1
|
Ammerman BM, Dennis ER, Ling D, Hannafin JA. Ultrasound-Guided Glenohumeral Corticosteroid Injection for the Treatment of Adhesive Capsulitis of the Shoulder: The Role of Clinical Stage in Response to Treatment. Sports Health 2024; 16:333-339. [PMID: 37097090 PMCID: PMC11025513 DOI: 10.1177/19417381231168799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Treatment for idiopathic adhesive capsulitis of the shoulder remains controversial. Stages 1 to 2 reflect an inflammatory process supporting a rationale for intra-articular glenohumeral joint corticosteroid injection to treat synovial inflammation and prevent progression to capsular fibrosis. HYPOTHESIS We hypothesize that an intra-articular ultrasound-guided glenohumeral injection (USGI) of corticosteroid in patients diagnosed with Stage 1 or 2 idiopathic adhesive capsulitis will result in timely functional recovery and resolution of pain and stiffness. STUDY DESIGN Case series. LEVEL OF EVIDENCE Level 4. METHODS Patients with Stage 1 or 2 idiopathic adhesive capsulitis treated with an intra-articular corticosteroid injection were included. Patients were seen by a single physician and diagnosed using history and physical examination with careful attention to measurement of glenohumeral range of motion (ROM). A total of 61 patients met inclusion criteria. ROM measurements documented in the patient charts were recorded in forward flexion, abduction, internal rotation, and external rotation in neutral abduction. All ROM measurements were performed pre- and postinjection. All patients were treated with an USGI of local anesthetic and depomedrol. Recovery criteria were defined as forward flexion, abduction, and external rotation within 15° of the contralateral side and internal rotation within 3 spinous process levels of the contralateral side. RESULTS A total of 11 patients with Stage 1 and 50 patients with Stage 2 adhesive capsulitis comprised the final study cohort. Within the Stage 1 cohort, all 11 patients met recovery criteria for forward flexion and internal rotation (100%), 10 met recovery criteria for abduction (91%), and 8 met recovery criteria for external rotation (73%). Within the Stage 2 cohort, 31 patients met recovery criteria for forward flexion (62%), 30 met recovery criteria for abduction (60%), 36 met recovery criteria for internal rotation (72%), and 25 met recovery criteria for external rotation (50%). The difference in time to recovery in days was statistically significant in all ROM planes and was within 2 to 6 weeks for patients in Stage 1 and 7 to 10 weeks for Stage 2. CONCLUSION USGI for early adhesive capsulitis allows patients to recover ROM more rapidly if performed early after onset of pain and stiffness. CLINICAL RELEVANCE These results stress the importance of recognition of idiopathic adhesive capsulitis in its early stages and subsequent intervention with an intra-articular glenohumeral corticosteroid injection.
Collapse
Affiliation(s)
| | | | - Daphne Ling
- Hospital for Special Surgery, New York, New York
| | | |
Collapse
|
2
|
Peng Z, Qi B, Luo Z, Sun Y, Zhang X, Lin J, Pang J, Zhang P, Zhao Z, Wang X, Chen J. Agomir-122-loaded nanoparticles coated with cell membrane of activated fibroblasts to treat frozen shoulder based on homologous targeting. J Nanobiotechnology 2024; 22:165. [PMID: 38600567 PMCID: PMC11008019 DOI: 10.1186/s12951-024-02403-w] [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: 07/14/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
As a common musculoskeletal disorder, frozen shoulder is characterized by thickened joint capsule and limited range of motion, affecting 2-5% of the general population and more than 20% of patients with diabetes mellitus. Pathologically, joint capsule fibrosis resulting from fibroblast activation is the key event. The activated fibroblasts are proliferative and contractive, producing excessive collagen. Albeit high prevalence, effective anti-fibrosis modalities, especially fibroblast-targeting therapies, are still lacking. In this study, microRNA-122 was first identified from sequencing data as a potential therapeutic agent to antagonize fibroblast activation. Then, Agomir-122, an analog of microRNA-122, was loaded into poly(lactic-co-glycolic acid) (PLGA) nanoparticles (Agomir-122@NP), a carrier with excellent biocompatibility for the agent delivery. Moreover, relying on the homologous targeting effect, we coated Agomir-122@NP with the cell membrane derived from activated fibroblasts (Agomir-122@MNP), with an attempt to inhibit the proliferation, contraction, and collagen production of abnormally activated fibroblasts. After confirming the targeting effect of Agomir-122@MNP on activated fibroblasts in vitro, we proved that Agomir-122@MNP effectively curtailed fibroblasts activation, ameliorated joint capsule fibrosis, and restored range of motion in mouse models both prophylactically and therapeutically. Overall, an effective targeted delivery method was developed with promising translational value against frozen shoulder.
Collapse
Affiliation(s)
- Zhen Peng
- Department of Sports Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiaotong University, 85# Wujin Road, Hongkou District, Shanghai, 200080, China
| | - Beijie Qi
- Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
- Shanghai Medicine College, Fudan University, Shanghai, 201399, China
| | - Zhiwen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200080, China
| | - Yaying Sun
- Department of Sports Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiaotong University, 85# Wujin Road, Hongkou District, Shanghai, 200080, China
| | - Xingyu Zhang
- Department of Sports Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiaotong University, 85# Wujin Road, Hongkou District, Shanghai, 200080, China
| | - Jinrong Lin
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200080, China
| | - Jinhui Pang
- Department of Sports Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiaotong University, 85# Wujin Road, Hongkou District, Shanghai, 200080, China
| | - Peng Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200080, China
| | - Zhihu Zhao
- Department of Orthopaedics, Tianjin Hospital, No. 406, Jiefangnan Road, Hexi District, Tianjin, 300000, China.
| | - Xianwen Wang
- School of Biomedical Engineering, Research and Engineering Center of Biomedical Materials, Anhui Medical University, Hefei, 230032, China.
| | - Jiwu Chen
- Department of Sports Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiaotong University, 85# Wujin Road, Hongkou District, Shanghai, 200080, China.
| |
Collapse
|
3
|
Huang YH, Kuo YC, Hsieh LF, Tsai CM, Liu YF, Hsieh TL. Efficacy of Combination Therapy (Hydrodilatation and Subdeltoid Bursa Injection With Corticosteroid, Mobilization, and Physical Therapy) vs Physical Therapy Alone for Treating Frozen Shoulder: A Randomized Single-Blind Controlled Trial, Phase I. Arch Phys Med Rehabil 2024; 105:631-638. [PMID: 38092231 DOI: 10.1016/j.apmr.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/20/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To compare the efficacy of combination therapy (hydrodilatation and subdeltoid bursa injection with corticosteroid, mobilization, and physical therapy [PT]) with that of PT alone for treating frozen shoulder. DESIGN A prospective, 2-arm parallel, single-blinded, randomized controlled trial. SETTING Rehabilitation clinic of a private academic hospital. PARTICIPANTS Patients (n=70) with frozen shoulder (freezing stage). INTERVENTIONS Participants (n=35) in the combination group underwent hydrodilatation and subdeltoid bursa injection with corticosteroid twice, mobilization, and usual-care PT for 8 weeks; participants (n=35) in the PT group received only the usual-care PT for 8 weeks. MAIN OUTCOME MEASURES The Shoulder Pain and Disability Index (SPADI) was the primary outcome measure. The secondary outcome measures were pain scores on a visual analog scale, range of motion (ROM), the Shoulder Disability Questionnaire (SDQ), quality of life (evaluated using the 36-item Short-Form Health Survey [SF-36]), and self-assessment of the treatment effect. RESULTS Compared with the PT group, the combination group had significantly better pain (during activity), SPADI, SDQ, active and passive ROM, and self-assessment scores (all P<.001) as well as scores on some parts of the SF-36 (physical function and bodily pain, P<.05). Between-group differences were significant at the 1-, 2-, 4-, and 6-month follow-ups. CONCLUSIONS A combination of hydrodilatation (with corticosteroid), bursal corticosteroid injection, and joint mobilization with PT was superior to PT alone for treating frozen shoulder, and the effects persisted for at least 6 months.
Collapse
Affiliation(s)
- Yu-Hao Huang
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ying-Chen Kuo
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Lin-Fen Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
| | - Chun-Mei Tsai
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ya-Fang Liu
- Administration Division, Research Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Tien-Lee Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
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 2024; 105:760-769. [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] [MESH Headings] [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.
Collapse
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.
| | | |
Collapse
|
6
|
Babaei-Ghazani A, Eftekharsadat B, Soleymanzadeh H, ZoghAli M. Ultrasound-Guided Pes Anserine Bursitis Injection Choices: Prolotherapy or Oxygen-Ozone or Corticosteroid: A Randomized Multicenter Clinical Trial. Am J Phys Med Rehabil 2024; 103:310-317. [PMID: 37752656 DOI: 10.1097/phm.0000000000002343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Pes anserine bursitis is the most common cause of periarticular knee pain. The aim of the study was to evaluate the efficacy of local injection-based therapies with different materials. DESIGN The enrolled patients were randomly allocated to three groups to receive different interventions. Outcome measures included pain severity using the visual analog scale and the Western Ontario and McMaster Universities osteoarthritis index that was evaluated before the intervention, 1 and 8 wks after that. RESULTS This trial was performed on 72 participants, with male-to-female ratio of 0.14 and with a mean age of 61.49 ± 9.35 yrs. Corticosteroids in the first group, oxygen-ozone in the second group, and dextrose 20% in the third group, were injected into the pes anserine bursa under ultrasound guidance. Interaction between time and group showed a statistically significant improvement in visual analog scale and Western Ontario and McMaster Universities Arthritis Index ( P ≤ 0.05) in favor of corticosteroids and oxygen-ozone groups after 1 wk and in favor of oxygen-ozone and prolotherapy groups after 8 wks. CONCLUSIONS All three treatment options are effective for patients with pes anserine bursitis. This study showed that the effects of oxygen-ozone injection and prolotherapy last longer than those of corticosteroid injection.
Collapse
Affiliation(s)
- Arash Babaei-Ghazani
- From the Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (AB-G); Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Canada (AB-G); Physical Medicine and Rehabilitation Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran (BE); Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran (HS); and Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (MZ)
| | | | | | | |
Collapse
|
7
|
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 2024; 34:439-443. [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/07/2023] [Accepted: 08/18/2023] [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.
Collapse
Affiliation(s)
- Kazuya Tamai
- Department of Orthopedic Surgery, Tohto Bunkyo Hospital, Tokyo, Japan
| | - Junichiro Hamada
- Department of Orthopedic Surgery, Kuwano Kyoritsu Hospital, Fukushima, Japan
| | - Yuichi Nagase
- Department of Rheumatology Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | | | - Masashi Naito
- Department of Orthopedic Surgery, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Hideaki Asai
- Department of Orthopedic Surgery, Yashio Central General Hospital, Yashio, Saitama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|
8
|
Lin CL, Lee YH, Chen YW, Liao CD, Huang SW. Predictive Factors of Intra-articular Corticosteroid Injections With Ultrasound-Guided Posterior Capsule Approach for Patients With Primary Adhesive Capsulitis. Am J Phys Med Rehabil 2024; 103:215-221. [PMID: 37752075 DOI: 10.1097/phm.0000000000002340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND Adhesive capsulitis affects the shoulder joint, causing pain and limiting motion. In clinical practice, the effectiveness of injections varies, and the factors influencing their success remain unclear. This study investigates the predictors of effective corticosteroid injections in patients with primary adhesive capsulitis. DESIGN This retrospective study enrolled adhesive capsulitis patients older than 35 yrs who received intra-articular corticosteroid injections. The response was determined based on patients' pain and range of motion 3 mos after the injection. Demographic data, medical comorbidities, and radiographic parameters (critical shoulder angle and acromial index) were compared between the effective and noneffective groups. Receiver operating characteristic curves and logistic regression were used to identify the predictors of injection effectiveness. RESULTS This study included 325 patients with primary adhesive capsulitis, who were divided into responder (189 patients, 58.2%) and nonresponder (136 patients, 41.8%) groups. The receiver operating characteristic curve revealed that the acromial index score indicated favorable discrimination for predicting a poor response to injections, whereas the critical shoulder angle score did not. Logistic regression revealed that the pain period, diabetes mellitus, and acromial index are predictors of nonresponders to injections. CONCLUSIONS Long pain duration, the presence of diabetes mellitus, and an acromial index score greater than 0.711 were predictors of nonresponse to corticosteroid injections for primary adhesive capsulitis patients.
