Zapalenie torebki stawowej barku (adhesive capsulitis) – Rokowania, prognozy i postęp choroby

Zapalenie torebki stawowej barku (adhesive capsulitis)
Rokowania, prognozy i postęp choroby

Zapalenie torebki stawowej barku (frozen shoulder) charakteryzuje się długotrwałym bólem i ograniczoną ruchomością, z naturalnym przebiegiem trwającym zwykle 1-3 lata. W badaniu obejmującym 269 barków u 223 pacjentów, po średnim okresie obserwacji 4,4 lat, 59% pacjentów osiągnęło stan prawie normalny, 41% zgłaszało utrzymujące się objawy (94% łagodne), a 6% doświadczało ciężkich dolegliwości. Najsilniejsza poprawa występuje we wczesnych fazach choroby, a tempo poprawy zwalnia w dalszym przebiegu. Czynniki prognostyczne obejmują nasilenie objawów początkowych (p<0,001), zakres rotacji zewnętrznej stawu barkowego, a także choroby współistniejące, takie jak cukrzyca, zaburzenia tarczycy, niska wartość BMI, spondyloza szyjna i hiperlipidemia. Model predykcyjny łączący BMI, spondylozę szyjną, cukrzycę typu 2 i hiperlipidemię wykazuje AUC 0,787, czułość 0,621 i swoistość 0,822 dla wystąpienia schorzenia.

Zapalenie torebki stawowej barku (adhesive capsulitis) – Rokowanie

Naturalny przebieg choroby
Czynniki prognostyczne
Rokowanie w zależności od metody leczenia
Komplikacje i nawroty
Implikacje kliniczne
Podsumowanie rokowania
Kolejne rozdziały

Zapalenie torebki stawowej barku (adhesive capsulitis) – Rokowanie

Zapalenie torebki stawowej barku (frozen shoulder) jest schorzeniem charakteryzującym się długotrwałym bólem barku i ograniczoną ruchomością. Mimo że choroba ta ma charakter samoograniczający się, rokowanie może być zróżnicowane w zależności od wielu czynników. Dogłębne zrozumienie przebiegu choroby i czynników prognostycznych ma kluczowe znaczenie dla właściwego zarządzania oczekiwaniami pacjentów oraz planowania terapii.¹²

Naturalny przebieg choroby

Naturalny przebieg zapalenia torebki stawowej barku najczęściej opisywany jest jako samoograniczający się, z poprawą występującą w ciągu 1-3 lat. Jednak dowody naukowe wskazują na bardziej złożony obraz progresji choroby.³ W badaniu z udziałem 269 stawów barkowych u 223 pacjentów ze średnim okresem obserwacji 4,4 lat (zakres 2-20 lat) zaobserwowano, że:

59% pacjentów osiągnęło stan normalny lub prawie normalny barku
41% pacjentów zgłaszało utrzymujące się objawy, z których większość (94%) była łagodna
Jedynie 6% pacjentów doświadczało ciężkich objawów z bólem i utratą funkcji⁴⁵

Badania nad długoterminowym przebiegiem choroby wykazały, że wbrew wcześniejszym przekonaniom, najsilniejsza poprawa następuje we wczesnych fazach choroby, a następnie tempo poprawy zwalnia. Jest to sprzeczne z tradycyjnym poglądem, że największa poprawa występuje w późniejszych etapach.⁶ W kontekście leczenia zachowawczego, badania wskazują, że u wielu pacjentów może utrzymywać się długotrwały ból, a nawet 10% pacjentów nigdy nie odzyskuje pełnej funkcji barku.⁷

Czynniki prognostyczne

W ocenie rokowania zapalenia torebki stawowej barku zidentyfikowano kilka istotnych czynników prognostycznych:

Czynniki kliniczne

Z badań wynika, że nasilenie objawów na początku choroby ma istotny wpływ na rokowanie długoterminowe. Pacjenci z najcięższymi objawami w momencie wystąpienia choroby mają najgorsze rokowanie długoterminowe (p<0,001).⁸ Dodatkowo zakres rotacji zewnętrznej w stawie barkowym okazał się czynnikiem prognostycznym wpływającym na ból barku, niepełnosprawność i jakość życia w 9-miesięcznej obserwacji.⁹

Choroby współistniejące

Obecność chorób współistniejących znacząco wpływa na rokowanie w zapaleniu torebki stawowej barku:

Cukrzyca – jednoznacznie zidentyfikowana jako negatywny czynnik prognostyczny dla wyniku końcowego¹⁰
Zaburzenia tarczycy – wpływają na rokowanie dotyczące bólu, niepełnosprawności i jakości życia¹¹
Objawy autonomiczne – stanowią czynnik prognostyczny dla wyników leczenia¹²
Niska wartość BMI, spondyloza szyjna, cukrzyca typu 2 i hiperlipidemia – zidentyfikowane jako niezależne czynniki ryzyka dla zapalenia torebki stawowej barku¹³

Warto zaznaczyć, że model oparty na kombinacji czynników: BMI, spondylozy szyjnej, cukrzycy typu 2 i hiperlipidemii wykazuje dobrą zdolność predykcyjną wystąpienia zapalenia torebki stawowej barku, z polem pod krzywą 0,787, czułością 0,621 i swoistością 0,822.¹⁴

Czynniki psychologiczne

Badania wykazały, że czynniki psychometryczne mierzone za pomocą podskali Pseudoneurologii w kwestionariuszu SHC (Subjective Health Complaints) mogą przewidywać wynik leczenia w zamrożonym barku mierzony za pomocą SPADI (Shoulder Pain and Disability Index) po 8 tygodniach (p<0,001). Nie przewidują one jednak tempa poprawy (zmiany w SPADI od punktu wyjściowego do 8 tygodni). Sugeruje to, że parametry psychometryczne mogą wpływać na objawy, ale nie przewidują tempa zdrowienia.¹⁵¹⁶

Co ciekawe, w badaniu stwierdzono, że pacjenci z zamrożonym barkiem wykazywali niewielką współchorobowość mierzoną kwestionariuszem SHC i uzyskiwali normalne wyniki w zakresie neurotyczności.¹⁷ W kontekście ogólnym, współchorobowość psychologiczna zwiększa subiektywne odczuwanie cierpienia związanego z bólem i dysfunkcją.¹⁸

Rokowanie w zależności od metody leczenia

Wpływ metody leczenia na długoterminowe rokowanie w zapaleniu torebki stawowej barku jest nadal przedmiotem badań:

Zapalenie torebki stawowej barku jest uważane za schorzenie samoograniczające się, a długoterminowe wyniki są zasadniczo takie same, niezależnie od zastosowanej metody leczenia¹⁹
Pacjenci zakwalifikowani do grupy interwencyjnej mieli istotnie lepsze rokowanie (p<0,001) zarówno w zakresie wyniku SPADI po 8 tygodniach, jak i zmiany w SPADI od wartości wyjściowej do 8 tygodnia²⁰
Badania dotyczące hydrodilatacji (rozszerzania wodnego) przyniosły sprzeczne wyniki, szczególnie u pacjentów z cukrzycą. Systematyczny przegląd i metaanaliza wykazały, że hydrodilatacja ma jedynie niewielki, klinicznie nieistotny wpływ na zapalenie torebki stawowej barku²¹
Przegląd leczenia chirurgicznego w 56 przypadkach wykazał, że kapsulotomia dolna daje najlepsze wyniki, a niższe wskaźniki ponownych operacji obserwowano u pacjentów otrzymujących śródmiąższową infuzję znieczulenia do rehabilitacji pooperacyjnej²²

Komplikacje i nawroty

Dominującym powikłaniem zapalenia torebki stawowej barku jest utrzymująca się sztywność barku lub ból. Kilka doniesień wskazuje, że u większości pacjentów ból i/lub sztywność mogą utrzymywać się nawet do 3 lat po leczeniu zachowawczym.²³ Niewielka liczba pacjentów doświadcza nawrotu choroby pomimo interwencji chirurgicznej i fizjoterapii. W takich przypadkach wskazane może być zastosowanie blokady międzyskaleniowej i intensywnej fizjoterapii.²⁴

Implikacje kliniczne

Analizy korelacji w badaniach długoterminowych wykazały głównie słabe do umiarkowanych korelacje, co sugeruje, że w ocenie i leczeniu zapalenia torebki stawowej barku należy uwzględnić także inne zmienne niż tylko fizyczne.²⁵ Warto podkreślić, że wyniki leczenia w tej populacji mogą być zależne od różnych zmiennych, co wskazuje na konieczność indywidualnego podejścia do każdego pacjenta.²⁶

Biorąc pod uwagę, że większość poprawy funkcjonalnej następuje we wczesnych fazach (3-6 miesięcy) po ocenie wyjściowej, a rotacja zewnętrzna i wewnętrzna w poziomie stawu barkowego nadal poprawiają się w dłuższej perspektywie, planowanie leczenia powinno uwzględniać te naturalne wzorce zdrowienia.²⁷

