A Comparison of the Efficacy of Non-Surgical and Arthroscopic Treatments on Shoulder Function and Pain in Diabetic Patients with Adhesive Capsulitis

Background and Objective: Adhesive capsulitis is one of the most common shoulder disorders, particularly in diabetic patients, and its treatment has been challenging. Adhesive capsulitis begins with a gradual increase in shoulder pain, spontaneous onset, and limitation of active and passive movements of the glenohumeral joint in all directions. In 90% of cases, it responds to conservative treatment; however, if there is no symptomatic improvement after 3-6 months of conservative treatment, surgical treatment, including arthroscopic or open capsular release, should be considered. The current study aimed to compare the efficacy of non-surgical and arthroscopic treatments on shoulder function and pain in diabetic patients with adhesive capsulitis. Methods: This quasi-experimental study was conducted on 48 diabetic patients (16 males and 32 females; mean age: 53.56±15.93 years) with adhesive capsulitis referring to the orthopedics clinic of 5th Azar Educational and Therapeutic Center in Gorgan, Iran during 2021-2022. Initially, patients were placed under the supervision of shoulder fellowship for conservative treatment for 3 months, and patients without any clinical improvement and with resistant to conservative treatments after 6 months were included in the study. Patients were voluntarily decided to be assigned to one of two treatment groups: Non-surgical (conservative treatment) and arthroscopic surgical (arthroscopic shoulder release). The functional outcomes and limitations of shoulder movement of patients were compared based on the disabilities of the arm, shoulder, and hand (DASH) score in the pre-test and after 3 and 6 months of intervention. The data were presented using descriptive statistical indices. Then, the functional outcomes and limitations of shoulder movement were evaluated. Results: The mean shoulder function score 3 and 6 months after the intervention was lower in the arthroscopic release surgery group (45.80±19.32 and 43.10±14.12) than in the conservative treatment group (67.89±17.46 and 72.10±15.16) (P<0.05). The mean and standard deviation of symptom scores, such as pain, burning, weakness, and stiffness of the shoulder, 3 and 6 months after the intervention were lower in the arthroscopic release surgery group (12.70±5.66 and 10.02±4.06) than in the conservative treatment group (19.83±8.17 and 21.14±9.37) (P<0.05). Conclusion: The decreased shoulder function and symptom severity at 3 and 6 months after the intervention was more effective in the arthroscopic release surgery group than in the conservative treatment group.