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Li J, Zhao R, Wang C, Song J, Guo X, Ge Y, Chu X. Structural and functional abnormalities in the medial prefrontal cortex were associated with pain and depressive symptoms in patients with adhesive capsulitis. Pain Rep 2024; 9:e1139. [PMID: 38444775 PMCID: PMC10914225 DOI: 10.1097/pr9.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 03/07/2024] Open
Abstract
Introduction Chronic pain and depression have been shown to coexist in patients with adhesive capsulitis (AC). Recent studies identified the shared brain plasticity between pain and depression; however, how such neuroplasticity contributes to AC remains unclear. Here, we employed a combination of psychophysics, structural MRI, and functional MRI techniques to examine the brain's structural and functional changes in AC. Methods Fifty-two patients with AC and 52 healthy controls (HCs) were included in our study. Voxelwise comparisons were performed to reveal the differences in grey matter volume (GMV) and regional homogeneity (ReHo) between AC and HCs. Furthermore, region of interest to whole brain functional connectivity (FC) was calculated and compared between the groups. Finally, Pearson correlation coefficients were computed to reveal the association between clinical data and brain alterations. Mediation analyses were performed to investigate the path association among brain alterations and clinical measures. Results Three main findings were observed: (1) patients with AC exhibited a higher depression subscale of hospital anxiety and depression scale (HADS-D) score correlating with the GMV within the right medial prefrontal cortices (mPFC) compared with HCs; (2) relative to HCs, patients with AC exhibited lower ReHo within the right mPFC, which largely overlapped with the structural abnormalities; (3) the impact of pain duration on HADS-D score was mediated by ventral part of medial prefrontal cortices (vmPFC) GMV in patients with AC. Conclusion In summary, our current findings suggest that vmPFC alterations correlate with both the pain duration and the emotional comorbidities experienced by patients with AC. Our research provides an enhanced comprehension of the underlying mechanisms of AC, thereby facilitating the development of more effective treatment approaches for AC.
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Affiliation(s)
- Jie Li
- Department of Orthopedics Surgery, Tianjin Hospital, Tianjin, China
| | - Rui Zhao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Chenguang Wang
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiajun Song
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Xing Guo
- Department of Orthopedic, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Yeqi Ge
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Xu Chu
- Department of Orthopaedic, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
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Zorgno I, Simeone FJ, Galdamez ME, Chang CY, Huber FA, Torriani M. Decreased rotator cuff muscle cross-sectional areas in subjects with adhesive capsulitis: a study comparing male and female subjects. Skeletal Radiol 2024; 53:761-767. [PMID: 37875572 DOI: 10.1007/s00256-023-04487-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE To compare rotator cuff (RC) muscle cross-sectional areas (CSA) in subjects with adhesive capsulitis (AC) to age- and sex-matched controls. MATERIALS AND METHODS We retrospectively analyzed 97 shoulder MRIs or MR arthrography studies, of which 42 were clinically diagnosed with AC (27 female, 15 male) and 55 were age- and sex-matched controls (38 female, 17 male). All AC subjects underwent imaging ≥ 6 months after symptom onset. All imaging was examined to exclude RC full-thickness tears and prior surgery. A standardized T1 sagittal MR image was segmented in each subject to obtain the CSA of subscapularis (SSC), supraspinatus (SSP), and infraspinatus (ISP) muscles. Differences in CSAs between AC and control subjects were analyzed by sex (females and males separately) and all subjects combined. RESULTS AC females had significantly decreased SSC (P = 0.002) and total (P = 0.006) CSAs compared to controls. Male AC subjects showed decreased SSC (P = 0.044), SSP (P = 0.001), and total (P = 0.005) CSAs. Across all subjects, male and female, the AC cohort had significantly decreased SSC (P = 0.019) and total (P = 0.029) CSAs compared to controls. CONCLUSION Decreased RC muscle CSAs were present in AC subjects with ≥ 6 months of symptom duration, with decreased SSC and total CSAs in male and female subjects, and decreased SSP CSA in males.
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Affiliation(s)
- Ivanna Zorgno
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street YAW-6048, Boston, MA, 02114, USA
| | - F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street YAW-6048, Boston, MA, 02114, USA
| | - Marilyn E Galdamez
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street YAW-6048, Boston, MA, 02114, USA
| | - Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street YAW-6048, Boston, MA, 02114, USA
| | - Florian A Huber
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street YAW-6048, Boston, MA, 02114, USA
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street YAW-6048, Boston, MA, 02114, USA.
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de Angelis Guerra Dotta T, Assunção JH, Baptista E, E Silva FBA, Gracitelli MEC, Neto AAF, Malavolta EA. Diagnostic accuracy of non-contrast MRI in frozen shoulder. Arch Orthop Trauma Surg 2024; 144:1149-1159. [PMID: 38231206 DOI: 10.1007/s00402-023-05184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Despite being the most used exam today, few studies have evaluated the accuracy of findings on non-contrast magnetic resonance imaging (MRI). The primary objective of the study was to evaluate the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of non-contrast MRI findings in frozen shoulder, isolated and in combination. The secondary objectives were to define the interobserver and intraobserver agreement of the assessments and the odds ratio for frozen shoulder because of the various findings of MRI. METHODS A retrospective diagnostic accuracy study comparing non-contrast MRI findings between the frozen shoulder group and the control group. Sensitivity, specificity, positive and negative predictive value, accuracy, odds ratio, interobserver and intraobserver agreement were calculated for each finding and their possible associations. RESULTS The hyperintensity on capsule in the axillary recess presented 84% sensitivity, 94% specificity, and 89% accuracy. The obliteration of the subcoracoid fat triangle in the rotator interval had sensitivity 34%, specificity 82% and accuracy 58%. For coracohumeral ligament thickness ≥ 2 mm had specificity 66%, 48% specificity and 57% accuracy. Capsule thickness in the axillary recess ≥ 4 mm resulted in 54% sensitivity, 82% specificity, and 68% accuracy. Regarding interobserver agreement, only the posteroinferior and posterosuperior quadrants showed moderate results, and all the others showed strong reliability. The odds ratio for hyperintensity in the axillary recess was 82.3 for frozen shoulder. The association of these findings increased specificity (95%). CONCLUSION The accuracy of non-contrast magnetic resonance imaging is high for diagnosing frozen shoulder, especially when evaluating the hyperintensity of the axillary recess. The exam has high reliability and reproducibility. The presence of an association of signs increases the specificity of the test. LEVEL OF EVIDENCE Level III, study of diagnostic test.
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Affiliation(s)
- Thiago de Angelis Guerra Dotta
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil.
| | - Jorge Henrique Assunção
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Eduardo Baptista
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Fernando Brandão Andrade E Silva
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Mauro Emilio Conforto Gracitelli
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Arnaldo Amado Ferreira Neto
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Eduardo Angeli Malavolta
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
- Hospital do Coração-HCor, São Paulo, SP, Brazil
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Gómez-Muñoz E, Sánchez-Ibáñez I, Garríguez-Pérez D, García-Fernández C, Marco F, Lópiz Y. Functional results of Circumferential Capsular Release in adhesive shoulder capsulitis. Comparative study of patients over and under fifty years of age. Arch Orthop Trauma Surg 2024; 144:1303-1310. [PMID: 38153437 DOI: 10.1007/s00402-023-05175-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION The aim of our study is to evaluate the functional and mobility outcomes in patients who have undergone arthroscopic circumferential arthrolysis of the shoulder and to find out if there are differences in the results in relation to the patient's age. MATERIALS AND METHODS This is a retrospective case series of patients with idiopathic adhesive capsulitis treated by arthroscopic 360º circumferential capsulotomy in lateral position and followed for a minimum of 2 years. Range of motion (ROM), functional outcomes using the Constant Score (CS), health-related quality of life outcomes with the EuroQol Five Dimensions tool (EQ-5D), pain using the Visual Analogue Scale (VAS). RESULTS A total of 26 shoulders were included, 10 men (41.7%) and 14 women (58.3%), with 2 patients being bilateral. The mean age was 48.64 ± 7.5 years, and the mean follow-up was 50.2 months. Postoperative ROM improved significantly compared to preoperative ROM (p < 0.05). Shoulder forward flexion improved by 38.6° (95%CI 22.3-54.9, p < 0.01), abduction by 35.2° (95%CI 17.6-52.8, p < 0.01) and external rotation by 21.9° (95%CI 12.8-30.9, p < 0.01 p < 0.01). Median internal rotation improved from buttock to T12 (p < 0.01). The mean improvement in CS was 54.3 ± 24.4 points (p < 0.01). The EQ-5D and VAS scores at the end of follow-up were 0.73 ± 0.23 and 2.73 ± 2.55, respectively. There were no statistical differences between young patients and patients aged 50 years or older in ROM or functional results. CONCLUSIONS Patient age did not affect outcomes significantly, with patients older than 50 years showing similar results to younger patients.
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Affiliation(s)
- Eduardo Gómez-Muñoz
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Investigation Performed at Hospital Clínico San Carlos Hospital, Madrid, Spain.
| | - Ivan Sánchez-Ibáñez
- Department of Physical Medicine and Rehabilitation, Clínico San Carlos Hospital, Madrid, Spain
| | - Daniel Garríguez-Pérez
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Investigation Performed at Hospital Clínico San Carlos Hospital, Madrid, Spain
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Investigation Performed at Hospital Clínico San Carlos Hospital, Madrid, Spain
| | - Fernando Marco
- Department of Surgery, Complutense University, Madrid, Spain
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Yaiza Lópiz
- Department of Surgery, Complutense University, Madrid, Spain
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
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Wu SY, Hsu PC, Tsai YY, Huang JR, Wang KA, Wang JC. Efficacy of combined ultrasound-guided hydrodilatation with hyaluronic acid and physical therapy in patients with adhesive capsulitis: A randomised controlled trial. Clin Rehabil 2024; 38:202-215. [PMID: 37697666 DOI: 10.1177/02692155231200089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To evaluate the therapeutic effect of combining ultrasound-guided hydrodilatation with hyaluronic acid and physical therapy compared with physical therapy alone in patients with adhesive capsulitis. DESIGN A prospective, single-blinded, randomised controlled trial. SETTING Single medical centre. PARTICIPANTS Patients with adhesive capsulitis (N = 62) were divided into group A: ultrasound-guided hydrodilatation with hyaluronic acid + physical therapy (N = 31) and group B: physical therapy alone (N = 31). INTERVENTIONS Group A received three doses of ultrasound-guided hydrodilatation with hyaluronic acid-based injectates (20 mL in total). Both groups underwent structured physical therapy. OUTCOME MEASURES The primary outcome measure was Constant score, while secondary outcomes included Shoulder Pain and Disability Index score, numerical rating scale (at rest, night, and during motion), 36-item Short Form Health Survey, and range of motion of the shoulder. All measurements were collected at baseline, 6 weeks, and 12 weeks post-injection. RESULTS At week 12, the Constant scores were 68.29 ± 14.55 and 62.77 ± 14.44 for groups A and B, respectively. There was a greater reduction in the Constant score, Shoulder Pain and Disability Index, and numerical rating scale between the baseline and 6 weeks and between the baseline and 12 weeks in group A (Constant score: p < 0.05, Shoulder Pain and Disability Index: p < 0.01, and numerical rating scale: p < 0.05). CONCLUSION The combination of ultrasound-guided hydrodilatation with hyaluronic acid in conjunction with physical therapy provides additional benefits compared to physical therapy alone for the treatment of adhesive capsulitis at up to 12 weeks. TRIAL REGISTRATION ClinicalTrials.gov: NCT02708706.
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Affiliation(s)
- Shang-Yu Wu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Cheng Hsu
- Department of Physical Medicine and Rehabilitation, West Garden Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation Medicine, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan
| | - Yuan-Yuan Tsai
- Department of Physical Medicine and Rehabilitation Medicine, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan
| | - Jian-Ru Huang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kevin A Wang
- Divison of General Surgery, Department of Surgery, Shin-Kong Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Kuhn I, Erber B, Goller SS. [ Adhesive capsulitis]. Radiologie (Heidelb) 2024; 64:119-124. [PMID: 37801107 DOI: 10.1007/s00117-023-01217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Adhesive capsulitis (CA; also called Frozen shoulder) is a common, usually unilateral disease of the shoulder joint primarily affecting middle-aged women. Primary, idiopathic, and secondary forms are distinguished. Painful active and passive movement restriction are the clinically leading symptoms. COURSE OF THE DISEASE The disease usually progresses in three successive stages: freezing phase, frozen phase, and thawing phase. CLINICAL DIAGNOSIS AND IMAGING CA is primarily diagnosed clinically, with imaging being used to assess or exclude differential diagnoses. Radiography as part of basic diagnostics allows exclusion of common differential diagnoses such as osteoarthritis of the shoulder or calcific tendinitis. Native magnetic resonance imaging (MRI) and MR arthrography (MRA) reveal pathomorphologies typical of CA. Intravenously administered gadolinium increases the sensitivity of MRI. Sonography may be used as a complementary diagnostic modality or as an alternative in case of contraindications to MRI. Fluoroscopy-guided arthrography has been replaced by MRI because of its invasiveness. Computed tomography (CT) has no role in diagnostics due to its radiation exposure and significantly lower sensitivity and specificity compared to MRI. TREATMENT Therapy of CA is stage-adapted and includes conservative measures such as analgesics and physiotherapy and surgical procedures such as arthroscopic arthrolysis. The therapeutic spectrum is supplemented by new, innovative procedures such as transarterial periarticular embolization. PROGNOSIS CA is self-limiting and usually persists for 2-3 years. However, the patients may even suffer from pain and limited range of motion beyond this time.
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Affiliation(s)
- Isabella Kuhn
- Muskuloskelettales Universitätszentrum München (MUM), LMU Klinikum, Ziemssenstr. 5, 80336, München, Deutschland
| | - Bernd Erber
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - Sophia Samira Goller
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
- Radiologie, Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz.
