Pharmacological and Surgical Treatments
Drug
Non-Steroidal Anti-Inflammatory Drugs Oral Steroids Subscapularis Nerve Blocks (bupivacaine injection) Intra-Articular Steroid Injections (alternative to oral steroids; see images above) |
Effect
Routinely prescribed in all stages for analgesic effects assisting physical therapy and sleep Significant rapid pain relief, increased movement and decreased disability in the short term (3–4 weeks) Blocking nerve impulses to subscapularis muscle (susceptible to muscle guarding) thus decreasing overall pain Marked improvements in ROM and pain relief in stage 1 and early stage 2. Benefits may last up to a year |
Limitations
Limited literature on significant differences in drug and placebo groups
Negligible long term effects. Not routinely used if same benefit from injected (side-effects avoided) Lack of credible research since 2000 Higher level evidence for long term benefits unavailable |
Research
(Neviaser and Hannafin, 2010; Rhind et.al, 1982)
(Cochrane Review: Green et.al, 2010; Buchinder et.al, 2004) (Dahan et.al ,2000) (Neviaser and Hannafin, 2010; Van der Windt et.al, 1998; Rizk et.al, 1991) |
Procedure
Hydrodilatation Manipulation Under Anesthetics (MUA) MUA Video link (below) Arthroscopy (standard procedure for refractory adhesive capsulitis: see graphic above) Open Release Surgery (rarely performed) |
Effect
Injection of fluid into joint, stretching the capsule to allow greater range of motion and decrease pressure on nerve endings Removal of pain for short term allows for unrestricted manipulation. Large improvements for patients unresponsive to manual therapy Debriding joint to remove capsular contractures, manipulation and setting processes. Identification of potential secondary causes of symptoms Last resort following failure at arthroscopic and closed manipulation |
Limitations
Clinical experience with technique and application is limited Some complications with secondary injuries but these can be minimized with correct techniques Morbidity risks of open procedure and prolonged recovery Poor results for insulin dependent diabetics |
Literature
(Nevaiser and Hannafin 2010; Qurashi et.al, 2007) (Dodenhoff et.al, 2009; Ogilvie-Harriset.al, 1995) (Neviaser and Hannafin, 2010) (Omari and Buckner, 2001) |