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Yan Y, Li X, Chen C, Cui D, Wang Z, Li M, Long Y, Zhang J, Li C, Wang Z, Zhou C, Yao Z, Wang D, Hou J, Yang R. A mussel-inspired, antibacterial, antioxidant, injectable composite hydrogel for the sustain delivery of salvianolic acid B for the treatment of frozen shoulder. Bioact Mater 2024; 40:396-416. [PMID: 39022185 PMCID: PMC11252718 DOI: 10.1016/j.bioactmat.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/02/2024] [Accepted: 06/06/2024] [Indexed: 07/20/2024] Open
Abstract
Frozen shoulder (FS) manifests as progressively worsening pain and a reduction in shoulder range of motion (ROM). Salvianolic acid B (SaB) is recently expected to be used in the treatment of fibrosis diseases including FS. We firstly demonstrate that SaB can effectively hinder the progression of oxidative stress, inflammation, and pathological fibrosis within the synovial tissue in FS, potentially leading to the reduction or reversal of capsule fibrosis and joint stiffness. For further clinical application, we design and synthesize a novel, superior, antioxidant and antibacterial CSMA-PBA/OD-DA (CPDA) hydrogel for the delivery of SaB. In vitro experiments demonstrate that the CPDA hydrogel exhibits excellent biocompatibility and rheological properties, rendering it suitable for intra-articular injections. Upon injection into the contracted joint cavity of FS model rat, the SaB-CPDA hydrogel accelerate the recovery of ROM and exhibit superior anti-fibrosis effect, presenting the promise for the treatment of FS in vivo.
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Affiliation(s)
- Yan Yan
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Xinhao Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Chen Chen
- Department of Geriatric Dentistry, NMPA Key Laboratory for Dental Materials National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Dedong Cui
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Zhuo Wang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Ming Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Yi Long
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Jinming Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Cheng Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Zhiling Wang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Chuanhai Zhou
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Zeyu Yao
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Dan Wang
- School of Biomedical Science, The Chinese University of Hong Kong, Hong Kong, 999077, China
| | - Jingyi Hou
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Rui Yang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000, China
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Kim SW, Lim JY, Kim S, Do JG, Lee JI, Hwang JH. Responsiveness and Minimal Clinically Important Difference of the Canadian Occupational Performance Measure Among Patients With Frozen Shoulder. Am J Occup Ther 2024; 78:7804205060. [PMID: 38917031 DOI: 10.5014/ajot.2024.050573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
IMPORTANCE Patient-reported outcome measures provide insights into intervention effects on patients. The Canadian Occupational Performance Measure (COPM) emphasizes identifying priorities in daily activity engagement and evaluating an individual's perception of changes over time. OBJECTIVE To assess the responsiveness of the COPM and the minimal clinically important difference (MCID) among patients with frozen shoulders. DESIGN Prospective, single-blind, randomized controlled trial. SETTING Two physical medicine and rehabilitation clinics. PARTICIPANTS Ninety-four patients with frozen shoulders enrolled in a previous study. OUTCOMES AND MEASURES Baseline and 3-mo evaluations of the COPM and other measures. Responsiveness was assessed using effect size (ES) and standardized response mean (SRM). The MCID values were determined through a distribution-based approach, which used the 0.5 standard deviation and ES methods, and an anchor-based approach, which used the receiver operating characteristic curve method. RESULTS The ES and SRM results indicated that the COPM had high responsiveness. The distribution-based MCID values for COPM Performance and COPM Satisfaction were 1.17 and 1.44, respectively. The anchor-based MCID values were 2.5 (area under the curve [AUC] = 0.78, 95% confidence interval [CI] [0.64-0.91]) and 2.1 (AUC = 0.76, 95% CI [0.60-0.91]), respectively. CONCLUSIONS AND RELEVANCE The findings suggest that the COPM is a responsive outcome measure for patients with frozen shoulder. The established MCID values for the COPM can be valuable for interpreting changes in patient performance and satisfaction, thus aiding clinical interventions and research planning. Plain-Language Summary: This is the first study to review the effectiveness of the Canadian Occupational Performance Measure (COPM) to determine the success of occupational therapy interventions for people with a frozen shoulder. The findings suggest that the COPM is an effective and valuable tool for clients with a frozen shoulder to understand their experiences and treatment priorities and to detect meaningful changes in their performance and satisfaction after an occupational therapy intervention.
