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Nambi G, Alghadier M, Eltayeb MM, Aldhafian OR, Saleh AK, Alsanousi N, Ibrahim MNA, Attallah AA, Ismail MA, Elfeshawy M, Wahd YESH, Albarakati AJA. Additional Effect of Extracorporeal Shockwave Therapy with Lidocaine Injection on Clinical and MRI Findings in Frozen Shoulder: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial. Pain Ther 2024; 13:251-268. [PMID: 38315378 DOI: 10.1007/s40122-024-00575-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Frozen shoulder is a very common musculoskeletal condition and the evidence related to the additional effects of extracorporeal shockwave therapy (ESWT) with intra-articular (IA) lidocaine injection in individuals with frozen shoulder is rare. Therefore, this study aims to compare and investigate the additional effects of extracorporeal shockwave therapy (ESWT) with intra-articular (IA) lidocaine injection in a frozen shoulder. METHODS Sixty eligible participants with frozen shoulder were included and the active group (n = 30, age 52.12 ± 5.2 years) received a lidocaine injection (1% lidocaine (Xylocaine) and 2cc (80 mg) methylprednisolone acetate) with active ESWT (3.5 bar air pressure and 2000 pulses with an energy flux density (EFD) ¼ 0.16 mJ/mm2) three sessions a week for 4 weeks. The placebo group (n = 30, age 53.56 ± 5.5 years) received lidocaine injection with placebo treatment (a special head that blocked the shock waves) three sessions a week for 4 weeks. Both groups received progressive resistance exercises (PRE) to the shoulder muscles. The primary outcome was pain intensity, measured with the visual analogue scale. The other outcome measures were the thickness of the coracohumeral ligament (CHL) measured by magnetic resonance imaging (MRI), abduction, and lateral rotation range of motion (ROM), functional disability, kinesiophobia, depression status, and quality of life. Participants were assessed at baseline, after 4 weeks, 8 weeks, and at 6-month follow-up. RESULTS The post-intervention at 4 weeks showed an improvement of 2.0 (CI 95% 1.71-2.28) in the active group compared to the placebo group. Similar effects were noted after 8 weeks (2.2) (CI 95% 1.91-2.48) and at the 6-month (1.9) (CI 95% 1.61-2.18) follow-up. Similar improvements were also found in the thickness of the CHL ligament (0.6) (CI 95% 0.46-0.73), abduction and lateral rotation (ROM) (- 23.6) (CI 95% - 27.47 to -19.72), (- 18.10) (CI 95% - 19.72 to - 16.47), functional disability (16.2) (CI 95% 14.85-17.54), kinesiophobia (11.0 (CI 95% 10.21-11.98), depression status (4.4) (CI 95% 4.03-4.76) and quality of life (0.9) (CI 95% 0.79-1.00) (p = 0.001) at the 6-month follow-up period, where mean estimates and their confidence intervals all included worthwhile effects. There were no adverse reactions or side effects noted in either the active or placebo groups during and after the treatment. CONCLUSIONS The study concluded that the addition of extracorporeal shockwave therapy after intra-articular lidocaine injection improves pain, functional disability, range of motion, kinesiophobia, depression status, and quality of life in people with frozen shoulder. TRIAL REGISTRATION https://ctri.nic.in , identifier; CTRI/2020/04/024834 prospectively registered on 24/04/2020.
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Affiliation(s)
- Gopal Nambi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia.
| | - Mshari Alghadier
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Mudathir Mohamedahmed Eltayeb
- Department of Medical Surgical Nursing, College of Nursing, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Osama R Aldhafian
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Ayman K Saleh
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
- Department of Orthopedics, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt
| | - Nesreen Alsanousi
- Department of Basic Medical Sciences, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | | | - Abdehamid A Attallah
- Department of Orthopedics, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt
| | | | - Mohamed Elfeshawy
- Department of Orthopedics, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt
| | | | - Alaa Jameel A Albarakati
- Department of Surgery, College of Medicine, Umm Al-Qura University, Al-Qunfudah Branch, Makkah, Saudi Arabia
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Zhang J, Song Y, Zhu L, You Y, Hu J, Xu X, Wang C, Lu J, Shen Q, Xu X, Teng C, Du Y. An injectable thermosensitive hyaluronic acid/pluronic F-127 hydrogel for deep penetration and combination therapy of frozen shoulder. Int J Biol Macromol 2024; 263:130342. [PMID: 38395289 DOI: 10.1016/j.ijbiomac.2024.130342] [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: 09/25/2023] [Revised: 01/31/2024] [Accepted: 02/19/2024] [Indexed: 02/25/2024]
Abstract
Frozen shoulder (FS) is a common and progressive shoulder disorder that causes glenohumeral joint stiffness, characterized by inflammation and fibrosis. The treatment options are quite limited, and the therapeutic response is hindered by the fibrous membrane formed by excessive collagen and the rapid removal by synovial fluid. To address these challenges, we designed a hyaluronic acid/Pluronic F-127 (HP)-based injectable thermosensitive hydrogel as a drug carrier loaded with dexamethasone and collagenase (HPDC). We screened for an optimal HP hydrogel that can sustain drug release for approximately 10 days both in vitro and in vivo. In the meanwhile, we found that HP hydrogel could inhibit the proliferation and diminish the adhesion capacity of rat synovial cells induced by transforming growth factor-β1. Furthermore, using an established immobilization rat model of FS, intra-articular injection of HPDC significantly improved joint range of motion compared to medication alone. Relying on sustained drug release, the accumulated collagen fibers were degraded by collagenase to promote the deep delivery of dexamethasone. These findings showed a positive combined treatment effect of HPDC, providing a novel idea for the comprehensive treatment of FS.
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Affiliation(s)
- Jucong Zhang
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Yanling Song
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Luwen Zhu
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Yuchan You
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Jiahao Hu
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Xinyi Xu
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Chen Wang
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Jingyi Lu
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Qiying Shen
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Xiaoling Xu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou 310015, China.
| | - Chong Teng
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu 32200, China.
| | - Yongzhong Du
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China; Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, 18 Chaowang Road, Hangzhou, Zhejiang 310014, China; Innovation Center of Translational Pharmacy, Jinhua Institute of Zhejiang University, Jinhua 321299, China.
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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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Kraal T, de Wit Y, The B, van Boekel L, Oost IKV, Boer R, Borne MV, Goossens P, Koenraadt K, Eygendaal D. Improved range of motion after manipulation under anesthesia versus physiotherapy for stage two frozen shoulder: a randomized controlled trial. JSES Int 2024; 8:293-298. [PMID: 38464443 PMCID: PMC10920131 DOI: 10.1016/j.jseint.2023.11.004] [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: 03/12/2024] Open
Abstract
Background Frozen shoulder (FS) is a common cause of shoulder pain and stiffness. Conservative treatment is sufficient for the majority of patients with long-term recovery of shoulder function. Manipulation under anesthesia (MUA) is known as a well-established treatment option if conservative treatment fails. It is unknown whether MUA does indeed shorten the duration of symptoms or leads to a superior outcome compared to conservative treatment. The objective of the current trial is to evaluate the effectiveness of MUA followed by a physiotherapy (PT) program compared to a PT program alone in patients with stage 2 FS. Methods A prospective, single-center randomized controlled trial was performed. Patients between 18 and 70 years old with stage 2 FS were deemed eligible if an initial course of conservative treatment consisting of PT and intra-articular corticosteroid infiltration was considered unsatisfactory. Patients were randomized, and data was collected with an online data management platform (CASTOR). MUA was performed by a single surgeon under interscalene block, and intensive PT treatment protocol was started within 4 hours after MUA. In the PT group, patients were referred to instructed physiotherapist, and treatment was guided by tissue irritability. The primary outcome was the Shoulder Pain and Disability Index (SPADI) score. Secondary outcomes were pain, range of motion (ROM), Oxford Shoulder Score, quality of life, and ability to work. Results In total, 82 patients were included, 42 in the PT group and 40 in the MUA group. There was a significant improvement in SPADI, Oxford Shoulder Score, pain, ROM, and quality of life in both groups at 1-year follow-up. SPADI scores at three months were significantly improved in favor of MUA. MUA showed a significantly bigger increase in anteflexion and abduction compared to PT at all points of follow-up. No significant differences between both groups were found for all other parameters. No fractures, dislocations, or brachial plexus injuries occurred in this trial. Conclusion MUA in stage 2 FS can be considered safe and results in a faster recovery of ROM and improved functional outcome, measured with SPADI scores, compared to PT alone in the short term. After 1 year, except for slightly better ROM scores for MUA, the result of MUA is equal to PT.
