The epidemiology and etiology of adhesive capsulitis in the U.S. Medicare population

Sara M Sarasua, Sarah Floyd, William C Bridges, Stephan G Pill, Sara M Sarasua, Sarah Floyd, William C Bridges, Stephan G Pill

Abstract

Background: Adhesive capsulitis (AC) of the shoulder, also known as frozen shoulder, causes substantial pain and disability. In cases of secondary AC, the inflammation and fibrosis of the synovial joint can be triggered by trauma or surgery to the joint followed by extended immobility. However, for primary AC the inciting trigger is unknown. The burden of the disorder among the elderly is also unknown leading to this age group being left out of therapeutic research studies, potentially receiving delayed diagnoses, and unknown financial costs to the Medicare system. The purpose of this analysis was to describe the epidemiology of AC in individuals over the age of 65, an age group little studied for this disorder. The second purpose was to investigate whether specific medications, co-morbidities, infections, and traumas are risk factors or triggers for primary AC in this population.

Methods: We used Medicare claims data from 2010-2012 to investigate the prevalence of AC and assess comorbid risk factors and seasonality. Selected medications, distal trauma, and classes of infections as potential inflammatory triggers for primary AC were investigated using a case-control study design with patients with rotator cuff tears as the comparison group. Medications were identified from National Drug codes and translated to World Health Organization ATC codes for analysis. Health conditions were identified using ICD9-CM codes.

Results: We found a one-year prevalence rate of AC of approximately 0.35% among adults aged 65 years and older which translates to approximately 142,000 older adults in the United States having frozen shoulder syndrome. Diabetes and Parkinson's disease were significantly associated with the diagnosis of AC in the elderly. Cases were somewhat more common from August through December, although a clear seasonal trend was not observed. Medications, traumas, and infections were similar for cases and controls.

Conclusions: This investigation identified the burden of AC in the US elderly population and applied case-control methodology to identify triggers for its onset in this population. Efforts to reduce chronic health conditions such as diabetes may reduce seemingly unrelated conditions such as AC. The inciting trigger for this idiopathic condition remains elusive.

Keywords: Adhesive capsulitis; Epidemiology; Frozen shoulder; Risk factors; Stiff shoulder.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow chart of the selection of cases and controls. FFS- Fee-for-service beneficiaries. Does not include Medicare Advantage plan participants
Fig. 2
Fig. 2
Monthly seasonal distribution of diagnoses for adhesive capsulitis and rotator cuff tears, adults ages 65 and older, 2011 U.S. Medicare Data. Error bars show 1 SD of 0.8% for AC and 0.6% for RCT. The average line shows the expectation of 8.3% of diagnoses to occur each month if there is no monthly variation

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