Review Question - QID 3158

Frozen shoulder, also known as adhesive capsulitis, is a frustrating condition for patients and requires significant patience as it takes several months to resolve. Resolution of symptoms typically occurs without significant intervention.

Neviaser et al. reviewed the management of adhesive capsulitis. Appropriate treatment begins with gentle progressive stretching exercises. Adjuncts such as NSAID's, intra-articular corticosteroids and hyaluronic acid may be used as needed. The primary indication for surgical intervention is a failure to obtain symptomatic improvement and continued functional disability following = 6 months of physical therapy.

Dierks et al. performed a prospective study on 77 patients with frozen shoulder. The group that underwent “supervised neglect” (gentle stretching and resumption of activities as symptoms allowed) had a higher percentage of Constant scores over 80 at 2 years, and also reached that level sooner, than patients who underwent aggressive therapy past the pain threshold. None of the patients in either group underwent injections or manipulations, although they could take NSAID's as needed.

Incorrect Answers:
Answer 1: Immediate aggressive physical therapy has not been shown to provide additional benefit compared to a gentle progressive stretching program.
Answer 2: There is currently no evidence for the use of PRP injections in patients with adhesive capsulitis.
Answer 3 & 5: Surgical intervention is not indicated in this patient as she has not yet had a trial of conservative therapy.