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Affiliation(s)
- Tim Kraal
- Department of Orthopedic Surgery, Flevo Hospital, Almere, the Netherlands
| | - Yordi de Wit
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands
- Foundation for Orthopedic Research, Care & Education, Amphia Hospital, Breda, the Netherlands
| | - Bertram The
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands
- Foundation for Orthopedic Research, Care & Education, Amphia Hospital, Breda, the Netherlands
| | - Leonieke van Boekel
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands
- Foundation for Orthopedic Research, Care & Education, Amphia Hospital, Breda, the Netherlands
| | - Iris Koenraadt-van Oost
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands
- Foundation for Orthopedic Research, Care & Education, Amphia Hospital, Breda, the Netherlands
| | - Ronald Boer
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands
| | - Maaike vd Borne
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands
| | - Pjotr Goossens
- Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands
| | - Koen Koenraadt
- Foundation for Orthopedic Research, Care & Education, Amphia Hospital, Breda, the Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Erasmus MC, Rotterdam, the Netherlands
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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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Skaliczki G, Kovács K, Antal I, Sallai I, Kovács B, Nyőgér Z, Géresi Á, Kiss B, Várnagy A. Arthroscopic capsular release is more effective in pain relief than conservative treatment in patients with frozen shoulder. BMC Musculoskelet Disord 2024; 25:145. [PMID: 38365741 PMCID: PMC10870563 DOI: 10.1186/s12891-024-07275-7] [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: 09/17/2023] [Accepted: 02/09/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Frozen shoulder is a common medical condition, but the ideal therapeutic method is yet to be determined. Our aim was to analyze the pain-relieving effect of different treatment options used for the management of this disease. METHODS Medical records of 59 patients (22 male, 37 female, average age: 55.5 years ±9.9) with early stage primary frozen shoulder were evaluated, their demographic data, physical examination, concomitant diseases and treatment specific data were registered. Life quality and the level of pain were assessed using the Oxford Shoulder Score (OSS) and Numeric Rating Scale (NRS). Different treatment modalities and their effect on pain relief were recorded. Any existing correlation between life quality, pain and demographic data, concomitant diseases or the therapeutic method used was investigated. RESULTS The level of pain measured on NRS improved from 7.9 ± 1.6 to 1.9 ± 2.2. The most effective therapeutic method in terms of pain relief was surgery, followed by physiotherapy and intraarticular steroid injection (NRS score after treatment: 2 - p < 0.0001; 3.3 - p < 0.0001; 4.9 - p < 0.0001, respectively). Non-steroidal anti-inflammatory drugs (NSAIDs) did not reduce pain significantly. OSS improved from 24 to 43.6 and was not affected by the investigated variables, time to recovery was not influenced by the demographic data, the type of treatment or concomitant diseases. CONCLUSIONS Arthroscopic capsular release, physiotherapy and intraarticular steroid injection outperformed physical therapy and NSAID treatment in terms of pain relief. Despite of slight but persistent post-therapeutic pain found in half of the cases, treatment was considered satisfactory by the patients. Nor patient specific neither therapy specific data had a significant effect on the course of the disease.
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Affiliation(s)
- Gábor Skaliczki
- Department of Orthopedics, Semmelweis University, Korányi Sándor utca 2, Budapest, 1083, Hungary.
| | - Krisztián Kovács
- Department of Orthopedics, Semmelweis University, Korányi Sándor utca 2, Budapest, 1083, Hungary
| | - Imre Antal
- Department of Orthopedics, Semmelweis University, Korányi Sándor utca 2, Budapest, 1083, Hungary
| | - Imre Sallai
- Department of Orthopedics, Semmelweis University, Korányi Sándor utca 2, Budapest, 1083, Hungary
| | - Beáta Kovács
- Department of Orthopedics, Semmelweis University, Korányi Sándor utca 2, Budapest, 1083, Hungary
| | - Zoltán Nyőgér
- Department of Orthopedics and Traumatology, Petz Aladár University Teaching Hospital, Vasvári Pál utca 2-4, Győr, 9024, Hungary
| | - Áron Géresi
- Department of Orthopedics, Semmelweis University, Korányi Sándor utca 2, Budapest, 1083, Hungary
| | - Balázs Kiss
- Department of Biophysics and Radiation Biology, Semmelweis University, Tűzoltó utca 37-47, Budapest, 1094, Hungary
| | - Anna Várnagy
- Department of Orthopedics, Semmelweis University, Korányi Sándor utca 2, Budapest, 1083, Hungary
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Lu W, Pu B, Wang S, Li M, An Y, Lian J, Wang Y. Bidirectional two-sample Mendelian randomization analysis identifies causal associations between cardiovascular diseases and frozen shoulder. J Orthop Surg Res 2024; 19:116. [PMID: 38310246 PMCID: PMC10837867 DOI: 10.1186/s13018-024-04600-7] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/28/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Although prior observational studies indicate an association between cardiovascular diseases (CVDs) and frozen shoulder (FS), the potential causal relationship between them remains uncertain. This study aims to explore the genetic causal relationship between CVDs and FS using Mendelian randomization (MR). METHODS Genetic variations closely associated with FS were obtained from the FinnGen Consortium. Summary data for CVD, including atrial fibrillation (AF), coronary artery disease (CAD), heart failure (HF), myocardial infarction (MI), stroke, and ischemic stroke (IS), were sourced from several large-scale genome-wide association studies (GWAS). MR analysis was performed using inverse variance weighting (IVW), MR Egger, and weighted median methods. IVW, as the primary MR analysis method, complemented by other sensitivity analyses, was utilized to validate the robustness of the results. Further reverse MR analysis was conducted to explore the presence of reverse causal relationships. RESULTS In the forward MR analysis, genetically determined risk of stroke and IS was positively associated with FS (OR [95% CI] = 1.58 (1.23-2.03), P < 0.01; OR [95% CI] = 1.46 (1.16-1.85), P < 0.01, respectively). There was no strong evidence of an effect of genetically predicted other CVDs on FS risk. Sensitivity analyses confirmed the robustness of the results. In the reverse MR analysis, no causal relationships were observed between FS and various CVDs. CONCLUSION The study suggests that stroke increases the risk of developing FS. However, further basic and clinical research is needed to substantiate our findings.
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Affiliation(s)
- WeiSong Lu
- Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan, China
| | - Bin Pu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Sen Wang
- Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan, China
| | - MengZe Li
- Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan, China
| | - Yue An
- Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan, China
| | - Jie Lian
- Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan, China
| | - YongQuan Wang
- Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan, China.
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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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Xu T, Xia Q, Zhang L, Yang X, Fu W. Type 2 diabetes and fasting glycemic traits are causal factors of frozen shoulder: a 2-sample Mendelian randomization analysis. J Shoulder Elbow Surg 2024; 33:399-408. [PMID: 37748531 DOI: 10.1016/j.jse.2023.08.006] [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: 05/11/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The causal relationship between type 2 diabetes (T2D) and frozen shoulder is unclear. This study aims to explore the genetic causal association between T2D and glycemic traits (fasting glucose [FG], fasting insulin [FI], glycated hemoglobin [HbA1c], and 2-hour postprandial glucose [2hGlu]) on frozen shoulder. METHODS Using 2-sample Mendelian randomization (MR), we analyzed nonconfounded estimates of the effects of T2D and glycemic traits on frozen shoulder. Single-nucleotide polymorphisms (SNPs) strongly associated (P < 5 × 10-8) with exposures from genome-wide association studies (GWAS) were identified. We employed fixed effect mode inverse variance weighting (IVW-FE), random effect mode IVW (IVW-MRE), MR-Egger, and weighted median to assess the association of exposures and outcome. Sensitivity analysis was conducted to test for heterogeneity and multidirectionality bias in MR. RESULTS We found a significant genetic causal correlation between T2D (IVW-MRE P = .007, odds ratio [OR] 1.093, 95% confidence interval [CI] 1.03-1.16), FG (IVW-FE P < .001, OR 1.455, 95% CI 1.173-1.806), and frozen shoulder, but no evidence for causal correlation between FI, HbA1c, and 2hGlu and frozen shoulder. Although there was certain heterogeneity, sensitivity analysis reveals no deviation from the MR assumptions. CONCLUSION This study supports a genetic causal relationship between T2D and FG and frozen shoulder.
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Affiliation(s)
- Tianhao Xu
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qinghong Xia
- Operating Room of Anesthesia Surgery Center, West China Hospital, Sichuan University West China School of Nursing, Chengdu, Sichuan, China
| | - Lei Zhang
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaolong Yang
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weili Fu
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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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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Liang CW, Cheng HY, Lee YH, De Liao C, Huang SW. Corticosteroid Injection Methods for Frozen Shoulder: A Network Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)00035-2. [PMID: 38244851 DOI: 10.1016/j.apmr.2024.01.003] [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: 06/16/2023] [Revised: 11/16/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To investigate the efficacy of corticosteroid (CS) injection methods for frozen shoulder. DATA SOURCES PubMed, Embase, and Cochrane Library were searched up to May 6, 2023. STUDY SELECTION Randomized controlled trials (RCTs) that investigated CS injection methods for frozen shoulder were included. DATA EXTRACTION Data were extracted independently by 2 authors. Risk of bias was assessed using the RoB 2 tool. DATA SYNTHESIS A random-effects network meta-analysis was performed within a frequentist framework. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations approach. A total of 66 RCTs involving 4491 patients were included. For short-term outcomes, 4-site injection (vs placebo [PLA]: standardized mean difference [SMD]=-2.20, 95% confidence interval [CI], -2.81 to -1.59 in pain; SMD=2.02; 95% CI, 1.39-2.65 in global function) was the most effective (low certainty). Rotator interval injection was the optimal treatment with moderate to high certainty (vs PLA: SMD=-1.07, 95% CI, -1.51 to -0.64 in pain; SMD=0.94, 95% CI, 0.49-1.40 in global function). For midterm outcomes, 4-site injection was most effective (vs PLA: SMD=-1.71, 95% CI, -2.41 to -1.01 in pain; SMD=2.22, 95% CI, 1.34-3.09 in global function; low certainty). Distension via rotator interval (D-RI) was the optimal treatment with moderate to high certainty (vs PLA: SMD=-1.10, 95% CI, -1.69 to -0.51 in pain; SMD=1.46, 95% CI, 0.73-2.20 in global function). Distension and intra-articular injection via anterior or posterior approaches produced effects equivalent to those of rotator interval injection and D-RI. CONCLUSIONS Rotator interval injection, distension, and intra-articular injection had equivalent effects on symptom relief. More RCTs are required to validate the superiority of multisite injections.