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Affiliation(s)
- Sun Woo Kim
- Sun Woo Kim, MS, OT, is Researcher, Department of Physical and Rehabilitation Medicine, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ji Young Lim
- Ji Young Lim, PhD, PT, is Research Professor, Department of Physical and Rehabilitation Medicine, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Seonghee Kim
- Seonghee Kim, BS, OT, is Researcher, Department of Physical and Rehabilitation Medicine, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jong Geol Do
- Jong Geol Do, PhD, MD, is Professor, Department of Physical and Rehabilitation Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jong In Lee
- Jong In Lee, PhD, MD, is Professor, Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hye Hwang
- Ji Hye Hwang, PhD, MD, is Professor, Department of Physical and Rehabilitation Medicine, Samsung Medical Center; School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea;
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Pirri C, Sorbino A, Manocchio N, Pirri N, Devito A, Foti C, Migliore A. Chondrotoxicity of Intra-Articular Injection Treatment: A Scoping Review. Int J Mol Sci 2024; 25:7010. [PMID: 39000119 PMCID: PMC11241418 DOI: 10.3390/ijms25137010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/10/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
The purpose of this scoping review was to identify possible chondrotoxic effects caused by drugs usually used for intra-articular injections. PubMed, Scopus, Web of Science and Cochrane were searched. Inclusion criteria required randomized controlled trials written in English that evaluate the toxic effect that damages the cartilage. The literature search resulted in 185 unique articles. 133 full-text articles were screened for inclusion, of which 65 were included. Corticosteroids, with the exception of triamcinolone, along with local anaesthetics, potentially excluding ropivacaine and liposomal bupivacaine, and nonsteroidal anti-inflammatory drugs, exhibited insufficient safety profiles to warrant casual use in clinical settings. Hyaluronic acid, on the other hand, appears to demonstrate safety while also mitigating risks associated with concurrent compounds, thereby facilitating therapeutic combinations. Additionally, there remains a paucity of data regarding platelet-rich plasma, necessitating further evaluation of its potential efficacy and safety. Overall, it seems that results are significantly influenced by the dosage and frequency of injections administered, observed in both human and animal studies.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy
| | - Andrea Sorbino
- Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Nicola Manocchio
- Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Nina Pirri
- Department of Medicine-DIMED, School of Radiology, Radiology Institute, University of Padova, 35121 Padova, Italy
| | - Antonio Devito
- Internal Medicine, S. Pietro Fatebenefratelli Hospital, 00189 Rome, Italy
| | - Calogero Foti
- Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Alberto Migliore
- Rheumatology, S. Pietro Fatebenefratelli Hospital, 00189 Rome, Italy
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Pamboris GM, Pavlou K, Paraskevopoulos E, Mohagheghi AA. Effect of open vs. closed kinetic chain exercises in ACL rehabilitation on knee joint pain, laxity, extensor muscles strength, and function: a systematic review with meta-analysis. Front Sports Act Living 2024; 6:1416690. [PMID: 38887689 PMCID: PMC11180725 DOI: 10.3389/fspor.2024.1416690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Anterior cruciate ligament (ACL) injuries are common among physically active individuals, often requiring ACL reconstruction (ACLR) for recovery. Rehabilitating these injuries involves determining the appropriate timing for initiating open kinetic chain (OKC) exercises. Although OKC exercises are effective post-ACLR, their use in rehabilitation remains a subject of debate. Therefore, this study aims to conduct a systematic review to determine whether OKC or closed kinetic chain (CKC) exercises result in differences in laxity, strength of the knee extensor muscle group, function, and functional performance in ACL rehabilitation. Five electronic databases were searched for randomized controlled between-group trials (RCTs). Two reviewers independently