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Sahu D, Gupta S, Shetty G, Choudhury HS. Frozen shoulder after COVID-19 vaccination versus idiopathic frozen shoulder: similar clinical features and functional improvement at 1-year follow-up. JSES Rev Rep Tech 2024; 4:41-47. [PMID: 38323207 PMCID: PMC10840564 DOI: 10.1016/j.xrrt.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background Frozen shoulder after COVID-19 vaccination is sparsely discussed in the medical literature. We aimed to evaluate: (1) the differences in the baseline clinical features and functional outcomes of conservatively treated frozen shoulder following COVID-19 vaccination compared to idiopathic frozen shoulder (2) the improvements in pain scores, functional outcomes, and range of motion (ROM) at 6-10 months and at 1 year of follow-up in patients with frozen shoulder after COVID-19 vaccination treated by conservative therapy. Methods Between June 2021 and December 2021, 12 patients (13 shoulders) that were diagnosed with frozen shoulder after COVID-19 vaccination (vaccine related frozen shoulder [VRF] group) (final follow-up of 12.4 months ± 0.8 months) were compared with 20 patients that were diagnosed as idiopathic frozen shoulder unrelated to vaccination (unvaccinated frozen shoulder [UFS] group) (average follow-up of 13.4 ± 3.1 months). All patients were treated with home-based stretching exercises. Four (33%) patients in the VRF group and 15 (75%) patients in the UFS group underwent steroid injection in the suprascapular notch by an experienced radiologist. Results The left side was affected more frequently in the VRF group [n = 10 (83.3%)] than in the UFS group [n = 8 (40%), P = .03]. The VRF and the UFS groups were similar in the rest of the baseline clinical features, such as the age distribution, men/women ratio, baseline Oxford Shoulder Scores (OSS), ROM deficit, and pain visual analogue scale (VAS) scores. The OSS, VAS pain scores, and the ROM deficit significantly improved in the VRF group at the 6-10-month follow-up and then at the final (12.4 ± 0.8 months) follow-up compared to the baseline values. At the final follow-up, there were no significant differences in the average external rotation, external rotation deficit, elevation, elevation deficit, internal rotation, pain VAS scores, and OSS between the VRF and the UFS group. Conclusion To conclude, frozen shoulder following COVID-19 vaccination may present with clinical features similar to those of the idiopathic frozen shoulder. Furthermore, the patients with frozen shoulder following COVID-19 vaccination may continue to improve over one year with conservative treatment; the final improvements in function and ROM are similar to those with idiopathic frozen shoulder.
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Affiliation(s)
- Dipit Sahu
- Sir H.N. Reliance Foundation Hospital, Mumbai, India
- Mumbai Shoulder Institute, Mumbai, India
- Jupiter Hospital, Thane, India
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Pimenta M, Vassalou EE, Klontzas ME, Dimitri-Pinheiro S, Ramos I, Karantanas AH. Ultrasound-guided hydrodilatation for adhesive capsulitis: capsule-preserving versus capsule-rupturing technique. Skeletal Radiol 2024; 53:253-261. [PMID: 37400605 PMCID: PMC10730627 DOI: 10.1007/s00256-023-04392-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/17/2023] [Accepted: 06/18/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To compare the clinical efficacy of capsule-rupturing versus capsule-preserving ultrasound-guided hydrodilatation in patients with shoulder adhesive capsulitis (AC). To determine potential factors affecting the outcome over a 6-month follow-up. MATERIALS AND METHODS Within a 2-year period, 149 consecutive patients with AC were prospectively enrolled and allocated into (i) group-CR, including 39 patients receiving hydrodilatation of the glenohumeral joint (GHJ) with capsular rupture and (ii) group-CP, including 110 patients treated with GHJ hydrodilatation with capsular preservation. Demographics, affected shoulder, and AC grade were recorded. Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and visual analog scale (VAS) were used for clinical assessment at baseline/1/3/6 months. Comparisons were performed with Mann-Whitney U test and Kolmogorov-Smirnov test. Linear regression was used to identify predictors of outcome. P value < 0.05 defined significance. RESULTS DASH and VAS scores in both groups improved significantly compared to baseline (P < 0.001) and were significantly lower in the CP compared to CR group at all time-points following intervention (P < 0.001). Capsule rupture was a significant predictor of DASH score at all time-points (P < 0.001). DASH scores correlated to initial DASH score at all time-points (P < 0.001). DASH/VAS scores at 1 month were correlated to the AC grade (P = 0.025/0.02). CONCLUSION GHJ hydrodilatation results in pain elimination and functional improvement till the mid-term in patients with AC, with improved outcome when adopting the capsule-preserving compared to the capsule-rupturing technique. Higher initial DASH score is predictive of impaired functionality in the mid-term.
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Affiliation(s)
- Madalena Pimenta
- Oporto Armed Forced Hospital, University Clinical Center D. Pedro V, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Evangelia E Vassalou
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Crete, Greece
| | - Michail E Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, 71110, Heraklion, Greece
| | - Sofia Dimitri-Pinheiro
- Faculty of Medicine, University of Porto, Porto, Portugal
- Biomedicine Department, Unit of Biochemistry, Faculty of Medicine, University of Porto, Porto, Portugal
- Radiology Department, Portuguese Institute of Oncology of Porto - Francisco Gentil EPE, Porto, Portugal
| | - Isabel Ramos
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Apostolos H Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Crete, Greece.
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, 71110, Heraklion, Greece.
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Martens G, Fontaine R, Goffin P, Raaf M, Tasset H, Lecoq JP, Benmouna K, Kaux JF, Forthomme B. Continuous suprascapular nerve blockade to potentiate intensive rehabilitation for refractory adhesive shoulder capsulitis: a cohort study. Int Orthop 2024; 48:495-503. [PMID: 37848767 DOI: 10.1007/s00264-023-05999-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Evaluating the short- and long-term efficacy of a continuous ten day suprascapular nerve block combined with daily multidisciplinary rehabilitation on shoulder range of motion (ROM), pain, and function in patients with refractory adhesive capsulitis (AC). METHODS In this retrospective cohort study, patients admitted to a specialized pain clinic for refractory AC for more than 6 months underwent continuous suprascapular nerve blockade for ten days and received 2 hours of physiotherapy and occupational therapy daily. Standardized assessments were performed at baseline, at days three, six, ten, 30, 90, and 180, and included active and passive ROM measurements, the visual analog scale (VAS) for pain and the disabilities of the arm, shoulder and hand (DASH) questionnaire to assess pain, disability, and quality of life. Improvements over time were assessed using ANOVAs. RESULTS Thirty-two patients were followed (age: 52 ± 8 years, 25 females, mean symptoms duration of two years). There was a significant improvement in ROM for all amplitudes at day ten (short-term; range: 20-35°, p < 0.001) and at day 180 (long-term; range: 18-47°, p < 0.001). The pain and disability scores significantly reduced by day 180 (mean VAS reduction: 2.6 units, p < 0.001; mean DASH reduction: 9.5 points, p < 0.001). CONCLUSION Continuous SSNB combined with intensive multidisciplinary rehabilitation represents an efficient therapeutic option for patients with chronic AC who did not respond to conventional treatments.
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Affiliation(s)
- Géraldine Martens
- Department of Physical Medicine and Sports Traumatology, SportS², FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium.
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium.
| | - Robert Fontaine
- Anesthesia & Intensive Care Department, University Hospital of Liège, Liège, Belgium
| | - Pierre Goffin
- Anesthesia & Intensive Care Department, MontLegia Hospital, Groupe Santé CHC, Liège, Belgium
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Mélissa Raaf
- Anesthesia & Intensive Care Department, University Hospital of Liège, Liège, Belgium
- Anesthesia & Intensive Care Department, MontLegia Hospital, Groupe Santé CHC, Liège, Belgium
| | - Hadrien Tasset
- Anesthesia & Intensive Care Department, University Hospital of Liège, Liège, Belgium
| | - Jean-Pierre Lecoq
- Anesthesia & Intensive Care Department, University Hospital of Liège, Liège, Belgium
| | - Karim Benmouna
- Department of Physical Medicine and Sports Traumatology, SportS², FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium
| | - Jean-François Kaux
- Department of Physical Medicine and Sports Traumatology, SportS², FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium
| | - Bénédicte Forthomme
- Department of Physical Medicine and Sports Traumatology, SportS², FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Khan S, Arsh A, Khan S, Ali S. Deep transverse friction massage in the management of adhesive capsulitis: A systematic review. Pak J Med Sci 2024; 40:526-533. [PMID: 38356832 PMCID: PMC10862451 DOI: 10.12669/pjms.40.3.7218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/25/2023] [Accepted: 12/31/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives To review published clinical trials which assessed the effects of deep transverse friction massage on pain and range of motion in patients with adhesive capsulitis. Methods A systematic review was conducted according to PRISMA guidelines. Literature search was performed in MEDLINE, AMED, EMBASE, HMIC, CINAHL, PEDRO, and SPORTDiscus. Two independent reviewers performed screening of the articles retrieved from different databases. Clinical trials published in English language from the earliest record to March 2022 that reported effects of deep transverse friction massage/Cyriax's friction massage on pain and/or range of motion in patients with diagnosis of adhesive capsulitis were included. The Critical Appraisal Skills Programme was used for quality assessment of the included studies. Results A total of six studies reporting on 226 adhesive capsulitis patients were included in the systematic review. All the six studies were randomized controlled clinical trials. On the Critical Appraisal Skills Programme tool, four of the six studies had a score of 8/11, while the other two studies received a score of 7/11 and 6/11. Out of these six trials, four reported that pain was significantly (P<0.05) improved in the deep transverse friction massage group as compared to the control group. Regarding range of motion outcome, five studies showed that range of motion was significantly (P<0.05) improved in the deep transverse friction massage group while only one study showed non-significant results. Conclusion It can be concluded that deep transverse friction massage significantly relieves pain and improves the range of motion in individuals with adhesive capsulitis.
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Affiliation(s)
- Shahid Khan
- Shahid Khan, DPT, MSPT Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Pakistan
| | - Aatik Arsh
- Aatik Arsh, DPT, MSPT, PhD Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Pakistan
| | - Sargand Khan
- Sargand Khan, DPT, MSPT Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Pakistan
| | - Shahid Ali
- Shahid Ali DPT, MSPT Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Pakistan
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12
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Musa A, Miller S, Amado AA, Abbas M, Kayder OO, Newberger S, Harb A. ACE in the Hole: Adhesive Capsulitis Embolization for the Treatment of Frozen Shoulder. Cardiovasc Intervent Radiol 2024; 47:146-147. [PMID: 38082021 DOI: 10.1007/s00270-023-03622-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Arif Musa
- Department of Radiology, Detroit Receiving Hospital, Detroit Medical Center, Wayne State University School of Medicine, 4201 St. Antoine Street, Detroit, MI, 48201, USA.
| | - Stephan Miller
- Department of Radiology, Detroit Receiving Hospital, Detroit Medical Center, Wayne State University School of Medicine, 4201 St. Antoine Street, Detroit, MI, 48201, USA
| | - Adam A Amado
- Department of Radiology, Detroit Receiving Hospital, Detroit Medical Center, Wayne State University School of Medicine, 4201 St. Antoine Street, Detroit, MI, 48201, USA
| | - Mahmoud Abbas
- Department of Radiology, Detroit Receiving Hospital, Detroit Medical Center, Wayne State University School of Medicine, 4201 St. Antoine Street, Detroit, MI, 48201, USA
| | - Orest O Kayder
- Department of Radiology, Detroit Receiving Hospital, Detroit Medical Center, Wayne State University School of Medicine, 4201 St. Antoine Street, Detroit, MI, 48201, USA
| | - Shane Newberger
- Department of Radiology, Detroit Receiving Hospital, Detroit Medical Center, Wayne State University School of Medicine, 4201 St. Antoine Street, Detroit, MI, 48201, USA
| | - Ali Harb
- Department of Radiology, Detroit Receiving Hospital, Detroit Medical Center, Wayne State University School of Medicine, 4201 St. Antoine Street, Detroit, MI, 48201, USA
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13
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Wagan AA, Surahyo P. Un-resolving frozen shoulder: Are we really treating it? Pak J Med Sci 2024; 40:165-169. [PMID: 38196471 PMCID: PMC10772408 DOI: 10.12669/pjms.40.1.7440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/24/2023] [Accepted: 09/20/2023] [Indexed: 01/11/2024] Open
Abstract
Objective To perform ultrasound examination in un-resolving frozen shoulder disorder, in Pakistani cohort visiting rheumatology clinic. Methods This cross sectional study was carried out at Department of Rheumatology, Indus Medical College Tando Mohhamad Khan, from 16th March 2022 to 30th October 2022. Patients diagnosed as unilateral frozen shoulder on clinical grounds and received intra-articular injection (s) in last six months, never been investigated, still persisting with pain and restricted range of shoulder motion were enrolled. After the demographic details and shoulder examination, ultrasound examination of both shoulder joints was performed by senior musculoskeletal radiologist, to know the exact diagnosis. Results In 138 cases on ultrasound examination following injuries were noted: rotator cuff tendinopathy (RCT) (61%), adhesive capsulitis (21%), mixed lesion (rotator cuff tendinopathy and adhesive capsulitis) (14%).In age group < 50 years rotator cuff tendinopathy was the major lesion, while in cases >50 years age group: adhesive capsulitis (AC) was predominant lesion (p-0.05).Rotator cuff tendinopathy had significant association with supraspinatus tears (p<0.5). Conclusion In Un-resolving frozen shoulder pain, ultrasound examination of involved joint helps in reaching the exact cause which may differ from the existing diagnosis and guides to further management.
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Affiliation(s)
- Abrar Ahmed Wagan
- Abrar Ahmed Wagan, MBBS, FCPS (Medicine), FCPS (Rheumatology), FACR. Associate Professor of Rheumatology, Indus Medical College, Tando Mohammad Khan, Pakistan
| | - Paras Surahyo
- Paras Surahyo, MBBS, FCPS (Radiology) Assistant Professor, Department of Radiology, Bilawal Medical College, Jamshoro, Pakistan
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Pretorius J, Mirdad R, Nemat N, Ghobrial BZ, Murphy C. The efficacy of platelet-rich plasma injections compared to corticosteroids and physiotherapy in adhesive capsulitis: A systematic review and meta-analysis. J Orthop 2024; 47:35-44. [PMID: 38022840 PMCID: PMC10679531 DOI: 10.1016/j.jor.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Adhesive Capsulitis is a common condition of the shoulder with significant morbidity and protracted disease. It is usually characterized by sudden onset with progressive symptoms of pain and loss of function. This systematic review compares platelet rich plasma (PRP) intra-articular injections with corticosteroids (CS) injections and physiotherapy. Material and methods A literature search was performed using online databases (Pubmed, Cochrane, EMBASE, Medline and CINAHL) including all the studies performed on humans through April 2023. Prospective comparative studies were included in this review of patients with adhesive capsulitis assessing the use of PRP injections versus corticosteroid injections or physiotherapy. The standardized mean difference (SMD) with 95 % confidence interval in VAS/DASH/SPADI and ROM scores was calculated using a random effects model, comparing PRP to corticosteroids injections and physiotherapy across studies. Results A total of 11 studies and 971 patients, with a mean age of 52.1, were included in this analysis with 7 being randomised trials and four cohort studies. The control group was corticosteroid injections in 8 studies and physiotherapy in the other three studies. Overall PRP lead to a statistically significant improved outcome at 3 and 6 months follow up for all outcome parameters. The outcome measures at three months includes VAS 0.73 (0.31, 1.16) SMD, DASH 0.66 (0.36, 0.96) SMD, SPADI 1.50 (0.43, 2.57) SMD, ER 1.47 (0.27, 2.66) SMD and Abduction 1.10 (0.21, 1.98) SMD. Six months assessment similarly favoured PRP with VAS 3.17 (1.26, 5.08) SMD and DASH 2.10 (1.66, 2.55) SMD scores. Furthermore, a subgroup analysis demonstrated that PRP was favourable to corticosteroids as control with significant improvement in pain (VAS) at 3 months 0.65 (0.29, 1.00) and 6 months 3.17 (1.26, 5.08) SMD. Conclusion This review demonstrated that intra-articular PRP injections for adhesive capsulitis produces favourable outcomes when compared to corticosteroid injections and physiotherapy. PRP produces improved pain and functional scores as well as range of motion, which is statistically significant from 3 to 6 months post intervention. PRP seems to be a safe and effective alternative non-invasive treatment modality for patients with adhesive capsulitis.