Podsumowanie rokowania

Zapalenie torebki stawowej barku jest schorzeniem, które w większości przypadków ma tendencję do samoograniczania się, jednak u znaczącej części pacjentów (około 40%) objawy mogą utrzymywać się długoterminowo. Na rokowanie wpływają czynniki takie jak nasilenie początkowych objawów, obecność chorób współistniejących (szczególnie cukrzycy), zakres rotacji zewnętrznej oraz czynniki psychologiczne. Metody leczenia mogą wpływać na tempo poprawy, ale długoterminowe wyniki są często podobne niezależnie od zastosowanej terapii. Zrozumienie tych czynników prognostycznych jest kluczowe dla właściwego zarządzania oczekiwaniami pacjentów i optymalizacji planu leczenia.²⁸²⁹³⁰

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Materiały źródłowe

#1 Adhesive Capsulitis (Frozen Shoulder) Treatment & Management: Approach Considerations, Medical Therapy, Extracorporeal Shockwave Therapy
https://emedicine.medscape.com/article/1261598-treatment
The goals of treatment for frozen shoulder syndrome (FSS) are to relieve pain and restore movement and shoulder function. FSS is self-limiting; long-term outcomes are essentially the same, regardless of the treatment used. […] However, studies on the natural history of the condition have noted long-term pain in many patients who receive nonoperative treatment, with as many as 10% of patients never fully recovering normal shoulder activities. […] Studies of hydrodilatation have yielded conflicting results, especially with regard to patients with diabetes mellitus. For example, a systematic review and meta-analysis concluded that hydrodilatation has only a small, clinically insignificant effect on adhesive capsulitis. […] A review by Miyazaki et al of surgical treatment in 56 shoulders with FSS concluded that that inferior capsulotomy yields the best results. In addition, these authors reported lower reoperation rates in patients who receive interscalene catheter anesthetic infusion for postoperative rehabilitation.
#2 Risk factors and predictive models for frozen shoulder | Scientific Reports
https://www.nature.com/articles/s41598-024-66360-y
Frozen shoulder (FS) is characterized by enduring shoulder pain and restricted mobility. The natural progression of FS is typically self-limiting, with symptoms subsiding within a span of 2 years. Nevertheless, a considerable number of individuals encounter persistent symptoms and functional impairments. In their study, Kim et al. discovered that 41% of the 223 patients examined continued to experience persistent symptoms four years after the initial onset. Additionally, 6% of these patients reported severe pain and loss of function. The symptoms associated with FS have the potential to cause disability in patients and contribute to increased public healthcare expenditures. […] Despite the existence of numerous studies investigating the risk factors associated with FS, the challenge of early diagnosis persists. Furthermore, a significant proportion of patients exhibit multiple comorbidities. Currently, no research has been conducted to determine whether diverse risk factors can predict the onset of FS. Consequently, the objective of this study is to identify the risk factors associated with FS by means of a case-control study, develop a predictive model, and formulate a simplified equation, with the ultimate aim of offering valuable insights for the early detection of FS.
#3 Exploration of the clinical course of frozen shoulder: A longitudinal multicenter prospective study of functional impairments | Brazilian Journal of Physical Therapy
https://www.rbf-bjpt.org.br/en-exploration-clinical-course-frozen-shoulder-articulo-S1413355523000606
Most functional impairments the patients experience improve in the short-term. […] Shoulder rotation at 90 abduction continues to improve in the long-term. […] Almost all factors improved in the early phase (36 months) after baseline assessment, while ER and IR ROM at shoulder level continued to improve long term. […] Formerly, the clinical course of FS was often described as self-limiting, with recovery within 1 to 3 years, with most recovery in the later stages. […] In contrast, Wong et al., in their systematic literature review, found moderate evidence for an improvement in range of motion (ROM) and shoulder disability in the early stages, which slows with time. […] The primary aim of the current study was to explore the clinical course of FS over a 9-month period after baseline assessment regarding self-reported shoulder disabilities, pain intensity, ROM, muscle strength, scapular upward rotation, and proprioception.
#4 Long-term outcome of frozen shoulder – PubMed
https://pubmed.ncbi.nlm.nih.gov/17993282/
Two-hundred and sixty-nine shoulders in 223 patients with a diagnosis of primary frozen shoulder were studied. The main outcome measure was the Oxford shoulder score. The mean follow-up from symptom onset was 4.4 years (range, 2-20 years). The mean age at symptom onset was 53.4 years; with women affected more commonly than men (1.6:1.0). […] In the long term, 59% of patients had normal or near normal shoulders and 41% reported some ongoing symptoms. The majority of these persistent symptoms were mild (94%), with pain being the most common complaint. Only 6% had severe symptoms with pain and functional loss. Those with the most severe symptoms at condition onset had the worst long-term prognosis, P .001.
#5 Risk factors and predictive models for frozen shoulder | Scientific Reports