evaluated the risk of bias using the PEDro scale. We performed a meta-analysis using a random-effects model or calculated mean differences (fixed-effect) where appropriate. Certainty of evidence was judged using the GRADE approach. The systematic literature search yielded 480 articles, of which 9 met the inclusion criteria. The evidence for all outcomes ranged from very low to low certainty. Across all comparisons, inconsistent results were found in outcome measures related to knee function between OKC and CKC exercises post-ACLR. A significant increase in quadriceps isokinetic strength was found in post-ACLR and ACL-deficient knees in favor of OKC exercises at 3 (p = 0.03) and 4 (p = 0.008) months, respectively. A significant decrease in knee laxity was observed in ACL-deficient knees in favor of OKC at 10 weeks (p = 0.01), although inconsistency was noted at 4 months. Finally, a significant decrease in pain was found in favor of early OKC compared to late OKC (p < 0.003). Additionally, in ACL-deficient knees, low load resistance training (LLRT) OKC showed no significant laxity difference compared to controls (p > 0.05). In contrast, high load resistance training (HLRT) OKC had less laxity than controls at 6 weeks (p = 0.02) but not at 12 weeks (p > 0.05). OKC exercises appear to be superior to CKC for improving quadriceps strength 3-4 months post-injury, whether as a part of conservative or post-surgery rehabilitation. On the other hand, OKC exercises seem to be either superior or equally effective to CKC for improving knee laxity, thus presenting their importance in being included in a rehabilitation protocol from the initial phase. Systematic Review Registration PROSPERO [CRD42023475230].
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Affiliation(s)
- George M. Pamboris
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Kyriakos Pavlou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Eleftherios Paraskevopoulos
- Department of Physiotherapy, Aegean College, Athens, Greece
- Laboratory of Biomechanics, Department of Physiotherapy, University of Peloponnese, Sparta, Greece
| | - Amir A. Mohagheghi
- Division of Sport, Health, and Exercise Sciences, Brunel University London, Uxbridge, United Kingdom
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Rhim HC, Schon JM, Xu R, Schowalter S, Ha J, Hsu C, Andrew M, Robinson DM, Tenforde AS, Daneshvar DH. Targeting the Sweet Spot: A Systematic Review With Meta-Analysis of Anterior Versus Posterior Glenohumeral Joint Injections for Adhesive Capsulitis. Clin J Sport Med 2024:00042752-990000000-00191. [PMID: 38810121 DOI: 10.1097/jsm.0000000000001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To compare clinical outcomes following steroid injections using the anterior and posterior approaches. DESIGN Systematic review with meta-analysis. SETTING Embase, Web of Science, and Cochrane Center Register of Controlled Trials were searched for randomized control trials (RCTs) and prospective comparative studies. PATIENTS Patients with adhesive capsulitis. INTERVENTIONS Glenohumeral steroid injections using either anterior or posterior approach. MAIN OUTCOME MEASURES Pain visual analog scale (VAS) and shoulder range of motion (ROM) at 12 weeks, accuracy, and adverse events. Standardized mean difference (SMD) for VAS and weighted mean difference (WMD) for ROMs. RESULTS We identified 6 RCTs and one prospective comparative study with a total of 468 patients. While there was no difference in pain VAS at 12 weeks between the 2 approaches (SMD, -0.86; 95% CI, -1.76 to 0.04), the anterior approach resulted in greater improvements in external rotation (WMD, 8.08; 95% CI, 0.79-15.38) and abduction (WMD, 6.76; 95% CI, 3.05-10.48) compared with the posterior approach. Subgroup analysis with RCTs that utilized steroid injection with hydrodilatation for both approaches demonstrated greater reduction in pain VAS at 12 weeks with the anterior approach (SMD, -0.52; 95% CI, -0.98 to -0.07). Overall, procedures were well tolerated without major complications. CONCLUSIONS While pain reduction is similar, the anterior approach may be more beneficial in restoring shoulder external rotation and abduction compared with the posterior approach at 12 weeks. Steroid injection combined with hydrodilatation may further improve pain control when performed with the anterior approach at 12 weeks.
