortens the natural history of this condition.
Neviaser15 (1987) did not found similar effectiveness of surgical treatments.
Callinan et al41 (2003)
• Support hydrodilatation and nerve blockade.
Farrell CM et al45 (2005)
• Excellent results from manipulation
Maund et al8 in Health Technology Assessment (March 2012),
• concluded that there was limited clinical evidence on the effectiveness of treatments for
primary frozen shoulder.
NO
CONSENSUS
AIMS AND OBJECTIVES
Study the relative efficacy of Arthroscopic capsular release and
Intra-articular steroid injection matched to a control group of
patients receiving standard conservative treatment for Idiopathic
Adhesive Capsulitis of shoulder.
MATERIALS AND METHODS
STUDY DESIGN
• Prospective comparative study.
• Conducted from September 2012 to April 2014.
SAMPLE SIZE
• 30 consecutive patients of both sexes, 40 to 75 years of age.
1. Control/Conservative group of patients receiving Standard treatment i.e. Analgesics +
hot water fomentation + shortwave diathermy + supervised physiotherapy followed by
home exercises program.
2. Intra-articular steroids injections plus distension + supervised physiotherapy followed by
home exercises program.
3. Arthroscopic Capsular Release + supervised physiotherapy followed by home exercises program.
MATERIALS AND METHODS CONTD.
INCLUSION CRITERIA:
Binder & Bulgen3, Lundberg B.J5 and Codman9.
1. Shoulder Pain around Deltoid insertion for at least one month.
2. Restriction of movements, both active and passive.
3. normal radiographs of the shoulder.
EXCLUSION CRITERIA:
1. Injury to ipsilateral shoulder or arm.
2. Surgical procedure on ipsilateral shoulder, cervical spine, thorax and breast
within past 2 yrs.
3. uncontrolled diabetes10.
PARAMETERS ASSESED
ROM Measurements
1. Passive glenohumeral abduction
2. Passive external rotation
3. Passive internal rotation
4. Active overhead elevation
Shoulder Rating Questionnaire11
• no significant difference in the
pretreatment SRQ scores
OBSERVATIONS AND RESULTS
56.6% patients belonged to 40-50 years of age
Demographics
12 males and 18 females
DIABETES
• Diabetes was found to be
associated with adhesive capsulitis in
a very high percentage of patients
(66%) in the present study.
• 8 out of 30 patients were already on
treatment.
• 12 patients however, were
diagnosed to have impaired glucose
tolerance .
OBSERVATIONS AND RESULTS
The improvement gained in external rotation ROM was
statistically significant in Arthroscopic capsular release group as
compared to Conservative group at 6 months of follow-up
(p value 0.044; 95% C.I.)
DISCUSSION
Patients in the ACR groups achieved maximum gain in ROM in absolute values in all
the four movements. (p value >0.05)
The gain in external rotation, in ACR group was significantly better (p value <0.44)
However, in actual terms it did not translate into the SRQ scores.
This can be attributed to the fact that in the vast majority of patients it is the end
range of motion which is affected and it might not be necessarily needed for
patients in 50+ age groups and so overall functional outcome might still be sufficient
despite the fact there is still residual stiffness and pain.
CONCLUSION
Conservative management is usually the first line of management offered
for adhesive capsulitis.
Observations of our study make us believe that it is still an effective
treatment modality with consistent results and devoid of any iatrogenic
complications.
We were not able to draw any superiority of ACR and
steroid injection over conservative treatment except for
a finding of significantly improved external rotation in
ACR at six months of follow-up.
REFERENCES
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