Comparative Association of Immobilization Duration with Adhesive Capsulitis in Post-Fracture Versus Soft-Tissue Shoulder Injuries: A Cross-Sectional Study

Abstract

Background: Adhesive capsulitis is a disabling shoulder disorder characterized by pain, stiffness, and restricted mobility, frequently linked to prolonged immobilization. The comparative risk associated with immobilization after fractures versus soft-tissue injuries remains poorly understood. Objective: To investigate the association between immobilization duration and adhesive capsulitis, and to compare its prevalence and predictors in patients with post-fracture versus soft-tissue shoulder injuries. Methods: A cross-sectional study was conducted at the Orthopedic and Rehabilitation Departments of Hayatabad Medical Complex, Peshawar, enrolling 120 patients (60 post-fracture, 60 soft-tissue) aged 30–70 years with a history of shoulder immobilization for at least two weeks. Pain was assessed with the Visual Analog Scale (VAS), function with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and range of motion by goniometry. Adhesive capsulitis was diagnosed clinically. Statistical analysis included chi-square tests, t-tests, and logistic regression, with p < 0.05 considered significant. Results: Mean immobilization was longer in post-fracture cases (6.1 ± 2.3 weeks) than soft-tissue cases (3.9 ± 1.8 weeks, p < 0.001). Adhesive capsulitis prevalence increased with immobilization duration: 16.0% (<3 weeks), 38.5% (3–6 weeks), and 65.1% (>6 weeks, p < 0.001). Independent predictors were immobilization >6 weeks (OR 4.23, 95% CI 1.92–9.32) and fracture injury (OR 2.67, 95% CI 1.21–5.91). Conclusion: Immobilization beyond six weeks significantly increases adhesive capsulitis risk, particularly in post-fracture injuries. Limiting immobilization and promoting early mobilization may reduce disability and improve functional recovery.