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Affiliation(s)
- Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Jason M Schon
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Raylin Xu
- Harvard Medical School, Boston, Massachusetts; and
| | - Sean Schowalter
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Jane Ha
- Clinical and Translational Epidemiology Unit, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts
| | - Connie Hsu
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Michael Andrew
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - David M Robinson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
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Lin YJ, Chung CY, Chen CPC, Hsieh YW, Wang CF, Chen CC. The Feasibility and Efficacy of Remote App-Guided Home Exercises for Frozen Shoulder: A Pilot Study. Healthcare (Basel) 2024; 12:1095. [PMID: 38891171 PMCID: PMC11171612 DOI: 10.3390/healthcare12111095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Home exercise programs are beneficial in managing frozen shoulder (FS), yet adherence remains challenging. This pilot study introduces the remote app, Defrozen, designed for home exercises and assesses its feasibility and clinical outcomes in FS patients undergoing intra-articular and sub-acromial corticosteroid treatment. Over a four-week period, patients used the Defrozen-app, engaging in guided exercises. The feasibility of the intervention was assessed through several measurement scales, including adherence, the Technology Acceptance Model 2 (TAM2), the System Usability Scale (SUS), and User Satisfaction and Engagement (USE). Clinical outcomes included pain scale, Oxford Shoulder Score (OSS), Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) Score, and passive range of motion. The TAM2 results indicated high perceived usefulness (4.5/5), ease of use (4.8/5), and intention to use (4.4/5); the SUS score was high at 81.7/100, complemented by USE scores reflecting ease of learning (4.9/5) and satisfaction (4.3/5). Clinical outcomes showed significant pain reduction, improved shoulder function, reduced shoulder-related disability, and increased shoulder range of motion. These findings suggest the Defrozen-app as a promising solution for FS, significantly improving adherence and showing potential to enhance clinical outcomes. However, these clinical outcome results are preliminary and necessitate further validation through a large-scale randomized controlled trial to definitively confirm efficacy and assess long-term benefits.
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Affiliation(s)
- Yi-Jun Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333423, Taiwan; (Y.-J.L.); (C.-Y.C.); (C.P.C.C.)
| | - Chia-Ying Chung
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333423, Taiwan; (Y.-J.L.); (C.-Y.C.); (C.P.C.C.)
| | - Carl P. C. Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333423, Taiwan; (Y.-J.L.); (C.-Y.C.); (C.P.C.C.)
| | - Yu-Wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Ching-Fu Wang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
- Biomedical Engineering Research and Development Center, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333423, Taiwan; (Y.-J.L.); (C.-Y.C.); (C.P.C.C.)
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Ödemiş E, Baysal CV. Clinical evaluation of a patient participation assessment system for upper extremity rehabilitation exercises. Med Biol Eng Comput 2024; 62:1441-1457. [PMID: 38231343 PMCID: PMC11021326 DOI: 10.1007/s11517-023-03014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/29/2023] [Indexed: 01/18/2024]
Abstract
In conventional and robotic rehabilitation, the patient's active participation in exercises is essential for the maximum functional output to be received from therapy. In rehabilitation exercises performed with robotic devices, the difficulty levels of therapy tasks and the device assistance are adjusted based on the patient's therapy performance to improve active participation. However, the existing therapy performance evaluation methods are based on either some specific device designs or certain therapy tasks, which limits their widespread use. In this paper, the effectiveness of a participation assessment system, which can evaluate patients' therapy performance, tiredness, and slacking independent of any device design and therapy exercise, was clinically tested on ten patients diagnosed with frozen shoulder syndrome. The patients performed exercises using the system once a week throughout their 4-week treatment period. Multiple clinical measurements and scales were employed during the clinical study to assess patients' progress and status, such as tiredness throughout the therapy process. The clinical data, along with the patient findings obtained from the participation assessment system, were statistically analyzed and compared. The findings revealed that the patients' improvements and progress during the therapy process clinically coincide with the variations in the performance evaluation results of the system, and the implemented method successfully assesses the patients' participation during the rehabilitation exercises.
