Department of Orthopaedic Surgery, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA.
Department of Orthopaedic Surgery, Blanchfield Army Community Hospital Orthopedic Clinic, Fort Campbell, KY, USA.
J Shoulder Elbow Surg. 2018 Aug;27(8):1437-1443. doi: 10.1016/j.jse.2018.04.004. Epub 2018 May 25.
Adhesive capsulitis is characterized by a gradual, painful loss of shoulder motion. This study evaluated patient variables significantly associated with developing adhesive capsulitis compared with a sex-matched control group without adhesive capsulitis. We also sought to determine those factors associated with adhesive capsulitis patients requiring surgical intervention.
All patients presenting to our hospital with adhesive capsulitis between 2004 and 2014 were identified. Demographic characteristics were collected, and a sex-matched control group was randomly generated from the electronic medical record and used for comparison. Patients who underwent surgical intervention for adhesive capsulitis were also identified, and factors associated with surgical intervention were identified with logistic regression analysis.
Included were 2190 adhesive capsulitis patients with a normal age distribution of 56.4 ± 13.1 years. Most were classified as overweight (30.7%) or obese (27.0%). Compared with controls, adhesive capsulitis patients were more likely to be younger (<50 vs. ≥50 years; odds ratio [OR], 0.69; P < .001), obese (OR, 1.26; P < .001), black/African American (OR, 1.71; P < .001), Hispanic/Latino (OR, 4.85; P < .001), or diabetic (OR, 1.12; P < .001) and less likely to have hypertension (OR, 0.93; P = .006). Overall, 361 subsequently underwent surgical intervention. Older patients, racial minorities, and government-sponsored/uninsured patients were significantly less likely to have surgery for adhesive capsulitis (P < .01), whereas workers' compensation patients were 8 times more likely to receive surgery compared with privately insured patients (P < .001).
Obesity and diabetes were significantly associated with adhesive capsulitis and should be considered modifiable patient factors. Additionally, younger patients and racial minorities were also significantly more likely to be diagnosed with adhesive capsulitis. Younger, white, and workers' compensation patients were more likely to receive surgery, whereas patients with government-sponsored or no insurance status were more likely to receive nonoperative treatment.
粘连性肩关节囊炎的特征是肩部运动逐渐出现疼痛性丧失。本研究评估了与无粘连性肩关节囊炎的性别匹配对照组相比，与粘连性肩关节囊炎相关的患者变量。我们还试图确定与需要手术干预的粘连性肩关节囊炎患者相关的因素。
我们确定了 2004 年至 2014 年期间在我院就诊的所有粘连性肩关节囊炎患者。收集了人口统计学特征，并从电子病历中随机生成了性别匹配的对照组进行比较。还确定了因粘连性肩关节囊炎接受手术干预的患者，并通过逻辑回归分析确定了与手术干预相关的因素。
纳入了 2190 例粘连性肩关节囊炎患者，其正常年龄分布为 56.4±13.1 岁。大多数患者被归类为超重（30.7%）或肥胖（27.0%）。与对照组相比，粘连性肩关节囊炎患者更年轻（<50 岁与≥50 岁；比值比[OR]，0.69；P<.001）、肥胖（OR，1.26；P<.001）、黑/非裔美国人（OR，1.71；P<.001）、西班牙裔/拉丁裔（OR，4.85；P<.001）或糖尿病（OR，1.12；P<.001），而高血压（OR，0.93；P=.006）的比例较低。总体而言，361 例患者随后接受了手术干预。年龄较大的患者、少数民族患者和政府资助/无保险的患者接受粘连性肩关节囊炎手术的可能性显著降低（P<.01），而与私人保险患者相比，工人赔偿患者接受手术的可能性高 8 倍（P<.001）。
肥胖和糖尿病与粘连性肩关节囊炎显著相关，应被视为可改变的患者因素。此外，年轻患者和少数民族患者也更有可能被诊断为粘连性肩关节囊炎。年轻、白人、工人赔偿患者更有可能接受手术治疗，而政府资助或无保险的患者更有可能接受非手术治疗。