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Affiliation(s)
- Jacques Pretorius
- University Hospital Galway, Newcastle Road, Galway, County Galway, H91YR71, Ireland
| | - Rayyan Mirdad
- University Hospital Galway, Newcastle Road, Galway, County Galway, H91YR71, Ireland
| | - Nouman Nemat
- Waterford University Hospital, Dunmore Road, Waterford, X91ER8E, Ireland
| | | | - Colin Murphy
- University Hospital Galway, Newcastle Road, Galway, County Galway, H91YR71, Ireland
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Dupeyron A, Dobija L, Castelli C, Petiot S, Tavares I, Gélis A, Coudeyre E. Nitrous oxide provided during intensive physiotherapy for shoulder adhesive capsulitis does not improve function: A randomised controlled trial. Ann Phys Rehabil Med 2023; 67:101803. [PMID: 38118247 DOI: 10.1016/j.rehab.2023.101803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/22/2023] [Accepted: 10/05/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND There is no consensus on treatment for adhesive capsulitis of the shoulder. Physiotherapy is often used to increase range of motion but individuals may experience pain during mobilisation. OBJECTIVES The objective of this study was to determine whether rehabilitation under N2O for shoulder AC improved pain and function more than rehabilitation alone (with placebo gas). METHOD A randomised, 1:1 parallel arm, double-blind study in 4 university hospital outpatient centres. Adults with adhesive capsulitis for at least 3 months with intact cartilage were included. Participants were randomised in blocks of 4 and stratified by centre to receive 20 sessions of intensive physiotherapy over 10 days; the 10 morning sessions were performed with either nitrous oxide (intervention) or sham gas (placebo). PRIMARY OUTCOME improvement in shoulder function at day 14 (D14) (Constant-Murley score). RESULTS Seventy-five participants were included, and data from 69 were analysed: 37 in the placebo group and 32 in the intervention group. Improvements occurred in both groups after the intervention. No significant difference in the Constant-Murley score was found between groups at D14 (median score increase of 12.0, IQR 5.6; 19.5 points in placebo group vs. 13.7, 5.2; 18.2 in the N20 group, p = 0.78). Pain score during sessions reduced in the intervention group from the first to final session (-11.6, p = 0.053) but not for the placebo group (-4.2, p = 0.414). Seven serious adverse events were recorded, 4 in the intervention group and 3 in the placebo group, with 11 minor adverse events only in the intervention group (mostly shortness of breath). CONCLUSION Nitrous oxide gas associated with intensive physiotherapy for shoulder adhesive capsulitis did not improve function, pain or quality of life more than physiotherapy alone. zHowever, pain experienced during physiotherapy sessions appeared lower. TRIAL REGISTRATION Clinical Trial registration number NCT01087229.
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Affiliation(s)
- Arnaud Dupeyron
- Department of Physical Medicine and Rehabilitation, CHU Nîmes, Univ Montpellier, Nîmes, France; EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Montpellier, France.
| | - Lech Dobija
- Department of Physical Medicine and Rehabilitation, CHRU de Clermont-Ferrand Université Clermont Auvergne, France
| | - Christel Castelli
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Sylvie Petiot
- Department of Physical Medicine and Rehabilitation, CHU Nîmes, Univ Montpellier, Le Grau du Roi, France
| | - Isabelle Tavares
- Department of Physical Medicine and Rehabilitation, CHRU Lapeyronie, Univ Montpellier, Montpellier, France
| | - Anthony Gélis
- Propara Neurologic Rehabilitation Centre, Parc Euromédecine, Montpellier, France
| | - Emmanuel Coudeyre
- Department of Physical Medicine and Rehabilitation, CHRU de Clermont-Ferrand Université Clermont Auvergne, France; INRA, Unité de Nutrition Humaine (UNH, UMR 1019), CRNH Auvergne, Clermont-Ferrand, France
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16
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Biglia A, Morandi V, Zanframundo G, Donati D, Maggiore F, Vita F, Sammarchi L, Pagani C, Cavagna L, Galletti S, Montecucco C. Adhesive capsulitis after COVID-19 vaccine injection: a peculiar case treated with combined bursa distention and glenohumeral capsular hydrodilatation. J Ultrasound 2023; 26:909-911. [PMID: 36595199 PMCID: PMC9809505 DOI: 10.1007/s40477-022-00739-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/01/2022] [Indexed: 01/04/2023] Open
Abstract
Frozen shoulder is a common and self-limiting condition affecting the soft tissues of the shoulders, characterized by severe pain, impaired range of motion (ROM) and limitation of daily activities. Its prevalence is 5% and it occurs most commonly in the fifth and sixth decades of life; women are more affected [DePalma in Clin Orthop Relat Res 466:552-560, 2008]. It can be idiopathic or associated with other conditions such as metabolic disorders, diabetes, thyroid diseases, prolonged immobilization, trauma [DePalma in Clin Orthop Relat Res 466:552-560, 2008], or complications after vaccine administration known as SIRVA (Shoulder injury related to vaccine administration). SIRVA is not caused by the vaccine itself but by inappropriate vaccination techniques [Martín Arias et al. in Vaccine 35:4870-4876, 2017]. The natural history of the frozen shoulder is a progression through three stages based on clinical and arthroscopic presentations: freezing, frozen and thawing [DePalma in Clin Orthop Relat Res 466:552-560, 2008; Do et al. in Orthop J Sport Med 9:232596712110036, 2021]. The onset is characterized by disabling pain, that worsens at night; it is induced by inflammation and hypervascularity and lasts from 10 to 36 weeks [Do et al. in Orthop J Sport Med 9:232596712110036, 2021]. The second stage is predominated by stiffness and severe reduction of ROM. This phase typically lasts from 9 to 12 months [Do et al. in Orthop J Sport Med 9:232596712110036, 2021]. Eventually, a recovery phase occurs, with a gradual recovery of the ROM that can last between 12 and 42 months. Ultrasound is an emerging diagnostic tool that contributes to differential diagnosis and treatment [Zappia et al. in Insights Imaging 7:365-371, 2016; Ricci et al. in J Ultrasound Med 39:633-635, 2020]: signs of adhesive capsulitis consist of thickening of the inferior recess of the glenohumeral joint capsule, thickening of the coracohumeral ligament and soft tissue structures in the rotator cuff interval, with hypervascularity. An unspecific sign is increased fluid in the tendon sheath of the long head of the biceps [Martín Arias et al. in Vaccine 35:4870-4876, 2017; Tandon et al. in J Ultrasound 20:227-236, 2017].
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Affiliation(s)
- Alessandro Biglia
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy
| | - Valentina Morandi
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy.
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy.
| | - Giovanni Zanframundo
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy
| | - Danilo Donati
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, BO, Italy
| | - Francesco Maggiore
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy
| | - Fabio Vita
- Department of Orthopedic and Traumatological Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luigi Sammarchi
- Department of Diagnostic and Interventional Radiology and Neuroradiology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - Chiara Pagani
- Department of Diagnostic and Interventional Radiology and Neuroradiology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - Lorenzo Cavagna
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy
| | - Stefano Galletti
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology, Bologna, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy
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Pattnaik S, Kumar P, Sarkar B, Oraon AK. Comparison of Kaltenborn mobilization technique and muscle energy technique on range of motion, pain and function in subjects with chronic shoulder adhesive capsulitis. Hong Kong Physiother J 2023; 43:149-159. [PMID: 37583922 PMCID: PMC10423676 DOI: 10.1142/s1013702523500166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/09/2023] [Indexed: 08/17/2023] Open
Abstract
Background Shoulder adhesive capsulitis (AC) is a common musculoskeletal condition causing pain, loss of range of motion (ROM) in the shoulder, and a decrease in its functionality, yet poorly defined and understood since its identification. Kaltenborn mobilization technique (KMT) and muscle energy technique (MET) are commonly used physiotherapeutic techniques for their treatment. To the best of our understanding, there was no study found to compare the effectiveness of one technique over another. Objective The objective of this study was to compare the effectiveness of KMT and MET on the ROM, pain and function in subjects with chronic shoulder AC. Methods In this single-centred, single-blinded quasi-experimental study with a pretest-posttest design 35 subjects were randomized into two groups: Group A (n = 18 ) received KMT and Group B (n = 17 ) received MET along with the moist hot pack (MHP), supervised exercises and home exercises common to both the groups. A total of 32 subjects completed the study with three dropouts. Subjects were evaluated before and after 10 treatment sessions for the outcomes, shoulder external rotation passive range of motion (ER-PROM) and abduction passive range of motion (ABD-PROM) using the universal goniometer, intensity of pain using the numeric pain rating scale (NPRS) and functional disability using the shoulder pain and disability index (SPADI). Results Analysis of 32 subjects showed that both groups were homogenous at baseline. The within-group analysis showed significant improvement (p < 0 . 05 ) in both groups related to all the outcomes. But when we compared the groups, Group B showed significant (p < 0 . 05 ) improvement in NPRS and SPADI in comparison to Group A. However, there was non-significant (p > 0 . 05 ) difference found in ER-PROM and ABD-PROM. Conclusion Both KMT and MET are effective in improving ROM, pain and function but MET showed a significant reduction of pain and improvement in function in subjects with chronic shoulder AC, thus supporting its use as a physiotherapeutic treatment technique.
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Affiliation(s)
- Sandeep Pattnaik
- National Institute for Locomotor Disabilities (Divyangjan) Kolkata 700090, West Bengal, India
| | - Pravin Kumar
- National Institute for Locomotor Disabilities (Divyangjan) Kolkata 700090, West Bengal, India
| | - Bibhuti Sarkar
- National Institute for Locomotor Disabilities (Divyangjan) Kolkata 700090, West Bengal, India
| | - Anil Kumar Oraon
- National Institute for Locomotor Disabilities (Divyangjan) Kolkata 700090, West Bengal, India
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Song W, Guo X, Wang X, Yu J, Jiang W, Wei C, Zhao Y. A multi-center, single-blinded, randomized, parallel-group, superiority study to compare the efficacy of manipulation under anesthesia versus intra-articular steroid injection in the treatment of patients with frozen shoulder and a diagnosis of rotator cuff injury or tear by MRI: study protocol for a randomized controlled trial. Trials 2023; 24:765. [PMID: 38012777 PMCID: PMC10683184 DOI: 10.1186/s13063-023-07810-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Frozen shoulder (FS) is a common condition that can cause severe pain and limited range of motion in the shoulder joint. While intra-articular steroid injection has been shown to be an effective treatment for FS, manipulation under anesthesia (MUA) is an alternative treatment that has gained popularity in recent years. However, there is a lack of evidence regarding the effectiveness of MUA on FS patients with concomitant rotator cuff injury or tear. Though a few studies have shown that MUA is not associated with rotator cuff tears, and will not exacerbate the injury, more high-quality studies with bigger sample sizes are needed. Therefore, the aim of this multi-center, single-blinded, randomized, parallel-group, superiority study is to compare the efficacy of MUA versus intra-articular steroid injection in the treatment of FS patients with a diagnosis of rotator cuff injury or tear by MRI. METHODS A parallel, single-blinded, multi-center randomized controlled trial of 320 patients will be conducted at three hospitals of China. Eligible patients with frozen shoulder and rotator cuff injury or tear diagnosed by MRI will be randomly assigned to, in equal proportions, the manipulation under anesthesia group and the intra-articular steroid injection group via a central randomization system, undergoing a corresponding operation on day one and a sequent physical exercise for 14 days. The primary outcome is the comprehensive efficacy evaluation (total effective rate) and the change of Constant-Murley Score. Outcome assessors and data analysts will be blinded, and participants will be asked not to reveal their allocation to assessors. DISCUSSION This study aims to explore the superiority of manipulation under anesthesia in reducing pain and improving shoulder function in frozen shoulder patients accompanied with rotator cuff injury. To provide a scientific basis for the dissemination and application of manipulation under anesthesia, and a better knowledge for the role of MUA in the treatment of frozen shoulder accompanied with rotator cuff injury. TRIAL REGISTRATION Chictr.org.cn ChiCTR2200067122 . Registered on 27 December 2022. ChiCTR is a primary registry of the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) network and includes all items from the WHO Trial Registration data set in Trial registration.
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Affiliation(s)
- Wuwei Song
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoyu Guo
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang Wang
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Jiacheng Yu
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenyu Jiang
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen Wei
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuhao Zhao
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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de la Barra Ortiz HA, Parizotto N, Arias M, Liebano R. Effectiveness of high-intensity laser therapy in the treatment of patients with frozen shoulder: a systematic review and meta-analysis. Lasers Med Sci 2023; 38:266. [PMID: 37981583 DOI: 10.1007/s10103-023-03901-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 09/30/2023] [Indexed: 11/21/2023]
Abstract
The purpose of this study is to evaluate the effects of high-intensity laser therapy (HILT) in patients with frozen shoulder. PRISMA guidelines were adhered to, and a systematic search was conducted in the PubMed, Web of Science, Scopus, CINAHL, Science Direct, and PEDro databases (last update: September 4, 2023; search period: December 2022-September 2023). The inclusion criteria encompassed RCTs comparing HILT with other physical therapy interventions in frozen patients with frozen shoulders, with or without sham HILT, assessing pain intensity, shoulder ROM, and disability outcomes. The quality of the RCTs was assessed with the Cochrane Risk of Bias tool, and evidence was assessed using the GRADE approach. Five trials met the eligibility criteria and were included in the review and meta-analysis, which pooled results from the visual analog scale (VAS), goniometry, and the shoulder pain and disability index (SPADI). Mean differences (MDs) for pain intensity and disability show a pooled effect in favor of HILT both for VAS (MD = - 2.23 cm, 95% CI: - 3.25, - 1.22) and SPADI (MD = - 10.1% (95% CI = - 16.5, - 3.7), changes that are statistical (p < 0.01) and clinical. The MD for flexion (MD = 9.0°; 95% CI: - 2.36°, 20.3°; p = 0.12), abduction (MD = 3.4°; 95% CI: - 6.9°, 13.7°; p = 0.51), and external rotation (MD = - 0.95°; 95% CI: - 5.36°, 3.5°; p = 0.67) does not show statistical and clinical differences between groups after treatment. PI and disability changes were graded as important due to their clinical and statistical results. HILT into a physical therapy plan reduce pain and disability, but it does not outperform conventional physical therapy in improving shoulder ROM. It is suggested that future RCTs compare the effects of HILT and LLLT to assess their possible differences in their analgesic effects.
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Affiliation(s)
- Hernán Andrés de la Barra Ortiz
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, 7591538, Santiago, Chile.
