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Menekse S, Karatas Ö, Zora H. Impact of open bursectomy and biceps tendon release with closed manipulation in frozen shoulder. Medicine (Baltimore) 2024; 103:e37499. [PMID: 38489701 PMCID: PMC10939693 DOI: 10.1097/md.0000000000037499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
This retrospective observational study evaluated the efficacy of 2 different surgical approaches for the treatment of frozen shoulder (adhesive capsulitis). This study aimed to compare the efficacy, safety, and recovery times of the 2 treatment modalities. Fifty patients diagnosed with frozen shoulder and treated at Seyhan State Hospital were included in the study. The patients were retrospectively divided into 2 groups based on the treatment received. Group 1 consisted of 25 patients who underwent standard closed manipulation under anesthesia, a technique involving passive movements of the shoulder joint to tear the tight capsule and expand the range of motion (ROM). Group 2, which included 25 patients, underwent closed manipulation in addition to open bursectomy and biceps tendon capsule release. Open bursectomy involves surgical removal of the bursa to alleviate inflammation, while biceps tendon capsule release addresses chronic biceps tendonitis by partially removing the capsule of the tendon. Data on demographic information, operative details, preoperative and postoperative conditions, and patient-reported outcomes were collected and analyzed. Data analysis revealed that the combination of closed manipulation with open bursectomy and biceps tendon capsule release was more effective in reducing pain, increasing ROM, and improving quality of life than closed manipulation alone. The discussion would typically elaborate on how the results compare with existing literature, the clinical implications, and any potential limitations of the study. The results showed that the method that combined closed manipulation with open bursectomy and biceps tendon capsule release was better than closed manipulation alone in terms of reducing pain, increasing ROM, and improving quality of life.
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Affiliation(s)
- Serdar Menekse
- Orthopedic Department, Adana Seyhan State Hospital, Seyhan, Adana, Turkey
| | - Özlem Karatas
- Physical Therapy and Rehabilitation Department, Akdeniz Universty Medicine School, Antalya, Turkey
| | - Hakan Zora
- Orthopedic Department, Special Medicabil Hospital, Bursa, Turkey
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Inglese F, Montemagno M, Brigo A, Nigro M, Giorgini A, Micheloni GM, Porcellini G. High satisfaction rate and range of motion can be expected in frozen shoulder after awake manipulation with brachial plexus block. J Orthop Traumatol 2024; 25:3. [PMID: 38282068 PMCID: PMC10822830 DOI: 10.1186/s10195-024-00747-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/01/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Adhesive capsulitis (AC) is a disease of the glenohumeral joint that is characterized by pain and both passive and active global stiffness with a slow and insidious onset. The disease can occur spontaneously (primary AC) or it can be secondary to other comorbidities, surgery, or trauma, such as fracture or dislocation. Multiple treatment approaches have been suggested: intra-articular steroid injection, physical therapy, manipulation under total anesthesia, and arthroscopic or open surgery. Shoulder manipulation under anesthesia is usually proposed to patients that suffer from severe AC and have already undergone several nonoperative treatments without benefit. Different techniques have been proposed. This study presents our manipulation technique and the clinical results we achieved after shoulder mobilization under brachial plexus block in patients with phase III primary AC. MATERIALS AND METHODS A retrospective cohort study was performed on a sample of 110 patients with phase III AC who were treated with this manipulation and followed up for 1 year. Patients underwent two assessments-before the procedure (T0) and 4 months after it (T1)-based on the Numerical Rating Scale, Simple Shoulder Test, and joint range of motion to assess shoulder pain, function, and joint articulation, respectively. Furthermore, the patients had to express their degree of satisfaction with the procedure and the results achieved. RESULTS Positive and statistically significant results were recorded in terms of pain reduction (ΔNPRS = - 5.4; p < 0.01) and improved functionality (Simple Shoulder Test Δ = 5; p < 0.01). Passive range of motion was statistically significantly increased for each movement at T1. Large increases were observed in extrarotation range of motion (ROM): R1 (Δ = 77.5°) and R2 (Δ = 70°), whereas little improvements were observed in intrarotation ROM. Patients achieved satisfying functional and articular recovery in all cases. Complications that needed further treatment occurred in three cases: a brachial plexus injury, a glenoid flake fracture, and persistent pain and stiffness. CONCLUSIONS In this study, we proposed a standardized method of manipulation under brachial plexus block for patients affected by phase III adhesive capsulitis. The technique was applied among a large cohort of patients, who reported a high satisfaction rate and range-of-motion recovery after 4 months. This could represent an alternative treatment to surgery that has a shorter timeline and does not require patient hospitalization. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
| | - M Montemagno
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Hospital Policlinico-San Marco, University of Catania, Catania, Italy
| | - A Brigo
- Orthopedic and Traumatology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - M Nigro
- Orthopedic and Traumatology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - A Giorgini
- Villa Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - G M Micheloni
- Villa Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - G Porcellini
- Orthopedic and Traumatology Department, University of Modena and Reggio Emilia, Modena, Italy.