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Affiliation(s)
- Chun-Wei Liang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei; Department of Primary Care Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei
| | - Hsiao-Yi Cheng
- School of Medicine, College of Medicine, Taipei Medical University, Taipei; Department of Primary Care Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
| | - Yu-Hao Lee
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Chun- De Liao
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei; Master's Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei.
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Takahashi R, Kajita Y, Fujii S, Harada Y. Risk factors for recurrence of frozen shoulder after shoulder manipulation under ultrasound-guided cervical nerve root block. JSES Int 2024; 8:90-94. [PMID: 38312279 PMCID: PMC10837711 DOI: 10.1016/j.jseint.2023.09.002] [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: 02/06/2024] Open
Abstract
Background This study aimed to investigate risk factors for recurrence of frozen shoulder after shoulder manipulation under ultrasound-guided cervical nerve root block (MUC). Methods We retrospectively reviewed 135 frozen shoulders in 121 patients who underwent MUC. We defined frozen shoulder as a limited shoulder range of motion (ROM) (passive forward flexion <120°, external rotation <30°, or internal rotation lower than L3). Patients fulfilling any one criteria were considered to have frozen shoulder. If patients continued to have severe pain and limited ROM at 3 months after MUC, we defined as recurrence of frozen shoulder and they were offered a further MUC or arthroscopic capsular release (ACR). We compared the ROM, Constant Shoulder (CS) score, and University of California, Los Angeles score before and 3 months after MUC between patients with the successful of MUC group (Success group) with those recurrence of frozen shoulder who required a further MUC or ACR group (Recurrence group). Multiple logistic regression analysis was used to identify risk factors for recurrence of frozen shoulder after MUC. Results Patients who underwent MUC were retrospectively enrolled and divided into: the successful of MUC group (Success group, n = 112) and required a further MUC or ACR group (Recurrence group, n = 9). The Recurrence group had significantly lower external rotation and CS score before MUC than those in the Success group (P < .05). The Recurrence group showed significantly inferior all ROM and functional scores 3 months after MUC (P < .05). The levels of blood glucose and hemoglobin A1c both before and 3 months after MUC in the Recurrence group showed inferior compared with those of Success group. The difference, although not statistically significant, trended towards significance (before MUC/3 months after MUC; the glucose levels P = .06/.06, the hemoglobin A1c levels P = .07/.09, respectively). The visual analog scale pain score (at rest, during activity, at night) both before and 3 months after MUC in the Recurrence group showed significantly higher scores compared with those of Success group (P < .05). Multiple logistic regression analysis revealed that lower CS score before MUC was independent risk factor for recurrence of frozen shoulder after MUC. Conclusion The overall incidence of recurrence of frozen shoulder after MUC was 7.4%. The lower CS score before MUC was an independent risk factor for recurrence of frozen shoulder after MUC. Moreover, patients in the Recurrence group tended to have poorly controlled diabetes and higher visual analog scale pain score both before and 3 months after MUC.
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Affiliation(s)
- Ryosuke Takahashi
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | - Shunsuke Fujii
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
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Pandey V, Aier S, Agarwal S, Sandhu AS, Murali SD. Prevalence of prediabetes in patients with idiopathic frozen shoulder: a prospective study. JSES Int 2024; 8:85-89. [PMID: 38312298 PMCID: PMC10837728 DOI: 10.1016/j.jseint.2023.08.017] [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] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background The association between diabetes and frozen shoulder is well established. However, the data regarding prediabetes and primary frozen shoulder (PFS) are still lacking. Methods In a prospective study, 158 patients with PFS were included. The prediabetes status was ascertained by estimating serum hemoglobin A1c (HbA1c) levels in patients with PFS. According to the level of HbA1c, patients were classified into normoglycemic, prediabetic, and diabetic. In addition, random blood sugar (RBS) was also performed. Results Out of 158 participants, 84 (53.2%) were male and 74 (46.8%) were female. Nine patients had bilateral shoulder involvement, and all were diabetics; 47.5% (n = 75) of the patients were in the age group of 51-60 years, 16.5% (n = 26) of the participants were normoglycemic, 37.3% (n = 59) were prediabetics, and 46.2% (n = 73) were diabetics. The difference in mean HbA1c values between the 3 groups was statistically significant (P < .001). However, there was no statistical difference in various age groups (P = .86) or gender (P = .68) between normoglycemics, prediabetics, and diabetics. The difference in mean RBS values between diabetic-nondiabetic and diabetic-prediabetic groups were statistically significant (P < .001), whereas no significant difference was detected between nondiabetic and prediabetic (P = .355). Conclusion The prevalence of prediabetes is 37.5% in patients with PFS. Single-point HbA1c estimation is an acceptable tool to detect prediabetes, whereas RBS estimation should not be used to detect prediabetes.
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Affiliation(s)
- Vivek Pandey
- Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - Sashitejmen Aier
- Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - Saksham Agarwal
- Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - Avneet Singh Sandhu
- Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India
| | - Sujayendra D. Murali
- Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Karnataka, India
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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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Hu J, Wei K, Xu Y, Chen L. Outcome of arthroscopic triple release combined with rotator cuff repair in the treatment of rotator cuff injury combined with frozen shoulder. Pak J Med Sci 2024; 40:520-525. [PMID: 38356817 PMCID: PMC10862443 DOI: 10.12669/pjms.40.3.7709] [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: 02/15/2023] [Revised: 07/31/2023] [Accepted: 11/17/2023] [Indexed: 02/16/2024] Open
Abstract
Objective To investigate the effect of arthroscopic triple release combined with rotator cuff repair in the treatment of rotator cuff injury combined with frozen shoulder and its influence on the range of motion and pain score of shoulder joint, and the levels of serum pain mediators. Methods This was prospective study. A total of 132 patients with rotator cuff injury combined with frozen shoulder admitted to The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine from December 2020 to December 2022 were prospectively selected and divided into two groups according to the random number table method: control group (n=67) and observation group (n=65). Patients in the control group were treated with arthroscopic rotator cuff repair alone, while those in the observation group were treated with arthroscopic triple release combined with rotator cuff repair, and the surgical effects of the two groups were compared. Results Three months after treatment, the external rotation, internal rotation, abduction, forward flexion, β-endorphin(β-EP), prostagranin E2 (PGE2) and substance P(SP)in the observation group were better than those in the control group (P<0.05), while the weight-bearing strength of the affected limb in internal rotation, external rotation and forward flexion was higher than that of the control group(P<0.05). Meanwhile, the Visual Analogue Scale (VAS) score of the observation group was lower than that of the control group at one month and three months after treatment, while the University of California at Los Angeles shoulder rating scale (UCLA) score and Constant-Murley Score (CMS) were higher than those of the control group (P< 0.05). Conclusion Arthroscopic triple release combined with rotator cuff repair improves various effects for patients with rotator cuff injury combined with frozen shoulder, such as ameliorating the muscle strength of the affected limb and improving the level of pain mediators.