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Paulo, Brazil.
| | - Nivaldo Parizotto
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Paulo, Brazil
| | - Mariana Arias
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Paulo, Brazil
| | - Richard Liebano
- Physiotherapeutic Resources Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Paulo, Brazil
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
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20
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Galasso O, Mercurio M, Luciano F, Mancuso C, Gasparini G, De Benedetto M, Orlando N, Castricini R. Arthroscopic capsular release for frozen shoulder: when etiology matters. Knee Surg Sports Traumatol Arthrosc 2023; 31:5248-5254. [PMID: 37702747 PMCID: PMC10598184 DOI: 10.1007/s00167-023-07561-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE No therapeutic intervention is universally accepted for frozen shoulder, and the most effective management to restore motion and diminish pain has yet to be defined. The aim of this study was to investigate functional and psychological outcomes in patients who underwent arthroscopic capsular release for a frozen shoulder. METHODS A retrospective study with prospective data collection was conducted with 78 patients suffering from frozen shoulder resistance to conservative treatment. Considering the etiology, there were 36 (46.2%) idiopathic, 31 (39.7%) postoperative, and 11 (14.1%) posttraumatic cases. Preoperatively, each patient was evaluated with the range of motion (ROM) assessment and the Constant-Murley score (CMS). At follow-up, the 4-point subjective satisfaction scale (SSS), the ROM assessment, the SF-12 questionnaire, the numerical rating scale (NRS) for the subjective assessment of pain, the CMS and the Hospital Anxiety and Depression Scale (HADS) were assessed. RESULTS After a mean follow-up of 54.2 ± 22.3 months, ROM and CMS showed a statistically significant improvement between pre- and postoperative values (all p < 0.001). Before surgery, the mean CMS was 36.9% that of sex- and age-matched healthy individuals, and all patients showed a CMS lower than the normative data. At the final follow-up visit, the mean CMS was 99.9% that of sex- and age-matched healthy individuals, and 49 (62.8%) patients showed a CMS equal to or higher than the normative data. The mean increase in the CMS was 56.1 ± 8.3 points. The mean SSS, HADS-A, HADS-D, and NRS were 3.7 ± 0.5, 2.5 ± 1.6, 2.2 ± 1.3, and 2.2 ± 1.0, respectively. All patients returned to their previous level of work and sports activity after 2 and 2.5 months, respectively. The multivariate analysis showed the association between a higher postoperative CMS and the idiopathic etiology of a frozen shoulder (p = 0.004, β = 3.971). No intraoperative complications occurred. Postoperatively, four patients (5.1%) were treated with intra-articular steroid injections to manage residual symptoms. One patient (1.3%) with a postoperative frozen shoulder showed persistent symptoms and underwent a new successful arthroscopic capsular release. CONCLUSION High patient satisfaction and statistically significant ROM and CMS recovery can be achieved after arthroscopic capsular release to manage frozen shoulder. Better functional outcomes are expected when the etiology is idiopathic. Results can help surgeons identify the patients who will most benefit from surgery and should be discussed with the patient. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, 88100, Catanzaro, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, 88100, Catanzaro, Italy
| | - Francesco Luciano
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, 88100, Catanzaro, Italy
| | - Claudia Mancuso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, 88100, Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, 88100, Catanzaro, Italy.
| | | | - Nicola Orlando
- Division of Orthopaedic and Trauma Surgery, "Villa Verde", 63900, Fermo, Italy
| | - Roberto Castricini
- Division of Orthopaedic and Trauma Surgery, "Villa Verde", 63900, Fermo, Italy
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21
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Korkoman AJ, Alammari AS, Alqahtani NH, AlQahtani AA. The incidence of adhesive capsulitis and COVID-19 pandemic effect. JSES Int 2023; 7:2406-2409. [PMID: 37969511 PMCID: PMC10638584 DOI: 10.1016/j.jseint.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background There are multiple pieces of evidence in the literature that coronavirus disease 2019 (COVID-19) has a pronounced effect on physiological health. There is little existing literature that has studied the pandemic's impact on adhesive capsulitis (AC) incidence. This study aimed to compare the incidence of primary AC before and during the pandemic. Methods A retrospective cohort study was done to establish the incidence of primary AC during the COVID-19 pandemic, from March 2020 to March 2021, the pandemic period, and from March 2019 to March 2020, the control period. During these periods, all patients diagnosed with primary AC were included. Patients were also categorized into three different treatment groups according to corticosteroid injection status (none, 1 injection, and 2 injections). The waiting time for the appointment was calculated as a possible confounding factor. Statistical analysis used the chi-square for categorical variables and the Student t test for continuous variables. Results There were 69 patients diagnosed with primary AC out of 704 new referrals during the pandemic. One year earlier, a total of 73 patients were diagnosed with primary AC out of 1148 new referrals. Representing a relative increase of 3.5% (P = .086) in the incidence of primary AC. No significant differences were found between the control and the pandemic groups in regard to the distribution of patients per treatment group (P = .13), age (P = .49), sex (P = .21), laterality (P = .54), diabetic disease (P = .45), and thyroid disease (P = .62). Conclusion There was a nonstatistically significant increase in the incidence of primary AC during the COVID-19 pandemic. No other significant differences were found. Further research is still needed to evaluate the relationship between the COVID-19 pandemic and AC.
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Affiliation(s)
| | | | - Nayef Hadi Alqahtani
- Radiology Department at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Ali AlQahtani
- Orthopedic Surgery Department at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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22
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Jaideep A, Eapen C, Prabhakar AJ, Patel V. Upper-crossed syndrome and disability in shoulder adhesive capsulitis. J Bodyw Mov Ther 2023; 36:282-290. [PMID: 37949573 DOI: 10.1016/j.jbmt.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 11/12/2023]
Abstract
STUDY DESIGN Cross-sectional analytical study. INTRODUCTION Adhesive capsulitis (AC) is a long-standing condition with varying extents of disability seen among patients. The role of postural manifestations and contractile tissue involvement in this condition is poorly understood and yet to be explored. PURPOSE This study aimed to analyze if individuals with adhesive capsulitis demonstrated the characteristics of an upper crossed syndrome (UCS) postural manifestation and whether or not its presence affected the extent of disability experienced by this population. METHODS Sixty-five individuals with AC were assessed for the presence of UCS. Scapular muscle strength and length alterations, forward head posture (FHP), and disability were assessed and compared between those with and without UCS. Paired T test and an independent T test were utilized to compare means within and between these groups, respectively, while non-parametric measures were utilized for their skewed counterparts. Phi coefficient (φ) was used to determine the strength of association between the descriptive patient characteristics. The correlation between symptom duration and degree of postural involvement was analyzed using Pearson's correlation coefficient. RESULTS 43.1% of the study population demonstrated UCS and 80% FHP with a significant negative correlation between Cranio Vertebral Angle and chronicity of AC (r = -0.27). Individuals with AC demonstrated significantly decreased scapular muscle strength (p = <.001) and pectoralis minor length on the affected side (p = .03). No differences were seen between groups with and without UCS. The mean SPADI scores between groups demonstrated a more significant level of perceived pain and disability in individuals with UCS (p = .049). CONCLUSIONS As seen in UCS, individuals with AC demonstrated alterations in movement patterns and posture. UCS was seen to contribute towards the existing disability in AC. This study suggests a careful evaluation and intervention based on these findings to document its effect on pain and dysfunction in AC.
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Affiliation(s)
- Aishwarya Jaideep
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Charu Eapen
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - Ashish John Prabhakar
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Vivekbhai Patel
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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23
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Kirker K, O’Connell M, Bradley L, Torres-Panchame RE, Masaracchio M. Manual therapy and exercise for adhesive capsulitis: a systematic review with meta-analysis. J Man Manip Ther 2023; 31:311-327. [PMID: 36861780 PMCID: PMC10566414 DOI: 10.1080/10669817.2023.2180702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/08/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Adhesive capsulitis (AC) affects approximately 1% of the general population. Current research lacks clear guidance on the dosage of manual therapy and exercise interventions. OBJECTIVE The purpose of this systematic review was to assess the effectiveness of manual therapy and exercise in the management of AC, with a secondary aim of describing the available literature present on the dosage of interventions. METHODS Eligible studies were randomized clinical/quasi-experimental trials with complete data analysis and no limits on date of publication, published in English, recruited participants >18 years of age with primary adhesive capsulitis, that had at least two groups with one group receiving manual therapy (MT) alone, exercise alone, or MT and exercise, that included at least one outcome measure of pain, disability, or external rotation range of motion, and that had dosage of visits clearly defined. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias 2 Tool. The Grading of Recommendations Assessment, Development, and Evaluation was used to provide an overall assessment of the quality of evidence. Meta-analyses were conducted when possible, and dosage was discussed in narrative form. RESULTS Sixteen studies were included. All meta-analyses revealed non-significant effects of pain, disability, and external rotation range of motion at short- and long-term follow-up, with an overall level of evidence ranging from very low to low. CONCLUSION Non-significant findings with low-to-very-low-quality of evidence were found across meta-analyses, preventing seamless transition of research evidence to clinical practice. Lack of consistency in study designs, manual therapy techniques, dosing parameters, and duration of care impedes the ability to make strong recommendations regarding optimal dosage of physical therapy for individuals with AC.
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Affiliation(s)
- Kaitlin Kirker
- Department of Physical Therapy, Long Island University, 1 University Plaza, Brooklyn, NY, United States
| | - Melanie O’Connell
- Department of Physical Therapy, Long Island University, 1 University Plaza, Brooklyn, NY, United States
| | - Lisa Bradley
- Department of Physical Therapy, Long Island University, 1 University Plaza, Brooklyn, NY, United States
| | | | - Michael Masaracchio
- Department of Physical Therapy, Long Island University, 1 University Plaza, Brooklyn, NY, United States
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24
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Baradaran A, Ebrahimzadeh MH, Sabzevari S, Baradaran A, Razi S, Kachooei AR. Is there any advantage between using continuous passive motion and conventional physical therapy in patients with primary adhesive capsulitis?: A systematic review and meta-analysis. J Bodyw Mov Ther 2023; 36:133-141. [PMID: 37949549 DOI: 10.1016/j.jbmt.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/18/2023] [Accepted: 06/05/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND We are unsure if continuous passive motion (CPM) has any role in the nonoperative management of the Primary Stiff Shoulder (frozen shoulder). We hypothesized that there is no difference in pain improvement, range of motion, and function with or without CPM in patients with a primary stiff shoulder. METHOD We searched the databases for clinical trials comparing CPM versus no-CPM physiotherapy. In the final step, we reviewed five randomized clinical trials. We collected the data of Constant Shoulder Score (CSS), the visual analog scale of pain, shoulder pain and disability index (SPADI), and range of motion (flexion, abduction, external and internal rotation). We used a random-effects model to analyze the data. RESULTS Five studies with a total of 224 patients were included. There were 113 patients in the CPM arm and 111 in the control arm. Both the CPM and control groups showed significant improvements in all measured parameters compared to the first visit after 8-24 weeks. Meta-analysis of pooled data showed significant differences in pain improvement, forward flexion, and CSS favoring the CPM. Still, there was no significant difference in abduction, external and internal rotation, and SPADI. DISCUSSION The CPM seems to be slightly effective in improving pain and motion in the short term, but its long-term efficacy is still under question. The extra cost and time must be considered when offering the CPM.
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Affiliation(s)
- Ashkan Baradaran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Family Medicine, McGill University, Canada
| | | | - Soheil Sabzevari
- Weill Cornell University, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Shiva Razi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir R Kachooei
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Rothman Orthopaedics Florida at AdventHealth, Orlando, USA; Department of Orthopaedic Surgery, University of Central Florida, Florida, USA.
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25
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Arrambide-Garza FJ, Guerrero-Zertuche JT, Alvarez-Villalobos NA, Quiroga-Garza A, Espinosa-Uribe A, Vilchez-Cavazos F, Salinas-Alvarez Y, Rivera-Perez JA, Elizondo-Omaña RE. Rotator Interval vs Posterior Approach Ultrasound-guided Corticosteroid Injections in Primary Frozen Shoulder: A Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2023:S0003-9993(23)00519-1. [PMID: 37690742 DOI: 10.1016/j.apmr.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To compare the efficacy of rotator interval (RI) vs posterior approach (PA) ultrasound (US) guided corticosteroid injections into the glenohumeral (GH) joint in primary frozen shoulder (PFS). DATA SOURCES A systematic literature search for all relevant studies on Medline, Scopus, Embase, Web of Science, and Cochrane Central, up to January 2023 was conducted. STUDY SELECTION Randomized controlled trials that directly compared the US-guided corticosteroid injection into the RI and GH joint using PA in patients clinically and radiographically diagnosed with PFS. DATA EXTRACTION The primary outcome was pain, and the secondary outcomes were function, and range of motion (ROM). Two authors independently assessed the risk of bias using the Cochrane risk-of-bias tool version 2. A random-effects model and generic inverse variance method were performed. Effect sizes were estimated using mean difference (MD) and standardized mean difference (SMD). DATA SYNTHESIS A total of 5 clinical trials involving 323 subjects were included for the meta-analysis. US-guided corticosteroid injections into the RI revealed significant pain relief (MD 1.33 [95% confidence interval (CI) 0.20 to 2.46]; P=.02) and significant functional improvement (SMD 1.31 [95% CI 0.11 to 2.51]; P=.03) compared with the PA after 12 weeks. CONCLUSION The results suggest the injection of corticosteroid into RI space is more effective than PA after 12 weeks in improving both pain and functional scores in patients with PFS.
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Affiliation(s)
| | | | - Neri Alejandro Alvarez-Villalobos
- Universidad Autonoma de Nuevo Leon, School of Medicine, 360 Research Development Center, Monterrey, Mexico; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA; Instituto Mexicano del Seguro Social, Nuevo Leon Delegation, Monterrey, Mexico
| | - Alejandro Quiroga-Garza
- Universidad Autonoma de Nuevo Leon, School of Medicine, Human Anatomy Department, Mexico; Instituto Mexicano del Seguro Social, Nuevo Leon Delegation, Monterrey, Mexico
| | - Abraham Espinosa-Uribe
- Universidad Autonoma de Nuevo Leon, School of Medicine, Human Anatomy Department, Mexico; Hospital Christus Muguerza, High Specialty, Department of Orthopedics and Traumatology, Monterrey, Mexico
| | - Felix Vilchez-Cavazos
- Autonoma de Nuevo Leon, University Hospital "Dr José Eleuterio González", Orthopedic Surgery Division, Monterrey, México
| | | | - Juan Antonio Rivera-Perez
- Dirección de Medicina y Ciencias Aplicadas, Comisión Nacional De Cultura Física y Deporte, Ciudad de México, México.
