What’s your view of shoulder surgery for adhesive capsulitis, pain and reduced range of motion? Patient has tried extensive physical therapy and steroid injections without major improvement. Shoulder was injured in a fall in January. Surgery would be shoulder arthroscopy, lysis of adhesions, manipulation under anesthesia.
An exam suggested adhesive capsulitis. Follow-up imaging:
Shoulder XR - no significant OA, type II acromion, no fractures
Shoulder MRI - adhesive capsulitis, no significant rotator cuff tear
I genuinely hate to play it depends here, but it really does in these instances. It is ultimately the patient’s decision but the evidence for this type of surgery isn’t great. The upside of adhesive capsulitis is it tends to be self resolving, the downside is that the time frame in which that occurs is often on the year scale. Things that would likely influence how hard I would lean towards surgery would be what is the gain in ROM for ER/IR/flx since January, what functional improvements have occurred (something like a SPADI can be useful here), what are current pain levels, what constituted extensive physical therapy (this is a big one for me, but I will also concede shows my bias), and what the surgeon’s expectations were for resolution. I realize that is a lot but it’s not uncommon with this diagnosis to have some improvement in domains but it not feel like it as the patient isn’t back to doing all the things they want to do. If they gained 30 degrees ROM, SPADI improved, but they were still experiencing pain and that was the primary driver we may have some conversations around how the upper limit of threshold for tolerance has improved but symptoms are staying the same. Once again though, it is ultimately the patients decision.
The patient has had a very high level of pain throughout. She’s now more used to it, but it still makes things very difficult. Her basic attitude is that the surgery is worth trying if there’s a reasonable chance it will decrease pain (even if due to a placebo effect) unless there are strong arguments against it.
According to her sports medicine doctor ROM went from AROM 60/25/side, PROM 70 in May to AROM 90/25/side, PROM 70 in November. The surgeon examined her the next day and reported AROM 120/80/T10, PROM same. Either they’re using different scales or inter-rater reliability is not optimal.