Disclosures: Roshan Chhatlani, DO: No financial relationships or conflicts of interest

Objective: Determine the best available non-operative approach for adhesive capsulitis and optimal strategy for an appropriate treatment plan.

Design: Electronic search of multiple databases including PubMed, Wiley Online Library, Google Scholar, and Ovid Medline. Setting : This systematic review included case studies, consensus recommendations, literature reviews, and original research. Participants : Not applicable (N/A)

Interventions: Physical therapy, oral pharmacological therapy, intra-articular corticosteroid injections, intra-capsular hydrodilatation/hydrodissection, intra-articular platelet-rich plasma (PRP) injections, intra-articular sodium hyaluronate injections, and suprascapular nerve blocks.

Main Outcome Measures: Not applicable (N/A)

Results: One prospective study included oral steroids versus intra-articular steroid injections which revealed that intra-articular steroid injections provided better objective pain scores and patient satisfaction. Oral non-steroidal anti-inflammatory (NSAID) medications have been shown to also improve pain symptoms in the early stage but its efficacy versus oral steroids in adhesive capsulitis has not been studied. One study compared hydrodilatation along with intra-articular steroids versus injection of steroids without dilatation and the results showed there was no significant difference in the improvement of pain. There is evidence that a suprascapular nerve block can be beneficial for patients with refractory frozen shoulder cases while a more recent study reports that patients with both a suprascapular nerve block along with intra-articular corticosteroid injections have a greater treatment efficacy than those interventions alone. Intra-articular sodium hyaluronate injections remain controversial based on prior studies. Platelet-rich plasma (PRP) intra-articular injections may provide greater improvement when used in conjunction with intra-articular corticosteroid injections. Conclusions: Available studies show that physical therapy and intra-articular corticosteroid injections are effective first line treatments whether done alone or in combination. There may be a place for platelet-rich plasma in refractory cases of adhesive capsulitis but more multi-center randomized control trials with longer duration are needed.

Level of Evidence: Level I

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/current-non-operative-treatments-for-adhesive-capsulitis-a-systematic-review/