Collapse
Affiliation(s)
- Che-Li Lin
- From the Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (C-LL); Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (C-LL); Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan (Y-HL, Y-WC, C-DL, S-WH); Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (Y-HL, Y-WC, S-WH); and International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan (C-DL)
| | | | | | | | | |
Collapse
|
9
|
Kiel J, Applewhite AI, Bertasi TGO, Bertasi RAO, Seemann LL, Costa LMC, Helmi H, Pujalte GGA. Ketorolac Injections for Musculoskeletal Conditions: A Narrative Review. Clin Med Res 2024; 22:19-27. [PMID: 38609144 DOI: 10.3121/cmr.2024.1847] [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: 04/27/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 04/14/2024]
Abstract
Musculoskeletal conditions of the upper and lower extremities are commonly treated with corticosteroid injections. Ketorolac, a parenteral nonsteroidal anti-inflammatory drug, represents an alternative injectant for common shoulder, hip, and knee conditions. A review of the current literature was conducted on the efficacy of ketorolac injection in musculoskeletal diseases. Several studies support the use and efficacy of ketorolac injection in subacromial bursitis, adhesive capsulitis, and hip and knee osteoarthritis. Given the systemic effects of glucocorticoid injections, ketorolac may be a safe and effective alternative in patients with musculoskeletal disease. However, more evidence is required to better understand the effects ketorolac has on the human body during inflammatory processes.
Collapse
Affiliation(s)
- John Kiel
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida
- Department of Sports Medicine, University of Florida, Jacksonville, Florida
| | | | - Tais G O Bertasi
- Department of Medicine, Mount Sinai Morningside-West, New York, New York
| | | | - LaRae L Seemann
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida
| | - Lorena M C Costa
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida
- Current affiliation: Department of Pathology at Atrium Health, Wake Forest Baptist, Winston-Salem, North Carolina
| | - Haytham Helmi
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida
| | - George G A Pujalte
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida
- Division of Sports Medicine, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
10
|
Inglese F, Montemagno M, Brigo A, Nigro M, Giorgini A, Micheloni GM, Porcellini G. High satisfaction rate and range of motion can be expected in frozen shoulder after awake manipulation with brachial plexus block. J Orthop Traumatol 2024; 25:3. [PMID: 38282068 PMCID: PMC10822830 DOI: 10.1186/s10195-024-00747-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/01/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Adhesive capsulitis (AC) is a disease of the glenohumeral joint that is characterized by pain and both passive and active global stiffness with a slow and insidious onset. The disease can occur spontaneously (primary AC) or it can be secondary to other comorbidities, surgery, or trauma, such as fracture or dislocation. Multiple treatment approaches have been suggested: intra-articular steroid injection, physical therapy, manipulation under total anesthesia, and arthroscopic or open surgery. Shoulder manipulation under anesthesia is usually proposed to patients that suffer from severe AC and have already undergone several nonoperative treatments without benefit. Different techniques have been proposed. This study presents our manipulation technique and the clinical results we achieved after shoulder mobilization under brachial plexus block in patients with phase III primary AC. MATERIALS AND METHODS A retrospective cohort study was performed on a sample of 110 patients with phase III AC who were treated with this manipulation and followed up for 1 year. Patients underwent two assessments-before the procedure (T0) and 4 months after it (T1)-based on the Numerical Rating Scale, Simple Shoulder Test, and joint range of motion to assess shoulder pain, function, and joint articulation, respectively. Furthermore, the patients had to express their degree of satisfaction with the procedure and the results achieved. RESULTS Positive and statistically significant results were recorded in terms of pain reduction (ΔNPRS = - 5.4; p < 0.01) and improved functionality (Simple Shoulder Test Δ = 5; p < 0.01). Passive range of motion was statistically significantly increased for each movement at T1. Large increases were observed in extrarotation range of motion (ROM): R1 (Δ = 77.5°) and R2 (Δ = 70°), whereas little improvements were observed in intrarotation ROM. Patients achieved satisfying functional and articular recovery in all cases. Complications that needed further treatment occurred in three cases: a brachial plexus injury, a glenoid flake fracture, and persistent pain and stiffness. CONCLUSIONS In this study, we proposed a standardized method of manipulation under brachial plexus block for patients affected by phase III adhesive capsulitis. The technique was applied among a large cohort of patients, who reported a high satisfaction rate and range-of-motion recovery after 4 months. This could represent an alternative treatment to surgery that has a shorter timeline and does not require patient hospitalization. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
| | - M Montemagno
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Hospital Policlinico-San Marco, University of Catania, Catania, Italy
| | - A Brigo
- Orthopedic and Traumatology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - M Nigro
- Orthopedic and Traumatology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - A Giorgini
- Villa Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - G M Micheloni
- Villa Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - G Porcellini
- Orthopedic and Traumatology Department, University of Modena and Reggio Emilia, Modena, Italy.
| |
Collapse
|
11
|
Metayer B, Fouasson-Chailloux A, Le Goff B, Darrieutort-Laffite C. A prospective study of 100 patients with rotator cuff tendinopathy showed no correlation between subacromial bursitis and the efficacy of ultrasound-guided corticosteroid injection. Eur Radiol 2024; 34:300-307. [PMID: 37540320 DOI: 10.1007/s00330-023-09989-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/24/2023] [Accepted: 06/07/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES The objective of this study was to determine whether the presence of subacromial bursitis in patients with rotator cuff tendinopathy (RCT) was associated with a better outcome after ultrasound (US)-guided subacromial corticosteroid injection. METHODS A single-center prospective study was performed including patients referred for subacromial injection to manage RCT. At baseline, all patients received an US-guided intra-bursal injection of betamethasone (1 ml). The primary endpoint was reduced pain 3 months (M3) after the procedure: a good responder was defined by a decrease in Visual Analogue Scale pain of more than 30%. Secondary endpoints included functional recovery assessed by the Oxford Shoulder Score (OSS) and clinical success at 6 weeks (W6). We also explored the association between good clinical response and other factors, such as US or X-ray features. RESULTS One hundred patients were included and 49 presented with subacromial bursitis. At M3, 60% of patients (54/100) were considered good responders. The rate of good responders did not differ between the bursitis and non-bursitis groups (p = 0.6). During follow-up, OSS improved over time whether bursitis was present or not. We did not find any US or X-ray features significantly associated with a favorable clinical outcome. CONCLUSION The presence of subacromial bursitis did not influence clinical outcomes at 3 months post-subacromial injection in patients suffering from RCT. CLINICAL RELEVANCE STATEMENT The presence of subacromial bursitis did not influence clinical outcomes at 3 months post-subacromial corticosteroid injection in patients with rotator cuff tendinopathy. For patient management, looking for ultrasonographic signs of bursitis does not appear relevant for the indication of the injection. KEY POINTS • Ultrasound-guided subacromial corticosteroid injections led to a significant improvement in 60% of patients suffering from rotator cuff tendinopathy. • The presence of subacromial bursitis was not associated with better improvement at 3 months post-injection. • Except for the Minnesota score referring to job satisfaction, we did not find any baseline clinical, X-ray, or ultrasound characteristics associated with a successful outcome.
Collapse
Affiliation(s)
- Benoit Metayer
- Service de Rhumatologie, CH de Cholet, Cholet, France
- Service de Rhumatologie, CHU Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique Et Réadaptation Locomotrice Et Respiratoire, CHU Nantes, Nantes, France
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000, Nantes, France
| | - Benoit Le Goff
- Service de Rhumatologie, CHU Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000, Nantes, France
| | - Christelle Darrieutort-Laffite
- Service de Rhumatologie, CHU Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France.
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000, Nantes, France.
| |
Collapse
|
12
|
Moghissi K, Dixon K, Edwards A. Frozen (capsulitis) of shoulder Treated by LED Red light: A case report. Photodiagnosis Photodyn Ther 2023; 44:103764. [PMID: 37660870 DOI: 10.1016/j.pdpdt.2023.103764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
Shoulder capsulitis is a painful condition in which movement of the shoulder becomes limited. Objective: The aim, based on study of a single case, was to evaluate subjective and objective short-term effects of radiation of the shoulder joint using LED red light (630nm, 37.5 Jcm over 500s) in a case of chronic shoulder capsulitis. The case was a 96-year-old man with painful and restricted movement of the right shoulder joint. A record was made of parameters before the start of treatment using the Oxford Shoulder Score [1] and repeated following 12 treatment sessions in a four-week period. Results indicate improvement in a number of parameters and almost pain free essential movement without use of NSAI gel. On the basis of findings, the method warrants a pilot study to test reproducibility and to establish optimal number of treatments. Treatment was to two areas.
Collapse
Affiliation(s)
- Keyvan Moghissi
- The Yorkshire Laser Centre, 3 West Leys Park, Swanland, HU14 3LS UK.
| | - Kate Dixon
- The Yorkshire Laser Centre, 3 West Leys Park, Swanland, HU14 3LS UK
| | - Andrew Edwards
- Consultant Orthopaedic Surgeon North Lincolnshire and Goole and District Hospital UK
| |
Collapse
|
13
|
Latzka E, Cali M, Ishii H, Portugal S, Soo Hoo J. Hydrodilatation versus corticosteroid injection in treatment for adhesive capsulitis. PM R 2023; 15:1580-1587. [PMID: 37902102 DOI: 10.1002/pmrj.13094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 10/31/2023]
Affiliation(s)
- Erek Latzka
- Boston Sports & Biologics, Wellesley, MA, USA
| | - Malia Cali
- The Steadman Clinic, Frisco, CO, United States
| | - Haruki Ishii
- Department of Orthopedics, Emory University School of Medicine, Atlanta GA, United States
| | - Salvador Portugal
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, USA
| | - Jennifer Soo Hoo
- Department of Clinical Rehabilitation Medicine, Weill Cornell Medicine, New York, USA
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Kaur IP, Mughal MS, Aslam F, Schram J, Bansal P. Non-surgical treatment of aseptic olecranon bursitis: A systematic review. Reumatol Clin (Engl Ed) 2023; 19:482-487. [PMID: 37945181 DOI: 10.1016/j.reumae.2023.05.004] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/23/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Olecranon bursitis (OB), characterized by inflammation and fluid collection in the olecranon bursa is a commonly encountered out-patient condition. The data is heterogeneous regarding a stepwise and standardized approach to aseptic OB treatment and the efficacy of intra-bursal corticosteroid injections (CSI). The objective of this review is to systematically evaluate the non-surgical treatment options for aseptic OB. METHODS This systematic review was conducted in accordance with PRISMA recommendations. The English and non-English literature search was performed in 5 medical databases to identify studies evaluating the treatment of OB. All included studies were evaluated for risk of bias (RoB) using the revised Cochrane RoB tool for randomized control trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for case-control and cohort studies. RESULTS For the final analyses, 2 RCTs and 2 observational studies were included. The RoB for the RCTs was high and both failed to demonstrate a significant difference in terms of the resolution of OB and bursal tenderness among various invasive and non-invasive treatment options. Corticosteroid injection (CSI) was associated with a significant decline in the duration of symptoms. However, it was associated with a higher number of complications including bursal infection and skin atrophy. CONCLUSION Based on the available data, it appears that the clinical resolution of aseptic OB can occur with conservative methods if implemented earlier in the disease course. Although CSI is more effective than other treatments, it should be reserved for refractory cases because of a higher complication rate.
