Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, New York, NY, USA.
Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, New York, NY, USA.
J Shoulder Elbow Surg. 2023 Aug;32(8):1710-1717. doi: 10.1016/j.jse.2023.01.007. Epub 2023 Feb 1.
Primary idiopathic adhesive capsulitis (AC) is characterized by shoulder pain and global limitations in range of motion (ROM). The aim of this study was to determine (1) if a spectrum of symptom severity exists during the freezing phase of AC and (2) identify factors associated with patient selection of corticosteroid injection (CSI) for treatment.
Patients presenting within 6 months of symptom onset of AC (freezing phase) were enrolled in this single-site retrospective case control study. Visual analog pain scale (VAS) score, shoulder ROM, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores, and Patient-Reported Outcomes Measurement Information System (PROMIS function and pain) scores were collected. Each patient was offered oral anti-inflammatory medication, physical therapy, and intra-articular CSI. Patients were divided into 2 cohorts: those electing vs. those deferring CSI. Multivariable logistic regression was performed to identify patient or symptom characteristics predictive of electing CSI.
A total of 112 patients (mean age = 54.7 ± 8.8 years, female = 76 [67.9%], mean symptom duration = 13.2 ± 7.9 weeks, elected CSI = 74 [66.1%]) were included in our analysis. The overall study population demonstrated a wide spectrum of VAS pain scores (6.0 ± 2.8, range: 0-10) and ROM: forward elevation (99° ± 27°, range: 30°-150°), abduction (82° ± 24°, range: 30°-130°), external rotation (47° ± 13°, range: 0°-90°), internal rotation (38° ± 26°, range: 5°-90°). The CSI group had higher mean VAS pain score (6.6 ± 2.5 vs. 4.9 ± 3.0, P = .005) and greater limitations in ROM for forward elevation (92° ± 27° vs. 113° ± 25°, P = .001) and abduction (77° ± 24° vs. 90° ± 21°, P = .005) compared with the non-CSI cohort. The CSI group demonstrated significantly worse shoulder function based on Constant (P < .05), ASES (P = .001), P-UE (P = .016), P-Intensity (P = .002), and P-Interference (P = .004). Logistic regression demonstrated decreased total shoulder ROM in forward elevation and abduction plane (OR = 0.98, 95% CI = 0.97-0.99, P = .004). Hispanic ethnicity and increased VAS pain score (OR = 1.20, 95% CI = 1.01-1.43, P = .04) were associated with increased likelihood of electing CSI.
A spectrum of symptom severity exists during the freezing phase of primary AC, despite similar etiology. AC patients with greater pain severity, and greater limitations in ROM at initial evaluation were associated with patient selection of CSI.
原发性特发性粘连性肩关节囊炎（AC）的特征是肩部疼痛和运动范围（ROM）的整体受限。本研究的目的是确定（1）在 AC 的冻结期是否存在一系列症状严重程度，以及（2）确定与患者选择皮质类固醇注射（CSI）治疗相关的因素。
本研究纳入了在 AC 发病后 6 个月内就诊的单部位回顾性病例对照研究患者。采集视觉模拟疼痛量表（VAS）评分、肩部 ROM、美国肩肘外科医生协会（ASES）标准肩关节评估表（ASES）评分、患者报告的结果测量信息系统（PROMIS 功能和疼痛）评分。每位患者均接受口服抗炎药、物理治疗和关节内 CSI。患者分为 2 组：选择 CSI 治疗组和不选择 CSI 治疗组。采用多变量逻辑回归分析确定预测选择 CSI 的患者或症状特征。
共纳入 112 例患者（平均年龄 54.7 ± 8.8 岁，女性 76 例[67.9%]，平均症状持续时间 13.2 ± 7.9 周，选择 CSI 治疗 74 例[66.1%]）。总体研究人群的 VAS 疼痛评分（6.0 ± 2.8，范围：0-10）和 ROM 差异较大：前向抬高（99° ± 27°，范围：30°-150°）、外展（82° ± 24°，范围：30°-130°）、外旋（47° ± 13°，范围：0°-90°）、内旋（38° ± 26°，范围：5°-90°）。CSI 组的平均 VAS 疼痛评分（6.6 ± 2.5 vs. 4.9 ± 3.0，P =.005）和 ROM 限制更大，前向抬高（92° ± 27° vs. 113° ± 25°，P =.001）和外展（77° ± 24° vs. 90° ± 21°，P =.005）与非 CSI 组相比。CSI 组的Constant（P <.05）、ASES（P =.001）、P-UE（P =.016）、P-Intensity（P =.002）和 P-Interference（P =.004）评分显示出明显较差的肩部功能。逻辑回归显示，在前向抬高和外展平面的总肩部 ROM 减少（OR = 0.98，95%CI = 0.97-0.99，P =.004）。西班牙裔和 VAS 疼痛评分增加（OR = 1.20，95%CI = 1.01-1.43，P =.04）与选择 CSI 的可能性增加相关。
原发性 AC 的冻结期存在一系列症状严重程度，尽管病因相似。在初始评估中，疼痛程度更严重和 ROM 限制更大的 AC 患者更倾向于选择 CSI。