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Cucchi D, Di Giacomo G, Compagnoni R, Castricini R, Formigoni C, Radici M, Melis B, Brindisino F, De Giorgi S, De Vita A, Lisai A, Mangiavini L, Candela V, Carrozzo A, Pannone A, Menon A, Giudici LD, Klumpp R, Padua R, Carnevale A, Rosa F, Marmotti A, Peretti GM, Berruto M, Milano G, Randelli P, Bonaspetti G, De Girolamo L. A high level of scientific evidence is available to guide treatment of primary shoulder stiffness: The SIAGASCOT consensus. Knee Surg Sports Traumatol Arthrosc 2024; 32:37-46. [PMID: 38226696 DOI: 10.1002/ksa.12017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/21/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Shoulder stiffness (SS) is a condition characterised by active and passive restricted glenohumeral range of motion, which can occur spontaneously in an idiopathic manner or be associated with a known underlying aetiology. Several treatment options are available and currently no consensus has been obtained on which treatment algorithm represents the best choice for the patient. Herein we present the results of a national consensus on the treatment of primary SS. METHODS The project followed the modified Delphi consensus process, involving a steering, a rating and a peer-review group. Sixteen questions were generated and subsequently answered by the steering group after a thorough literature search. A rating group composed by professionals specialised in the diagnosis and treatment of shoulder pathologies rated the question-answer sets according to the scientific evidence and their clinical experience. RESULTS Recommendations were rated with an average of 8.4 points out of maximum 9 points. None of the 16 answers received a rating of less than 8 and all the answers were considered as appropriate. The majority of responses were assessed as Grade A, signifying a substantial availability of scientific evidence to guide treatment and support recommendations encompassing diagnostics, physiotherapy, electrophysical agents, oral and injective medical therapies, as well as surgical interventions for primary SS. CONCLUSIONS A consensus regarding the conservative and surgical treatment of primary SS could be achieved at a national level. This consensus sets basis for evidence-based clinical practice in the management of primary SS and can serve as a model for similar initiatives and adaptable guidelines in other European countries and potentially on a global scale. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
| | | | - Riccardo Compagnoni
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
| | - Roberto Castricini
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Casa di Cura Villa Verde, Fermo, Italy
| | - Chiara Formigoni
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- GIDIF-RBM - Italian Group of Information Specialist from Pharmaceutical Company and Biomedical Research Institutes, Milan, Italy
| | - Mattia Radici
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
| | - Barbara Melis
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Unità di Ortopedia e traumatologia dello sport, Casa di cura "Policlinico Città di Quartu", Quartu Sant'Elena, Italy
| | - Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, Italy
| | - Silvana De Giorgi
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari, Bari, Italy
| | - Andrea De Vita
- Concordia Hospital Roma, Rome, Italy
- SIAGASCOT "Shoulder" Committee, Rome, Italy
| | - Andrea Lisai
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Unità Funzionale Chirurgia della Spalla, Humanitas San Pio X, Milan, Italy
| | - Laura Mangiavini
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- IRCCS Istituto Ortopedico Galeazzi-Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Candela
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Alessandro Carrozzo
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Antonello Pannone
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Policlinico "Città di Udine", Udine, Italy
| | - Alessandra Menon
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Scuola di Specializzazione in Statistica Sanitaria e Biometria, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Luca Dei Giudici
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Casa di Cura "Villa dei Pini", Civitanova Marche, Italy
| | - Raymond Klumpp
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Department of Orthopaedics and Trauma Surgery, ASST Bergamo Ovest, Treviglio, Italy
| | | | - Arianna Carnevale
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Francesco Rosa
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Humanitas Clinical and Research Center -IRCCS, Rozzano, Italy
| | - Antongiulio Marmotti
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- Department of Orthopaedics and Traumatology, University of Torino, Turin, Italy
| | - Giuseppe M Peretti
- IRCCS Istituto Ortopedico Galeazzi-Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Massimo Berruto
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
| | - Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- ASST Spedali Civili, UOC Clinica Ortopedica, Brescia, Italy
| | - Pietro Randelli
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Bonaspetti
- Department of Orthopaedics and Traumatology, Clinica S. Anna, Brescia, Italy
| | - Laura De Girolamo
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- IRCCS Istituto Ortopedico Galeazzi-Sant'Ambrogio, Milan, Italy
- Laboratorio di Biotecnologie applicate all'Ortopedia, Milan, Italy
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