Collapse
Affiliation(s)
- Ikwinder Preet Kaur
- Department of Rheumatology, University of Florida College of Medicine, 653-1 8th St W, Jacksonville, FL 32209, United States
| | - Mohsin Sheraz Mughal
- Department of Cardiology, UHS Wilson Medical Center, Johnson City, NY 13790, United States
| | - Fawad Aslam
- Department of Rheumatology, Mayo Clinic - Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, United States
| | - Jennifer Schram
- Librarian and Supervisor, Mayo Clinic Libraries - Wisconsin, Mayo Clinic Health System, 1400 Bellinger Street, Eau Claire, WI 54701, United States
| | - Pankaj Bansal
- Department of Rheumatology, Mayo Clinic Health System, 1400 Bellinger Street, Eau Claire, WI 54701, United States.
| |
Collapse
|
16
|
Sinha P. Letter to the Editor regarding Çelik et al: "Oral corticosteroids vs. exercises on treatment of frozen shoulder: a randomized, single-blinded study". J Shoulder Elbow Surg 2023; 32:e583. [PMID: 37558085 DOI: 10.1016/j.jse.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/26/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Pratik Sinha
- Department of Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA.
| |
Collapse
|
17
|
Celik D. Response to Sinha regarding: "Oral corticosteroids vs. exercises on treatment of frozen shoulder: a randomized, single-blinded study". J Shoulder Elbow Surg 2023; 32:e584. [PMID: 37595942 DOI: 10.1016/j.jse.2023.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Derya Celik
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| |
Collapse
|
18
|
Miyano M, Tsukuda Y, Hiratsuka S, Hamasaki M, Iwasaki N. Chronic shoulder injury related to vaccine administration following coronavirus disease 2019 vaccination: a case report. J Med Case Rep 2023; 17:456. [PMID: 37845692 PMCID: PMC10580499 DOI: 10.1186/s13256-023-04198-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Shoulder injury related to vaccine administration, defined as shoulder pain and limited range of motion occurring after administration in the upper arm, has been previously reported. The symptom resolved completely after treatment with oral nonsteroidal anti-inflammatory drugs or an intraarticular steroid injection, however there have been few reports of long-term symptoms following coronavirus disease 2019 vaccination. This case report describes a healthy, middle-aged, healthcare worker who developed post-vaccination subacromial-subdeltoid bursitis that lasted for more than 6 months after Pfizer-BioNTech coronavirus disease 2019 vaccination. CASE PRESENTATION A 55-year-old Japanese woman with no significant medical history was vaccinated in the standard site, with the needle direction perpendicular to the skin. Within a few hours after the second vaccination, severe shoulder pain and limited range of motion appeared. Although shoulder range of motion improved, her shoulder pain did not improved for several months, and she consulted an orthopedic doctor 5 months later. Radiographs of her left shoulder did not provide helpful diagnostic information. High intensity in the subacromial-subdeltoid space was seen on short TI inversion recovery of magnetic resonance imaging, showing subacromial-subdeltoid bursitis. She was diagnosed with a shoulder injury related to vaccine administration. The patient was started on an oral anti-inflammatory drug, and the left subacromial space was injected with 2.5 mg of betamethasone with 3 ml of 1% lidocaine without epinephrine every 2 weeks. One month after starting this treatment, since her shoulder pain had not improved, the oral anti-inflammatory drug was switched to tramadol hydrochloride acetaminophen. However, 3 months after switching medication, the shoulder pain continued, and she worked so as to have minimal impact on her shoulder. CONCLUSION A case of subacromial-subdeltoid bursitis following a second dose of the Pfizer-BioNTech coronavirus disease 2019 vaccine that lasted many months is reported. Injection technique is a modifiable risk factor, the adverse effects of which could potentially be mitigated with appropriate and relevant training of healthcare providers. To prevent this type of case, the appropriate landmark, needle length, and direction should be confirmed.
Collapse
Affiliation(s)
- Masahiro Miyano
- Department of Orthopaedic Surgery, Otaru General Hospital, Wakamatsu 1-1-1, Otaru, Hokkaido, 047-8550, Japan
| | - Yukinori Tsukuda
- Department of Orthopaedic Surgery, Otaru General Hospital, Wakamatsu 1-1-1, Otaru, Hokkaido, 047-8550, Japan.
| | - Shigeto Hiratsuka
- Department of Orthopaedic Surgery, Otaru General Hospital, Wakamatsu 1-1-1, Otaru, Hokkaido, 047-8550, Japan
| | - Masanari Hamasaki
- Department of Orthopaedic Surgery, Otaru General Hospital, Wakamatsu 1-1-1, Otaru, Hokkaido, 047-8550, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
19
|
Deng Z, Li X, Sun X, Sui Y, Tang K, Shu H, Nie M, Wang H. Comparison Between Multisite Injection and Single Rotator Interval Injection of Corticosteroid in Primary Frozen Shoulder (Adhesive Capsulitis): A Randomized Controlled Trial. Pain Physician 2023; 26:E661-E669. [PMID: 37847919] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Steroid injection is a commonly used conservative treatment for primary frozen shoulder (PFS), but the optimal injection site remains undetermined. OBJECTIVES We conducted a prospective randomized controlled trial of multisite combined injection (MCI) vs single rotator interval injection (SRI). STUDY DESIGN A randomized double-blinded controlled trial. SETTING Center for Joint Surgery, Department of Orthopaedic Surgery, the Second Affiliated Hospital of Chongqing Medical University. METHODS Sixty-four patients with PFS were randomly assigned to 2 groups. The experimental group received MCI in the rotator interval, intraarticular, and subacromial bursa; the control group received an SRI. Both groups were injected with one mL of 40 mg triamcinolone acetonide and 4 mL of 2% lidocaine. The injection process was completed under ultrasound guidance. Follow-up points were 4, 8, and 12 weeks postinjection. The outcome measures included the Visual Analog Scale (VAS) score, the American Shoulder and Elbow Surgeons (ASES) score, the Constant-Murley Shoulder (CMS) score, passive range of motion of the shoulder, and patient satisfaction rating. RESULTS Thirty patients in the MCI group and 29 patients in the SRI group were included in the data analysis. All the outcomes in the 2 groups were significantly better postinjection than preinjection. The MCI group had a lower VAS score than the SRI group at 4 weeks (3.1 ± 1.2 vs 4.3 ± 1.6) and 8 weeks (2.2 ± 1.2 vs. 3.4 ± 1.2) (P < 0.05). Compared with the SRI group, the MCI group had a significant improvement in flexion and abduction (P < 0.01). Additionally, the ASES and CMS scores in the MCI group were better than those in the SRI group at 4, 8 and 12 weeks (P < 0.01). LIMITATIONS Limitations include the sample size of this study is small and a that it was conducted at a single-center. CONCLUSIONS Both MCI and SRI effectively alleviated pain and restored range of motion in patients with PFS. However, the MCI group had obviously lower early pain scores, better flexion and abduction, and better function scores than the SRI group; no additional adverse events were observed.
Collapse
Affiliation(s)
- Zhibo Deng
- The Second Affiliated Hospital of Chongqing Medical University, China
| | - Xiangwei Li
- The Second Affiliated Hospital of Chongqing Medical University, China
| | - Xianding Sun
- The Second Affiliated Hospital of Chongqing Medical University, China
| | - Yajuan Sui
- The Second Affiliated Hospital of Chongqing Medical University, China
| | - Kaiying Tang
- The Second Affiliated Hospital of Chongqing Medical University, China
| | - Han Shu
- The Second Affiliated Hospital of Chongqing Medical University, China
| | - Mao Nie
- The Second Affiliated Hospital of Chongqing Medical University, China
| | - Hao Wang
- The Second Affiliated Hospital of Chongqing Medical University, China
| |
Collapse
|
20
|
Lin LC, Lee YH, Chen YW, Hsu TH, Vitoonpong T, Liou TH, Huang SW. Comparison Clinical Effects of Hypertonic Dextrose and Steroid Injections on Chronic Subacromial Bursitis: A Double-Blind Randomized Controlled Trial. Am J Phys Med Rehabil 2023; 102:867-872. [PMID: 36897810 DOI: 10.1097/phm.0000000000002232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVE The aim of the study is to determine and compare the treatment efficacy of subacromial steroid injections and dextrose prolotherapy for chronic subacromial bursitis patients. DESIGN Fifty-four patients with chronic subacromial bursitis were enrolled in this double-blind randomized controlled trial. Shoulder Pain and Disability Index and visual analog scale were the primary outcomes. RESULTS The steroid group ( n = 26) exhibited significant visual analog scale score improvements comparing with baseline at weeks 2, 6, and 12; the dextrose prolotherapy group ( n = 28) exhibited visual analog scale score improvements at weeks 6 and 12. The steroid group displayed significant Shoulder Pain and Disability Index score improvements compared with baseline at weeks 2, 6, and 12; the dextrose prolotherapy group exhibited significant score decreases at weeks 2 and 6. Compared with the dextrose prolotherapy group, the steroid group demonstrated significantly greater decreases in visual analog scale scores at weeks 2 and 6; the steroid group showed significantly greater decreases in Shoulder Pain and Disability Index scores at weeks 2, 6, and 12. CONCLUSIONS Both hypertonic dextrose prolotherapy and steroid injections can provide short-term improvements of pain and disability among chronic subacromial bursitis patients. Moreover, steroid injections showed better effectiveness than hypertonic dextrose prolotherapy in ameliorating pain and improving function.
Collapse
Affiliation(s)
- Lien-Chieh Lin
- From the Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan (L-CL, Y-HL, Y-WC, T-HH, T-HL, S-WH); Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (L-CL, Y-HL, Y-WC, T-HH, T-HL, S-WH); and Rehabilitation Department, King Chulalongkorn Memorial Hospital, Bangkok, Thailand (TV)
| | | | | | | | | | | | | |
Collapse
|
21
|
Poku D, Hassan R, Migliorini F, Maffulli N. Efficacy of hydrodilatation in frozen shoulder: a systematic review and meta-analysis. Br Med Bull 2023; 147:121-147. [PMID: 37496207 PMCID: PMC10788845 DOI: 10.1093/bmb/ldad018] [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: 05/14/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION It is unclear whether hydrodilatation is beneficial in the management of frozen shoulder compared with other common conservative management modalities. This systematic review evaluates the efficacy of hydrodilatation for the management of frozen shoulder. SOURCES OF DATA A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An extensive search of PubMed, Embase, Scopus, Cochrane Central, Web of Science and CINAHL databases using multiple keyword combinations of 'shoulder', 'rotator', 'adhesive capsulitis', 'hydrodilatat*', 'distension' since inception of the databases to June 2023 was implemented. AREAS OF AGREEMENT Hydrodilatation leads to at least transient more marked improvements in shoulder disability and passive external rotation compared with intra-articular corticosteroid injections. AREAS OF CONTROVERSY Hydrodilatation improves passive external rotation in the longer term. Moreover, hydrodilatation may be a preferable option over manipulation under anaesthesia, given its lower cost and better patient convenience. GROWING POINTS Intensive mobilization after hydrodilatation is a promising adjuvant treatment option for patients suffering from a frozen shoulder. AREAS TIMELY FOR DEVELOPING RESEARCH Although current evidence suggests that hydrodilatation provides a transient improvement in disability in patients with frozen shoulder, its clinical relevance remains unclear. Further research is necessary to establish its role in the management of the condition.