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Affiliation(s)
- Erkan Ödemiş
- Department of Biomedical Engineering, Çukurova University, 01330, Saricam, Adana, Turkey.
| | - Cabbar Veysel Baysal
- Department of Biomedical Engineering, Çukurova University, 01330, Saricam, Adana, Turkey
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Brindisino F, Venturin D, Bartoli M, Caselli S, Pellicciari L, Poser A. Psychometric properties of the Disability of Arm Shoulder and Hand (DASH) in subjects with frozen shoulder: a reliability and validity study. BMC Musculoskelet Disord 2024; 25:260. [PMID: 38566086 PMCID: PMC10986124 DOI: 10.1186/s12891-024-07371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Frozen Shoulder (FS) is a painful condition characterized by severe pain and progressive restriction of shoulder movement, leading to functional impairment and reduced quality of life. While different Patient Reported Outcome Measurements (PROMs) tools exist for assessing shoulder diseases, few specific PROMs are validated for FS patients. PURPOSE This study aims to assess the psychometric properties of the Disability of Arm, Shoulder, and Hand (DASH) questionnaire in FS patients. METHODS One hundred and twenty-four subjects (mean ± SD age = 55.4 ± 7.9 years; 55.6% female) diagnosed with FS were included and completed the DASH questionnaire, the Numerical Pain Rating Scale (NPRS), the Shoulder Pain and Disability Index (SPADI), and the Short-Form Health Survey 36 (SF-36). Floor or ceiling effects were investigated. Structural validity was analysed through a unidimensional Confirmatory Factor Analysis (CFA), internal consistency through Cronbach's alpha, test-retest reliability through the Intraclass Correlation coefficient (ICC), measurement error through the Standard Error of Measurement (SEM), and the Minimum Detectable Change (MDC), and construct validity through the hypothesis testing with the correlation with the other outcome measures used. RESULTS No floor or ceiling effects were observed. CFA confirmed a one-factor structure after addressing local item dependency (Root Mean Square Error of Approximation = 0.055; Standardized Root Mean Square Residual = 0.077; Comparative Fit Index = 0.970; Tucker-Lewis Index = 0.968). Cronbach's alpha was high (= 0.951), and test-retest reliability was excellent (ICC = 0.999; 95% CI: 0.998-1.000). SEM was equal to 0.5 points, and MDC to 1.5 points. Construct validity was considered satisfactory as 80% of the a-priori hypotheses were met. CONCLUSION The DASH questionnaire demonstrated good psychometric properties in FS patients, supporting its use as a valuable tool for assessing the impact of FS in clinical and research settings.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, 86100, Italy
| | - Davide Venturin
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, 86100, Italy
| | - Matteo Bartoli
- Physiotherapy private practice KinesiLab, via Marcantonio Colonna 88, Marino, Italy
| | - Serena Caselli
- Unità Operativa di Medicina Riabilitativa, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Leonardo Pellicciari
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, Bologna, I-40139, Italy.
| | - Antonio Poser
- Physiotherapy private practice Kinè, Kinè s.r.l, Viale della Quercia 2/B,, Treviso, Italy
- University of Siena, c/o via Banchi di Sotto, 55, Siena, Italy
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Arrambide-Garza FJ, Guerrero-Zertuche JT, Alvarez-Villalobos NA, Quiroga-Garza A, Espinosa-Uribe A, Vilchez-Cavazos F, Salinas-Alvarez Y, Rivera-Perez JA, Elizondo-Omaña RE. Rotator Interval vs Posterior Approach Ultrasound-guided Corticosteroid Injections in Primary Frozen Shoulder: A Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 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] [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.