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Affiliation(s)
- Jieliang Hu
- Jieliang Hu, Second Department of Orthopedics, The Third Affiliated Hospital of Gansu University of Traditional, Chinese Medicine (Baiyin City First People’s Hospital), Baiyin 730900, Gansu, China
| | - Kongxing Wei
- Kongxing Wei, Second Department of Orthopedics, The Third Affiliated Hospital of Gansu University of Traditional, Chinese Medicine (Baiyin City First People’s Hospital), Baiyin 730900, Gansu, China
| | - Yinping Xu
- Yinping Xu, Second Department of Orthopedics, The Third Affiliated Hospital of Gansu University of Traditional, Chinese Medicine (Baiyin City First People’s Hospital), Baiyin 730900, Gansu, China
| | - Liyuan Chen
- Liyuan Chen, Second Department of Orthopedics, The Third Affiliated Hospital of Gansu University of Traditional, Chinese Medicine (Baiyin City First People’s Hospital), Baiyin 730900, Gansu, China
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18
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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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Mlv SK, Mittal R, Chauhan N. Arthroscopic findings after manipulation under anesthesia in idiopathic capsulitis of the shoulder: A prospective study. World J Clin Cases 2023; 11:8147-8152. [PMID: 38130786 PMCID: PMC10731179 DOI: 10.12998/wjcc.v11.i34.8147] [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: 09/01/2023] [Revised: 09/30/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Manipulation under anesthesia (MUA) of the shoulder joint is a commonly used method for the treatment of adhesive capsulitis. Though it has been known to be associated with a variety of complications, there is a paucity of studies describing the arthroscopic findings after MUA. AIM To describe the arthroscopic findings in patients with idiopathic adhesive capsulitis of the shoulder after MUA. METHODS We recruited 28 patients with idiopathic adhesive capsulitis who underwent arthroscopic capsular release. Manipulation of the shoulder was performed under anesthesia in all of these patients before capsular release. Intra-articular findings were recorded during arthroscopic capsular release in these patients. RESULTS All patients showed the presence of synovitis. Twenty-seven patients showed tears in the capsule on the anterior aspect. One patient had an avulsion of the anterior rim of the glenoid and labrum following the manipulation. Four patients had partial rotator cuff tears, and one patient showed a superior labrum anterior posterior lesion, which was not diagnosed preoperatively on magnetic resonance imaging. CONCLUSION MUA leads to rupture of the capsule, which is the desired outcome. However, the site of rupture of the capsule is dependent on the maneuvers of MUA. In addition, partial tears of the rotator cuff and osteochondral fractures of the glenoid can also occur.
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Affiliation(s)
- Sai Krishna Mlv
- Department of Orthopaedics, Aayush Hospital, Eluru 534002, Andhra Pradesh, India
| | - Ravi Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Nitin Chauhan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi 110029, 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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21
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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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22
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Simpson J, Keding A, Spencer S, Brealey S, Rangan A. Factor structure of the Oxford Shoulder Score: secondary analyses of the UK FROST and PROFHER trial populations. J Orthop Surg Res 2023; 18:846. [PMID: 37940977 PMCID: PMC10631035 DOI: 10.1186/s13018-023-04319-x] [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: 06/02/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023] Open
Abstract
AIMS Frozen shoulder and proximal humeral fracture can cause pain, stiffness and loss of function. The impact of these symptoms on patients can be measured using the comprehensively validated, 12-item Oxford Shoulder Score (OSS). Evidence suggests that pain and function may have a differential impact on patients' experience of shoulder conditions, and this may be important for clinical management. We therefore explored the factor structure of the OSS within the UK FROST and PROFHER trial populations. METHODS We performed exploratory factor analysis (EFA), followed by confirmatory factor analysis (CFA), on baseline UK FROST data from 490 of the 503 trial participants. Data at 6 months post-randomisation were used for 228 of the 250 participants for the PROFHER trial. RESULTS UK FROST factor extraction results, using Velicer's Minimum Average Partial and Horn's Parallel Analysis tests, suggested a unifactorial solution, but two factors were weakly indicated by the less reliable 'Kaiser's eigenvalue > 1' and scree tests. We explored this further using EFA. Eight items (2 to 7, 9 and 10) loaded onto a 'Function' factor, three on a 'Pain' factor (1, 8 and 12) and item 11 cross-loaded. However, one- and two-factor models were rejected in CFA. Factor extraction of PROFHER data at 6 months demonstrated a single first-order factor solution, which was also subsequently rejected in CFA. CONCLUSION Insufficient evidence was found, within the constraints of the data available, to support the use of 'Pain' and 'Function' sub-scales of the OSS in either patient population.
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Affiliation(s)
- J Simpson
- York Trials Unit, Department of Health Sciences, University of York, York, UK.
- Hull York Medical School, University of York, York, UK.
| | - A Keding
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - S Spencer
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | - S Brealey
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - A Rangan
- York Trials Unit, Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
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23
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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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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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Mertens MG, Struyf F, Verborgt O, Dueñas L, Balasch-Bernat M, Navarro-Ledesma S, Fernandez-Sanchez M, Luque-Suarez A, Lluch Girbes E, Meeus M. Exploration of the clinical course and longitudinal correlations in frozen shoulder: The role of autonomic function, central pain processing, and psychological variables. A longitudinal multicenter prospective observational study. Musculoskelet Sci Pract 2023; 67:102857. [PMID: 37725869 DOI: 10.1016/j.msksp.2023.102857] [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: 04/11/2023] [Revised: 08/29/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Altered central pain processing (CPP) and dysautonomia might play a role in the clinical course of frozen shoulder and psychological factors, like pain catastrophizing and hypervigilance, might influence clinical variables in frozen shoulder. OBJECTIVES To explore the clinical course of frozen shoulder regarding CPP, dysautonomia, pain catastrophizing, and hypervigilance and to explore whether longitudinal correlations between these outcomes and pain intensity were present. DESIGN prospective longitudinal observational study. METHOD Participants with frozen shoulder were recruited at hospitals and general practitioner practices and followed for 9 months. They completed six questionnaires (about demographics, shoulder pain and disability, pain intensity, pain catastrophizing, pain hypervigilance, and autonomic symptoms) and underwent tactile sensitivity (allodynia), pressure pain thresholds (hyperalgesia), temporal summation, and conditioned pain modulation during four timeframes (3-month intervals). RESULTS Initially, 149 participants with frozen shoulder were recruited and 88 completed all the measurements. An improvement from baseline to at least one follow-up measurement was found for shoulder pain and disability, pain intensity, pain catastrophizing, hypervigilance, and dysautonomia. A fair longitudinal correlation was found between pain intensity and catastrophizing and hypervigilance (r = 0.301-0.397). Poor longitudinal correlations were found between pain intensity and allodynia and hyperalgesia (r = -0.180-0.193), between pain catastrophizing and dysautonomia (r = 0.209) and between hypervigilance and hyperalgesia (r = -0.159). CONCLUSION Patients with frozen shoulder showed an early improvement that flattened with time in several pain and psychological variables over the course of 9 months. However, autonomic symptoms rather showed a late improvement over 9 months.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium; Department of Orthopedic Surgery, University Hospital (UZA), Edegem, Belgium.
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, 46010, Valencia, Spain.
| | - Mercè Balasch-Bernat
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, 46010, Valencia, Spain.
| | - Santiago Navarro-Ledesma
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Querol Street 5, 52004, Melilla, Spain.
| | | | | | - Enrique Lluch Girbes
- Pain in Motion International Research Group(1), Belgium; Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, 46010, Valencia, Spain; Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group(1), Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
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26
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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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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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Kurashina W, Sasanuma H, Iijima Y, Saito T, Saitsu A, Nakama S, Takeshita K. Relationship between pain and range of motion in frozen shoulder. JSES Int 2023; 7:774-779. [PMID: 37719810 PMCID: PMC10499860 DOI: 10.1016/j.jseint.2023.05.014] [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 A frozen shoulder (FS) is characterized by pain and limited range of motion (ROM). Although physical assessment of ROM is important for diagnosing and staging FS, ROM cannot be accurately assessed in clinical practice because of pain and muscle contraction. This study aimed to measure changes in shoulder joint ROM before and after anesthesia (ΔROM) in patients with FS and investigate the factors affecting these changes. Methods This study included 54 patients (age, 55.6 ± 9.4 years; 17 males; disease duration, 6.6 ± 3.4 months) with FS before manipulation under transmission anesthesia. FS was defined as having a ROM in external rotation (ER) that was less than 50% of that in the unaffected shoulder. Pain at night and during motion was assessed using a numerical rating scale. Before anesthesia, the passive ROM of forward flexion (FF), abduction (AD), and ER were measured in the supine position. After confirming that the anesthesia was effective, passive ROM was measured again. Results The ROM in the FF, AD, and ER after anesthesia was significantly higher than that before anesthesia (P < .001). ΔROM in the FF, AD, and ER was significantly correlated with pain at night (r = 0.51, P < .001; r = 0.45, P < .001; and r = 0.39, P = .004, respectively). Furthermore, ΔROM in the ER was significantly correlated with pain during motion (r = 0.31, P = .023) and disease duration (r = -0.31, P = .021). Conclusion The ROM of the FS is susceptible to pain and muscle contraction. Interventions, such as physical therapy, may be recommended after pain relief.