Collapse
Affiliation(s)
- Daryl Poku
- Faculty of Medicine, University of Southampton, Southampton, SO17 1TW, UK
| | - Rifat Hassan
- Faculty of Medicine, University of Southampton, Southampton, SO17 1TW, UK
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen 52074, Germany
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Bolzano 39100, Italy
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno 84084, Italy
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London E1 4DG, UK
- School of Pharmacy and Biotechnology, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, Keele ST5 5BG, UK
| |
Collapse
|
22
|
Ahn Y, Moon YS, Park GY, Cho SC, Lee YJ, Kwon DR, Lee SC. Efficacy of Intra-articular Triamcinolone and Hyaluronic Acid in a Frozen Shoulder Rat Model. Am J Sports Med 2023; 51:2881-2890. [PMID: 37551671 DOI: 10.1177/03635465231188524] [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] [Indexed: 08/09/2023]
Abstract
BACKGROUND Intra-articular corticosteroid or hyaluronic acid (HA) is commonly prescribed for frozen shoulder. However, few studies have investigated histological and molecular changes after injection. PURPOSE To compare the effectiveness of intra-articular injections of triamcinolone and HA in a frozen shoulder rat model and verify a greater effect of triamcinolone in passive shoulder abduction compared with HA. STUDY DESIGN Controlled laboratory study. METHODS Twenty male Sprague-Dawley rats were randomly allocated into 4 groups (n = 5 in each): control group, which did not receive cast immobilization or injection, and 3 experimental groups, which received 3 weeks of unilateral shoulder immobilization followed by intra-articular injections (normal saline, triamcinolone, or HA) at the immobilized shoulder. Passive shoulder abduction angle, histological and immunohistochemical staining, and Western blotting results were assessed 2 weeks after injection. The intensity and extent of staining were converted to semiquantitative scores for further analysis. RESULTS Shoulder abduction angles before sacrifice were 153.0°± 2.7° (control group), 107.0°± 5.7° (saline group), 139.0°± 9.6° (triamcinoline group), and 110.0°± 10.6° (HA group), showing significant differences between control and saline groups, control and HA groups, saline and triamcinoline groups, and triamcinoline and HA groups (P < .001) but not between control and triamcinoline groups (P = .053). Histologic evaluation revealed an increase in synovial folds and thickening of the capsular membrane in the saline and HA groups; this change was not evident in the triamcinolone group. A comparison of semiquantitative scores revealed greater expression levels of proteins involved in fibrosis and angiogenesis in the saline and HA groups compared with the control and triamcinolone groups. In Western blotting, the expression of inflammatory cytokines and the receptor for advanced glycation end products was significantly lower in the triamcinolone and HA groups than in the saline group. CONCLUSION Triamcinolone injection was more effective than normal saline or HA injection in improving range of motion and reversing fibrotic and angiogenic features of frozen shoulder. Both triamcinolone and HA injections elicited anti-inflammatory effects. CLINICAL RELEVANCE The antifibrotic and antiangiogenic properties of triamcinolone and the anti-inflammatory properties of both triamcinolone and HA should be considered when performing injections in clinical settings.
Collapse
Affiliation(s)
- Yongjin Ahn
- Department and Research Institute of Rehabilitation Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Yong Suk Moon
- Department of Anatomy, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Gi-Young Park
- Department of Rehabilitation Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Sung Cheol Cho
- Department of Rehabilitation Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Yoon-Jin Lee
- Department of Biochemistry, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Dong Rak Kwon
- Department of Rehabilitation Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Sang Chul Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
23
|
Dillon MT. In Freezing-Phase Frozen Shoulder, Adding Arthroscopic Release to Corticosteroid Hydrodilatation Improved Some Measures of ROM at 12 Months. J Bone Joint Surg Am 2023; 105:1281. [PMID: 37315122 DOI: 10.2106/jbjs.23.00495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Mark T Dillon
- Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
24
|
Rehman AU, Zeya N, Pereira FA. Commentary on: Comparison of outcomes of two different Corticosteroid Injection approaches for Primary Frozen Shoulder: A Randomized Controlled Study. J Rehabil Med 2023; 55:jrm12376. [PMID: 37550994 PMCID: PMC10424247 DOI: 10.2340/jrm.v55.12376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/20/2023] [Indexed: 08/09/2023] Open
Affiliation(s)
- Atiq-Ur- Rehman
- Dow Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan
| | - Nazia Zeya
- Dow Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan
| | - Felicianus Anthony Pereira
- Dow Institute of Physical Medicine & Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan.
| |
Collapse
|
25
|
Gokhan C, Maheshwari S, Nagraj H, Vrizidou S, Tharmalingam T. Complication of barbotage, acute calcific bursitis treated successfully. J Radiol Case Rep 2023; 17:1-7. [PMID: 37654898 PMCID: PMC10435257 DOI: 10.3941/jrcr.v17i8.4603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
One of the most common causes of chronic shoulder pain that significantly impairs patients' quality of life is rotator cuff calcific tendinitis. The supportive approach of analgesics, anti-inflammatory medications, and physiotherapy is preferred to treat mild symptoms. However, severe intractable symptoms necessitate alternative treatment, and ultrasonography-guided percutaneous barbotage is regarded as an effective treatment technique due to its minimal invasiveness, low cost, and rapid significant pain relief. Post-barbotage complications are reported as acute calcific bursitis along with infection, bleeding, and tendon rupture. In our case, a 41-year-old female presented with a substantial amount of pain shortly after barbotage, which was diagnosed as acute calcific bursitis, a complication of the procedure. Subacromial-subdeltoid steroid injection was used successfully to treat this condition.
Collapse
Affiliation(s)
- Cem Gokhan
- Accidents & Emergency Department, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Sagar Maheshwari
- Radiology Department, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Harish Nagraj
- Radiology Department, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Sofia Vrizidou
- Radiology Department, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Thulasi Tharmalingam
- Radiology Department, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| |
Collapse
|
26
|
Abstract
Frozen shoulder (FS) is a common condition with no defined optimal therapy. Tuina therapy, a traditional Chinese medicine (TCM) technique used to treat FS patients in Chinese hospitals, has demonstrated excellent results, but its mechanisms are not fully understood. Building on a previous study, this work aimed to develop a Tuina protocol for an FS rat model. We randomly divided 20 SD rats into control (C; n = 5), FS model (M; n = 5), FS model Tuina treatment (MT; n = 5), and FS model oral treatment (MO; n = 5) groups. This study used the cast immobilization method to establish the FS rat model. The effect of Tuina and oral dexamethasone on the glenohumeral range of motion (ROM) was evaluated, and the histological findings were assessed. Our study showed that Tuina and oral dexamethasone were able to improve shoulder active ROM and preserve the structure of the capsule, with Tuina therapy proving to be more effective than oral dexamethasone. In conclusion, the Tuina protocol established in this study was highly effective for FS.
Collapse
Affiliation(s)
- Yingjie Qiao
- College of Acupuncture and Tuina, Shandong University of Traditional Chinese Medicine
| | | | - Jianmin Wang
- Department of Tuina, Shandong University of Traditional Chinese Medicine Affiliated Hospital
| | - Muzhen Li
- College of Acupuncture and Tuina, Shandong University of Traditional Chinese Medicine
| | - Lijun Zheng
- College of Acupuncture and Tuina, Shandong University of Traditional Chinese Medicine
| | - Huadong Li
- Department of Tuina, Shandong University of Traditional Chinese Medicine Affiliated Hospital;
| | - Shidong Zhang
- College of Acupuncture and Tuina, Shandong University of Traditional Chinese Medicine
| |
Collapse
|
27
|
Weintraub MT, Barrack TN, Burnett RA, Serino J, Bhanot SS, Della Valle CJ. Ultrasound-Guided Iliopsoas Bursal Injections for Management of Iliopsoas Bursitis After Total Hip Arthroplasty. J Arthroplasty 2023; 38:S426-S430. [PMID: 36535438 DOI: 10.1016/j.arth.2022.12.015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Iliopsoas tendonitis can cause persistent pain after total hip arthroplasty (THA). Nonoperative management of iliopsoas tendonitis includes anti-inflammatory drugs and image-guided corticosteroid injections. This study evaluated the efficacy of ultrasound-guided corticosteroid injections (US-CSIs) for iliopsoas tendonitis following THA. METHODS We retrospectively reviewed 42 patients who received an US-CSI for iliopsoas tendonitis after primary THA between 2009 and 2020 at a single institution. Outcomes including reoperation, groin pain at last follow-up, additional intrabursal injection, and Harris Hip Score (HHS) were evaluated at a minimum of 1 year. Cross-table lateral radiographs (36 patients) or computed tomography scans (6 patients) were reviewed to determine if anterior cup overhang was present, indicating a mechanical etiology of iliopsoas tendonitis. Descriptive statistics and univariate comparison of HHS preinjection and postinjection were performed, with alpha < 0.05. RESULTS Among the 22 patients who did not have cup overhang, four (18.2%) had persistent groin pain at mean follow-up of 40 months (range, 14-94) after US-CSI. Three patients had a second injection; none had groin pain at most recent follow-up. No patients required acetabular revision. Mean HHS improved from 74 points (range, 52-94 points) to 91 points (range, 76-100 points; P < .001) at last follow-up. Among the 20 patients who had anterior cup overhang, five underwent acetabular revision after only temporary pain relief from injection. Groin pain was resolved in all revised patients at mean follow-up of 43 months (range, 12-60) after revision. Of the remaining 15 patients, five had persistent groin pain at mean follow-up of 35 months (range, 12-83). Mean HHS improved from 69 points (range, 50-96 points) preinjection to 81 (range, 56-98 points; P = .007) at last follow-up. CONCLUSION Resolution of groin pain was demonstrated in 78.6% of patients in the cohort; however, those who did not have acetabular overhang had higher rates of success. The overall revision rate was 11.9%. US-CSI appears to be safe and effective in the diagnosis and treatment of iliopsoas tendonitis following primary THA. LEVEL OF EVIDENCE Level IV, Therapeutic Study.
Collapse
Affiliation(s)
- Matthew T Weintraub
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Toby N Barrack
- Washington University in St. Louis Medical School, St. Louis, Missouri
| | - Robert A Burnett
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Joseph Serino
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Shelly S Bhanot
- Department of Interventional Radiology, Rush University Medical Center, Chicago, Illinois
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
28
|
Feusi O, Fleischmann T, Waschkies C, Pape HC, Werner CM, Tiziani S. Vitamin C as a Potential Prophylactic Measure Against Frozen Shoulder in an In Vivo Shoulder Contracture Animal Model. Am J Sports Med 2023; 51:2041-2049. [PMID: 37249131 PMCID: PMC10315865 DOI: 10.1177/03635465231172192] [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: 10/10/2022] [Accepted: 03/17/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Frozen shoulder is a common, painful, and movement-restricting condition. Although primary frozen shoulder is idiopathic, secondary frozen shoulder can occur after trauma or surgery. Prophylactic and therapeutic options are often unsatisfactory. Vitamin C (ascorbic acid) is a potent physiological antioxidant and likely inhibits the activation of nuclear factor κB, which plays a decisive role in inflammatory reactions. HYPOTHESIS Because of its anti-inflammatory effects, vitamin C may be valuable in the prevention of secondary frozen shoulder. STUDY DESIGN Controlled laboratory study. METHODS An in vivo shoulder contracture model was conducted by fixation of the right proximal limb of Sprague-Dawley rats. A treatment group (n = 8) receiving vitamin C orally was compared with a control group (n = 9) without vitamin C. The primary outcome was capsular thickness at the shoulder joint measured on magnetic resonance imaging (MRI) examination. Further histological examination was performed but was not statistically analyzed because of variability of the cutting plane through the glenoid. RESULTS Vitamin C treatment resulted in less thickening of the axillary fold of the operated shoulder at 2 of the 3 locations measured on MRI compared with untreated controls (insertion to the glenoid, P = .074; insertion to the humerus, P = .006; middle of the axillary recess, P = .008). The observed structural changes in histological examination corroborated the significant changes obtained from the MRI measurements. CONCLUSION Prophylactic vitamin C seemed to reduce the thickening of the axillary recess in secondary frozen shoulder in this preclinical study. CLINICAL RELEVANCE Vitamin C may be helpful as a noninvasive therapeutic measure to prevent secondary frozen shoulder (eg, within the context of surgery in the shoulder region or immobilization) or to treat primary frozen shoulder at an early stage. Further studies are required to evaluate the effect of this treatment in humans and the necessary dosage in humans.