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26
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Yoon JY, Han H, Shin MY, Jeong HJ, Kang Y, Jeon YD, Kim JU, Oh JH. What is the most predictive magnetic resonance imaging finding of rotator cuff tear concomitant with shoulder stiffness? JSES Int 2023; 7:756-762. [PMID: 37719831 PMCID: PMC10499857 DOI: 10.1016/j.jseint.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Common magnetic resonance imaging (MRI) findings in adhesive capsulitis are not often evident in rotator cuff tear concomitant with shoulder stiffness. This study aimed to determine the most predictive MRI finding of rotator cuff tear with shoulder stiffness to differentiate from that without stiffness. Materials and methods The data of patients who underwent arthroscopic rotator cuff repair between January 2014 and October 2019 were retrospectively reviewed. Stiffness was defined as forward flexion <120°, external rotation at side <30°, and internal rotation at back Results Anterior capsular thickness, glenoid capsular thickness in the axillary recess, and anterior and axillary capsular hyperintensities were significantly more dominant in the stiff group (all P < .05) than in the control group. Anterior capsular thickness and anterior capsular abnormal hyperintensity could be used to differentiate between the stiff and control groups (P < .05). Anterior capsular thickness showed high diagnostic performance with an area under the receiver operating characteristic curve of 0.993. The cut-off value for stiffness was 3.07 mm (sensitivity, 96.1%; specificity, 100%). Conclusion Anterior capsular thickening and abnormal hyperintensity were the most predictive MRI findings for stiffness in patients with rotator cuff tear and stiffness to differentiate from patients with rotator cuff tear without stiffness.
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Affiliation(s)
- Ji Young Yoon
- Department of Orthopaedic Surgery, National Police Hospital, Seoul, Republic of Korea
| | - HeeSoo Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Myoung Yeol Shin
- Department of Orthopaedic Surgery, National Police Hospital, Seoul, Republic of Korea
| | - Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Young Dae Jeon
- Department of Orthopaedic Surgery, Ulsan University College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Ji Un Kim
- Department of Orthopaedic Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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27
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De Virgilio-Salgado L, Deliz-Jimenez D, Ruberte H, Cedeño-Rodriguez F, Rivera-Rodriguez G, Ramírez N, Soler-Salas A, Deliz-Asmar E. Effect of surgical timing in outcomes in Hispanic patients after arthroscopic capsular release in diabetic and idiopathic adhesive capsulitis. JSES Int 2023; 7:786-792. [PMID: 37719808 PMCID: PMC10499843 DOI: 10.1016/j.jseint.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Adhesive capsulitis of the shoulder is a painful and debilitating condition. While the majority of patients improve with conservative treatment, those who do not improve require surgery such as arthroscopic capsular release (ACR) for symptom relief. However, there is limited literature regarding the optimal timeframe to proceed with surgery. Methods This retrospective cohort evaluated 134 Hispanic patients who underwent ACR for the treatment of adhesive capsulitis. Patients were divided into an early and a delayed treatment group that included all patients. Patients were then divided into diabetic and idiopathic subgroups. Early vs. delayed treatment outcomes (forward flexion, external rotation, Visual Analog Scale pain scores, and recurrence requiring reoperation) were assessed in all patients and in each subgroup. Results No statistically significant differences were found between the early and delayed release groups in postoperative forward flexion, external rotation, pain intensity scores, and recurrence requiring reoperation at 1 month, 3 months, and 6 months of follow-up in the all-patient group. In the idiopathic frozen shoulder subgroup, no significant differences were observed in postoperative forward flexion, external rotation, pain intensity scores, and recurrence requiring reoperation at 1 month, 3 months, and 6 months of follow-up. In the diabetic frozen shoulder subgroup, no significant differences were observed in postoperative forward flexion, external rotation, pain intensity scores, and recurrence requiring reoperation at 1 month and 6 months of follow-up visits. Conclusions There was no difference in outcomes following ACR for adhesive capsulitis between patients who underwent early release vs. delayed release. There were no significant differences in outcomes between early and delayed arthroscopic release in patients with a history of diabetes mellitus.
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Affiliation(s)
- Lucas De Virgilio-Salgado
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | - David Deliz-Jimenez
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | - Henry Ruberte
- General Surgery Department, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Francis Cedeño-Rodriguez
- University of Puerto Rico School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | | | - Norman Ramírez
- Orthopaedic Surgery Department, Mayagüez Medical Center, Mayagüez, PR, USA
| | - Antonio Soler-Salas
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | - Efrain Deliz-Asmar
- Department of Orthopaedic Surgery, Hospital HIMA San Pablo, Bayamon, PR, USA
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28
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Bi AS, Papalia AG, Romeo PV, Schoof LH, Kwon YW, Rokito AS, Zuckerman JD, Virk MS. Effect of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers on need for operative intervention for idiopathic adhesive capsulitis. JSES Int 2023; 7:793-798. [PMID: 37719830 PMCID: PMC10499842 DOI: 10.1016/j.jseint.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background The exact pathogenesis of idiopathic adhesive capsulitis (IAC) is not fully understood, but an inflammatory profibrotic cascade, largely mediated by transforming growth factor-beta 1 (TGF- β1) has been implicated. Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACE-Is) both decrease the activity of TGF-β1. The aim of this study was to determine the impact of ACE-Is or ARBs use on the need for operative intervention in IAC. Methods This was a retrospective cohort study of patients from a single institutional database with IAC, divided into two cohorts, with and without ACE-I and/or ARB use as the primary exposure and a minimum 2-year follow-up. The primary outcome measured was the incidence of operative intervention including manipulation under anesthesia (MUA) and arthroscopic capsular release (ACR). Additional multivariable logistic regression analysis was performed to evaluate associations between ACE-I/ARB use and likelihood of undergoing an operative procedure. Results A total of 17,645 patients met inclusion criteria, with 5424 patients in the ACE-I/ARB cohort and 12,221 in the non-ACE-I/ARB cohort. Overall, 422 (2.4%) patients underwent surgical treatment, 378 (2.1%) ACR, and 74 (0.4%) MUA. There was no significant difference between cohorts in the frequency of surgical procedures or time to procedure since diagnosis. There were no significant differences between individual ACE-Is or ARBs, although Losartan was found to have a trend of decreased rate of intervention (31.7% vs. 36.8%, P = .209) when compared to patients not on losartan that did not reach statistical significance. Patient factors predictive of undergoing MUA/ACR were diabetes (P = .013), obesity (P < .001), and male sex (P < .001). Increasing patient age reduces the likelihood of undergoing operative intervention, with patients aged 50-70 years (P = .022) and age >70 years (P < .001) demonstrating reduced odds as compared to patients aged <30 years. Conclusion Patients with IAC have an overall low (2.4%) rate of requiring surgical intervention. While the antifibrotic mechanism of ACE inhibitors and ARBs did not significantly affect the rate of requiring surgical intervention, male gender, obesity, younger age, and diabetes, all increased the risk for operative intervention. Losartan, specifically, may have a disease modifying effect on IAC that should be investigated with larger controlled trials.
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Affiliation(s)
- Andrew S. Bi
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Aidan G. Papalia
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Paul V. Romeo
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Lauren H. Schoof
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Young W. Kwon
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Andrew S. Rokito
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Joseph D. Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Mandeep S. Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
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Mertens MG, Meeus M, Verborgt O, Girbes EL, Horno SMD, Aguilar-Rodriguez M, Dueñas L, Navarro-Ledesma S, Fernandez-Sanchez M, Luque-Suarez A, Struyf F. Exploration of the clinical course of frozen shoulder: A longitudinal multicenter prospective study of functional impairments. Braz J Phys Ther 2023; 27:100539. [PMID: 37639942 PMCID: PMC10474583 DOI: 10.1016/j.bjpt.2023.100539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Contradictory evidence exists regarding the clinical course of frozen shoulder (FS). OBJECTIVES To explore the clinical course of FS regarding disabilities, pain, range of motion (ROM), muscle strength, scapular upward rotation, and proprioception and to establish longitudinal correlations between these variables. METHODS Patients with FS were prospectively followed for 9 months at 3-month intervals. Assessment included the Disabilities of the Arm, Shoulder and Hand questionnaire; visual analogue scale for pain; an inclinometer for shoulder external rotation (ER), internal rotation (IR), flexion, and abduction ROM, and scapular upward rotation and proprioception, as well as handheld dynamometry for muscle strength in shoulder abduction, ER, and IR. RESULTS Initially, 149 patients (98 females; mean (SD) age 53 (9) years) were included, with 88 completing all follow-up assessments. Most variables showed early improvement in the clinical course of FS, particularly ER and IR at 90° abduction, which continued to improve from 6 to 9 months of follow-up. Associations were observed between disabilities and pain (r = 0.61), disabilities/pain and ROM (r=-0.62 to -0.59 and r=-0.47 to -0.39, respectively), disabilities/pain and muscle strength (r=-0.24 to -0.35 and r=-0.36 to -0.17, respectively), and between disabilities/pain and scapular upward rotation below shoulder level (r = 0.23 to 0.38 and r = 0.24 to 0.30, respectively). ROM correlated with muscle strength (r = 0.14 to 0.44), while both ROM and ER muscle strength correlated with scapular upward rotation below shoulder level (r=-0.37 to -0.23 and r=-0.17 to -0.12, respectively). Muscle strength correlated with scapular upward rotation above shoulder level (r = 0.28 to 0.38) and lift-off muscle strength correlated with joint repositioning (r=-0.17 to -0.15). CONCLUSION Almost all factors improved in the early phase (3-6 months) after baseline assessment, while ER and IR ROM at shoulder level continued to improve long term.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium; Department of Orthopaedic Surgery, University Hospital (UZA), Edegem, Belgium
| | - Enrique Lluch Girbes
- Pain in Motion International Research Group, Belgium; Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain; Department of Physical Therapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Marta Aguilar-Rodriguez
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Santiago Navarro-Ledesma
- Department of Physical Therapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
| | | | | | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
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Foula AS, Sabry LS, Elmulla AF, Kamel MA, Hozien AI. Ultrasound-guided Shoulder Intraarticular Ozone Injection Versus Pulsed Radiofrequency Application for Shoulder Adhesive Capsulitis: A Randomized Controlled Trial. Pain Physician 2023; 26:E329-E340. [PMID: 37535775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND A diseased shoulder due to pain, stiffness, or weakness negatively affects patients' quality of life and their ability to carry out activities of daily living. Adhesive capsulitis is a disease characterized by shoulder pain and global limitation of movement in the shoulder joint. Many interventions have been proposed for the treatment of primary adhesive capsulitis. The current study compares the effect of ultrasound-guided intraarticular injection of ozone versus steroid versus intraarticular application of pulsed radiofrequency. OBJECTIVES The primary outcome of the current study was to compare the improvement in the Visual Analog Scale (VAS) after the 3 treatment modalities. The secondary outcomes included functional improvement measured by the Shoulder Pain and Disability Index (SPADI) and level of inflammatory biomarkers measured by serum intercellular adhesion molecule (ICAM-1) and high-sensitivity C-reactive protein(hs-CRP). STUDY DESIGN The current study is a prospective, double blinded, randomized controlled trial. We employed a double blinding technique for both the patients and the outcome assessors. SETTING Our study was carried out at the Medical Research Institute, Alexandria University, Egypt, after approval of the local ethical committee (IORG0008812). The study was registered in the "clinical trials library for protocol registration and results system" with number NCT04724317.The study included 45 patients with a diagnosis of primary adhesive capsulitis. METHODS Patients were randomly assigned to 3 equal groups: steroid group, ozone group, and pulsed radiofrequency group. Pain and global shoulder functions were assessed using the VAS at rest and with movement, range of motion (ROM), and the SPADI. Moreover, ICAM-1 and hs-CRP were measured as inflammatory markers. RESULTS The results of the current study reveal that all patients in all groups have had a statistically significant improvement after their intervention regarding pain, disability, ROM, and inflammatory markers. Pairwise comparisons revealed that improvement of the VAS during movement had a statistically significant improvement starting from the second week and continuing to the fourth and eighth week. VAS during rest had a significant improvement starting from follow-up week one in the steroid group. Moreover, improvement in the ROM and SPADI scores started from the second week follow-up. Percent improvement was calculated for each group and there was a statistically significant difference between groups in VAS at rest and ROM in the pulsed radiofrequency group compared to the steroid group.Regarding inflammatory markers, both ICAM-1 and hs-CRP had a significant improvement after all 3 interventions with no statistically significant difference among the groups. LIMITATIONS This study is a single-center study. A shortage of previously published data, and heterogeneity in the published methodology of the 3 interventions limited our discussion data for comparison with the previous literature. CONCLUSION Ultrasound-guided shoulder joint intraarticular injection of steroid, ozone, or pulsed radiofrequency application all result in a significant improvement in pain, disability, and ROM in primary adhesive capsulitis. They can be used as an effective treatment modality for this condition. Comparing groups statistically, the pulsed radiofrequency group had a more delayed, but statistically better long-term improvement compared to the other 2 groups.
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Affiliation(s)
- Ahmed S Foula
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Laila S Sabry
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Ahmed F Elmulla
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Maher A Kamel
- Medical Research Institute, Alexandria University, Alexandria, Egypt
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Ordahan B, Yigit F, Mülkoglu C. Efficacy of Low-level Laser Versus High-intensity Laser Therapy in the Management of Adhesive Capsulitis: A Randomized Clinical Trial. Saudi J Med Med Sci 2023; 11:201-207. [PMID: 37533657 PMCID: PMC10393096 DOI: 10.4103/sjmms.sjmms_626_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/20/2023] [Accepted: 06/11/2023] [Indexed: 08/04/2023]
Abstract
Background Low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) are effective in alleviating pain and improving functionality in patients with adhesive capsulitis (AC); however, no study has compared the efficacy of these two laser treatments. Objective To compare the effectiveness of LLLT and HILT in improving the shoulder joint range of motion and functional status and in reducing pain level in patients with AC. Trial Design Prospective, randomized, parallel group, patient- and assessor-blinded. Methods A total of 45 patients (aged: 18-65 years) with complaint of shoulder pain were evaluated for inclusion criteria, which included being aged 18-65 years and a diagnosis of AC based on physical examinations. Using computer-generated random numbers, eligible patients were randomized into two groups: HILT + stretching exercise and LLLT + stretching exercise groups. Both HILT and LLLT were performed three times/week for 3 weeks. Functional status and pain of the patients were evaluated with Shoulder Pain and Disability Index (SPADI) and Visual Analog Scale (VAS), while shoulder joint range of motion was measured with goniometry. All assessments were done before and 3 weeks after treatment. Results A total of 40 patients (20 in each group) completed the study. At baseline, there was no statistically significant difference in the demographic and clinical characteristics between both groups. Both the LLLT and HILT groups showed significant improvement in the VAS and SPADI scores 3 weeks after treatment; however, the improvement was significantly higher in the HILT group than the LLLT group. There was no significant improvement in goniometric scores in both groups compared with baseline. No injury or other musculoskeletal complications were recorded during or after the treatments. Conclusion HILT + stretching exercise treatment was more effective than LLLT + stretching exercise for improving functional parameters and pain in patients with AC. Trial Registration ClinicalTrials.gov Identifier: NCT05469672. Funding None.