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Affiliation(s)
| | | | - Neri Alejandro Alvarez-Villalobos
- Universidad Autonoma de Nuevo Leon, School of Medicine, 360 Research Development Center, Monterrey, Mexico; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA; Instituto Mexicano del Seguro Social, Nuevo Leon Delegation, Monterrey, Mexico
| | - Alejandro Quiroga-Garza
- Universidad Autonoma de Nuevo Leon, School of Medicine, Human Anatomy Department, Mexico; Instituto Mexicano del Seguro Social, Nuevo Leon Delegation, Monterrey, Mexico
| | - Abraham Espinosa-Uribe
- Universidad Autonoma de Nuevo Leon, School of Medicine, Human Anatomy Department, Mexico; Hospital Christus Muguerza, High Specialty, Department of Orthopedics and Traumatology, Monterrey, Mexico
| | - Felix Vilchez-Cavazos
- Autonoma de Nuevo Leon, University Hospital "Dr José Eleuterio González", Orthopedic Surgery Division, Monterrey, México
| | | | - Juan Antonio Rivera-Perez
- Dirección de Medicina y Ciencias Aplicadas, Comisión Nacional De Cultura Física y Deporte, Ciudad de México, México.
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Liang CW, Cheng HY, Lee YH, De Liao C, Huang SW. Corticosteroid Injection Methods for Frozen Shoulder: A Network Meta-analysis. Arch Phys Med Rehabil 2024; 105:750-759. [PMID: 38244851 DOI: 10.1016/j.apmr.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/16/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To investigate the efficacy of corticosteroid (CS) injection methods for frozen shoulder. DATA SOURCES PubMed, Embase, and Cochrane Library were searched up to May 6, 2023. STUDY SELECTION Randomized controlled trials (RCTs) that investigated CS injection methods for frozen shoulder were included. DATA EXTRACTION Data were extracted independently by 2 authors. Risk of bias was assessed using the RoB 2 tool. DATA SYNTHESIS A random-effects network meta-analysis was performed within a frequentist framework. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations approach. A total of 66 RCTs involving 4491 patients were included. For short-term outcomes, 4-site injection (vs placebo [PLA]: standardized mean difference [SMD]=-2.20, 95% confidence interval [CI], -2.81 to -1.59 in pain; SMD=2.02; 95% CI, 1.39-2.65 in global function) was the most effective (low certainty). Rotator interval injection was the optimal treatment with moderate to high certainty (vs PLA: SMD=-1.07, 95% CI, -1.51 to -0.64 in pain; SMD=0.94, 95% CI, 0.49-1.40 in global function). For midterm outcomes, 4-site injection was most effective (vs PLA: SMD=-1.71, 95% CI, -2.41 to -1.01 in pain; SMD=2.22, 95% CI, 1.34-3.09 in global function; low certainty). Distension via rotator interval (D-RI) was the optimal treatment with moderate to high certainty (vs PLA: SMD=-1.10, 95% CI, -1.69 to -0.51 in pain; SMD=1.46, 95% CI, 0.73-2.20 in global function). Distension and intra-articular injection via anterior or posterior approaches produced effects equivalent to those of rotator interval injection and D-RI. CONCLUSIONS Rotator interval injection, distension, and intra-articular injection had equivalent effects on symptom relief. More RCTs are required to validate the superiority of multisite injections.