Collapse
Affiliation(s)
- Oscar Feusi
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thea Fleischmann
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Conny Waschkies
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Clément M.L. Werner
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Simon Tiziani
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
29
|
Ghosh S, Pandey SK, Biswas A, Pandey J. Adhesive Capsulitis After COVID-19 Vaccination: A Case Series. Am J Phys Med Rehabil 2023; 102:e79-e82. [PMID: 36722847 PMCID: PMC10184708 DOI: 10.1097/phm.0000000000002194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
ABSTRACT Of the many bizarre complications of administration of the COVID 19 vaccine, adhesive capsulitis is almost unheard of, although shoulder injury related to vaccine administration, which by definition has symptom onset within 48 hrs and is caused by faulty injection technique, has been rarely reported. Nine cases of adhesive capsulitis, five males and four females with a mean age of 48.7 ± 12.7 yrs, presenting within 1 mo of intramuscular Covishield vaccine on the ipsilateral deltoid and fulfilling the standard UK FROST Multicenter Study diagnostic criteria are reported. The mean time interval from vaccination until symptom onset was 12.3 ± 3.1 days, and mean symptom duration was 9.4 ± 2.4 wks. Conventional treatment with nonsteroidal anti-inflammatory drugs, followed by intra-articular steroid injection coupled with suprascapular nerve steroid block, improved the pain score and range of movement in 8 wks. The exact pathogenesis remains an enigma, although mechanisms such as local spread via deltoid muscle microvasculature, nerves, or shoulder injury related to vaccine administration causing secondary adhesive capsulitis have been hypothesized. While adhesive capsulitis is a very common diagnosis in the physiatric outpatient setting, the possible association with Covishield vaccination, the Indian version of the Oxford AstraZeneca recombinant ChAdOx1 nCoV-19 vaccine, is almost absent in existing literature and hence likely to be missed by clinicians, which necessitates this report.
Collapse
|
30
|
Kamiya Y, Mishima K, Tanaka T, Sawamura K, Matsushita M, Imagama S. Acute osteomyelitis of the patella due to Pseudomonas aeruginosa in an immunocompetent child: A case report. Medicine (Baltimore) 2023; 102:e33012. [PMID: 36800616 PMCID: PMC9936032 DOI: 10.1097/md.0000000000033012] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
RATIONALE Plentiful vascularity and lack of the physis are thought to render the patella less vulnerable to osteomyelitis. Pseudomonas aeruginosa (PA) is an opportunistic pathogen predominantly affecting immunocompromised hosts. Despite the ubiquitous nature of PA, osteomyelitis of the patella caused by PA has been rarely reported in children. PATIENT CONCERNS A 5-year-old boy who had presented with a prolonged history of the left anterior knee pain following minor trauma was diagnosed with prepatellar bacterial cellulitis and bursitis. Afterward, a focal osteolytic lesion emerged at the ventral surface of the patella despite oral and intravenous antibiotic therapy lasting for weeks. We described clinical presentation as well as medical and surgical management of pediatric patellar osteomyelitis secondary to prepatellar septic bursitis. DIAGNOSES Pseudomonas aeruginosa-associated osteomyelitis of the patella. Magnetic resonance imaging of the left knee showed a focal destructive change of the ventral half of the cartilaginous patella and a suprapatellar joint effusion. Bacterial culture from the bursa revealed Pseudomonas aeruginosa. INTERVENTIONS Systemic inflammation, patellar osteochondral destruction, and purulent synovial fluid of the knee were prolonged for 6 weeks despite antibiotics use deemed appropriate and reparative surgical debridement, whereas they were eventually resolved with a 6-week course of intravenous ceftazidime and cessation of continuous intracapsular irrigation. OUTCOMES He was clinically asymptomatic at the latest follow-up but exhibited a minor leg length discrepancy <2 cm associated with overgrowth of the affected femur. LESSONS This is a rare case of Pseudomonas osteomyelitis of the patella in a healthy pediatric patient. Uncommon osteochondral sequelae occurred probably because of a protracted arthritis of the affected knee. We would like to emphasize the ineffectiveness of continuous irrigation without antibiotics for Pseudomonas aeruginosa-associated osteomyelitis.
Collapse
Affiliation(s)
- Yasunari Kamiya
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenichi Mishima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- * Correspondence: Kenichi Mishima, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan (e-mail: )
| | - Tetsuji Tanaka
- Department of Orthopaedic Surgery, Holy Spirit Hospital, Nagoya, Aichi, Japan
| | - Kenta Sawamura
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masaki Matsushita
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| |
Collapse
|
31
|
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).
Collapse
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
| |
Collapse
|
32
|
Lee SH, Choi HH, Chang MC. Comparison Between Corticosteroid Injection Into Coracohumeral Ligament and Inferior Glenohumeral Capsule and Corticosteroid Injection Into Posterior Glenohumeral Recess in Adhesive Capsulitis: A Prospective Randomized Trial. Pain Physician 2022; 25:E787-E793. [PMID: 36122259] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND For managing symptoms of adhesive capsulitis (AC), corticosteroid injection is typically conducted under the guidance of ultrasound via posterior glenohumeral recess (PGHR). It has been reported that pathologies such as inflammation and edema are most commonly observed in the coracohumeral ligament (CHL) and anterior and inferior joint capsules. We compared the therapeutic effects of corticosteroid injection into the CHL and inferior glenohumeral capsule (IGHC) with those of corticosteroid injection into PGHR in patients with AC. METHODS One hundred twenty consecutive patients with AC were included in this study and randomly allocated to either the CHL + IGHC group (n = 60) or the PGHR group (n = 60). Patients in both groups received 3 injections at 2 week intervals. After the first injection, if the patient's shoulder pain showed satisfactory improvement, further injections were not administered. The therapeutic effect was measured at 2 and 4 months after the first injection. Pain intensity was evaluated using the visual analog scale (VAS). Additionally, the passive range of motion (ROM) of the shoulder joint (abduction, external rotation, and internal rotation) was measured. RESULTS VAS scores and ROM of abduction, external rotation, and internal rotation improved at follow-up evaluation in both groups (P < 0.05) (CHL and IGHC: VAS, pre-treatment = 6.5 ± 0.5, 2 months = 2.1 ± 0.8, 4 months = 1.4 ± 0.6; ROM-abduction, pre-treatment = 131.3° ± 16.4°, 2 months = 162.4° ± 8.2°, 4 months = 176.2° ± 5.6°; ROM-external rotation, pre-treatment = 31.6° ± 16.9°, 2 months = 67.2° ± 11.1°, 4 months = 81.3° ± 12.1°, ROM-internal rotation, pre-treatment = 6.2 ± 2.2, 2 months = 4.0 ± 2.2, 4 months = 2.7 ± 1.2; PGHR: VAS, pre-treatment = 6.5 ± 0.5°, 2 months = 3.9 ± 1.1, 4 months = 2.1 ± 1.1; ROM-abduction, pre-treatment = 132.1° ± 9.5°, 2 months = 145.5° ± 11.7°, 4 months = 167.4° ± 11.2°; ROM-external rotation, pre-treatment = 32.4° ± 13.4°, 2 months = 49.3° ± 13.2°, 4 months = 72.7° ± 18.0°, ROM-internal rotation, pre-treatment = 6.3 ± 1.4, 2 months = 5.4 ± 0.8, 4 months = 3.6 ± 1.0). However, the improvements were greater in patients who received corticosteroid injection into the CHL and IGHC compared to that into the PGHR at 2 and 4 months after the initiation of the treatment (P < 0.05). LIMITATIONS Long-term therapeutic outcomes were not investigated, and the therapeutic effect of corticosteroid injection into the CHL and IGHC was not compared with placebo injection. CONCLUSION Corticosteroid injection into the CHL and IGHC might be a better treatment alternative for patients with AC.
Collapse
Affiliation(s)
- Sang Hoon Lee
- Department of Radiology, Madi Pain Management Center, Jeonju, Republic of Korea
| | - Hyun Hee Choi
- Madi Research and Development Center, Jeonju, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Korea
| |
Collapse
|
33
|
Cho CH, Kim DH, Kim DH, Choi BC, Kim SG, Lee DG, Cho JH. Comparative Efficacy of Rotator Interval Versus Posterior Capsule Approach Intraarticular Corticosteroid Injections for Primary Frozen Shoulder: A Single-blind, Randomized Trial. Pain Physician 2022; 25:313-321. [PMID: 35652771] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Intraarticular (IA) corticosteroid injection is commonly performed in patients with primary frozen shoulder (PFS). However, the best administration site remains controversial. OBJECTIVES To compare the efficacy of rotator interval (RI) vs posterior capsule (PC) approach for ultrasound-guided corticosteroid injections into the glenohumeral joint of patients with PFS. STUDY DESIGN A randomized, exploratory, prospective study. SETTING A single fellowship training institution in Daegu, Republic of Korea. METHODS This study was approved by the Institutional Review Board (2019-04-047-001). Ninety patients with PFS were randomly assigned to either RI approach (RI group, n = 43) or PC approach (PC group, n = 45) for ultrasound-guided IA corticosteroid injection. Fluoroscopic images to assess the accuracy of the injection were obtained immediately after injection by a shoulder specialist. Visual Analog Scale for pain, the American Shoulder and Elbow Surgeons score, the subjective shoulder value, and range of motion (ROM) were used to assess clinical outcomes for all patients at the time of presentation, and at 3, 6, and 12 weeks after injection. RESULTS The accuracy of injection was 76.7% (33/43) and 93.3% (42/45) in the RI and PC groups, respectively; the between-group difference was statistically significant (P = .028). Significant improvements were observed in both groups in terms of all clinical scores and ROMs throughout follow-up until 12 weeks after the injection (all P < .001). At 12 weeks, better improvements in forward flexion and abduction (P = .049 and .044) were observed in the RI group than in the PC group. No adverse effect related to injection was observed in either group. LIMITATIONS This study had no control group receiving placebo injections and limited follow-up time. CONCLUSIONS Both groups showed significant pain reduction and functional improvement until 12 weeks after injection. Although no significant differences were observed in pain and functional scores between the 2 groups, the RI group showed better improvement of ROM than the PC group. These results indicate that the RI and anterior structures are a major site in the pathogenesis and treatment target of PFS.
Collapse
Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Du Hwan Kim
- Department of Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Byong-Chan Choi
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Soon Gu Kim
- Education Support Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Dong Gyu Lee
- Education Support Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Jang Hyuk Cho
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| |
Collapse
|
34
|
Çınar BM, Battal VE, Bal N, Güler ÜÖ, Beyaz S. Comparison of efficacy of Oral versus Intra-articular Corticosteroid Application in the treatment of Frozen Shoulder: An experimental study in rats. Acta Orthop Traumatol Turc 2022; 56:64-70. [PMID: 35234132 DOI: 10.5152/j.aott.2021.20332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare clinical and histopathological effects of oral versus intraarticular corticosteroid application in a rat model of frozen shoulder. METHODS In this study, eighty adult Sprague-Dawley rats were used. The animals were divided into 5 equal groups. The frozen shoulder model was created by immobilizing animals' shoulders with internal fixation with sutures for 8 weeks. At the 8th week, sham (n: 16) and control (n: 16) groups were sacrificed to collect data for healthy and affected shoulders. Also, at the 8th week, 50 mg/ kg methylprednisolone was started for the oral treatment group, and a single dose of 0.5 mg/kg triamcinolone acetonide was injected for the intraarticular treatment group. The effect of additional steroid treatment was expected for 2 weeks, then all remaining treatment and natural course groups were sacrificed on the 10th week. RESULTS After sacrification, specimens taken as "en bloc" scapulothoracic disarticulation were randomly divided into two groups for a range of motion measurement and histopathological examination. The control (frozen shoulder model) group's shoulder range of motion in all directions was lower than the sham (healthy) group (P < 0.01). Natural course and intraarticular steroid groups, compared to the frozen shoulder model showed a significant increase in the direction of abduction (P < 0.05). Also, it was found for treatment groups that in all directions the range of motion was not as good as the healthy values (P < 0.01). The intraarticular treatment group showed higher degrees of abduction compared to the natural course and oral steroid treatment groups (P < 0.01). Oral steroid treatment group's range of motion was not significantly better than the disease model and had no superiority to the natural course group (P > 0.05). Histopathologically, no statistically significant difference was observed between the groups for signs of frozen shoulder which was found in the immobilized group (P > 0.05). Histopathologically, immobilization was found to cause thickening of the capsule that cannot be resolved by treatment. (P < 0.05). CONCLUSION In frozen shoulder disease, intraarticular steroid injection seems to be superior in increasing the range of motion than oral steroid treatment.
