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. 2022 Jan 25;10(1):23259671211069577.
doi: 10.1177/23259671211069577. eCollection 2022 Jan.

Evaluating Utilization Trends in Adhesive Capsulitis of the Shoulder: A Retrospective Cohort Analysis of a Large Database

Charles J Cogan  1 , Nicolas Cevallos  1 , Ryan D Freshman  1 , Drew Lansdown  1 , Brian T Feeley  1 , Alan L Zhang  1
Affiliations

Evaluating Utilization Trends in Adhesive Capsulitis of the Shoulder: A Retrospective Cohort Analysis of a Large Database

Charles J Cogan et al. Orthop J Sports Med. .

Abstract

Background: Nonoperative and operative treatment modalities have been used for symptom management of adhesive capsulitis, but neither has been shown to significantly alter the long-term natural history.

Purpose/hypothesis: The purpose was to evaluate the current trends in resource and treatment strategy utilization for patients with adhesive capsulitis. It was hypothesized that (1) patients with idiopathic adhesive capsulitis will primarily undergo nonoperative treatment and (2) patients with systemic medical comorbidities will demonstrate relatively higher utilization of nonoperative therapies.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: We searched the Mariner/PearlDiver database for Current Procedural Terminology and International Classification of Diseases codes to identify patients with adhesive capsulitis from 2010 to 2020 and to track their usage of diagnostic and therapeutic modalities, including radiography, magnetic resonance imaging (MRI), physical therapy, surgery, opioids, and injection. Patients with active records 1 year before and 2 years after initial diagnosis of adhesive capsulitis were eligible. Excluded were patients with secondary causes of adhesive capsulitis, such as fracture, infection, prior surgery, or other intra-articular pathology.

Results: The median age of this 165,937-patient cohort was 58 years, with 67% being women. There was a high prevalence of comorbid diabetes (44.2%), thyroid disorder (29.6%), and Dupuytren contracture (1.3%). Within 2 years of diagnosis of adhesive capsulitis, diagnostic and therapeutic modality utilization included radiography (47.2%), opioids (46.7%), physical therapy (43.1%), injection (39.0%), MRI (15.8%), arthroscopic surgery (2.7%), and manipulation under anesthesia (2.5%). Over 68% of the diagnostic and therapeutic modalities were rendered from 3 months before to 3 months after diagnosis. Patients with diabetes, thyroid disorders, tobacco use, and obesity had greater odds for treatment with physical therapy, opioids, radiography, and injection when compared with patients without these comorbidities (odds ratio [OR] range, 1.05-2.21; P < .0001). Patients with diabetes and thyroid disorders had decreased odds for surgery (OR range, 0.88-0.91; P ≤ .003). Patients with Dupuytren contracture had increased odds for all therapeutic modalities (OR range, 1.20-1.68; P < .0001).

Conclusion: Patients with adhesive capsulitis underwent primarily nonoperative treatment, with a high percentage utilizing opioids. The most active periods for treatment were from 3 months before diagnosis to 3 months after, and patients with medical comorbidities were more likely to undergo nonoperative treatment.

Keywords: adhesive capsulitis; database; frozen shoulder; opioids.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: D.L. has received education payments from Arthrex and Smith & Nephew and hospitality payments from Wright Medical. B.T.F. has received education payments from Evolution Surgical and hospitality payments from Zimmer Biomet. A.L.Z. has received consulting fees from DePuy and Stryker and hospitality payments from Arthrex and Zimmer Biomet. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
CONSORT diagram for cohort analysis.
Figure 2.
Figure 2.
Percentage of patients with adhesive capsulitis by age range (N = 165,937).
Figure 3.
Figure 3.
(A) Diagnostic and (B) therapeutic modality utilization by month from initial diagnosis. The percentage is the proportion of the total population with adhesive capsulitis (N = 165,937). MRI, magnetic resonance imaging (upper extremity); MUA, manipulation under anesthesia; PT, physical or occupational therapy; XR, shoulder radiograph. Opioids include hydrocodone and oxycodone.
See this image and copyright information in PMC

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