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Affiliation(s)
- Chun-Wei Liang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei; Department of Primary Care Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei
| | - Hsiao-Yi Cheng
- School of Medicine, College of Medicine, Taipei Medical University, Taipei; Department of Primary Care Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
| | - Yu-Hao Lee
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Chun- De Liao
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei; Master's Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei.
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11
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Dupeyron A, Dobija L, Castelli C, Petiot S, Tavares I, Gélis A, Coudeyre E. Nitrous oxide provided during intensive physiotherapy for shoulder adhesive capsulitis does not improve function: A randomised controlled trial. Ann Phys Rehabil Med 2024; 67:101803. [PMID: 38118247 DOI: 10.1016/j.rehab.2023.101803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/22/2023] [Accepted: 10/05/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND There is no consensus on treatment for adhesive capsulitis of the shoulder. Physiotherapy is often used to increase range of motion but individuals may experience pain during mobilisation. OBJECTIVES The objective of this study was to determine whether rehabilitation under N2O for shoulder AC improved pain and function more than rehabilitation alone (with placebo gas). METHOD A randomised, 1:1 parallel arm, double-blind study in 4 university hospital outpatient centres. Adults with adhesive capsulitis for at least 3 months with intact cartilage were included. Participants were randomised in blocks of 4 and stratified by centre to receive 20 sessions of intensive physiotherapy over 10 days; the 10 morning sessions were performed with either nitrous oxide (intervention) or sham gas (placebo). PRIMARY OUTCOME improvement in shoulder function at day 14 (D14) (Constant-Murley score). RESULTS Seventy-five participants were included, and data from 69 were analysed: 37 in the placebo group and 32 in the intervention group. Improvements occurred in both groups after the intervention. No significant difference in the Constant-Murley score was found between groups at D14 (median score increase of 12.0, IQR 5.6; 19.5 points in placebo group vs. 13.7, 5.2; 18.2 in the N20 group, p = 0.78). Pain score during sessions reduced in the intervention group from the first to final session (-11.6, p = 0.053) but not for the placebo group (-4.2, p = 0.414). Seven serious adverse events were recorded, 4 in the intervention group and 3 in the placebo group, with 11 minor adverse events only in the intervention group (mostly shortness of breath). CONCLUSION Nitrous oxide gas associated with intensive physiotherapy for shoulder adhesive capsulitis did not improve function, pain or quality of life more than physiotherapy alone. zHowever, pain experienced during physiotherapy sessions appeared lower. TRIAL REGISTRATION Clinical Trial registration number NCT01087229.
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Affiliation(s)
- Arnaud Dupeyron
- Department of Physical Medicine and Rehabilitation, CHU Nîmes, Univ Montpellier, Nîmes, France; EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Montpellier, France.
| | - Lech Dobija
- Department of Physical Medicine and Rehabilitation, CHRU de Clermont-Ferrand Université Clermont Auvergne, France
| | - Christel Castelli
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Sylvie Petiot
- Department of Physical Medicine and Rehabilitation, CHU Nîmes, Univ Montpellier, Le Grau du Roi, France
| | - Isabelle Tavares
- Department of Physical Medicine and Rehabilitation, CHRU Lapeyronie, Univ Montpellier, Montpellier, France
| | - Anthony Gélis
- Propara Neurologic Rehabilitation Centre, Parc Euromédecine, Montpellier, France
| | - Emmanuel Coudeyre
- Department of Physical Medicine and Rehabilitation, CHRU de Clermont-Ferrand Université Clermont Auvergne, France; INRA, Unité de Nutrition Humaine (UNH, UMR 1019), CRNH Auvergne, Clermont-Ferrand, France
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12
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Yüce A, Gür V, Yerli M, Misir A. The Lack of High-quality Educational Resources about Adhesive Capsulitis on YouTube. Rev Bras Ortop 2024; 59:e260-e268. [PMID: 38606132 PMCID: PMC11006515 DOI: 10.1055/s-0044-1785465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/04/2023] [Indexed: 04/13/2024] Open
Abstract