Collapse
Affiliation(s)
- Bekir Murat Çınar
- Department of Orthopaedics and Traumatology, Başkent University, Adana Training and Research Center, Adana, Turkey
| | - Vahit Erdal Battal
- Department of Orthopaedics and Traumatology, Başkent University, Adana Training and Research Center, Adana, Turkey
| | - Nebil Bal
- Department of Pathology, Başkent University, Adana Training and Research Center, Adana, Turkey
| | - Ümit Özgür Güler
- Department of Orthopaedics and Traumatology, Başkent University, Adana Training and Research Center, Adana, Turkey
| | - Salih Beyaz
- Department of Orthopaedics and Traumatology, Başkent University, Adana Training and Research Center, Adana, Turkey
| |
Collapse
|
35
|
Gencer Atalay K, Kurt S, Kaplan E, Yağcı İ. Clinical effects of suprascapular nerve block in addition to intra-articular corticosteroid injection in the early stages of adhesive capsulitis: A singleblind, randomized controlled trial. Acta Orthop Traumatol Turc 2021; 55:459-465. [PMID: 34967732 DOI: 10.5152/j.aott.2021.21071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the short and long-term effects of the combination of suprascapular nerve block (SSNB) and intra-articular corticosteroid injection (IAI) on pain, shoulder range of motion (ROM), disability, and quality of life in the management of patients with adhesive capsulitis (AC). METHODS Forty patients (ages 30-70 years) who were diagnosed with AC stages 1 and 2 were randomlyassigned to one of two groups: Group-1 received IAI and SSNB combination, while group-2 only-IAI. Both groups started a three-week rehabilitation program after the intervention. The Shoulder Pain and Disability Index (SPADI), Numeric Rating Scale (NRS), active and passive shoulder ROMs, and the Short Form 36(SF-36) were assessed by a physiatrist who was blinded to the allocation at baseline and three weeks, three months, and twelve months. The NRS and shoulder ROMs were also examined in the first hour. RESULTS Nineteen patients from each group with mean ages of 55.84±2.19 (15 females, 4 males) and51.79 ± 1.58 (14 females, 5 males) were included. Within the groups, SPADI and NRS scores were decreased, while active and passive ROMs and the physical function, physical role, and bodily pain domains of SF-36 were increased by time (P < 0.05). Between the groups, the change in NRS value and active flexion in the first hour was more remarkable in group 1 (P < 0.05). No significant difference between outcome measurements was found at the 3rd week, 3rd month, and 12th month (P > 0.05). CONCLUSIONS SSNB as an adjunct to IAI in AC positively affected the immediate pain relief and functional improvement after the intervention; however, it did not yield any additional benefit in the short and long-terms. LEVEL OF EVIDENCE Level I, Therapeutic Study.
Collapse
Affiliation(s)
- Kardelen Gencer Atalay
- Department of Physical Medicine and Rehabilitation, Marmara University, School of Medicine,İstanbul, Turkey
| | - Sefa Kurt
- Department of Physical Medicine and Rehabilitation, Marmara University, School of Medicine,İstanbul, Turkey
| | - Ebru Kaplan
- Department of Physical Medicine and Rehabilitation, Marmara University, School of Medicine,İstanbul, Turkey
| | - İlker Yağcı
- Department of Physical Medicine and Rehabilitation, Marmara University, School of Medicine,İstanbul, Turkey
| |
Collapse
|
36
|
Rijs Z, de Groot PCJ, Zwitser EW, Visser CPJ. Is the Anterior Injection Approach Without Ultrasound Guidance Superior to the Posterior Approach for Adhesive Capsulitis of the Shoulder? A Sequential, Prospective Trial. Clin Orthop Relat Res 2021; 479:2483-2489. [PMID: 33950868 PMCID: PMC8509907 DOI: 10.1097/corr.0000000000001803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/13/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder injections for conditions such as adhesive capsulitis are commonly performed and can be administered through image-based or landmark-based injection approaches. Ultrasound-guided injections are widely used and accurate because ultrasound allows real-time visualization of the needle and injected contrast. Landmark-based injections would be advantageous, if they were accurate, because they would save the time and expense associated with ultrasound. However, few prospective studies have compared well-described landmark-based shoulder injection techniques without ultrasound. QUESTION/PURPOSE Using anatomic landmarks, and without using ultrasound, is the accuracy of glenohumeral injection for adhesive capsulitis greater via the posterior approach or via a new anterior approach? METHODS Between 2018 and 2020, we treated 108 patients potentially eligible for adhesive capsulitis treatment. These patients had clinical symptoms of aggravating shoulder pain with a duration of less than 4 months and passively impaired, painful glenohumeral ROM. Due to the exclusion of patients with other shoulder conditions (full-thickness rotator cuff ruptures and posttraumatic stiffness), 95 patients received an injection in this sequential, prospective, comparative study. Between 2018 and 2019, 41 patients (17 males and 24 females; mean age 52 ± 5 years; mean BMI 24 ± 3 kg/m2) were injected through the posterior approach, with the acromion as the anatomical landmark, during the first part of the study period. After that, between 2019 and 2020, 54 patients (20 males and 34 females; mean age 54 ± 4 years; mean BMI 23 ± 3 kg/m2) received an injection through a new anterior approach, with the acromioclavicular joint as the anatomic landmark, during the second part of the study period. Injections via both approaches were administered by two experienced shoulder specialists (both with more than 10 years of experience). Both specialists had experience with the posterior approach before this study, and neither had previous training with the new anterior approach. Injections contained a corticosteroid, local anaesthetic, and contrast medium. Radiographs were taken within 20 minutes after the injection, and a radiologist blinded to the technique determined accuracy. Accurate injections were defined as having contrast fluid limited to the glenohumeral joint, while inaccurate injections displayed leakage of contrast fluid into the soft tissue or subacromial space. All of the enrolled patients were analyzed. RESULTS In the group with the posterior approach, the accuracy was 78% (32 of 41) in contrast to 94% (51 of 54, odds ratio 0.21 [95% CI 0.05 to 0.83]; p = 0.03) in patients with the new anterior approach. CONCLUSION The new anterior approach without the use of ultrasound was more accurate than the posterior approach. In fact, it was nearly as accurate as previously published ultrasound-guided approaches. We recommend using the new anterior approach for intraarticular glenohumeral injections instead of ultrasound-guided injections because it will save time and costs associated with ultrasound. Still, the clinical effects (anxiety, pain, functional outcome, and adverse events) of the new anterior approach should be compared with ultrasound-guided injections in a randomized study. LEVEL OF EVIDENCE Level II, therapeutic study.
Collapse
Affiliation(s)
- Zeger Rijs
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | |
Collapse
|
37
|
Oka K, Morioka H, Eguchi M, Sato Y, Tetsuka N, Iguchi M, Kanematsu T, Fukano H, Hoshino Y, Kiyoi H, Yagi T. Bursitis, Bacteremia, and Disseminated Infection of Mycobacteroides (Mycobacterium) abscessus subsp. massiliense. Intern Med 2021; 60:3041-3045. [PMID: 33775997 PMCID: PMC8502645 DOI: 10.2169/internalmedicine.6189-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a 59-year-old woman with a 2-year history of chronic bursitis of the hand who took 50 mg/day prednisolone for several autoimmune diseases. Mycobacteroides abscessus subsp. massiliense was isolated from the abscess and blood culture. Combination therapy (imipenem/cilastatin, amikacin, and clarithromycin) was administered for a month. Two months later, M. massiliense was detected from a blood culture again, and disseminated lesions were found. Clarithromycin and sitafloxacin were administered following eight weeks of the same regimen. Six months after the diagnosis, M. massiliense was isolated from a blood culture, and she expired due to multiple organ failure.
Collapse
Affiliation(s)
- Keisuke Oka
- Department of Infectious Diseases, Nagoya University Hospital, Japan
| | - Hiroshi Morioka
- Department of Infectious Diseases, Nagoya University Hospital, Japan
| | - Motoki Eguchi
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Japan
| | - Yoshitaka Sato
- Department of Infectious Diseases, Nagoya University Hospital, Japan
- Department of Virology, Nagoya University Graduate School of Medicine, Japan
| | - Nobuyuki Tetsuka
- Department of Infectious Diseases, Nagoya University Hospital, Japan
| | - Mitsutaka Iguchi
- Department of Infectious Diseases, Nagoya University Hospital, Japan
| | - Takeshi Kanematsu
- Department of Clinical Laboratory, Nagoya University Hospital, Japan
| | - Hanako Fukano
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Japan
| | - Yoshihiko Hoshino
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Japan
| | - Hitoshi Kiyoi
- Department of Hematology, Nagoya University Hospital, Japan
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Hospital, Japan
| |
Collapse
|
38
|
Choi KH, Park SG, Lee W, Boudier-Revéret M, Chang MC. Differential Diagnosis of Sudden-Onset Shoulder Pain in a 58-Yr-Old Male Patient With an Elevated C-Reactive Protein: A Clinical Vignette. Am J Phys Med Rehabil 2021; 100:e126-e128. [PMID: 33789324 DOI: 10.1097/phm.0000000000001746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kyu Hwan Choi
- From the Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea (KHC, MCC); Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea (S-GP); Department of Radiology, Topspine Hospital, Daegu, Republic of Korea (WL); and Department of Physical Medicine and Rehabilitation, Centre hospitalier de l'Université de Montréal, Montreal, Québec, Canada (MB-R)
| | | | | | | | | |
Collapse
|
39
|
Zhao H, Kong L, Shen J, Ma Y, Wu Z, Li H, He Y. Tetrandrine inhibits the occurrence and development of frozen shoulder by inhibiting inflammation, angiogenesis, and fibrosis. Biomed Pharmacother 2021; 140:111700. [PMID: 34044279 DOI: 10.1016/j.biopha.2021.111700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Frozen shoulders (FS) is a major clinical concern, where chronic synovial inflammation, abnormal angiogenesis, and fibrosis represent the critical pathologies in the glenohumeral capsule. However, no pharmacotherapy has been introduced to treat this pathology. Tetrandrine (TET) has been proposed as a treatment for many diseases due to its strong anti-inflammatory, anti-angiogenic, and anti-fibrotic effects. PURPOSE To study the anti-inflammatory, anti-angiogenic, and anti-fibrotic effects of TET on FS, and identify whether TET can prevent the development of FS in rats. STUDY DESIGN A controlled laboratory study. METHODS Forty-eight male Sprague-Dawley (SD) rats were randomly divided into control, TET, and FS groups. The TET group was intraperitoneally injected with TET every 2 days. TET and saline treatment were started on the day of FS surgery. After 8 weeks, the animals were sacrificed, and samples were collected for X-ray examination, glenohumeral range of motion (ROM) evaluation, histology and immunohistochemistry analysis, transmission electron microscopy (TEM) observation, and profibrogenic factors as well as proinflammatory cytokines measurements. RESULTS No significant difference in shoulder ROM was observed between the TET and control groups, but a significant difference was noted between these groups and the FS group (P < 0.01). Immunohistochemical staining showed no abnormal angiogenesis or fibrosis in the TET group or the control group. However, significant angiogenesis, collagen remodeling, and fibrosis were observed in the FS group, and the expression and proportion of type I and type III collagen in the FS group were significantly higher than those in the TET group or the control group (P < 0.01). TEM observation showed that TET protected the ultrastructure of collagen fibrous reticular arrangement of the articular capsule and prevented the formation of scar-like fibrotic structures, which are unique to FS. The significantly increased expression of Smad7 and the suppressed expression of Smad 2 in the TET group compared with that of the FS group indicated that TET also significantly inhibited the TGF-β1 intracellular signal pathway. The expression of profibrogenic factors and proinflammatory cytokines in the TET group and the control group was significantly lower than that in the TET group (P < 0.01). CONCLUSION The results demonstrated that TET protected the normal reticular structure of the capsule during the freezing period and prevented the development of FS by inhibiting inflammation, angiogenesis, and fibrosis in a rat FS model. CLINICAL RELEVANCE TET may be a safe and effective clinical medication for preventing and treating FS.