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Affiliation(s)
- Wataru Kurashina
- Rehabilitation Center, Tochigi Medical Center Shimotsuga, 420-1 Kawatsure, Ohira, Tochigi 3294498, Japan
- Graduate School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 3290498, Japan
| | - Hideyuki Sasanuma
- Department of Orthopedics Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 3290498, Japan
| | - Yuki Iijima
- Department of Orthopedics Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 3290498, Japan
| | - Tomohiro Saito
- Department of Orthopedics Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 3290498, Japan
| | - Akihiro Saitsu
- Department of Orthopedics Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 3290498, Japan
| | - Sueo Nakama
- Department of Orthopedics Surgery, Tochigi Medical Center Shimotsuga, 420-1 Kawatsure, Ohira, Tochigi 3294498, Japan
| | - Katsushi Takeshita
- Department of Orthopedics Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 3290498, Japan
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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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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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Tamai K, Hamada J, Nagase Y, Morishige M, Naito M, Asai H, Tanaka S. Frozen shoulder. An overview of pathology and biology with hopes to novel drug therapies. Mod Rheumatol 2023:road087. [PMID: 37632764 DOI: 10.1093/mr/road087] [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: 06/22/2023] [Revised: 08/07/2023] [Accepted: 08/25/2023] [Indexed: 08/28/2023]
Abstract
Frozen shoulder (FS) is a common disorder characterized by spontaneous onset of shoulder pain accompanied by progressive loss of range-of-motions. The cause of FS is still unclear and radical therapy has not been established. With the final aim of preventing or curing FS at an earlier stage, we reviewed the pathological and biological features of this disease. Many studies indicate that the main pathology of FS is inflammation initially and fibrosis later. There are inflammatory cytokines, immune cells, fibrotic growth factors, and type-III collagen in the synovium and the joint capsule. The immune cell landscape switches from the macrophages to T cells. Activated fibroblasts seem to regulate the inflammatory and fibrotic processes. The imbalance between matrix metalloproteinases and tissue inhibitors of metalloproteases might promote fibrosis. Additionally, advanced glycation end-products are noted in the FS synovium. Diabetes mellitus and hypothyroidism are closely related to the development of FS. In terms of nonsurgical treatment, oral or intra-articular glucocorticoids are the only drugs that provide early benefit. Some other anti-inflammatory or antifibrotic drugs may potentially control the FS, but have not been proven effective in the clinical setting. Future studies should be targeted to develop steroid-sparing agents that inhibit biological events in FS.
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Affiliation(s)
| | | | - Yuichi Nagase
- Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | | | - Masashi Naito
- National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Hideaki Asai
- Yashio Central General Hospital, Yashio, Saitama, Japan
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Li D, Zhang C, Xiang X, Cheng Y, Zhang L, Ma K. The Effect of Arthroscopic Extra-Articular Entire Coracohumeral Ligament Release for Patients with Recalcitrant Frozen Shoulder. Orthop Surg 2023; 15:1975-1982. [PMID: 36345115 PMCID: PMC10432473 DOI: 10.1111/os.13566] [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: 06/13/2022] [Revised: 08/21/2022] [Accepted: 09/21/2022] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE The thickened coracohumeral ligament (CHL) is an important part of the typical manifestations and magnetic resonance imaging of frozen shoulder. However, only a few clinical studies with limited cases on arthroscopic extra-articular entire CHL release exist in the literature. This study was to evaluate the effect of arthroscopic extra-articular entire CHL release for patients with recalcitrant frozen shoulder. METHODS From February 2014 to February 2020, 81 cases of recalcitrant frozen shoulder patients treated with surgery in a single-center shoulder department and followed for more than 2 years were analyzed. Arthroscopic 360° capsular release was performed with intra-articular partial release (IPR group) or additional extra-articular entire release (IPR + EER group) of CHL. The same rehabilitation program was performed after surgery in both groups. Visual analogue scale (VAS) for pain, range of motion (ROM), and the Constant-Murley scoring system was evaluated before operation, at 3 months after operation, 6 months after operation, and the final follow-up. T-test, Mann-Whitney U-test and chi-squared test were used to compared data. RESULTS There were 39 patients in the IPR group, with an average follow-up of 29.2 months. A total of Forty-two patients in the IPR + EER group completed a mean follow-up of 25.7 months. All incisions healed in stages. There were significant differences in Constant-Murley shoulder score, VAS score, and ROM before operation and at the final follow-up in both groups (both P < 0.001). The VAS score of the IPR + EER group was lower than that of the IPR group at 3 months after surgery (P < 0.05), and 6 months after operation (P < 0.05). External rotation, internal rotation, and abduction of ROMs and Constant-Murley shoulder score were significantly greater in the IPR + EER group at 3 months (P < 0.001, P < 0.05, P < 0.001, P < 0.05, respectively) and 6 months after operation (P < 0.001, P < 0.05, P < 0.001, P < 0.05, respectively). At the last follow-up, there was no significant difference in forward flexion, internal rotation, and abduction of ROMs, VAS, and the Constant-Murley shoulder score between the IPR and IPR + EER groups. The external rotation of the IPR + EER group was still greater than that of the IPR group at the last follow-up (P < 0.001). CONCLUSION Arthroscopic extra-articular entire coracohumeral ligament release could solve early pain of shoulder joint, recover shoulder joint functions effectively, and achieve a satisfactory efficacy in the treatment of recalcitrant frozen shoulder.
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Affiliation(s)
- Dan‐mei Li
- Shoulder and Elbow Surgery CenterLuoyang Orthopedic Hospital of Henan Province & Orthopedic Hospital of Henan ProvinceLuoyangChina
| | - Chuan Zhang
- Shoulder and Elbow Surgery CenterLuoyang Orthopedic Hospital of Henan Province & Orthopedic Hospital of Henan ProvinceLuoyangChina
| | - Xian‐Xiang Xiang
- Department of Orthopedic SurgeryAffiliated Zhongshan Hospital of Dalian UniversityDalianChina
| | - Yong‐Feng Cheng
- Department of Orthopedic SurgeryXiangtan Hospital of Traditional Chinese MedicineXiangtanChina
| | - Lai‐Fu Zhang
- Shoulder and Elbow Surgery CenterLuoyang Orthopedic Hospital of Henan Province & Orthopedic Hospital of Henan ProvinceLuoyangChina
| | - Kun Ma
- Shoulder and Elbow Surgery CenterLuoyang Orthopedic Hospital of Henan Province & Orthopedic Hospital of Henan ProvinceLuoyangChina
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Kim JH, Kwon MJ, Choi HG, Lee SJ, Hwang S, Lee J, Lee SH, Lee JW. Changes in the mean incidence and variance of orthopedic diseases before and during the COVID-19 pandemic in Korea: a retrospective study. BMC Musculoskelet Disord 2023; 24:540. [PMID: 37393227 DOI: 10.1186/s12891-023-06634-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 06/14/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND During the coronavirus disease (COVID-19) pandemic, the amount of moderate- to high-intensity physical activity significantly decreased. Therefore, the epidemiology of musculoskeletal diseases could possibly have changed. We assessed changes in the incidence of and variance in non-traumatic orthopedic diseases before and after the COVID-19 pandemic in Korea. METHODS This study included data from the Korea National Health Insurance Service, which covers the entire Korean population (approximately 50 million), from January 2018 to June 2021. Using International Classification of Diseases, Tenth Revision codes, 12 common orthopedic diseases were evaluated, including cervical disc disorders, lumbar disc disorders, forward head posture, myofascial pain syndrome, carpal tunnel syndrome, tennis elbow, frozen shoulder, rheumatoid arthritis, gout, hip fracture, distal radius fracture, and spine fracture diseases. "Pre-COVID-19" was the period until February 2020, and "COVID-19 pandemic period" was the period starting March 2020. Differences in the mean incidence and variance of diseases before and during the COVID-19 pandemic were compared. RESULTS In most cases, the incidence of orthopedic diseases decreased at the beginning of the pandemic and then increased thereafter. Among the 12 diseases, the incidence of three diseases showed a statistically significant change. The incidence of myofascial pain syndrome (P < 0.001) was lower during the COVID-19 pandemic than during the pre-COVID-19 period. The incidences of frozen shoulder (P < 0.001) and gout (P = 0.043) were higher during the COVID-19 pandemic than during the pre-COVID-19 period. However, no statistical difference in disease variations was observed between the two periods. CONCLUSIONS The incidence of orthopedic diseases varied during the COVID-19 pandemic among the Korean population. Although the incidence of myofascial pain syndrome was lower, that of frozen shoulder and gout was higher during the COVID-19 pandemic than during the pre-COVID-19 period. No disease variations during the COVID-19 pandemic were found.
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Affiliation(s)
- Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | | | - Sang Jun Lee
- Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Wonju-si, Gangwon-do, Korea
| | - Sangwon Hwang
- Artificial Intelligence Bigdata Medical Center, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Wonju-si, Gangwon-do, Korea
| | - Jaemin Lee
- Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Wonju-si, Gangwon-do, Korea
| | - San-Hui Lee
- Department of Obstetrics and Gynecology, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Wonju-si, Gangwon-do, Korea
| | - Jung Woo Lee
- Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Wonju-si, Gangwon-do, Korea.