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Affiliation(s)
- Banu Ordahan
- Department of Physical Medicine and Rehabilitation, Meram Medical School, Necmettin Erbakan University, Konya, Turkey
| | - Fatih Yigit
- Department of Physical Medicine and Rehabilitation, Meram Medical School, Necmettin Erbakan University, Konya, Turkey
| | - Cevriye Mülkoglu
- Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
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Jo HS, Kim HM, Han JY, Park HK. Atypical progress of frozen shoulder after COVID-19 vaccination: A case report. World J Clin Cases 2023; 11:3637-3642. [PMID: 37383894 PMCID: PMC10294196 DOI: 10.12998/wjcc.v11.i15.3637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/22/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND After vaccination was mandated worldwide, various adverse effects associated with the coronavirus disease 2019 (COVID-19) vaccination, including shoulder pain, have been reported. Here, we report a case of new-onset shoulder pain after BNT162b2 (Comirnaty, Pfizer-BioNTech) mRNA vaccination.
CASE SUMMARY A 50-year-old man visited our rehabilitation center with left shoulder range of motion (ROM) limitation that had persisted for more than 5 mo. The history included no specific noteworthy events, except vaccination. The pain in the patient’s left deltoid muscle appeared 1 day after the second BNT162b2 vaccination and intensified to severe pain. The patient self-administered aspirin, with which the pain subsided immediately, whereas ROM limitation persisted. At the first visit, the patient complained of dull pain and ROM restriction of the left shoulder (flexion 130°, abduction 110°, and external rotation 40°). Among the diagnostic studies conducted for the evaluation of the shoulder, magnetic resonance imaging showed a thickened coracohumeral ligament. Nerve conduction studies and needle electromyography showed no electrodiagnostic abnormalities. The patient received comprehensive rehabilitation for 7 mo and had an overall improvement in pain and ROM of the left shoulder.
CONCLUSION In this case of severe shoulder pain after COVID-19 vaccination that subsided immediately with aspirin treatment, the exact cause and mechanism of pain are unclear. However, the clinical symptoms and diagnostic workups in our report suggest the possibility that the COVID-19 vaccination triggered an immunochemical response that resulted in shoulder pathology.
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Affiliation(s)
- Hyun-Seok Jo
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Heart Research Center, Chonnam National University, Chonnam National University Medical School & Hospital, Gwangju City 61469, South Korea
| | - Hyeong-Min Kim
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Heart Research Center, Chonnam National University, Chonnam National University Medical School & Hospital, Gwangju City 61469, South Korea
| | - Jae-Young Han
- Department of Physical and Rehabilitation Medicine, Regional Cardiocerebrovascular Center, Center for Aging and Geriatrics, Research Institute of Medical Sciences, Heart Research Center, Chonnam National University, Chonnam National University Medical School & Hospital, Gwangju City 61469, South Korea
| | - Hyeng-Kyu Park
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Heart Research Center, Chonnam National University, Chonnam National University Medical School & Hospital, Gwangju City 61469, South Korea
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Dimitri-Pinheiro S, Klontzas ME, Pimenta M, Vassalou EE, Soares R, Karantanas AH. Ultrasound-guided hydrodistension for adhesive capsulitis: a longitudinal study on the effect of diabetes on treatment outcomes. Skeletal Radiol 2023; 52:1005-1014. [PMID: 35908089 DOI: 10.1007/s00256-022-04141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The effect of diabetes on adhesive capsulitis (AC) and its impact on the outcomes of ultrasound (US)-guided hydrodistension of the glenohumeral joint are still unclear. We aimed to identify predictors of US-guided hydrodistension outcomes, while assessing the performance of the method in diabetic compared to non-diabetic patients. MATERIALS AND METHODS A total of 135 patients with AC who underwent US-guided hydrodistension were prospectively included. Demographics and factors linked to chronic inflammation and diabetes were recorded and patients were followed-up for 6 months. Functionality and pain were evaluated with the Disabilities of the Arm, Shoulder and Hand (DASH) and the Visual Analogue Scale (VAS) score. Statistical analysis was performed with Mann-Whitney U test, linear, and binary logistic regression. RESULTS Diabetes was identified in 25/135 patients (18.5%). Diabetic patients had worse DASH and VAS score at presentation (P < 0.0001) and presented with a higher grade of AC (P < 0.0001) and lower range of motion (P < 0.01) compared to non-diabetics. Higher DASH (P = 0.025) and VAS scores (P = 0.039) at presentation were linked to worse functionality at 6 months. Presence and duration of diabetes, and the number of hydrodistension repeats, correlated with worse VAS and DASH scores at 6 months. The number of procedure repeats was the only independent predictor of complete pain resolution at 6 months (OR 0.418, P = 003). CONCLUSION Diabetes is linked to more severe AC at presentation and worse outcomes in patients undergoing US-guided hydrodistension. In resistant cases, repeating the intervention is independently linked to worse outcomes for at least 6 months post-intervention.
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Affiliation(s)
- Sofia Dimitri-Pinheiro
- Radiology Department, Portuguese Institute of Oncology of Porto - Francisco Gentil EPE, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
- Biomedicine Department, Unit of Biochemistry, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Michail E Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, 71110, Voutes, Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, 71003, Heraklion, Crete, Greece
| | - Madalena Pimenta
- Radiology Department, São João Hospital Centre, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Evangelia E Vassalou
- Department of Medical Imaging, University Hospital of Heraklion, 71110, Voutes, Heraklion, Crete, Greece
| | - Raquel Soares
- Biomedicine Department, Unit of Biochemistry, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal
- I3S - Institute for Innovation and Health Research, University of Porto, Rua Alfredo Allen, 2084200-135, Porto, Portugal
| | - Apostolos H Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, 71110, Voutes, Heraklion, Crete, Greece.
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, 71003, Heraklion, Crete, Greece.
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Nicholas Nacey, Fox MG, Blankenbaker DG, Chen D, Frick MA, Jawetz ST, Mathiasen RE, Raizman NM, Rajkotia KH, Said N, Stensby JD, Subhas N, Surasi DS, Walker EA, Chang EY. ACR Appropriateness Criteria® Chronic Shoulder Pain: 2022 Update. J Am Coll Radiol 2023; 20:S49-S69. [PMID: 37236752 DOI: 10.1016/j.jacr.2023.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Chronic shoulder pain is an extremely common presenting complaint. Potential pain generators include the rotator cuff tendons, biceps tendon, labrum, glenohumeral articular cartilage, acromioclavicular joint, bones, suprascapular and axillary nerves, and the joint capsule/synovium. Radiographs are typically the initial imaging study obtained in patients with chronic shoulder pain. Further imaging may often be required, with modality chosen based on patient symptoms and physical examination findings, which may lead the clinician to suspect a specific pain generator. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Nicholas Nacey
- Panel Vice-Chair, University of Virginia Health System, Charlottesville, Virginia.
| | | | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Doris Chen
- Stanford University, Stanford, California, Primary care physician
| | | | | | - Ross E Mathiasen
- University of Nebraska Medical Center, Omaha, Nebraska; American College of Emergency Physicians
| | - Noah M Raizman
- The Centers for Advanced Orthopaedics, George Washington University, Washington, District of Columbia; American Academy of Orthopaedic Surgeons
| | - Kavita H Rajkotia
- University of Michigan Health System, Ann Arbor, Michigan; Committee on Emergency Radiology-GSER
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Devaki Shilpa Surasi
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eric Y Chang
- Specialty Chair, VA San Diego Healthcare System, San Diego, California
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Zhao HY, Han CH, Yang C, Lee YJ, Ha IH, Park KS. Effectiveness of Pharmacopuncture Therapy in Adhesive Capsulitis: a Study Protocol for a Pragmatic Randomized Controlled Trial. J Acupunct Meridian Stud 2023; 16:70-78. [PMID: 37076182 DOI: 10.51507/j.jams.2023.16.2.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/05/2022] [Accepted: 03/25/2023] [Indexed: 04/21/2023] Open
Abstract
Background Adhesive capsulitis is a progressive, idiopathic disorder that significantly impacts individuals̓ daily lives and increases their medical burden. Pharmacopuncture therapy, which combines acupuncture techniques with herbal medicine, involves injecting herbal extracts into specific acupoints. This study aims to determine the effectiveness and safety of pharmacopuncture therapy in comparison to physiotherapy (PT) for treating adhesive capsulitis. Methods This research protocol outlines a two-arm, parallel, multi-center, pragmatic randomized controlled trial. Fifty participants will be randomly allocated to either the pharmacopuncture therapy or PT group, and they will receive 12 sessions of their respective therapies over a 6-week period. The primary outcome measure is the numeric rating scale for shoulder pain. Secondary outcomes include the visual analog scale score for shoulder pain, Shoulder Pain and Disability Index, Patients̓ Global Impression of Change score, Short Form-12 Health Survey Version 2 score, and EuroQol-5 Dimension. Statistical analysis will be conducted based on the intention-to-treat principle. Discussion This trial may offer high-quality and reliable clinical evidence for evaluating the effectiveness and safety of pharmacopuncture therapy compared to PT in the treatment of adhesive capsulitis. Furthermore, this study will serve as a valuable guideline for practitioners when making clinical decisions and managing adhesive capsulitis.
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Affiliation(s)
- Hui Yan Zhao
- Korean Convergence Medical Science, University of Science & Technology (UST), School of Korea Institute of Oriental Medicine, Daejeon, Korea
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Chang-Hyun Han
- Korean Convergence Medical Science, University of Science & Technology (UST), School of Korea Institute of Oriental Medicine, Daejeon, Korea
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea
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Jadon A, Sanyal S, Pavan S, Bakshi A, Bharadwaj A, Singh AP. Suprascapular Nerve Block (SSNB) improves the outcome in exercise based management of Primary Adhesive Capsulitis (PAC): A prospective randomized comparative study. J Anaesthesiol Clin Pharmacol 2023; 39:195-200. [PMID: 37564834 PMCID: PMC10410031 DOI: 10.4103/joacp.joacp_263_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 08/12/2023] Open
Abstract
Background and Aims Increased pain and associated stiffness hinders the advantages of exercise and process of recovery in primary adhesive capsulitis. We hypothesized that suprascapular nerve block may positively affect the outcome due to its role in pain relief of acute or chronic shoulder pain. We compared the effect of suprascapular nerve block and exercise with only exercise on the recovery of primary adhesive capsulitis. Material and Methods A total of 96 patients of both sexes presenting with primary adhesive capsulitis were divided by computer randomization in two equal groups (n = 48). Group A received exercise only and Group B received suprascapular nerve block followed by exercise. Oral paracetamol was given for analgesia as desired. Patients were followed up at 4, 8, 16, and 24 weeks. Pain was assessed by visual analog scale; functional outcome by Shoulder Pain and Disability Index and range of movement by goniometer. Results The pain scores and Shoulder Pain and Disability Index scores were significantly lower at all observation points of 4, 8,16, and 24 weeks in Group B than Group A (P < 0.05). The range of movement in all the ranges of forward flexion, extension, internal and external rotation, and abduction at all observation points was significantly higher in Group-B (P < 0.05) compared to Group A. The consumption of analgesics was significantly more in Group A than Group B at 4 and 8 weeks (P = 0.020 and P = 0.044) but comparable at 12 and 24 weeks (P = 0.145 and P = 0.237 respectively). Conclusion Combining SSNB with exercise is more effective in treatment of primary adhesive capsulitis than exercise alone and reduces the use of analgesics. SSNB it is effective and safe to use in primary adhesive capsulitis.
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Affiliation(s)
- Ashok Jadon
- Department of Anaesthesia and Pain Relief Service, Tata Motors Hospital, Telco Colony, Jamshedpur, Jharkhand, India
| | - Subhojit Sanyal
- Department of Orthopaedics, IPGMER, Kolkata, West Bengal, India
| | - Sudarshan Pavan
- Department of Orthopaedics, Tata Motors Hospital, Telco Colony, Jamshedpur, Jharkhand, India
| | - Apoorva Bakshi
- Department of Anaesthesia and Pain Relief Service, Tata Motors Hospital, Telco Colony, Jamshedpur, Jharkhand, India
| | - Arvind Bharadwaj
- Department of Orthopaedics, Tata Motors Hospital, Telco Colony, Jamshedpur, Jharkhand, India
| | - Abhay Pratap Singh
- Department of Orthopaedics, Tata Motors Hospital, Telco Colony, Jamshedpur, Jharkhand, India
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Aboelnour NH, Kamel FH, Basha MA, Azab AR, Hewidy IM, Ezzat M, Kamel NM. Combined effect of graded Thera-Band and scapular stabilization exercises on shoulder adhesive capsulitis post-mastectomy. Support Care Cancer 2023; 31:215. [PMID: 36922413 PMCID: PMC10017571 DOI: 10.1007/s00520-023-07641-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 02/13/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE The main aim of the trial was to assess the combined impact of graded Thera-Band strengthening exercises and scapular stabilization exercises on shoulder pain, physical function, and quality of life (QoL) in post-mastectomy adhesive capsulitis (AC). METHODS Seventy females with unilateral post-mastectomy AC partook in the trial. Participants were subdivided equally into two groups at random. Both groups obtained the traditional physical therapy program; in addition, the intervention group received graded Thera-Band exercises for shoulder muscles and scapular stabilization exercises 5 days a week for 8 weeks. Range of motion (ROM) and muscle power of shoulder were assessed by digital goniometer and handheld dynamometer, respectively. Disability of the Arm, Shoulder, and Hand questionnaire (DASH) was utilized for assessment of shoulder function and visual analogue scale (VAS) for pain measurement while short-form (SF-36) for QoL assessment. All evaluation data was recorded prior to the trial and at the eighth week of interventions for both groups. RESULTS All participants achieved improvements in shoulder ROM, muscle power, pain, and all aspects of QoL; however, higher statistical improvements were reported in all measurements with respect to strengthening exercises group (p < 0.001). CONCLUSION The addition of graded Thera-Band strengthening exercises and scapular stabilization exercises in post-mastectomy AC rehabilitation program has significant benefits in shoulder function and patients' QoL. TRIAL REGISTRATION This study is retrospectively registered at ClinicalTrials.gov NCT05311839.