https://www.nature.com/articles/s41598-024-66360-y
Frozen shoulder (FS) is characterized by enduring shoulder pain and restricted mobility. The natural progression of FS is typically self-limiting, with symptoms subsiding within a span of 2 years. Nevertheless, a considerable number of individuals encounter persistent symptoms and functional impairments. In their study, Kim et al. discovered that 41% of the 223 patients examined continued to experience persistent symptoms four years after the initial onset. Additionally, 6% of these patients reported severe pain and loss of function. The symptoms associated with FS have the potential to cause disability in patients and contribute to increased public healthcare expenditures. […] Despite the existence of numerous studies investigating the risk factors associated with FS, the challenge of early diagnosis persists. Furthermore, a significant proportion of patients exhibit multiple comorbidities. Currently, no research has been conducted to determine whether diverse risk factors can predict the onset of FS. Consequently, the objective of this study is to identify the risk factors associated with FS by means of a case-control study, develop a predictive model, and formulate a simplified equation, with the ultimate aim of offering valuable insights for the early detection of FS.
#6 Exploration of the clinical course of frozen shoulder: A longitudinal multicenter prospective study of functional impairments | Brazilian Journal of Physical Therapy
https://www.rbf-bjpt.org.br/en-exploration-clinical-course-frozen-shoulder-articulo-S1413355523000606
Most functional impairments the patients experience improve in the short-term. […] Shoulder rotation at 90 abduction continues to improve in the long-term. […] Almost all factors improved in the early phase (36 months) after baseline assessment, while ER and IR ROM at shoulder level continued to improve long term. […] Formerly, the clinical course of FS was often described as self-limiting, with recovery within 1 to 3 years, with most recovery in the later stages. […] In contrast, Wong et al., in their systematic literature review, found moderate evidence for an improvement in range of motion (ROM) and shoulder disability in the early stages, which slows with time. […] The primary aim of the current study was to explore the clinical course of FS over a 9-month period after baseline assessment regarding self-reported shoulder disabilities, pain intensity, ROM, muscle strength, scapular upward rotation, and proprioception.
#7 Adhesive Capsulitis (Frozen Shoulder) Treatment & Management: Approach Considerations, Medical Therapy, Extracorporeal Shockwave Therapy
https://emedicine.medscape.com/article/1261598-treatment
The goals of treatment for frozen shoulder syndrome (FSS) are to relieve pain and restore movement and shoulder function. FSS is self-limiting; long-term outcomes are essentially the same, regardless of the treatment used. […] However, studies on the natural history of the condition have noted long-term pain in many patients who receive nonoperative treatment, with as many as 10% of patients never fully recovering normal shoulder activities. […] Studies of hydrodilatation have yielded conflicting results, especially with regard to patients with diabetes mellitus. For example, a systematic review and meta-analysis concluded that hydrodilatation has only a small, clinically insignificant effect on adhesive capsulitis. […] A review by Miyazaki et al of surgical treatment in 56 shoulders with FSS concluded that that inferior capsulotomy yields the best results. In addition, these authors reported lower reoperation rates in patients who receive interscalene catheter anesthetic infusion for postoperative rehabilitation.
#8 Long-term outcome of frozen shoulder – PubMed
https://pubmed.ncbi.nlm.nih.gov/17993282/
Two-hundred and sixty-nine shoulders in 223 patients with a diagnosis of primary frozen shoulder were studied. The main outcome measure was the Oxford shoulder score. The mean follow-up from symptom onset was 4.4 years (range, 2-20 years). The mean age at symptom onset was 53.4 years; with women affected more commonly than men (1.6:1.0). […] In the long term, 59% of patients had normal or near normal shoulders and 41% reported some ongoing symptoms. The majority of these persistent symptoms were mild (94%), with pain being the most common complaint. Only 6% had severe symptoms with pain and functional loss. Those with the most severe symptoms at condition onset had the worst long-term prognosis, P .001.
#9 Understanding the clinical profile of patients with frozen shoulder: a longitudinal multicentre observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9680192/
There is a large diversity in the clinical presentation of frozen shoulder (FS) and the clinical outcome is not always satisfactory. […] Shoulder pain and disability improved over time and diabetes mellitus was found to be a prognostic factor for final outcome. […] In patients with FS, prognostic variables were able to predict different outcomes, indicating that outcomes in this population can be variable-dependent. […] External rotation ROM, and presence of DM, thyroid disorder and autonomic symptoms at baseline emerged to be prognostic factors for shoulder pain, disability and quality of life over 9 months follow-up in patients with FS. These factors explained 2.5%6.3% of the variance of those outcomes with adjustment for several covariates (ie, baseline score shoulder pain and disability and quality of life respectively, age, gender, treatment category and geographical region).
