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Adhesive capsulitis of the hip (SS-34)

      It is postulated that adhesive capsulitis of the hip is more common than suggested by published literature, which recounts only a few isolated cases, and that this condition shares many of the same characteristics seen in the shoulder. The purpose of this study is to report the findings of the first clinical case series on this condition. Methods: Since 1993, all patients undergoing hip arthroscopy have been prospectively assessed. This database currently consists of over 500 consecutive cases. In 1999, adhesive capsulitis was first recognized as a causative factor in patients with recalcitrant hip pain. Since then, 9 patients have been identified with this condition that have achieved at least 1 year follow-up and represent the substance of this report. The indication for arthroscopy was disabling symptoms refractory to conservative treatment with persistent painful restricted motion. Conservative treatment consisted of oral anti-inflammatory medication, lifestyle modifications to avoid offending activities, and supervised physical therapy. The procedure consisted of manipulation under anesthesia and concomitant arthroscopy to assess and address co-existent pathology. Results: There was 100% follow-up at an average of 17.3 months. There were 8 females and 1 male with an average age of 43.7 years. Radiographs were normal in 8 cases and revealed mild degenerative disease in the one male patient. 8 patients had an intra-articular injection of anesthetic which provided temporary relief of their symptoms. Among 7 MRIs, 2 demonstrated an effusion and 1 revealed evidence of an articulolabral lesion. Among 7 MRAs, 2 demonstrated evidence of labral pathology. None of the studies revealed evidence suggesting adhesive capsulitis. Examination under anesthesia revealed restricted rotational motion in all patients with an average loss of 19.4° external rotation and 5.6° internal rotation. Full range of motion was regained with manipulation. Arthroscopy revealed characteristic findings of adhesive capsulitis including hemorrhagic fibrinous debris within the pericapsular recesses and acetabular fossa. Other co-existent intra-articular pathology was present in 6 cases and included 5 articular lesions, 3 labral tears, and 1 partial disruption of the ligamentum teres. The average preoperative score was 53.7 and postoperative 86.7, representing an average improvement of 28 points (range 6–43). There were no complications. Discussion and Conclusions: Adhesive capsulitis of the hip is not as rare as would be suggested by the paucity of available literature. The clinical characteristics are similar to those commonly attributed to this condition in the shoulder, principally consisting of painful restricted motion and a clear predilection for middle aged females. It may occur with or without associated intra-articular pathology. It is likely that many of these may respond to conservative treatment. Recognizing the existence of this process will assist the physician in counseling patients and structuring a conservative recovery program. Arthroscopy can be beneficial in the treatment of recalcitrant cases but may assume less of a role with improved diagnostic skills essential to implementing a proper management strategy.