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Affiliation(s)
- Nancy H Aboelnour
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, 7 Ahmed Elzayat St, Bein El sarayat, Dokki, PO 12624, Giza, Egypt.
| | - FatmaAlzahraa H Kamel
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, 7 Ahmed Elzayat St, Bein El sarayat, Dokki, PO 12624, Giza, Egypt.,Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah, Qassim, Saudi Arabia
| | - Maged A Basha
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah, Qassim, Saudi Arabia.,Department of Physical Therapy, El-Sahel Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Cairo, Egypt
| | - Alshimaa R Azab
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.,Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Islam M Hewidy
- Adjunct Faculty at Physical Therapy Department, New York Medical College, Valhalla, NY, USA
| | - Mohamed Ezzat
- Department of Physical Therapy for Orthopedics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Noha M Kamel
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, 7 Ahmed Elzayat St, Bein El sarayat, Dokki, PO 12624, Giza, Egypt
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Chuang SH, Chen YP, Huang SW, Kuo YJ. Association Between Adhesive Capsulitis and Thyroid Disease: A Meta-Analysis. J Shoulder Elbow Surg 2023; 32:1314-1322. [PMID: 36871608 DOI: 10.1016/j.jse.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/07/2023] [Accepted: 01/22/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Adhesive capsulitis (AC) is a common clinical condition of the shoulders without a clear pathophysiology or etiology. Although thyroid disease has been linked to AC, an appropriate understanding of the disease and its epidemiological evidence are lacking. This meta-analysis investigated the association of AC with thyroid disease and identified which manifestations of thyroid disease contribute to the risk of AC. METHODS The databases of PubMed, Embase, and Scopus were searched for literature retrieval up to September 20, 2022. Articles evaluating the association between AC and any type of thyroid disease were enrolled. Data from studies reporting the prevalence and its 95% confidence interval (CI) were pooled. Subgroup analysis was performed on the different manifestations of thyroid disease. We explored heterogeneity with sensitivity analyses and publication bias with funnel plots and Egger's tests. Trim and fill analysis was conducted if publication bias was found. RESULTS In total, 10 case-control studies comprising a total of 127,967 patients were included. The prevalence of thyroid disease was significantly higher in patients with AC (odds ratio [OR] = 1.87, 95% CI: 1.37-2.57, P < 0.0001) than in patients without AC. The results of subgroup analysis indicated significantly higher rates of hypothyroidism (OR = 1.92, 95% CI: 1.09-3.39, P = 0.02) and subclinical hypothyroidism (OR = 2.56, 95% CI: 1.81-3.63, P < 0.00001), but not hyperthyroidism (OR = 1.42, 95% CI: 0.63-3.22, P = 0.40), among patients with AC than among those without AC. CONCLUSIONS Our meta-analysis demonstrated that thyroid disease, especially when presenting as hypothyroidism or subclinical hypothyroidism, is associated with an increased risk of AC. Evidence for an association between hyperthyroidism and AC was not found, although this may be due to the lack of related studies. Further research on the pathogeneses of and relationship between these two diseases is warranted.
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Affiliation(s)
- Shu-Han Chuang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Pin Chen
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shu-Wei Huang
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Romeo PV, Papalia AG, Alben MG, Gambhir N, Shankar D, Bi AS, Zuckerman JD, Virk MS. Prognostic factors associated with improvements in patient-reported outcomes in idiopathic adhesive capsulitis. JSES Int 2023; 7:336-341. [PMID: 36911781 PMCID: PMC9998727 DOI: 10.1016/j.jseint.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The purpose of this study was to identify prognostic factors that are associated with improvements in patient-reported outcomes measures (PROMs) related to upper extremity function and pain in those suffering from idiopathic adhesive capsulitis. Methods All patients treated conservatively for primary idiopathic adhesive capsulitis were identified from our institutional database between 2019 and 2021. Exclusion criteria included any patients treated surgically, follow-up less than one year, or incomplete survey results. PROMs including Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Test Version 2.0 (P-UE), Pain Interference (P-Interference), Pain Intensity (P-Intensity), and visual analog scale (VAS) pain scores. They were obtained at initial consultation and at one year to assess patient-perceived impact of their condition. Multiple linear and multivariable logistic regressions were performed to identify factors associated with improvement in patient-perceived pain and shoulder function using final PROM scores and difference in PROM scores from initial consultation. An independent t-test was used to compare baseline and one-year minimum follow-up PROMs. Odds ratios and their 95% confidence intervals were calculated for each factor; a P value of < .05 was considered statistically significant. Results A total of 56 patients (40 females and 16 males) were enrolled in the study with an average age of 54.7 ± 7.7 years. A significant improvement (P < .001) was demonstrated at one-year minimum outcomes for P-UE, P-Interference, P-Intensity, and VAS scores. With respect to comorbid conditions, hypothyroidism [P-UE (β: 9.57, P = .006)] was associated with greater improvements in PROMs, while hyperlipidemia [P-UE (β: -4.13, P = .01) and P-Intensity (β: 2.40, P = .02)] and anxiety [P-UE (β: -4.13, P = .03)] were associated with poorer reported changes in PROMs. Female sex [P-UE (β: 4.03, P = .007) and P-Interference (β: -2.65, P = .04)] and employment in manual labor professions [P-Interference (β: -3.07, P = .01), P-Intensity (β: -2.92, P = .006), and VAS (β: -0.66, P = .03)] were associated with significantly better patient-perceived outcomes. Hispanic heritage was associated with higher reported changes of P-Intensity (β: 8.45, P = .004) and VAS (β: 2.65, P = .002). Conclusion Patient-perceived improvements in PROMIS score during the natural history of adhesive capsulitis are likely multifactorial, with anxiety, hyperlipidemia, increased body mass index, and Hispanic heritage associated with reduced improvement in PROMIS scores.
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Affiliation(s)
- Paul V Romeo
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Aidan G Papalia
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Matthew G Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Neil Gambhir
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Dhruv Shankar
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Andrew S Bi
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Joseph D Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
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Fernández Martínez AM, Alonso DR, Baldi S, Arregui OB, Marcos MTC. Frozen Shoulder. Tech Vasc Interv Radiol 2023; 26:100882. [PMID: 36889844 DOI: 10.1016/j.tvir.2022.100882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Adhesive capsulitis (AC) develops spontaneously without a known cause and is a common cause of painful shoulder. The natural history of AC can last until 36 months and it is classically considered a self-limiting entity, however there is a high rate of refractory cases to conventional treatment with residual deficits during years. There is no consensus on the therapeutic guidelines to be followed in patients with AC. Several authors have pointed out the relevance of hypervascularization of the capsule in the pathophysiology of AC, that is why the objective of transarterial embolization (TAE) is to decrease the abnormal vascularization responsible for the inflammatory-fibrotic state that occurs in AC. TAE has now emerged as a therapeutic option in refractory patients. We describe the most important technical aspects of TAE and review the current literature on arterial embolization as a treatment for AC.
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Çelik D, Yasacı Z, Erşen A. Oral Corticosteroids versus Exercises on Treatment of Frozen Shoulder: A randomized, Single-blinded study. J Shoulder Elbow Surg 2023; 32:1127-1134. [PMID: 36842462 DOI: 10.1016/j.jse.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/04/2023] [Accepted: 01/22/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Many treatment strategies have been described for the management of frozen shoulder. However, to date no randomized controlled trial has directly compared the efficacy of exercise and oral corticosteroids. The aim of this study was to determine whether pain, range of motion, and function differ between patients with frozen shoulder randomized to treatment with exercise or oral corticosteroids. METHODS This prospective, randomized, assessor-blinded trial was performed to compare the effectiveness of exercise and oral corticosteroids in patients with frozen shoulder. Overall, 33 patients with FS were randomly assigned to receive either exercise (n=17) or oral corticosteroids (n = 16). The exercise was applied 2 times per week for 6 weeks for 12 visits and patients in oral corticosteroids group received prednisolone for 4 weeks. Participants were assessed at baseline, after 6-weeks and at the 12-week follow-up. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) and visual analog scale (VAS). The secondary outcomes were American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES), range of motion, and hospital anxiety and depression (HAD). scale. Repeated-measures analysis of covariance (ANCOVAs) with baseline scores as the covariates were used to determine between-group differences. An intention-to-treat analysis was performed using the multiple imputation method to impute values for all missing data. RESULTS Planned pairwise comparisons demonstrated significant improvements in pain relief and functional outcomes in both groups at the 6- and 12-week follow-ups compared to baseline. There were no significant time-by-group interactions between-group differences noted for the DASH (F=0.470, p= 0.93), VAS (F=0.006, p=0.94), flexion range of motion (ROM) (F=2.78, p=0.1), internal rotation ROM (F=3.440, p=0.07) and ASES (F=0.470, p=0.49). The overall group-by-time interaction for the 2×3 mixed-model ANCOVA using baseline scores as a covariate was significant for the abduction range (F=4.460, p=0.04) and external rotation range of motion (F=12.100, p = 0.002) in favor of the exercise group CONCLUSIONS: The study demonstrated that while both groups achieved significant improvements at the 6-, and 12-week follow-ups, the exercise group was superior in terms of abduction and external rotation range of motion. Additionally, even though both groups were improved, the effect sizes were larger in the exercise group. Considering the systemic side effects of oral corticosteroids, even at low doses, a well-planned exercise program that considers pain may be a good option for frozen shoulder.
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Affiliation(s)
- Derya Çelik
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul.
| | - Zeynal Yasacı
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Harran University, Sanliurfa.
| | - Ali Erşen
- Department of Orthopaedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Çapa, Istanbul, Turkey.
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Alben MG, Gambhir N, Shankar D, Gordon D, Zuckerman JD, Virk MS. Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) of upper extremity PROMIS scores in idiopathic adhesive capsulitis. Clin Rheumatol 2023; 42:579-589. [PMID: 36547817 DOI: 10.1007/s10067-022-06479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/04/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The purpose of this study is to calculate the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) of Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Testing v2.0 (UE), Pain Interference (P-Interference), and Pain Intensity (P-Intensity) in patients treated nonoperatively for idiopathic adhesive capsulitis (IAC). METHODS The anchor-based MCID, SCB, and PASS were calculated as the change in PROMIS scores representing the optimal cutoff for a ROC curve with an area under the curve (AUC) analysis. The distribution-based MCID was calculated as a range between the average standard error of measurement multiplied by two different constants: 1 and 2.77. Effect sizes and standardized response means (SRM) were calculated to assess the responsiveness of each PROMIS instrument while regression analyses were performed to identify factors associated with achieving these thresholds. RESULTS This study enrolled 115 patients. The anchor-based MCID for PROMIS UE, P-Interference, and P-Intensity was 5.11, 4.16, and 8.16, respectively. The respective SCB was 8.44, 6.65, and 10.05. The respective PASS was 8.47, 7.01, and 10.41. The odds of achieving MCID values in adhesive capsulitis were negatively affected by gender (male), higher forward elevation at the time of presentation, higher pain scores (P-Interference), need for ≥ 2 corticosteroid injections, and a concomitant diagnosis of diabetes. CONCLUSION The MCID, SCB, and PASS parameters for PROMIS scores can be utilized to determine the clinical meaningfulness of patient-reported improvements in these instruments during the nonoperative treatment and as a research tool to compare the efficacy of new treatments for adhesive capsulitis. LEVEL OF EVIDENCE Level III, basic science study, validation of outcome instruments. Key points • This is the first study to calculate the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for the Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity and Pain instruments in patients with idiopathic adhesive capsulitis (IAC) of the shoulder.• This study determined the impact of symptom severity, demographics, and comorbidities on achieving the MCID, SCB, and PASS for PROMIS instruments in IAC patients treated nonoperatively.
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Affiliation(s)
- Matthew G Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Neil Gambhir
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Dhruv Shankar
- Division of Sports Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Dan Gordon
- Department of Orthopedic Surgery, Baylor University Medical Center Dallas, Dallas, TX, USA
| | - Joseph D Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA.
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Chellamuthu G, Sathu S, Jeyaraman N, Jeyaraman M, Khanna M. Adhesive Capsulitis of Hip-A Systematic Review of Literature. Indian J Orthop 2023; 57:238-244. [PMID: 36777126 PMCID: PMC9880110 DOI: 10.1007/s43465-022-00808-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 12/17/2022] [Indexed: 01/09/2023]
Abstract
Introduction Adhesive capsulitis is clinically characterized by the gradual progressive painful loss of active and passive motion caused by the formation of adhesions of the joint capsule. Adhesive Capsulitis of the Hip (ACH) is not a well-explored clinical condition when compared to adhesive capsulitis of shoulder because of the underdiagnosis and rarity of this condition. Materials and Methods Cochrane, Scopus, Pubmed, Embase, and Web of Science databases were searched for original studies on ACH till December 2021 following Cochrane and PRISMA guidelines. Year of publication, authors, number of cases, baseline characteristics of the studies, causes described, presentation, associated conditions, method of diagnosis, treatment to be given, functional outcomes, and complications was extracted from each study. Results 16 articles were included in this review. 3 of the included studies were retrospective case-control studies, 6 were case series and the remaining 7 were case reports. A total of 224 ACH cases were recorded. Pain and stiffness of the hips were the most common clinical features. Investigations like serology, radiograph, and MRI have been used to rule out other conditions. Arthrography has been used to confirm the diagnosis in 7 studies. Spontaneous recovery is expected in one to two years. Management has been in the form of physiotherapy, intra-articular injection, and arthroscopy. Conclusion Literature on ACH is limited because of the rarity of the condition. The disease has a favorable prognosis with the possibility of spontaneous recovery. Physiotherapy has been the first line of management. Intractable cases require surgical intervention. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-022-00808-z.
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Affiliation(s)
- Girinivasan Chellamuthu
- Orthopaedic Research Group, Coimbatore, Tamil Nadu India
- Indian Orthopaedic Rheumatology Association (IORA), Lucknow, Uttar Pradesh India
- Department of Orthopaedics, Saveetha Medical College and Hospital, Chennai, Tamil Nadu India
| | - Sreedhar Sathu
- Indian Orthopaedic Rheumatology Association (IORA), Lucknow, Uttar Pradesh India
- Fellow in Orthopaedic Rheumatology, Dr. Ram Manohar Lohiya National Law University, Lucknow, Uttar Pradesh India
| | - Naveen Jeyaraman
- Orthopaedic Research Group, Coimbatore, Tamil Nadu India
- Indian Orthopaedic Rheumatology Association (IORA), Lucknow, Uttar Pradesh India
- Fellow in Orthopaedic Rheumatology, Dr. Ram Manohar Lohiya National Law University, Lucknow, Uttar Pradesh India
- Department of Orthopaedics, Rathimed Speciality Hospital, Chennai, Tamil Nadu India
| | - Madhan Jeyaraman
- Orthopaedic Research Group, Coimbatore, Tamil Nadu India
- Indian Orthopaedic Rheumatology Association (IORA), Lucknow, Uttar Pradesh India
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute University, Chennai, Tamil Nadu India
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX USA
| | - Manish Khanna
- Indian Orthopaedic Rheumatology Association (IORA), Lucknow, Uttar Pradesh India
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Uysal B, Özkuk K, Şahin N, Ökmen BM, Sezer R, Ateş Z. Comparison of the effectiveness of high-intensity laser and ultrasound therapies in adhesive capsulitis: A randomized controlled study. J Back Musculoskelet Rehabil 2023; 36:227-236. [PMID: 35964170 DOI: 10.3233/bmr-220026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adhesive capsulitis (AC) is a common musculoskeletal disease characterized with shoulder pain, limitation of range of motion (ROM) and disability. Although physical therapy is used in the treatment of AC, studies on its effectiveness are continuing. OBJECTIVE This study aimed to assess the effectiveness of ultrasound (US) and high-intensity laser therapy (HILT) in the treatment of AC. METHODS Sixty patients were randomized into two groups. Group I received US (15 sessions) and Group II received HILT (9 sessions) for 3 weeks. In addition, all patients received physical therapy program (hot pack, TENS and exercises). Assessments were made using VAS-pain, Shoulder Pain and Disability Index (SPADI), range of motion (ROM) at baseline and in post-treatment 3rd, 8th and 24th weeks. RESULTS There was no statistically significant difference between the groups in terms of all pre-treatment values. In intragroup assessment, statistically significant difference was identified in all the values of Groups 1 and 2 in all assessment periods compared with the pre-treatment values (p< 0.05). There was no significant difference between groups in all assessment periods. CONCLUSION According to results, US therapy and HILT were effective on the improvement of pain, ROM and functional conditions of patients in the treatment of AC.