#10 Understanding the clinical profile of patients with frozen shoulder: a longitudinal multicentre observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9680192/
There is a large diversity in the clinical presentation of frozen shoulder (FS) and the clinical outcome is not always satisfactory. […] Shoulder pain and disability improved over time and diabetes mellitus was found to be a prognostic factor for final outcome. […] In patients with FS, prognostic variables were able to predict different outcomes, indicating that outcomes in this population can be variable-dependent. […] External rotation ROM, and presence of DM, thyroid disorder and autonomic symptoms at baseline emerged to be prognostic factors for shoulder pain, disability and quality of life over 9 months follow-up in patients with FS. These factors explained 2.5%6.3% of the variance of those outcomes with adjustment for several covariates (ie, baseline score shoulder pain and disability and quality of life respectively, age, gender, treatment category and geographical region).
#11 Understanding the clinical profile of patients with frozen shoulder: a longitudinal multicentre observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9680192/
There is a large diversity in the clinical presentation of frozen shoulder (FS) and the clinical outcome is not always satisfactory. […] Shoulder pain and disability improved over time and diabetes mellitus was found to be a prognostic factor for final outcome. […] In patients with FS, prognostic variables were able to predict different outcomes, indicating that outcomes in this population can be variable-dependent. […] External rotation ROM, and presence of DM, thyroid disorder and autonomic symptoms at baseline emerged to be prognostic factors for shoulder pain, disability and quality of life over 9 months follow-up in patients with FS. These factors explained 2.5%6.3% of the variance of those outcomes with adjustment for several covariates (ie, baseline score shoulder pain and disability and quality of life respectively, age, gender, treatment category and geographical region).
#12 Understanding the clinical profile of patients with frozen shoulder: a longitudinal multicentre observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9680192/
There is a large diversity in the clinical presentation of frozen shoulder (FS) and the clinical outcome is not always satisfactory. […] Shoulder pain and disability improved over time and diabetes mellitus was found to be a prognostic factor for final outcome. […] In patients with FS, prognostic variables were able to predict different outcomes, indicating that outcomes in this population can be variable-dependent. […] External rotation ROM, and presence of DM, thyroid disorder and autonomic symptoms at baseline emerged to be prognostic factors for shoulder pain, disability and quality of life over 9 months follow-up in patients with FS. These factors explained 2.5%6.3% of the variance of those outcomes with adjustment for several covariates (ie, baseline score shoulder pain and disability and quality of life respectively, age, gender, treatment category and geographical region).
#13 Risk factors and predictive models for frozen shoulder | Scientific Reports
https://www.nature.com/articles/s41598-024-66360-y
The multivariate binary logistic regression analysis revealed that low BMI, cervical spondylosis, type 2 diabetes, and hyperlipidemia were identified as independent risk factors for FS. These factors were subsequently incorporated into a diagnostic prediction model, resulting in the development of simplified equations. The findings indicate that the combined index of BMI, cervical spondylosis, type 2 diabetes, and hyperlipidemia exhibits a favorable predictive capability for the occurrence of FS, as evidenced by an area under the curve of 0.787, a sensitivity of 0.621, and a specificity of 0.822. Consequently, this combined index holds promise as a valuable tool for early clinical diagnosis of FS.
#14 Risk factors and predictive models for frozen shoulder | Scientific Reports
https://www.nature.com/articles/s41598-024-66360-y
The multivariate binary logistic regression analysis revealed that low BMI, cervical spondylosis, type 2 diabetes, and hyperlipidemia were identified as independent risk factors for FS. These factors were subsequently incorporated into a diagnostic prediction model, resulting in the development of simplified equations. The findings indicate that the combined index of BMI, cervical spondylosis, type 2 diabetes, and hyperlipidemia exhibits a favorable predictive capability for the occurrence of FS, as evidenced by an area under the curve of 0.787, a sensitivity of 0.621, and a specificity of 0.822. Consequently, this combined index holds promise as a valuable tool for early clinical diagnosis of FS.
#15 Predicting outcome in frozen shoulder (shoulder capsulitis) in presence of comorbidity as measured with subjective health complaints and neuroticism | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-017-1740-9