Collapse
Affiliation(s)
- Huakun Zhao
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Lingzhi Kong
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Ji Shen
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Yanhong Ma
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Zhi Wu
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, School of Biomedical Engineering and School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China
| | - Haiyan Li
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, School of Biomedical Engineering and School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China; Chemical and Environmental Engineering, School of Engineering, RMIT University, 124 La Trobe St, Melbourne, VIC 3000, Australia.
| | - Yaohua He
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China.
| |
Collapse
|
40
|
Yoon BH, Shim JC, Lee M, Oh HK, Sung YB, Choo SK. Ultrasound-guided hydrodilatation for adhesive capsulitis of the hip is a safe and effective treatment. Int Orthop 2021; 45:1455-1461. [PMID: 33459829 PMCID: PMC8178136 DOI: 10.1007/s00264-020-04909-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022]
Abstract
Purpose Adhesive capsulitis of the hip (ACH) is likely that this condition had been previously encountered, but easily unrecognised. We investigated the clinical features of patients with ACH, the efficacy of ultrasound-guided intra-articular hydrodilatation, and the patients’ prognosis. Methods We enrolled 84 patients (93 hips) who visited the outpatient clinic from August 2018 to November 2019. ACH was diagnosed by restricted range of motion and sharp pain when turning with the affected leg fixed on the ground. We evaluated patient demographics and associated intra-articular pathologies found on magnetic resonance angiography (MRA) images. Injections were performed twice at two week intervals with a mixture of 0.5% lidocaine (25 mL) and triamcinolone (40 mg; 1 mL) with capsular distension under ultrasound guidance. Patients were assessed before and after treatment using a visual analogue scale (VAS), hip disability and osteoarthritis outcome score (HOOS), hip range of motion (ROM), and distance from floor to knee (DFK) when sitting in the cross-legged position. Results On MRA, 18 patients had abnormal findings (eight labral tears, seven abductor tendinosis, three primary arthrosis). The mean VAS decreased from 7.1 ± 1.1 to 0.8 ± 0.9 after the last injection, and the HOOS improved in all subsets. The mean DFK decreased from 17.9 ± 4.8 to 9.7 ± 2.8 cm, and passive ROM showed improvement, especially in flexion and rotation. In seven patients, symptom recurrence was reported a mean of 4.1 months after the latest injection, but no independent risk factor for recurrence was identified. Conclusion Based on these current observations, patients with ACH may receive relief from hip joint pain and experience improved function with a timely diagnosis and effective treatment.
Collapse
Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Korea
| | - Jae-Chan Shim
- Department of Radiology, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - MinKi Lee
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Korea
| | - Hyoung-Keun Oh
- Department of Orthopedic Surgery, Inje University College of Medicine, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Korea
| | - Yerl-Bo Sung
- Department of Orthopaedic Surgery, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Suk Kyu Choo
- Department of Orthopedic Surgery, Inje University College of Medicine, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Korea.
| |
Collapse
|
41
|
Zhang YW, Jiang C, Li XH, Li K. Effect and safety of Huangqi-Guizhi-Wuwu Decoction and Erxian Decoction in the treatment of frozen shoulder: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20540. [PMID: 32502014 PMCID: PMC7306347 DOI: 10.1097/md.0000000000020540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the effect and safety of Huangqi-Guizhi-Wuwu Decoction (HGWD) and Erxian Decoction (EXD) in the treatment of frozen shoulder (FS). METHODS We will compressively search potential randomized controlled trials from electronic databases of MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, Web of Science, Allied and Complementary Medicine Database, Google Scholar, and China National Knowledge Infrastructure. We will search all of them from inception of each electronic database up to the present without language limitations. Two researchers will conduct selection of study, data extraction, and study quality evaluation independently. Study quality will be identified using Cochrane risk of bias tool. Statistical analysis will be performed using RevMan 5.3 software. RESULTS This study will summarize high quality evidence of randomized controlled trials on exploring the effect and safety of HGWD and EXD in the treatment of FS. CONCLUSIONS The results of this study will provide helpful evidence of the effect and safety of HGWD and EXD in the treatment of FS to facilitate the clinical practice and guideline development. STUDY REGISTRATION NUMBER INPLASY202040070.
Collapse
Affiliation(s)
- You-Wei Zhang
- Department of Orthopedics, Baoji Central Hospital, Baoji, Shaanxi
| | - Chao Jiang
- The Third Department of Neurology, The Second Affiliated Hospital of Xi’an Medical University, Xi’an
- Department of Emergency, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Xiao-Hong Li
- Department of Orthopedics, Baoji Central Hospital, Baoji, Shaanxi
| | - Kai Li
- Department of Orthopedics, Baoji Central Hospital, Baoji, Shaanxi
| |
Collapse
|
42
|
Abstract
BACKGROUND Intra-articular (IA) corticosteroid injection is a commonly used therapy for frozen shoulder (FS), but controversy still exists regarding the injection site with the best outcome. This randomized controlled trial is designed to determine whether corticosteroid injection into the subacromial space was not inferior to IA injection in patients with FS. METHODS This study will be a single-center, randomized, and double-blinded trial. Sixty patients who meet inclusion criteria will be randomized in a ratio of 1:1 to either subacromial injection or IA injection group. The outcome evaluations will be conducted at 4 time points (baseline, 4, 8, and 12 weeks after the injection) by an independent physical therapist. The primary outcome measure is visual analog scale for pain, whereas the secondary outcomes include Constant score, and shoulder passive range of motion including abduction, forward elevation, external rotation at the side, and internal rotation at the side. DISCUSSION This study has limited inclusion and exclusion criteria and a well-controlled intervention. This clinical trial is expected to provide evidence of proper site of corticosteroid injection for the treatment of FS. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry5368).
Collapse
Affiliation(s)
- Yanbiao Wang
- Department of Orthopedics, Affiliated Hospital of Shandong Academy of Medical Sciences, Shandong First Medical University
| | - Jing Gong
- Department of Anesthesiology, The 960th Hospital of the People's Liberation Army Joint Logistice Support Force, Shandong, China
| |
Collapse
|
43
|
Pape JL, Boudier-Revéret M, Brismée JM, Gilbert KK, Grabs D, Sobczak S. Accuracy of unguided and ultrasound guided Coracohumeral ligament infiltrations - a feasibility cadaveric case series. BMC Musculoskelet Disord 2020; 21:136. [PMID: 32111219 PMCID: PMC7049223 DOI: 10.1186/s12891-020-3153-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 02/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Coracohumeral ligament (CHL) thickening, contracture, and fibroplasia have been identified in glenohumeral idiopathic adhesive capsulitis (GHIAC). The CHL is the main structure responsible for the range of motion limitations. Favorable outcomes have been reported with CHL surgical release. Intra-articular glenohumeral joint corticosteroid infiltrations are utilized to disrupt the inflammatory process and reduce pain in GHIAC. The aim of this study was to investigate whether the CHL could be accurately targeted with a periligamentous infiltration. METHODS A convenience sample of 12 unembalmed cadaver shoulders (mean age: 74.5 years, range 66-87 years) without evidence of previous injury or surgery were utilized in this exploratory double factor feasibility cadaveric (unguided and ultrasound (US) guided) case series. Two clinicians trained in musculoskeletal infiltration techniques carried out the infiltrations on each shoulder with colored latex. One clinician infiltrated without guidance, the other with US-guidance. The injecting clinicians were blinded to the others infiltration procedure and the order was randomized. An anatomist blinded to the infiltration order performed a shoulder dissection and recorded the infiltrate location. Percentage calculation for accuracy of infiltration and a chi-square evaluation of the difference between unguided and US-guided infiltrations was applied. RESULTS An accuracy of 75% was achieved for unguided infiltration and 80% for US-guided infiltration techniques. Chi-squared indicated there was no significant difference (p = 0.82) between the unguided and US-guided techniques. CONCLUSION US-guided and unguided infiltrations achieved good accuracy targeting the CHL, suggesting infiltrations can specifically and accurately target the CHL. In vivo investigation using such infiltration techniques are warranted.
Collapse
Affiliation(s)
- John L. Pape
- Department of Physiotherapy, University Hospital of North Tees, Stockton on Tees, UK
| | | | - Jean-Michel Brismée
- Department of Rehabilitation Sciences and Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX USA
| | - Kerry K. Gilbert
- Department of Rehabilitation Sciences and Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX USA
| | - Detlev Grabs
- Research Unit in Clinical and Functional Anatomy, Départment d’anatomie, Université du Québec à Trois-Rivières, Trois-Rivières, QC Canada
| | - Stéphane Sobczak
- Research Unit in Clinical and Functional Anatomy, Départment d’anatomie, Université du Québec à Trois-Rivières, Trois-Rivières, QC Canada
| |
Collapse
|
44
|
Karahan N, Ozdemir G, Kolukısa D, Duman S, Arslanoğlu F, Çetin M. Can Collagenase Be Used in the Treatment of Adhesive Capsulitis? Med Princ Pract 2020; 29:174-180. [PMID: 31480049 PMCID: PMC7098315 DOI: 10.1159/000503086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the efficacy of subacromial injections of collagenase and corticosteroid in rats with experimentally induced adhesive capsulitis. METHOD Thirty adult Wistar albino male rats were distributed into 3 groups of 10 rats each after stabilization of their shoulders for 3 weeks: the first group received a single dose of 0.002 mg (0.25 mL) subacromial collagenase; the second group received a single dose of 1.60 mg (0.25 mL) subacromial steroid, and the third group received a single dose of 0.25 mL subacromial saline solution. One week later, we investigated shoulder range of motions, collagen content of the shoulder, and joint cartilage structure. RESULTS There was no statistically significant difference in the cartilage damage between the groups (p > 0.05). Fibrosis measurements were significantly lower in the collagenase group than in the steroid and saline groups. There was no significant difference in fibrosis between the steroid and saline groups (p > 0.05). Abduction measurements were significantly higher in the collagenase group than in the steroid and saline groups (p < 0.001). No significant difference in the abduction measurements was observed between the saline and steroid groups (p > 0.05). CONCLUSION We observed that subacromial injections of collagenase Clostridium histolyticum effectively treated adhesive capsulitis. The results suggest that this treatment could be considered for use in patients with an intact rotator cuff.