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Affiliation(s)
- Bilal Uysal
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Balikesir University, Balikesir, Turkey
| | - Kağan Özkuk
- Department of Medical Ecology and Hydroclimatology, Faculty of Medicine, Usak University, Usak, Turkey
| | - Nilay Şahin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Balikesir University, Balikesir, Turkey
| | - Burcu M Ökmen
- Department of Physical Medicine and Rehabilitation, Saglik Bilimleri University Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Refia Sezer
- Department of Physical Medicine and Rehabilitation, İzzet Baysal Physical Medicine and Rehabilitation Training and Research Hospital, Bolu, Turkey
| | - Zeynep Ateş
- Department of Physical Medicine and Rehabilitation, İzzet Baysal Physical Medicine and Rehabilitation Training and Research Hospital, Bolu, Turkey
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Kim SK, Khan C, Ladd AL, Tashjian RZ. A shared genetic architecture between adhesive capsulitis and Dupuytren disease. J Shoulder Elbow Surg 2023; 32:174-185. [PMID: 35987430 DOI: 10.1016/j.jse.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/23/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The etiology of adhesive capsulitis involves inflammation, thickening, and fibrosis of the shoulder capsule. The underlying genetic factors are poorly understood. The purpose of this study was to identify genetic variants associated with adhesive capsulitis using the UK Biobank (UKB) cohort and compare them with variants associated with Dupuytren disease investigating a common etiology between the 2 fibrotic disorders. METHODS A genome-wide association study (GWAS) was performed using data from UKB with 10,773 cases of adhesive capsulitis, and a second GWAS was performed with 8891 cases of Dupuytren disease. Next, a comparison of association statistics was performed between adhesive capsulitis and Dupuytren disease using the data from both GWAS. Finally, single-nucleotide polymorphisms (SNPs) previously reported from candidate gene studies for adhesive capsulitis and Dupuytren disease were tested for association with adhesive capsulitis and Dupuytren disease using the summary statistics from their respective GWAS. RESULTS The UKB GWAS for adhesive capsulitis identified 6 loci that reached genome-wide statistical significance: a cluster of 11 closely linked SNPs on chromosome 1; a single SNP on chromosome 2; a single SNP on chromosome 14; 2 closely linked SNPs on chromosome 21; 33 closely linked SNPs on chromosome 22; and 3 closely linked SNPs on the X chromosome. These SNPs were associated with 8 different genes including TSPAN2/NGF, SATB2, MRPL52/MMP14, ERG, WNT7B, and FGF13. A GWAS for Dupuytren disease was performed and a comparison to the adhesive capsulitis GWAS showed 13 loci significantly associated with both phenotypes. A validation attempt of 6 previously reported SNPs associated with adhesive capsulitis using UKB summary statistics was unable to confirm any of the previously reported SNPs (all P > .19). All 23 previously reported SNPs associated with Dupuytren disease were confirmed using the UKB summary statistics (P < 2.1 × 10-3) CONCLUSION: This GWAS investigating adhesive capsulitis has identified 6 novel loci involving 8 different genes to be associated with adhesive capsulitis. A GWAS investigating Dupuytren disease was performed and compared to the adhesive capsulitis GWAS, and 13 common loci were identified between the 2 disorders with genes involved in pathologic fibrosis. We were unable to validate the SNPs in candidate genes previously reported to be associated with adhesive capsulitis although we were able to confirm all previously reported SNPs associated with Dupuytren disease. The strong genetic overlap between the adhesive capsulitis and Dupuytren disease loci suggests a similar etiology between the 2 diseases.
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Affiliation(s)
- Stuart K Kim
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA, USA
| | - Condor Khan
- Department of Developmental Biology, Stanford University School of Medicine, Stanford, CA, USA
| | - Amy L Ladd
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert Z Tashjian
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Roncaglia I. One size does not fit all - A transdisciplinary rehab program for adhesive capsulitis: A case report. J Bodyw Mov Ther 2023; 33:150-3. [PMID: 36775512 DOI: 10.1016/j.jbmt.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/02/2022] [Accepted: 09/18/2022] [Indexed: 11/21/2022]
Abstract
The World Health Organisation defines health as "physical, mental, and social well-being and not merely the absence of disease or infirmity". Furthermore, health promotion has been described as "the process of enabling all individuals to increase their control over, and to improve their health" (WHO, 1946; 1986). Our wellness starts with good nutrition, food through the digestive system and oxygen through the respiratory system. Without proper breathing mechanisms, the brain, whose priority is to survive will unconsciously limit our ability to function properly. Adhesive capsulitis also known as 'Frozen Shoulder' affects a high number of people, with the majority found in the female population between 50 and 60 years of age. The causes are still relatively unknown; however, the effects and debilitating consequences are well known, and rehabilitative procedures can include both surgical and non-surgical interventions depending on the initial structural diagnosis. Long-periods of aggressive rehabilitative physiotherapy can be part of a program including home-exercises. This paper presents partial outcomes in a female single case report with no previous medical conditions. Following a formal adhesive capsulitis diagnosis, a therapeutic program was set out by a qualified physiotherapist following an ultrasound guided hydro-dilation steroid injection. Physiotherapy was accompanied with a home program of physical and mental exercises as part of the ongoing rehabilitation and re-acquisition of normal range of movement and their functionality. Outcomes are discussed considering the transdisciplinary nature of the intervention program followed, providing some reflective clinical reasoning on the importance of a transdisciplinary approach to the management of this condition.
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Sundararajan SR, Dsouza T, Rajagopalakrishnan R, Bt P, Arumugam P, Rajasekaran S. Arthroscopic capsular release versus manipulation under anaesthesia for treating frozen shoulder - a prospective randomised study. Int Orthop 2022; 46:2593-2601. [PMID: 36048234 DOI: 10.1007/s00264-022-05558-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/17/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Arthroscopic capsular release (ACR) and Manipulation under anaesthesia(MUA) have been widely used in the treatment of frozen shoulder (FS). However, there is only limited Level-I evidence to prefer ACR over MUA. The purpose of our study was to conduct a randomised trial comparing ACR versus MUA to assess the difference in outcome, complications and cost-effectiveness of both procedures. METHODS From May 2020 to June 2021, patients presenting with FS were randomised into two groups ACR (n = 44) and MUA (n = 41). Patients with arthritis, full-thickness cuff tears, history of trauma/previous surgery around the shoulder were excluded from the study. Range of movement (ROM), pain grading using visual analogue scale (VAS), functional scores- UCLA, CONSTANT and EuroQol-5D scores were measured pre-operatively and post-operatively. MRI was done at three weeks post-operatively for screening complications of either procedure. Quality-adjusted life years (QALY) was used for cost-analysis. RESULTS Post-operatively, patients had significant improvement in pain, ROM and functional scores in both groups (P < 0.001) with no significant difference between groups at 24 weeks of follow-up. Diabetic patients undergoing ACR had lesser improvement in abduction and external rotation when compared to non-diabetic patients. Labral tears in MUA group and bone bruises in ACR group were the most common complications noted on the post-operative MRI. For ACR cost per QALY gained was 896 USD while that for MUA was 424 USD. CONCLUSION Both ACR and MUA resulted in good improvement in pain and shoulder function. Good outcomes, simple technique and better cost-effectiveness would still make MUA an attractive option over ACR for treating FS.
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Affiliation(s)
| | - Terence Dsouza
- Department of Arthroscopy and Sports Medicine, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Ramakanth Rajagopalakrishnan
- Department of Arthroscopy and Sports Medicine, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Pushpa Bt
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Palanisamy Arumugam
- Department of physiotherapy, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics & Spine Surgery, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
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Luo Z, Sun Y, Qi B, Lin J, Chen Y, Xu Y, Chen J. Human bone marrow mesenchymal stem cell-derived extracellular vesicles inhibit shoulder stiffness via let-7a/Tgfbr1 axis. Bioact Mater 2022; 17:344-359. [PMID: 35386460 PMCID: PMC8965035 DOI: 10.1016/j.bioactmat.2022.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/30/2021] [Accepted: 01/09/2022] [Indexed: 02/07/2023] Open
Abstract
Shoulder stiffness (SS) is a common shoulder disease characterized by increasing pain and limited range of motion. SS is considered to be an inflammatory and fibrotic disorder pathologically. However, there is no consensus on the most effective conservative treatment for fibrosis. Given that human Bone Marrow Mesenchymal Stem Cell-derived extracellular vesicles (BMSC-EVs) displayed promising therapeutic effects for various tissues, we investigated the therapeutic effect of BMSC-EVs on fibrosis in a mice immobilization model and two cell models. By conducting a series of experiments, we found that BMSC-EVs can significantly inhibit the fibrogenic process both in vitro and in vivo. In detail, BMSC-EVs suppressed the aberrant proliferation, high collagen production capacity, and activation of fibrotic pathways in TGF-β-stimulated fibroblasts in vitro. Besides, in vivo, BMSC-EVs reduced cell infiltration, reduced fibrotic tissue in the shoulder capsule, and improved shoulder mobility. In addition, via exosomal small RNA sequencing and qPCR analysis, let-7a-5p was verified to be the highest expressed miRNA with predicted antifibrotic capability in BMSC-EVs. The antifibrotic capacity of BMSC-EVs was significantly impaired after the knockdown of let-7a-5p. Moreover, we discovered that the mRNA of TGFBR1 (the membrane receptor of transforming growth factor β) was the target of let-7a-5p. Together, these findings elucidated the antifibrotic role of BMSC-EVs in shoulder capsular fibrosis. This study clarifies a new approach using stem cell-derived EVs therapy as an alternative to cell therapy, which may clinically benefit patients with SS in the future.
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Affiliation(s)
- Zhiwen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yaying Sun
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Beijie Qi
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinrong Lin
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yisheng Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuzhen Xu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Shandong Province, China
| | - Jiwu Chen
- Department of Sports Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Corresponding author. Shanghai General Hospital, No. 85 Wujin Road, Hongkou District, Shanghai, China.
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Jacob L, Koyanagi A, Oh H, Smith L, Konrad M, Shin JI, Haro JM, Kostev K. Association between adhesive capsulitis and depression: A five-year retrospective cohort study including 58,516 adults from Germany. J Psychiatr Res 2022; 155:395-400. [PMID: 36182769 DOI: 10.1016/j.jpsychires.2022.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/14/2022] [Accepted: 09/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known on the longitudinal relationship between adhesive capsulitis and depression. Therefore, the aim of this study was to investigate the association between adhesive capsulitis and the five-year cumulative incidence of depression in adults from Germany. METHODS The present retrospective cohort study included all adults aged ≥18 years with a first diagnosis of adhesive capsulitis in one of 1198 general practices in Germany between January 2010 and December 2018 (index date). Patients with adhesive capsulitis were matched to those without adhesive capsulitis using a propensity score based on age, sex, index year, average number of visits per year, and diagnoses documented prior to or at the index date (i.e., thyroid gland disorders, diabetes mellitus, coronary heart disease, cerebrovascular diseases, and Parkinson's disease and secondary parkinsonism). In individuals without adhesive capsulitis, the index date was a randomly selected visit date. RESULTS This study included 29,258 patients with and 29,258 patients without adhesive capsulitis (mean [SD] age 55.9 [15.6] years; 53.2% men). Within five years of the index date, there were 17.5% of patients with adhesive capsulitis and 8.7% of those without adhesive capsulitis diagnosed with incident depression (log-rank p-value<0.001). This result was corroborated in the Cox regression analysis, as there was a positive and significant association between adhesive capsulitis and the cumulative incidence of depression (HR = 1.86, 95% CI: 1.78-1.95). CONCLUSION In this study, adhesive capsulitis was associated with an increased cumulative incidence of depression. Further research is warranted to better understand the mediating factors involved in this relationship.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain; Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluis Companys 23, Barcelona, Spain
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Marcel Konrad
- Health & Social, FOM University of Applied Sciences for Economics and Management, Frankfurt am Main, Germany
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
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Stinton S, Beckley S, Salamani A, Dietz D, Branch T. Efficacy of high-intensity home mechanical stretch therapy for treatment of shoulder stiffness: a retrospective review. J Orthop Surg Res 2022; 17:434. [PMID: 36175903 PMCID: PMC9524064 DOI: 10.1186/s13018-022-03325-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Shoulder stiffness resulting in motion loss can be caused by numerous conditions, the most common of which is adhesive capsulitis. Surgical intervention is often necessary when conservative methods fail. High-intensity stretch (HIS) treatment may be able to provide increased motion gains while avoiding the cost and complications of surgery. Objectives The purpose of this study was to review data from patients who were prescribed a HIS device to recover their shoulder motion to determine the efficacy of the device. The hypotheses were that patients would achieve significant range of motion (ROM) gains and that ROM would increase to a level at which patients would be able to avoid a motion loss surgery and perform activities of daily living. Methods Clinical notes were reviewed for patients whose progress plateaued after 4 weeks of therapy and were subsequently prescribed the HIS device after failing to meet their treatment goals. ROM data were recorded for external rotation, abduction, forward flexion, and internal rotation. Pre- and post-treatment ROM data were compared using t-tests. Results Significant ROM gains were seen in all planes of motion (p < 0.001). Patients gained an average of 29.9° in external rotation with a last recorded rotation of 59.2°. In abduction, patients gained 40.5° with a last recorded abduction of 123.3°. In forward flexion, patients gained 30.3° with a last recorded flexion of 138.7°. In internal rotation, patients gained 15.2° with a last recorded rotation of 57.6°. These last recorded ranges of motion were sufficient to perform nearly all activities of daily living. Conclusions The HIS device was effective in treating patients with shoulder motion loss as demonstrated by the significant ROM gains in all planes of motion. The ability for a patient to recover lost motion quickly without surgery is of great value to quality of life and in healthcare cost savings. We believe this high-intensity stretch device should be considered for use by patients who are at risk for a motion loss surgery.
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Affiliation(s)
- Shaun Stinton
- ArthroResearch LLC, 441 Armour Place NE, Atlanta, GA, 30324, USA.
| | - Samantha Beckley
- ArthroResearch LLC, 441 Armour Place NE, Atlanta, GA, 30324, USA
| | - Alicia Salamani
- ArthroResearch LLC, 441 Armour Place NE, Atlanta, GA, 30324, USA
| | - Devinne Dietz
- ArthroResearch LLC, 441 Armour Place NE, Atlanta, GA, 30324, USA
| | - Thomas Branch
- Ermi LLC, 2872 Woodcock Blvd. Suite 100, Atlanta, GA, 30341, USA
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