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Kalita J, Pandey PC, Shukla R, Misra UK. Prednisolone 20 mg vs 40 mg in complex regional pain syndrome type I: A randomized controlled trial. J Clin Neurosci 2023; 113:108-113. [PMID: 37257216 DOI: 10.1016/j.jocn.2023.05.017] [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: 04/08/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND High dose of corticosteroid has been found beneficial in complex regional pain syndrome type I (CRPS-I). We report the efficacy and safety of prednisolone 20 mg versus 40 mg in CRPS-I in an open label randomized controlled trial. METHODS The patients with CRPS-I of the shoulder joint with a CRPS score of ≥8 were included. Their demographic details, comorbidities, and underlying etiology were noted. The severity of CRPS was assessed using a 0-14 CRPS scale, the pain using a 0-10 Visual Analogue Scale (VAS), and sleep quality using a 0-10. Daily Sleep Interference Scale (DSIS). Patients were randomized to prednisolone 40 mg/day (group I) or 20 mg/day (group II) for 14 days, then tapered to 10 mg in group I and to 5 mg in group II by 1 month. Thereafter both groups received prednisolone 5 mg/day for 2 months. The primary outcome was a >50% reduction in VAS score, and secondary outcomes were a reduction in CRPS score, DSIS score, and adverse events. RESULTS Fifty patients were included, and their baseline characteristics were comparable. At one month, all the patients had >50% reduction in the VAS score. The effect size was 0.38 (95% CI 0.93-0.20; p = 0.20). On the Kaplan-Mayer analysis, the improvement in the VAS score (Hazard ratio-1.43, 95 % CI-0.80-2.56, p = 0.22) and the CRPS score (HR-0.79,95 % CI-0.45-1.39; p = 0.41) was insignificant between the two groups. The DSIS score improved in group II (HR-1.85,95 % Cl-1.04-3.31,p = 0.04). Group I patients needed frequent adjustment of antidiabetic drugs (14 vs 6; p = 0.04). CONCLUSION The efficacy of prednisolone 20 mg is not inferior to 40 mg in CRPS-I, and is safe in diabetic patients. LIMITATIONS This is an open label randomized controlled trial with small sample size without a placebo arm.
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Affiliation(s)
- Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226014, India.
| | - Prakash C Pandey
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226014, India
| | - Ruchi Shukla
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226014, India
| | - Usha K Misra
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226014, India
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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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Jacob L, Koyanagi A, Haro JM, Shin JI, Smith L, Gremke N, Kalder M, Kostev K. Is there an association between breast cancer and incident adhesive capsulitis of the shoulder? A retrospective cohort study from Germany. Support Care Cancer 2023; 31:347. [PMID: 37212901 DOI: 10.1007/s00520-023-07808-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Preliminary data suggest that women with breast cancer are at particularly high risk of adhesive capsulitis of the shoulder. Therefore, this study aimed to investigate the potential association between breast cancer and adhesive capsulitis in adults from Germany. METHODS This retrospective cohort study included all women aged ≥ 18 years who were diagnosed for the first time with breast cancer in one of 1,274 general practices in Germany between January 2000 and December 2018 (index date). Women without breast cancer were matched (1:1) to those with breast cancer using a propensity score based on age at the index date, index year, and the average number of medical consultations per year during the follow-up. In women without breast cancer, the index date was a randomly selected visit date between 2000 and 2018. The association between breast cancer and the 10-year incidence of adhesive capsulitis was studied using Kaplan-Meier curves and a Cox regression model adjusted for age and several comorbidities. RESULTS There were 52,524 women included in this study (mean [SD] age 64.2 [12.9] years). The 10-year incidence of adhesive capsulitis was 3.6% in both the group with and the group without breast cancer (log-rank p-value = 0.317). The Cox regression analysis further showed no significant association between breast cancer and adhesive capsulitis (HR = 0.96, 95% CI = 0.86-1.08). CONCLUSION In this sample of women from Germany, breast cancer was not significantly associated with adhesive capsulitis. Although the present preliminary findings are reassuring, general practitioners should regularly assess shoulder function in breast cancer survivors.
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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
- Department of Physical Medicine and Rehabilitation, Lariboisière-Fernand Widal Hospital, AP-HP, University Paris Cité, Paris, 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
| | - 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
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Niklas Gremke
- Department of Gynecology and Obstetrics, Philipps-University, Marburg, Germany
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, Philipps-University, Marburg, Germany
| | - Karel Kostev
- Epidemiology, IQVIA, Unterschweinstiege 2-14, 60549, Frankfurt am Main, Germany.
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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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Piechowiak R, Sajan A, Isaacson A, Lerner J, Bagla S. Angiographic Analysis of Anatomical Variants in Adhesive Capsulitis Embolization. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03427-9. [PMID: 37041388 DOI: 10.1007/s00270-023-03427-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/23/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE To analyze the complex shoulder vasculature and identify potential challenges during adhesive capsulitis embolization (ACE). MATERIALS AND METHODS Two interventional radiologists evaluated angiographic findings from 21 ACE procedures. The suprascapular artery (SSA), thoracoacromial artery (TAA), coracoid branch (CB), circumflex scapular artery (CSA), and anterior/posterior circumflex humeral artery (ACHA/PCHA) were assessed for their presence, course, diameter within 1 cm of origin, angle to the proximal parent vessel, and distance from the clavicle. RESULTS 83 arteries were embolized: CB (20.5%), TAA (19.3%), PCHA (19.3%), ACHA (16.9%), CSA (14.5%), and SSA (9.6%). The CSA had the largest diameter (4.3 mm), while CB had the smallest diameter (1.0 mm). An acute angle to the parent vessel was noted with the SSA, TAA, ACHA, and PCHA. A common origin for CSA and PCHA was noted in 2 patients. A common origin for TAA and SSA was also noted in one patient. The CB appears perpendicular to the axillary artery and courses vertically toward the coracoid process. The TAA branches off the axillary artery and courses along the medial border of the pectoralis minor. The PCHA and ACHA originate from the axillary artery. The CSA is located on the medial side of axillary artery. The SSA originates from the thyrocervical trunk and courses laterally toward the superior border of the scapula. CONCLUSION An anatomical-technical guide is provided to help interventional radiologists during ACE to treat adhesive capsulitis.
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Affiliation(s)
- Rachel Piechowiak
- Prostate Centers USA, 1801 Robert Fulton Dr Suite 510, Reston, VA, 20191, USA
| | - Abin Sajan
- Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, USA
| | - Ari Isaacson
- Prostate Centers USA, 9400 Brier Creek Pkwy Suite 202, Raleigh, NC, 27617, USA
| | - Jade Lerner
- St George's University School of Medicine, University Centre Grenada, West Indies, Grenada.
| | - Sandeep Bagla
- Prostate Centers USA, 2755 Hartland Rd #110, Falls Church, VA, 22043, USA
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Bilsborough Smith C, Nadesan K, Cairns M, Chester R, Lewis J. Living with frozen shoulder. 'Here are the risks. I want the injection'. An interpretative phenomenological analysis. Musculoskelet Sci Pract 2023; 65:102755. [PMID: 37172553 DOI: 10.1016/j.msksp.2023.102755] [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: 12/12/2022] [Revised: 03/09/2023] [Accepted: 04/02/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Frozen shoulder is a disabling condition characterised by severe pain and loss of shoulder movement and may affect up to 5% of the population. Qualitative research documents debilitating pain and how treatment to reduce pain is a priority for people diagnosed with frozen shoulder. Corticosteroid injections are a principal treatment to reduce the pain of frozen shoulder, however little is known about the patient experience. OBJECTIVES This study aims to address this gap in the knowledge by exploring the lived experience of people with frozen shoulder who have undergone an injection and to highlight other novel findings. DESIGN This is a qualitative study using interpretative phenomenological analysis. One-to-one, semi-structured interviews were conducted with seven people diagnosed with frozen shoulder who had received a corticosteroid injection as part of their management. METHODOLOGY A purposive sample of participants were interviewed via MSTeams™ due to Covid-19 restrictions. Data was collected through semi-structured interviews and analysed in accordance with interpretive phenomenological analysis methods. RESULTS Three group experiential themes were identified: the dilemma surrounding injections; the challenges of understanding the causes of frozen shoulder; the impact on self and others. CONCLUSION Participants conveyed a strong desire in seeking a corticosteroid injection whilst seemingly dismissing the risks. A novel concept was illuminated as frozen shoulder seemed inextricably linked with the ageing process, which negatively impacted body-image. The impact on others is driven by a sense of the unfamiliar nature of illness and it is incumbent on healthcare professionals to seek opportunities to explore the individual's beliefs.
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Affiliation(s)
- Christine Bilsborough Smith
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom; School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom.
| | - Kayathiri Nadesan
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom.
| | - Melinda Cairns
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom.
| | - Rachel Chester
- School of Health and Social Sciences, Faculty of Medicine and Health, University of East Anglia, Norwich, Norfolk, United Kingdom.
| | - Jeremy Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom; Department of Clinical Therapies, University of Limerick, Ireland.