There is a substantive lack of knowledge about comorbidity in patients with frozen shoulder. The aim of this study was to investigate whether subjective health complaints and Neuroticism would predict treatment outcome in patients diagnosed with frozen shoulder as measured by the Shoulder Pain and Disability Index (SPADI) and change in SPADI. […] In this study, patients with frozen shoulder had little comorbidity as measured with SHC and scored normally with respect to Neuroticism. Only the Pseudoneurology subscale in SHC correlated significantly with SPADI and had significant predictive power (p 0.001) for the outcome at 8 weeks. […] Psychometric parameters as measured by the Pseudoneurology subscale in SHC questionnaire did predict the treatment outcome in frozen shoulder as measured by SPADI at 8 weeks, but not by change in SPADI from baseline to 8 weeks. One may conclude that psychometric parameters may affect symptoms, but do not predict the rate of recovery in frozen shoulder.
#16 Predicting outcome in frozen shoulder (shoulder capsulitis) in presence of comorbidity as measured with subjective health complaints and neuroticism | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-017-1740-9
In this study, we found that patients with frozen shoulder had little comorbidity as measured with SHC and they scored normally on the Neuroticism questionnaire. We found that both the SHC Pseudoneurology subscale and group allocation predicted pain and function as measured by SPADI at 8 weeks. However, when looking at factors predicting change in SPADI from baseline to 8 weeks, shoulder pain duration and group allocation predicted better outcome, while SHC as a whole and each subscale lost its predictive power. […] Belonging to the intervention group had significant predictive value (p 0.001) for both SPADI at 8 weeks and change in SPADI from baseline to 8 weeks. Contrary to what we had expected, SHC total score, SHC subscales and Neuroticism had no predictive value for change in SPADI from baseline to 8 weeks. […] In general, psychological comorbidity has been found to enhance self-experience of suffering due to pain and dysfunction.
#17 Predicting outcome in frozen shoulder (shoulder capsulitis) in presence of comorbidity as measured with subjective health complaints and neuroticism | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-017-1740-9
There is a substantive lack of knowledge about comorbidity in patients with frozen shoulder. The aim of this study was to investigate whether subjective health complaints and Neuroticism would predict treatment outcome in patients diagnosed with frozen shoulder as measured by the Shoulder Pain and Disability Index (SPADI) and change in SPADI. […] In this study, patients with frozen shoulder had little comorbidity as measured with SHC and scored normally with respect to Neuroticism. Only the Pseudoneurology subscale in SHC correlated significantly with SPADI and had significant predictive power (p 0.001) for the outcome at 8 weeks. […] Psychometric parameters as measured by the Pseudoneurology subscale in SHC questionnaire did predict the treatment outcome in frozen shoulder as measured by SPADI at 8 weeks, but not by change in SPADI from baseline to 8 weeks. One may conclude that psychometric parameters may affect symptoms, but do not predict the rate of recovery in frozen shoulder.
#18 Predicting outcome in frozen shoulder (shoulder capsulitis) in presence of comorbidity as measured with subjective health complaints and neuroticism | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-017-1740-9
In this study, we found that patients with frozen shoulder had little comorbidity as measured with SHC and they scored normally on the Neuroticism questionnaire. We found that both the SHC Pseudoneurology subscale and group allocation predicted pain and function as measured by SPADI at 8 weeks. However, when looking at factors predicting change in SPADI from baseline to 8 weeks, shoulder pain duration and group allocation predicted better outcome, while SHC as a whole and each subscale lost its predictive power. […] Belonging to the intervention group had significant predictive value (p 0.001) for both SPADI at 8 weeks and change in SPADI from baseline to 8 weeks. Contrary to what we had expected, SHC total score, SHC subscales and Neuroticism had no predictive value for change in SPADI from baseline to 8 weeks. […] In general, psychological comorbidity has been found to enhance self-experience of suffering due to pain and dysfunction.
#19 Adhesive Capsulitis (Frozen Shoulder) Treatment & Management: Approach Considerations, Medical Therapy, Extracorporeal Shockwave Therapy
https://emedicine.medscape.com/article/1261598-treatment
The goals of treatment for frozen shoulder syndrome (FSS) are to relieve pain and restore movement and shoulder function. FSS is self-limiting; long-term outcomes are essentially the same, regardless of the treatment used. […] However, studies on the natural history of the condition have noted long-term pain in many patients who receive nonoperative treatment, with as many as 10% of patients never fully recovering normal shoulder activities. […] Studies of hydrodilatation have yielded conflicting results, especially with regard to patients with diabetes mellitus. For example, a systematic review and meta-analysis concluded that hydrodilatation has only a small, clinically insignificant effect on adhesive capsulitis. […] A review by Miyazaki et al of surgical treatment in 56 shoulders with FSS concluded that that inferior capsulotomy yields the best results. In addition, these authors reported lower reoperation rates in patients who receive interscalene catheter anesthetic infusion for postoperative rehabilitation.
