TITLE:
Arthroscopic Capsular Release for Frozen Shoulder—Time to Thaw the Delay?
AUTHORS:
Christopher Munro, Scott L. Barker, Kapil Kumar
KEYWORDS:
Frozen Shoulder; Adhesive Capsulitis; Capsular Release; Arthroscopic; Economics
JOURNAL NAME:
Surgical Science,
Vol.4 No.9A,
August
27,
2013
ABSTRACT:
Introduction: Frozen shoulder is a common
condition that affects the working population. Current management regimes are
variable nationwide and the evidence base on which to base these decisions is
poor. The longevity and severity of symptoms often result in great economic
burden, both to health services and in terms of absence from work. Early
surgical intervention with arthroscopic capsular release may result in improved
symptoms and earlier return to both work and leisure activities. Aims: The aim of
our prospective cohort study was to investigate whether early intervention with
arthroscopic capsular release resulted in improvement of symptoms and whether
this would in turn provide overall economic benefit to society. Methods: Patients
diagnosed with frozen shoulder at an elective orthopaedic specialist shoulder
clinic were recruited prospectively. Data were gathered by way of questionnaire to
ascertain the demographic information of the patient as well as their previous
treatment in the primary care setting and absence from work. Initial Oxford
Shoulder Score (OSS) was also calculated: Arthroscopic capsular release was
then performed and further data gathered at four-week post-operative follow-up. Economic
impact of delay to treatment and cost of intervention were calculated using government data
from the national tariff which cost different forms of treatment. Statistical
analysis was then performed on the results. Results: Twenty five patients were recruited.
Mean results were: Age of patients: 53.5 years, duration of symptoms prior to
intervention: 35.2 weeks, days absent from work: 31.5, number of previous
physiotherapy sessions: 7.2, number of steroid injections: 1.3. Mean
pre-operative OSS was 37.4 (range 27 - 58, SD 7.4). Mean post-operative OSS was 15.9 (range 12 - 22, SD 2.3), P 0.01. Mean improvement in OSS was
21.5 (range 12 - 38, SD 7.1). The cost of non-operative treatment per patient including absence from
work to the point of surgical intervention was ￡3954. The overall cost of
arthroscopic capsular release per patient was ￡1861, a difference of ￡2093.
There were no surgical complications. Conclusion: Arthroscopic capsular release improved
shoulder function on OSS within four weeks. This is significantly shorter than
the natural history of frozen shoulder. The overall cost of arthroscopic
capsular release is significantly less than the cost of treating the patients
non-operatively up to the point of surgical intervention. Early surgical intervention
may improve symptoms quickly and reduce economic burden of the disease. A
randomised controlled trial comparing early with late intervention would
further elucidate potential benefits.