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Mao X, Li Z, Gu S, Song W, Zhang M, Tan X, Mao Z. MicroRNA-211-5p in extracellular vesicles derived from BMSCs facilitates the repair of rat frozen shoulder via regulating KDM2B/LACC1 axis. Tissue Cell 2023; 81:102006. [PMID: 36610229 DOI: 10.1016/j.tice.2022.102006] [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: 07/06/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aims to explore the mechanism of miR-211-5p in extracellular vesicles (EVs) derived from bone marrow mesenchymal stem cells (BMSCs) in improving frozen shoulder (FS) in rat models. METHODS Rat BMSCs and EVs derived from rat BMSCs were isolated, identified, and then injected into rats to assess the expression of TGF-β, MMP1, MMP3, MMP12, GAP43, and PGP9.5 in shoulder capsule tissues. The range of motion of bilateral glenohumeral joints was assessed and pathological changes of shoulder capsule tissues were observed after hematoxylin-eosin staining. The binding sites of miR-211-5p to KDM2B and LACC1 to H3K4me3 were measured. FS rat models with LACC1 highly expressed were established to assess the motion of bilateral glenohumeral joints and expression of arthritis related factors in rats. RESULTS EVs were successfully extracted from BMSCs. Injection of BMSCs-EVs could improve the activity of bilateral glenohumeral joints and the pathological condition of joint capsule in rats. Elevated expression of miR-211-5p was found in rats injected with BMSCs-EVs. Dual luciferase assay showed that miR-211-5p had a binding site with KDM2B. ChIP, qRT-PCR, and western blot experiments showed BMSCs-EVs injection resulted in elevated enrichment of LACC1 promoter in shoulder capsule tissues of FS rats, and decreased mRNA and protein expression of KDM2B and increased H3K4me3 methylation. Overexpression of LACC1 could also improve the pathological condition of joint capsule tissue. CONCLUSION miR-211-5p in EVs derived from BMSCs increased H3K4me3 methylation in shoulder capsule tissue of rats by binding KDM2B, resulting in up-regulated transcription level of LACC1 and improving FS. AVAILABILITY OF DATA AND MATERIALS The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.
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Affiliation(s)
- Xiaodong Mao
- Department of Orthopedics & Traumatology, Department of Joint Surgery, Changsha Hospital of Traditional Chinese Medicine, Changsha Eighth Hospital, Changsha, Hunan 410008, PR China
| | - Zhi Li
- Department of Orthopedics & Traumatology, Department of Joint Surgery, Changsha Hospital of Traditional Chinese Medicine, Changsha Eighth Hospital, Changsha, Hunan 410008, PR China
| | - Shaofang Gu
- Department of Orthopedics & Traumatology, Department of Joint Surgery, Changsha Hospital of Traditional Chinese Medicine, Changsha Eighth Hospital, Changsha, Hunan 410008, PR China
| | - Wei Song
- Department of Orthopedics & Traumatology, Department of Joint Surgery, Changsha Hospital of Traditional Chinese Medicine, Changsha Eighth Hospital, Changsha, Hunan 410008, PR China
| | - Mimi Zhang
- Department of Orthopedics & Traumatology, Department of Joint Surgery, Changsha Hospital of Traditional Chinese Medicine, Changsha Eighth Hospital, Changsha, Hunan 410008, PR China
| | - Xiao Tan
- Department of Orthopedics & Traumatology, Department of Joint Surgery, Changsha Hospital of Traditional Chinese Medicine, Changsha Eighth Hospital, Changsha, Hunan 410008, PR China
| | - Ziqing Mao
- Department of Orthopedics & Traumatology, Department of Joint Surgery, Changsha Hospital of Traditional Chinese Medicine, Changsha Eighth Hospital, Changsha, Hunan 410008, PR China.
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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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Wang JM, Mi SS, Zheng LJ, Qiao YJ, Zhang WL, Xue K, Li HD. Efficacy and safety of Tuina and intermediate frequency electrotherapy for frozen shoulder: MRI-based observation evidence. Am J Transl Res 2023; 15:1766-1778. [PMID: 37056812 PMCID: PMC10086926] [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] [Received: 11/03/2022] [Accepted: 01/31/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Tuina and Intermediate Frequency (IF) electrotherapy are commonly used treatments for frozen shoulder (FS). This study aimed to compare the clinical efficacy of Tuina and IF electrotherapy in the treatment of stage II frozen shoulder and to provide evidence-based treatment for FS. METHODS The FS patients were randomized into two groups, the observation group, which received Tuina, and the control group, which received IF electrotherapy. The total treatment duration was 20 minutes per treatment, 3 times per week; the treatment period was 6 weeks. Assessments were performed at baseline, 3 weeks, 6 weeks, and 16 weeks after follow-up. Primary assessments included visual analog scale (VAS), Constant-Murley scale (CMS), and secondary assessments included shoulder MRI, rotator cuff muscle diffusion tensor imaging (DTI). RESULTS A total of 57 patients participated in this study, in the observation group (n = 29) and the control group (n = 28). At the end of the 3rd and 6th weeks of treatment, Tuina was significantly more effective than IF electrotherapy in reducing the VAS score and improving the Constant-Murley total score (P<0.05), but there was no significant difference in scores between the two groups at the 16-week follow-up (P>0.05). MRI results in both groups: compared to the control group, the observation group had better results in reducing the degree of periapical edema and reducing the thickness of the axillary humeral capsule (P<0.05); and the observation group had significantly more efficacy than the control group in improving the diffusion state of water molecules in the rotator cuff muscles (P<0.05). CONCLUSION Tuina is more effective than IF electrotherapy in improving the symptoms of FS patients as it can rapidly relieve the pain and restore the function of the affected shoulder, reduce the edema of the shoulder capsule, restore the function of the rotator cuff muscles, and shorten the natural course of FS. Name of the registry: This study was registered in the Shandong University of Traditional Chinese Medicine Affiliated Hospital; Grant No. (2021) Lun Audit No. (033) - KY; Date of registration: 2021.4.27.
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Affiliation(s)
- Jian-Min Wang
- Department of Tuina, Shandong University of Traditional Chinese Medicine Affiliated HospitalJinan, Shandong, China
| | - Shuai-Shuai Mi
- School of Acupuncture-Tuina, Shandong University of Traditional Chinese MedicineJinan, Shandong, China
| | - Li-Jun Zheng
- Department of Tuina, Shandong University of Traditional Chinese Medicine Affiliated HospitalJinan, Shandong, China
| | - Ying-Jie Qiao
- Department of Tuina, Shandong University of Traditional Chinese Medicine Affiliated HospitalJinan, Shandong, China
| | - Wan-Li Zhang
- Department of Tuina, Shandong University of Traditional Chinese Medicine Affiliated HospitalJinan, Shandong, China
| | - Kun Xue
- Department of Tuina, Shandong University of Traditional Chinese Medicine Affiliated HospitalJinan, Shandong, China
| | - Hua-Dong Li
- Department of Tuina, Shandong University of Traditional Chinese Medicine Affiliated HospitalJinan, Shandong, China
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Jain A, Nagar M, Jain S, Barasker SK. Suprascapular nerve block is faster and as effective as hydrodistension in relieving frozen shoulder-associated pain and disability: A prospective, single-blind observational study with a follow-up of 24 weeks. J Anaesthesiol Clin Pharmacol 2023; 39:45-50. [PMID: 37250252 PMCID: PMC10220177 DOI: 10.4103/joacp.joacp_114_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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/09/2021] [Accepted: 07/20/2021] [Indexed: 03/21/2023] Open
Abstract
Background and Aims Hydrodistension (HD) and suprascapular nerve block (SSNB) have been shown to reduce pain and improve shoulder function in frozen shoulder (FS). The aim of this study was to compare the efficacy of HD and SSNB in the treatment of idiopathic FS. Material and Methods This was a prospective observational study. A total of 65 patients with FS were treated with SSNB or HD. The functional outcome was evaluated by Shoulder Pain and Disability Index (SPADI) score and active shoulder range of motion (ROM) measured at 2 weeks, 6 weeks, 12 weeks, and 24 weeks. Parametric data were analyzed using an independent sample T-test. Nonparametric data were analyzed using the Mann-Whitney test and Wilcoxon test. A P value less than 0.05 was considered significant. Result At the end of 24 weeks, the two-group improved significantly from the baseline and the improvement was comparable between the two groups. ROM also improved significantly in both groups. At 2nd week, SPADI score was significantly less in SSNB group (P < 0.05). About 43% of patients considered HD extremely painful. Conclusion Both HD and SSNB are almost equally effective in reducing pain and improving shoulder function. However, SSNB leads to a faster improvement.
