Grant L. Jones, MD

I reviewed with great interest the presentation by Paul F. Abraham, BS, from Massachusetts General Hospital, on the effectiveness of  physical therapy compared with watchful waiting for the treatment of adhesive capsulitis at the Orthopaedic Research Society Annual Meeting.

Adhesive capsulitis is a debilitating condition of insidious onset characterized by the initial onset of pain followed by the progressive loss of motion.  Fortunately, in a majority of patients, it is a self-limiting disease which resolves without surgical intervention.  Unfortunately, the “thawing process” can often be prolonged, so multiple interventions have been suggested and studied to expedite the recovery.  One treatment option is formal physical therapy (PT) to help regain motion and decrease the length of disability.  Abraham and his colleagues utilized a randomized controlled trial to evaluate whether PT provided any benefit over watchful waiting. They found patients in both the PT and watchful waiting groups demonstrated significant improvement in passive range of motion and VAS pain scores with no differences between the groups at 6 months and 12 months.  Furthermore, the average costs per patient in the PT group was $6,150.46 vs. $180.00 in the watchful waiting group. The authors concluded watchful waiting is not inferior to PT in terms of patient outcomes, but it is much less expensive; therefore, watchful waiting should be considered the treatment of choice for adhesive capsulitis.

The strength of this study is that it was a prospective randomized controlled trial, for which the authors should be commended.  However, there were a few weakness with the investigation including that there were a low number of patients, which raises the possibility of the study not being adequately powered to detect differences and there were confounders which were not controlled, such as which patients received corticosteroid injections, which have been shown to expedite the recovery.  Overall, the study is impactful in that it demonstrates that formal PT may not be necessary to treat adhesive capsulitis, which could result in a significant reduction in treatment costs. This is important in the present health care environment of cost containment.  However, studies that have a larger cohort of patients and which control for variables, like injections, are necessary to confirm results of the study.