#20 Predicting outcome in frozen shoulder (shoulder capsulitis) in presence of comorbidity as measured with subjective health complaints and neuroticism | BMC Musculoskeletal Disorders | Full Text
https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-017-1740-9
In this study, we found that patients with frozen shoulder had little comorbidity as measured with SHC and they scored normally on the Neuroticism questionnaire. We found that both the SHC Pseudoneurology subscale and group allocation predicted pain and function as measured by SPADI at 8 weeks. However, when looking at factors predicting change in SPADI from baseline to 8 weeks, shoulder pain duration and group allocation predicted better outcome, while SHC as a whole and each subscale lost its predictive power. […] Belonging to the intervention group had significant predictive value (p 0.001) for both SPADI at 8 weeks and change in SPADI from baseline to 8 weeks. Contrary to what we had expected, SHC total score, SHC subscales and Neuroticism had no predictive value for change in SPADI from baseline to 8 weeks. […] In general, psychological comorbidity has been found to enhance self-experience of suffering due to pain and dysfunction.
#21 Adhesive Capsulitis (Frozen Shoulder) Treatment & Management: Approach Considerations, Medical Therapy, Extracorporeal Shockwave Therapy
https://emedicine.medscape.com/article/1261598-treatment
The goals of treatment for frozen shoulder syndrome (FSS) are to relieve pain and restore movement and shoulder function. FSS is self-limiting; long-term outcomes are essentially the same, regardless of the treatment used. […] However, studies on the natural history of the condition have noted long-term pain in many patients who receive nonoperative treatment, with as many as 10% of patients never fully recovering normal shoulder activities. […] Studies of hydrodilatation have yielded conflicting results, especially with regard to patients with diabetes mellitus. For example, a systematic review and meta-analysis concluded that hydrodilatation has only a small, clinically insignificant effect on adhesive capsulitis. […] A review by Miyazaki et al of surgical treatment in 56 shoulders with FSS concluded that that inferior capsulotomy yields the best results. In addition, these authors reported lower reoperation rates in patients who receive interscalene catheter anesthetic infusion for postoperative rehabilitation.
#22 Adhesive Capsulitis (Frozen Shoulder) Treatment & Management: Approach Considerations, Medical Therapy, Extracorporeal Shockwave Therapy
https://emedicine.medscape.com/article/1261598-treatment
The goals of treatment for frozen shoulder syndrome (FSS) are to relieve pain and restore movement and shoulder function. FSS is self-limiting; long-term outcomes are essentially the same, regardless of the treatment used. […] However, studies on the natural history of the condition have noted long-term pain in many patients who receive nonoperative treatment, with as many as 10% of patients never fully recovering normal shoulder activities. […] Studies of hydrodilatation have yielded conflicting results, especially with regard to patients with diabetes mellitus. For example, a systematic review and meta-analysis concluded that hydrodilatation has only a small, clinically insignificant effect on adhesive capsulitis. […] A review by Miyazaki et al of surgical treatment in 56 shoulders with FSS concluded that that inferior capsulotomy yields the best results. In addition, these authors reported lower reoperation rates in patients who receive interscalene catheter anesthetic infusion for postoperative rehabilitation.
#23 Adhesive Capsulitis (Frozen Shoulder) Treatment & Management: Approach Considerations, Medical Therapy, Extracorporeal Shockwave Therapy
https://emedicine.medscape.com/article/1261598-treatment
A small number of patients with adhesive capsulitis experience relapse, despite surgical intervention and physical therapy. Admitting these patients for interscalene anesthesia and aggressive physical therapy may be appropriate. […] The predominant complication arising from adhesive capsulitis is residual shoulder stiffness or pain. Several reports have indicated that most patients may continue to have pain and/or stiffness for up to 3 years following conservative treatment.
#24 Adhesive Capsulitis (Frozen Shoulder) Treatment & Management: Approach Considerations, Medical Therapy, Extracorporeal Shockwave Therapy
https://emedicine.medscape.com/article/1261598-treatment
A small number of patients with adhesive capsulitis experience relapse, despite surgical intervention and physical therapy. Admitting these patients for interscalene anesthesia and aggressive physical therapy may be appropriate. […] The predominant complication arising from adhesive capsulitis is residual shoulder stiffness or pain. Several reports have indicated that most patients may continue to have pain and/or stiffness for up to 3 years following conservative treatment.
#25 Exploration of the clinical course of frozen shoulder: A longitudinal multicenter prospective study of functional impairments | Brazilian Journal of Physical Therapy
https://www.rbf-bjpt.org.br/en-exploration-clinical-course-frozen-shoulder-articulo-S1413355523000606
The results indicate stronger recovery in the early phases but then slows down in the later phases, potentially leading to incomplete recovery as stated by some authors. […] The longitudinal correlation analyses indicated mainly poor to moderate correlations, suggesting that there are also other variables that need to be considered during assessment and treatment besides the physical variables.