Collapse
Affiliation(s)
- Nazım Karahan
- Department of Orthopaedics and Traumatology, Corlu State Hospital, Tekirdağ, Turkey,
| | - Güzelali Ozdemir
- Department of Orthopaedics and Traumatology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Duygu Kolukısa
- Department of Pathology, Mersin City Hospital, Mersin, Turkey
| | - Serda Duman
- Department of Orthopaedics and Traumatology, Diyarbakir Selahattin Eyyubi State Hospital, Diyarbakır, Turkey
| | - Fatih Arslanoğlu
- Department of Orthopaedics and Traumatology, Istanbul Medipol Universitesi, Istanbul, Turkey
| | - Mehmet Çetin
- Department of Orthopaedics and Traumatology, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| |
Collapse
|
45
|
Anjum R, Aggarwal J, Gautam R, Pathak S, Sharma A. Evaluating the Outcome of Two Different Regimes in Adhesive Capsulitis: A Prospective Clinical Study. Med Princ Pract 2020; 29:225-230. [PMID: 31514191 PMCID: PMC7315175 DOI: 10.1159/000503317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/10/2018] [Accepted: 09/12/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Adhesive capsulitis or frozen shoulder is a painful condition affecting up to 5% of the general population. We conducted this study with the aim of evaluating the results of physiotherapy plus intra-articular methylprednisolone injection versus physiotherapy alone in idiopathic frozen shoulder. METHODS This prospective clinical study was conducted in a tertiary care center between August 2016 and August 2018. Patients who were diagnosed with idiopathic frozen shoulder were included in the study, and each patient was randomly allocated to one of two groups: physiotherapy alone (group A) and physiotherapy plus intra-articular steroid injection (group B). RESULTS A total of 52 cases diagnosed with idiopathic frozen shoulder were included and treated with the two modalities. There was a significant improvement in group B compared to group A at 6 weeks and 3 months in the range of flexion, abduction, and external rotation. The Shoulder Pain and Disability Index showed improvement in both pain and disability score in group B -compared to group A, and improvement was significant at 6 weeks and 3 months. CONCLUSION The results demonstrate the advantages of physiotherapy plus intra-articular steroid injection in idiopathic frozen shoulder. The predictability of results with physiotherapy plus intra-articular steroid injection in selected patients is excellent, and it is a better modality of treatment compared to physiotherapy alone.
Collapse
Affiliation(s)
| | - Jatin Aggarwal
- MM Institute of Medical Sciences and Research, Ambala, India
| | - Rakesh Gautam
- MM Institute of Medical Sciences and Research, Ambala, India
| | - Subodh Pathak
- MM Institute of Medical Sciences and Research, Ambala, India
| | - Aryan Sharma
- MM Institute of Medical Sciences and Research, Ambala, India
| |
Collapse
|
46
|
Khodaee M, Spadafore S, Spittler J. Painful, swollen elbow. J Fam Pract 2020; 69:311-313. [PMID: 32724913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Was a recent procedure responsible for this patient's pain?
Collapse
Affiliation(s)
- Morteza Khodaee
- Department of Family Medicine & Orthopedics, University of Colorado School of Medicine, Denver, USA.
| | - Stephen Spadafore
- Department of Family Medicine & Orthopedics, University of Colorado School of Medicine, Denver, USA
| | - Jack Spittler
- Department of Family Medicine & Orthopedics, University of Colorado School of Medicine, Denver, USA
| |
Collapse
|
47
|
Barman A, Mukherjee S, Sahoo J, Maiti R, Rao PB, Sinha MK, Sahoo D, Tripathy SK, Patro BK, Bag ND. Single Intra-articular Platelet-Rich Plasma Versus Corticosteroid Injections in the Treatment of Adhesive Capsulitis of the Shoulder: A Cohort Study. Am J Phys Med Rehabil 2019; 98:549-557. [PMID: 30676339 DOI: 10.1097/phm.0000000000001144] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of the study was to compare the effects of single intra-articular platelet-rich plasma (PRP) and corticosteroid (CS) injections in patients with adhesive capsulitis of the shoulder. DESIGN Patients aged 18-70 yrs of either sex, diagnosed with adhesive capsulitis of shoulder, with less than 6-mo duration, were included. In intra-articular corticosteroid (IA-CS, control) group, 30 patients received a single injection (4 ml) of IA-CS and in IA-PRP (test) group, 30 patients received single IA-PRP injection (4 ml) into the glenohumeral joint under ultrasound guidance. All patients were prospectively followed for 12 wks. RESULTS Twenty-eight patients in IA-PRP group and 27 in IA-CS group finished the entire 12-wk study period. At 12 wks, decrements in visual analog scale and total shoulder pain and disability index scores, in IA-PRP group, were 58.4 and 55.1, compared with 48.7 and 45.8 in IA-CS group. In range of movement, IA-PRP group showed significant improvement in passive abduction (-50.4 vs. -39.4), internal (-36.8 vs. -25.8), and external rotations (-35.4 vs. -25.9) compared with IA-CS group, respectively. No major complications were observed in any patients. CONCLUSIONS At 12-wk follow-up, a single dose of IA-PRP injection was found to be more effective than an IA-CS injection, in terms of improving pain, disability, and shoulder range of movement in patients with adhesive capsulitis of the shoulder.
Collapse
Affiliation(s)
- Apurba Barman
- From the Departments of Physical Medicine and Rehabilitation (AB, JS), Transfusion Medicine (SM, DS), Pharmacology (RM), Anesthesia and Intensive Care (PBR), General Surgery (MKS), Orthopaedics (SKT), Community and Family Medicine (BKP), and Radiodiagnosis (NDB), All India Institute of Medical Sciences, Bhubaneswar, India
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Blessing WA, Okajima SM, Cubria MB, Villa-Camacho JC, Perez-Viloria M, Williamson PM, Sabogal AN, Suarez S, Ang LH, White S, Flynn E, Rodriguez EK, Grinstaff MW, Nazarian A. Intraarticular injection of relaxin-2 alleviates shoulder arthrofibrosis. Proc Natl Acad Sci U S A 2019; 116:12183-12192. [PMID: 31160441 PMCID: PMC6589647 DOI: 10.1073/pnas.1900355116] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Arthrofibrosis is a prevalent condition affecting greater than 5% of the general population and leads to a painful decrease in joint range of motion (ROM) and loss of independence due to pathologic accumulation of periarticular scar tissue. Current treatment options are limited in effectiveness and do not address the underlying cause of the condition: accumulation of fibrotic collagenous tissue. Herein, the naturally occurring peptide hormone relaxin-2 is administered for the treatment of adhesive capsulitis (frozen shoulder) and to restore glenohumeral ROM in shoulder arthrofibrosis. Recombinant human relaxin-2 down-regulates type I collagen and α smooth muscle actin production and increases intracellular cAMP concentration in human fibroblast-like synoviocytes, consistent with a mechanism of extracellular matrix degradation and remodeling. Pharmacokinetic profiling of a bolus administration into the glenohumeral joint space reveals the brief systemic and intraarticular (IA) half-lives of relaxin-2: 0.96 h and 0.62 h, respectively. Furthermore, using an established, immobilization murine model of shoulder arthrofibrosis, multiple IA injections of human relaxin-2 significantly improve ROM, returning it to baseline measurements collected before limb immobilization. This is in contrast to single IA (sIA) or multiple i.v. (mIV) injections of relaxin-2 with which the ROM remains constrained. The histological hallmarks of contracture (e.g., fibrotic adhesions and reduced joint space) are absent in the animals treated with multiple IA injections of relaxin-2 compared with the untreated control and the sIA- and mIV-treated animals. As these findings show, local delivery of relaxin-2 is an innovative treatment of shoulder arthrofibrosis.
Collapse
Affiliation(s)
- William A Blessing
- Department of Biomedical Engineering, Boston University, Boston, MA 02215
- Department of Chemistry, Boston University, Boston, MA 02215
- Department of Medicine, Boston University, Boston, MA 02215
| | - Stephen M Okajima
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - M Belen Cubria
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Juan C Villa-Camacho
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Miguel Perez-Viloria
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Patrick M Williamson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Angie N Sabogal
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Sebastian Suarez
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Lay-Hong Ang
- Confocal Imaging and IHC Core, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Suzanne White
- Confocal Imaging and IHC Core, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Evelyn Flynn
- Orthopedic Research Laboratories, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115
| | - Edward K Rodriguez
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115;
| | - Mark W Grinstaff
- Department of Biomedical Engineering, Boston University, Boston, MA 02215;
- Department of Chemistry, Boston University, Boston, MA 02215
- Department of Medicine, Boston University, Boston, MA 02215
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115;
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan 0025, Armenia
| |
Collapse
|
49
|
Akhtar M, Nadeem RDA, Shah Gillani SFH, Cheema OI, Nadeem MR. Comparison of intra articular NSAID (ketorolac) injection versus hyaluronic acid injection for the mean decrease of pain score (according to UCLA shoulder rating scale) in the management of adhesive capsulitis. Pak J Pharm Sci 2019; 32:953-956. [PMID: 31278705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Adhesive capsulitis is painful condition, associated with gradual loss of active and passive shoulder motion that has a disabling capability. In this study we compared the short term outcome by measuring the mean decrease of pain in adhesive capsulitis using University of California Los-Angeles (UCLA) shoulder rating scale after intra-articular Non-Steroidal Anti Inflammatory Drug (NSAID) Ketorolac and Hyaluronic acid injection. This Randomized controlled trial was carried out using non probability consecutive sampling technique from 1st November 2015 to 30th April 2016. Total 160 patients with adhesive capsulitis for six months' age between 18 to 70 years were taken and randomly divided into two equal groups by computer allocation method. The 80 patients in Group A received Intra-articular (NSAID) Ketorolac injection while patients in Group B were given Intra-articular Hyaluronic acid. Pain score for both the groups were recorded using UCLA shoulder rating scale before treatment and then at follow up after a period of 4 weeks. Out of total 160 cases, 47.5% (n=38) in Group A and 45% (n=36) in Group B were male whereas 52.5% (n=42) in Group A and 55% (n=44) in Group B were females. Most commonly affected age group with 40% (n=32) participants was aged between 51 - 60 years. Mean age of Group A was 37.87±1.027 and in Group B was 45.37±5.743. Interestingly 60% (n=48) of Group A and 55% (n=44) of Group B had involvement of the right shoulder. Pre-treatment UCLA pain score was calculated to be 14.90±4.969 in Group-A and 15.16±5.578 in Group-B. Final post treatment UCLA score was 26.67±2.331 in Group A and 21.72±3.838 in Group B. The mean decrease of pain in Adhesive capsulitis using UCLA rating scale was significantly better in NSAID group as compared to Hyaluronic acid group.
Collapse
Affiliation(s)
| | | | | | - Omer Iqbal Cheema
- Department of Orthopedics Surgery, Unit- II, King Edward Medical University / Mayo Hospital, Lahore, Pakistan
| | | |
Collapse
|
50
|
Wu Y, Chen Q, Chen K, He F, Quan J, Chen S, Guo X. Clinical efficacy of ultrasound-guided injection in the treatment of olecranon subcutaneous bursitis. J Xray Sci Technol 2019; 27:1145-1153. [PMID: 31609717 DOI: 10.3233/xst-190562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Recent studies have shown that ultrasound-guided injection of glucocorticoids is superior to blind puncture methods. OBJECTIVE To evaluate clinical efficacy of ultrasound-guided drug injection in the treatment of olecranon subcutaneous bursitis. METHODS From June 2016 to September 2018, 45 patients diagnosed with obvious synovial effusion and treated with ultrasound-guided injection therapy for olecranon bursitis were included in this study. Under the guidance of ultrasound, the synovial effusion aspiration was performed and 2 ml of the compound betamethasone mixture was injected into the bursae and dressed under pressure. Ultrasound examination was performed 2 weeks after operation and the secondary fluid aspiration and drug injection treatment were performed. The depth of synovial effusion, the thickness of synovial hyperplasia and the blood flow signal were measured 4 weeks after operation to evaluate the therapeutic effect. RESULTS After first treatment, the recurrence rate of the olecranon mass were 40%. After secondary treatment, recurrence of olecranon mass occurred in 6 of the 45 patients with a recurrence rate of 13.3%. After 4 weeks of follow-up, the depth of olecranon synovial effusion, the average thickness of synovial hyperplasia and the blood flow signal decreased significantly after treatment (P < 0.05). CONCLUSIONS Ultrasound-guided drug injection is safe and effective in treating olecranon subcutaneous bursitis. Although the recurrence rate is high after the first treatment, the second treatment is simple and can reduce the recurrence rate. The patients have a high acceptance rate, which is worthy of clinical promotion.
Collapse
Affiliation(s)
- Yanyan Wu
- Ultrasonic Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qin Chen
- Ultrasonic Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Kai Chen
- Ultrasonic Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Fanding He
- Ultrasonic Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jierong Quan
- Ultrasonic Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shiyin Chen
- Chinese Medicine Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuanyan Guo
- Ultrasonic Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| |
Collapse
|