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Affiliation(s)
- Anuj Jain
- Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Manoj Nagar
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Suruchi Jain
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Swapnil Kumar Barasker
- Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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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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Dai Z, Liu Q, Liu B, Long K, Liao Y, Wu B, Huang W, Liu C. Combined arthroscopic release with corticosteroid hydrodilatation versus corticosteroid hydrodilatation only in treating freezing-phase primary frozen shoulder: a randomized clinical trial. BMC Musculoskelet Disord 2022; 23:1102. [PMID: 36528565 PMCID: PMC9758809 DOI: 10.1186/s12891-022-06065-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There has been no ideal treatment for freezing-phase frozen shoulder to rapidly relieve pain and improve joint mobility. No any other team directly compared the effectiveness of combination of arthroscopic release and corticosteroid hydrodilatation with corticosteroid hydrodilatation only in treatment of freezing-phase frozen shoulder. METHODS Seventy-two patients with freezing-phase frozen shoulder were randomly assigned to combined arthroscopic release with corticosteroid hydrodilatation (group A) or corticosteroid hydrodilatation only (group B). Clinical states were examined at baseline and periodically (Weeks 1, 4, 12, 24 and 1 year) after intervention by passive ROM; visual analog scale (VAS); UCLA and Disabilities of the Arm, Shoulder, and Hand (DASH) score. RESULTS The passive ROM, VAS, UCLA and DASH scores always improved along the time points (all p < 0.01). The passive abduction (pAB), passive forward flexion (pFL), passive external rotation (pER), passive internal rotation (pIR) were better in group A than in group B at Week 1, 4, 12, 24 (all p < 0.01). At 1 year post-operation, the pFL and pIR were better in group A than in group B (all p < 0.01). VAS scores of group A were similar with those of group B (all p > 0.01), the differences between group A and group B were all lower than minimal clinically important difference (MCID). At Week 12, the UCLA sores and DASH scores were 26.8 ± 3.8, 14.2 ± 2.0 in group A versus 22.3 ± 3.4, 22.5 ± 3.1 in group B (all p < 0.01). At Week 24 post-operation, there were 32.7 ± 2.0, 9.8 ± 1.5 in group A versus 26.3 ± 3.6, 17.5 ± 3.5 in group B (all p < 0.01). At 1 year post-operation, there were 34.5 ± 0.8, 1.7 ± 1.5 in group A versus 32.1 ± 2.3, 8.8 ± 2.8 in group B (all p < 0.01), the differences of UCLA scores between group A and group B at Week 24 was higher than the MCID. There were no complications such as infection, nerve or vascular injury. CONCLUSIONS Combined arthroscopic release with corticosteroid hydrodilatation would yield better results in passive ROM and function than corticosteroid hydrodilatation only. TRIAL REGISTRATION ChiCTR1900024235, July 2, 2019 (Retrospectively registered).
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Affiliation(s)
- Zhu Dai
- Department of Orthopaedics, the First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
| | - Quanhui Liu
- Department of Orthopaedics, the First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Bo Liu
- Department of Orthopaedics, the First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Ke Long
- Department of Orthopaedics, the First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Ying Liao
- Department of Orthopaedics, the First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Biao Wu
- Department of Orthopaedics, the First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Wen Huang
- Department of Orthopaedics, the First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Chao Liu
- Department of Orthopaedics, the First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
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Mohamed AA. Influence of enhancing dynamic scapular recognition on shoulder disability, and pain in diabetics with frozen shoulder: A case report. World J Clin Cases 2022; 10:12410-12415. [PMID: 36483817 PMCID: PMC9724531 DOI: 10.12998/wjcc.v10.i33.12410] [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: 08/30/2022] [Revised: 10/14/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Frozen shoulder (FS) is a familiar disorder. Diabetics with FS have more severe symptoms and a worse prognosis. Thus, this study investigated the influence of enhancing dynamic scapular recognition on shoulder disability and pain in diabetics with FS.
CASE SUMMARY A Forty-five years-old male person with diabetes mellitus and a unilateral FS (stage II) for at least 3 mo with shoulder pain and limitation in both passive and active ranges of motion (ROMs) of the glenohumeral joint of ≥ 25% in 2 directions participated in this study. This person received dynamic scapular recognition exercise was applied to a diabetic person with a unilateral FS (stage II). The main outcome measures were upward rotation of the scapula, shoulder pain and disability index, and shoulder range of motion of flexion, abduction, and external rotation. The dynamic scapular exercise was performed for 15 min/session and 3 sessions/wk lasted for 4 wk. After 4 wk of intervention, there were improvements between pre-treatment and post-treatment in shoulder pain, shoulder pain and disability index, shoulder ROM, and upward rotation of the scapula.
CONCLUSION This case report suggested that enhancing dynamic scapular recognition may improve shoulder pain and disability; upward rotation of the scapula; and shoulder ROM of shoulder abduction, flexion, and external rotation after 4 wk.
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Affiliation(s)
- Ayman A Mohamed
- Basic Sciences Department, Faculty of Physical Therapy, Beni-Suef University, Beni Suef 34522, Egypt
- Basic Sciences Department, Faculty of Physical Therapy, Nahda University, Beni Suef 23146, Egypt
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Ikeda A, Ikezu M, Kaneiwa J, Kudo S. Reliability of the assessment of scapular posterior tilt angle using the smartphone and scapular movement during arm elevation in healthy individuals and patients with frozen shoulder: a cross-sectional study. JSES Int 2022; 7:162-166. [PMID: 36820411 PMCID: PMC9937809 DOI: 10.1016/j.jseint.2022.10.007] [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: 11/09/2022] Open
Abstract
Background Frozen shoulders are associated with abnormal scapular movements. However, scapular posterior tilt movement in frozen shoulders has not been investigated using simple clinical methods. This study aimed to clarify the reliability of scapular posterior tilting movement using a smartphone and scapular posterior tilting movement in healthy individuals and patients with frozen shoulder. Methods The participants were 22 healthy young (age 25.9 ± 4.1 years), 22 healthy middle-aged (age 52.6 ± 4.4 years), and 37 individuals with frozen shoulder (age 56.0 ± 7.0 years). Scapular posterior tilting movement was measured at shoulder flexion 0° (0° posterior tilt), shoulder flexion 90° (90° posterior tilt), and scapular tilt excursion using a smartphone. The intrarater reliability was calculated using the intraclass correlation coefficient (1, 3). Results Intrarater reliability at 0° posterior tilt and 90° posterior tilt was 0.76 and 0.84, respectively. The 0° posterior tilt was not significantly different among the three groups (P = .90). The 90° posterior tilt was not significantly different among the three groups (P = .06). The scapular tilt excursions were significantly greater in the frozen shoulder group than in the middle-aged group (P = .03). Conclusion Measurement of scapular posterior tilting movement using a smartphone was highly reliable. The frozen shoulder might compensate for the limited arm elevation of the glenohumeral joint by scapular posterior tilting movement.
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Affiliation(s)
- Akari Ikeda
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
| | - Masahiro Ikezu
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
- Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan
- AR-Ex Medical Research Center, Tokyo, Japan
| | - Jumpei Kaneiwa
- Department of Rehabilitation, AR-Ex Oyamadai Orthopedic Clinic Tokyo Arthroscopy Center, Tokyo, Japan
- Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan
- AR-Ex Medical Research Center, Tokyo, Japan
| | - Shintarou Kudo
- Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan
- AR-Ex Medical Research Center, Tokyo, Japan
- Graduate School of Health Science, Morinomiya University of Medical Sciences, Osaka, Japan
- Corresponding author: Shintarou Kudo, PhD, PT, Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, 1-26-16 Nankokita Suminoe Ward, Osaka City, Osaka 559-8611, Japan.
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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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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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Abstract
Background Severe frozen shoulder (FS) is often resistant to treatment and can thus result in long-term functional impairment. However, its etiology remains unknown. We hypothesized that gene expression of FS would vary by synovial location. Methods The synovial tissues of patients with FS were collected prospectively and analyzed for the expression of 19 genes. Synovial tissues from patients with rotator cuff tear (RCT) or shoulder instability (SI) were also analyzed as controls. A total of 10 samples were analyzed from each group. The specimens were arthroscopically taken from three different locations: rotator interval (RI), axillary recess (AX), and subacromial bursa (SAB). Total RNA was extracted from the collected tissues and was analyzed by real-time polymerase chain reaction for the following genes: matrix metalloproteinases (MMPs); tissue inhibitors of metalloproteinases (TIMPs); inflammatory cytokines (IL1B, TNF, and IL6); type I and II procollagen (COL1A1 and COL2A1); growth factors (IGF1 and TGFB1); neural factors (NGF and NGFR); SOX9; and ACTA2. Results Site-specific analysis showed that MMP13, IL-6, SOX9, and COL1A1 were increased in all three sites. Four genes (MMP3, MMP9, COL2A1, and NGFR) were increased in the AX, MMP3 in the RI, and NGFR in the SAB were increased in the FS group than in the RCT and SI groups. In the FS group, there was a correlation between the expression of genes related to chondrogenesis (MMP2, IGF1, SOX9, COL2A1, NGF, and NGFR) or fibrosis (MMP9, TGFB1, and COL1A1). Conclusion The expression levels of numerous MMPs, pro-inflammatory cytokines, and collagen-related genes were increased in the FS group, suggesting that catabolic and anabolic changes have simultaneously occurred. In addition, genes related to chondrogenesis or fibrosis were highly expressed in the FS group, which might have affected the range of motion limitation of the shoulder. Compared to RI and SAB, the AX was the most common site of increased expression in FS. Analyzing the lower region of the shoulder joint may lead to the elucidation of the pathogenesis of FS.
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Affiliation(s)
- Hiroaki Nishimoto
- Graduate School of Technology, Industrial and Social Sciences, Tokushima University, Minami-Jyosanjima 1-1, Tokushima, 770-8502, Japan
| | - Shoji Fukuta
- Department of Orthopaedic Surgery, National Hospital Organization Kochi National Hospital, Kochi, Japan
| | - Naoshi Fukui
- Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan.,Clinical Research Center, National Hospital Organization Sagamihara Hospital, Kanagawa, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tetsuo Yamaguchi
- Graduate School of Technology, Industrial and Social Sciences, Tokushima University, Minami-Jyosanjima 1-1, Tokushima, 770-8502, Japan.
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