#26 Understanding the clinical profile of patients with frozen shoulder: a longitudinal multicentre observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9680192/
There is a large diversity in the clinical presentation of frozen shoulder (FS) and the clinical outcome is not always satisfactory. […] Shoulder pain and disability improved over time and diabetes mellitus was found to be a prognostic factor for final outcome. […] In patients with FS, prognostic variables were able to predict different outcomes, indicating that outcomes in this population can be variable-dependent. […] External rotation ROM, and presence of DM, thyroid disorder and autonomic symptoms at baseline emerged to be prognostic factors for shoulder pain, disability and quality of life over 9 months follow-up in patients with FS. These factors explained 2.5%6.3% of the variance of those outcomes with adjustment for several covariates (ie, baseline score shoulder pain and disability and quality of life respectively, age, gender, treatment category and geographical region).
#27 Exploration of the clinical course of frozen shoulder: A longitudinal multicenter prospective study of functional impairments | Brazilian Journal of Physical Therapy
https://www.rbf-bjpt.org.br/en-exploration-clinical-course-frozen-shoulder-articulo-S1413355523000606
Most functional impairments the patients experience improve in the short-term. […] Shoulder rotation at 90 abduction continues to improve in the long-term. […] Almost all factors improved in the early phase (36 months) after baseline assessment, while ER and IR ROM at shoulder level continued to improve long term. […] Formerly, the clinical course of FS was often described as self-limiting, with recovery within 1 to 3 years, with most recovery in the later stages. […] In contrast, Wong et al., in their systematic literature review, found moderate evidence for an improvement in range of motion (ROM) and shoulder disability in the early stages, which slows with time. […] The primary aim of the current study was to explore the clinical course of FS over a 9-month period after baseline assessment regarding self-reported shoulder disabilities, pain intensity, ROM, muscle strength, scapular upward rotation, and proprioception.
#28 Long-term outcome of frozen shoulder – PubMed
https://pubmed.ncbi.nlm.nih.gov/17993282/
Two-hundred and sixty-nine shoulders in 223 patients with a diagnosis of primary frozen shoulder were studied. The main outcome measure was the Oxford shoulder score. The mean follow-up from symptom onset was 4.4 years (range, 2-20 years). The mean age at symptom onset was 53.4 years; with women affected more commonly than men (1.6:1.0). […] In the long term, 59% of patients had normal or near normal shoulders and 41% reported some ongoing symptoms. The majority of these persistent symptoms were mild (94%), with pain being the most common complaint. Only 6% had severe symptoms with pain and functional loss. Those with the most severe symptoms at condition onset had the worst long-term prognosis, P .001.
#29 Adhesive Capsulitis (Frozen Shoulder) Treatment & Management: Approach Considerations, Medical Therapy, Extracorporeal Shockwave Therapy
https://emedicine.medscape.com/article/1261598-treatment
The goals of treatment for frozen shoulder syndrome (FSS) are to relieve pain and restore movement and shoulder function. FSS is self-limiting; long-term outcomes are essentially the same, regardless of the treatment used. […] However, studies on the natural history of the condition have noted long-term pain in many patients who receive nonoperative treatment, with as many as 10% of patients never fully recovering normal shoulder activities. […] Studies of hydrodilatation have yielded conflicting results, especially with regard to patients with diabetes mellitus. For example, a systematic review and meta-analysis concluded that hydrodilatation has only a small, clinically insignificant effect on adhesive capsulitis. […] A review by Miyazaki et al of surgical treatment in 56 shoulders with FSS concluded that that inferior capsulotomy yields the best results. In addition, these authors reported lower reoperation rates in patients who receive interscalene catheter anesthetic infusion for postoperative rehabilitation.
#30 Understanding the clinical profile of patients with frozen shoulder: a longitudinal multicentre observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9680192/
There is a large diversity in the clinical presentation of frozen shoulder (FS) and the clinical outcome is not always satisfactory. […] Shoulder pain and disability improved over time and diabetes mellitus was found to be a prognostic factor for final outcome. […] In patients with FS, prognostic variables were able to predict different outcomes, indicating that outcomes in this population can be variable-dependent. […] External rotation ROM, and presence of DM, thyroid disorder and autonomic symptoms at baseline emerged to be prognostic factors for shoulder pain, disability and quality of life over 9 months follow-up in patients with FS. These factors explained 2.5%6.3% of the variance of those outcomes with adjustment for several covariates (ie, baseline score shoulder pain and disability and quality of life respectively, age, gender, treatment category and geographical region).