Idiopathic adhesive capsulitis of the shoulder: a review

Effects of mastectomy on shoulder and spinal kinematics during bilateral upper-limb movement

BACKGROUND

Shoulder movement impairment is a commonly reported consequence of surgery for breast cancer.

OBJECTIVE

The aim of this study was to determine whether shoulder girdle kinematics, including those of the scapula, spine, and upper limb, in women who have undergone a unilateral mastectomy for breast cancer are different from those demonstrated by an age-matched control group.

DESIGN

An observational study using 3-dimensional kinematic analysis was performed.

METHODS

Women who had a unilateral mastectomy on their dominant-arm side (n=29, mean [+/-SD] age=62.4+/-8.9 years) or nondominant-arm side (n=24, mean [+/-SD] age=59.8+/-9.9 years), as well as a control group of age-matched women without upper-limb, shoulder, or spinal problems (n=22, mean [+/-SD] age=58.1+/-11.5 years), were measured while performing bilateral arm movements in the sagittal, scapular, and coronal planes. All of the women were free of shoulder pain at the time of testing. Data were collected from the glenohumeral joint, the scapulothoracic articulation, and the spine (upper and lower thoracic and lumbar regions) using an electromagnetic tracking system.

RESULTS

Women following mastectomy displayed altered patterns of scapular rotation compared with controls in all planes of movement. In particular, the scapula on the mastectomy side rotated upward to a markedly greater extent than that on the nonmastectomy side, and women following mastectomy displayed greater scapular excursion than controls.

CONCLUSIONS

The findings suggest that altered motor patterns of the scapula are associated with mastectomy on the same side. Whether these changes are harmful or not is unclear. Investigation of interventions designed to restore normal scapulohumeral relationships on the affected side following unilateral mastectomy for breast cancer is warranted.

Comparison of arthroscopic capsular release in diabetic and idiopathic frozen shoulder patients

INTRODUCTION

The clinical results of arthroscopic capsular release for frozen shoulder in diabetic (group 1) and idiopathic (group 2) patients were compared. Surgery was performed on 28 shoulders of 26 patients (24 women, 2 men) with frozen shoulder unresponsive to conservative treatment. The mean age was 50 (range 40-65). A total of 14 patients were included in group 1, and 12 were in group 2. The average duration of complaints was 10 and 7 months in groups 1 and 2, respectively. The evaluation of shoulder functions was made according to the University of California, Los Angeles (UCLA) and Constant Scoring Systems. Duration of complete pain relief and for regaining range of motion (ROM) after surgery were also noted in their final follow-up examination.

RESULTS

The mean follow-up period was 48.5 and 60.2 months in group 1 and group 2, respectively. There was no significant difference between the two groups in terms of the postoperative duration of complete pain relief and that for regaining ROM (P > 0.05). The duration of complete pain relief was 2.6 and 2.5 months, and regaining of ROM was 1.6 and 1.5 months for groups 1 and 2, respectively. The postoperative UCLA and Constant scores had significant increases in both groups compared to the preoperative ones (P < 0.05). There was a significant difference between the groups in terms of Constant scores (P < 0.05) while there was no difference in terms of UCLA scores (P > 0.05). There was a statistically significant difference in shoulder abduction and internal rotation degrees between the groups (P < 0.05).

CONCLUSION

The results of arthroscopic capsular release for frozen shoulder in diabetic patients had less good results in terms of range of motion and Constant-Score. There was no significant difference between the two groups in terms of the duration of pain relief and that of regaining the ROM.

Nonoperative management of adhesive capsulitis of the shoulder: oral cortisone application versus intra-articular cortisone injections

HYPOTHESIS

Oral and intra-articular injections of cortisone will lead to significant improvement and comparable results in the treatment of adhesive capsulitis of the shoulder.

MATERIALS AND METHODS

In a prospective randomized evaluation, 40 patients with idiopathic adhesive capsulitis of the shoulder were treated with an oral corticoid treatment regimen or 3 intra-articular injections of corticosteroids. Follow-up was after 4, 8, and 12 weeks, and 6 and 12 months. For the clinical evaluation, the Constant-Murley (CM) score, the Simple Shoulder Test (SST) and visual analog scales (VAS) for pain, function, and satisfaction were used.

RESULTS

In the patients treated with oral glucocorticoids, significant improvements were found for the CM score (P < .0001), SST (P=.035), VAS (P < .0001), and range of motion (P < .05) at the 4-week follow-up. The patients treated with an intra-articular glucocorticoid injection series also significantly improved in the CM score (P < .0001), SST (P < .0001), the VAS (P < .0001), and range of motion (P < .05) after 4 weeks. These results were confirmed at all other follow-up visits. Superior results were found for intra-articular injections in range of motion, CM score, SST, and patient satisfaction (P < .05). Differences in the VAS for pain and function were not significant (P > .05).

DISCUSSION

The use of cortisone in the treatment of idiopathic shoulder adhesive capsulitis leads to fast pain relief and improves range of motion. Intra-articular injections of glucocorticoids showed superior results in objective shoulder scores, range of motion, and patient satisfaction compared with a short course of oral corticosteroids.

Is it worthwhile to offer repeat hydrodilatation for frozen shoulder after 6 weeks?

AIMS

Frozen shoulder is a common problem for which hydrodilatation is an established treatment option although the optimal regime is not yet established. We asked 'is it worthwhile to offer a repeat hydrodilatation procedure after 6 weeks?'

METHODS

A total of 36 patients diagnosed with frozen shoulder and undergoing hydrodilatation were evaluated. All patients had an initial hydrodilatation and were offered a repeat procedure after 6 weeks. Of the total patients, 22 chose to undergo a repeat procedure. The Shoulder Disability Questionnaire UK Score and Oxford Shoulder Score were used to evaluate pre- and postprocedure outcome. The mean follow up was 15.4 months.

RESULTS

The Oxford Shoulder Score improved by a significant level after both single (30.5-17.1) and repeat hydrodilatation (36.0-21.4). No significant change was observed after either procedure when using the Shoulder Disability Questionnaire UK Score as an outcome measure.

CONCLUSIONS

The data are suggestive that routine hydrodilatation after 6 weeks is not appropriate and should be instead offered to those patients who can tolerate it and who have not fully benefitted after a single procedure.