Objective The advent of the Internet has provided new, easily accessible resources for patients seeking additional health information. Many doctors and healthcare organizations post informative videos on this platform, and nearly all patients are looking for videos online for a second opinion. Methods The phrases "frozen shoulder," "frozen shoulder treatment," "adhesive" capsulitis, and "adhesive capsulitis treatment" were entered into YouTube's search bar for a normal inquiry. The informativeness and overall quality of the adhesive capsulitis videos were rated using three separate scales. Results The mean and standard deviation values of the scoring systems were JAMA 1.25 ± 0.51, DISCERN 39.4 ± 13.4, GQS 2.83 ± 0.96 and ACSS 7.43 ± 4.86, respectively. Number of views, rate of views, and likes all had a positive correlation with Global Quality Score (GQS), as did DISCERN and ACSS. There was no statistically significant difference between the median JAMA, GQS score and Discern Criteria values according to the video source/uploader (p > 0.05). Conclusion YouTube videos on adhesive capsulitis, thus, need to be of higher quality, reliability, and instructive quality. There is a need for reliable videos about adhesive capsulitis, with instructional and high-quality cited.
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Affiliation(s)
- Ali Yüce
- Departamento de Ortopedia e Traumatologia, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istambul, Turquia
| | - Volkan Gür
- Departamento de Ortopedia e Traumatologia, Mengücek Gazi Education and Research Hospital, Erzincan Binali Yıldırım University, Erzincan, Turquia
| | - Mustafa Yerli
- Departamento de Ortopedia e Traumatologia, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istambul, Turquia
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13
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Navarro-Ledesma S, Hamed-Hamed D, Pruimboom L. A new perspective of frozen shoulder pathology; the interplay between the brain and the immune system. Front Physiol 2024; 15:1248612. [PMID: 38617059 PMCID: PMC11009429 DOI: 10.3389/fphys.2024.1248612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 03/18/2024] [Indexed: 04/16/2024] Open
Abstract
Frozen shoulder (FS), also known as adhesive capsulitis of the shoulder (FS), is a fibrotic inflammatory process of unknown etiology whose main symptoms are pain, stiffness and the loss of joint mobility. These symptoms may be associated with pathologies such as diabetes, Dupuytren's syndrome and the prevalence of today's sedentary lifestyle. This literature review provides an overview of the epidemiology and pathogenesis of this pathology, as well as the mechanisms of lowgrade chronic inflammation and infection, insulin resistance, and omics-science associated with it. We also propose a new hypothesis related to the possibility that the GABAergic system could play a decisive role in the development of frozen shoulder and that therefore diabetes type 1, endocrinological autoimmune disorders and frozen shoulder are connected by the same pathophysiological mechanisms. If that is true, the combined presence of psycho-emotional stress factors and pathogenic immune challenges could be the main causes of frozen shoulder syndrome. Finally, we propose a series of possible intervention strategies based on a multifactorial etiological and mechanistic concept.
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Affiliation(s)
- Santiago Navarro-Ledesma
- Department of Physical Therapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
- University Chair in Clinical Psychoneuroimmunology, University of Granada and PNI Europe, Melilla, Spain
| | - Dina Hamed-Hamed
- Clinical Medicine and Public Health PhD Program, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Leo Pruimboom
- University Chair in Clinical Psychoneuroimmunology, University of Granada and PNI Europe, Melilla, Spain
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14
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Tamai K, Hamada J, Nagase Y, Morishige M, Naito M, Asai H, Tanaka S. Frozen shoulder. An overview of pathology and biology with hopes to novel drug therapies. Mod Rheumatol 2024; 34:439-443. [PMID: 37632764 DOI: 10.1093/mr/road087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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.
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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
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15
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Dan F, Xie P, Yang J, Ruan W, Li J, Li X. Arthroscopic treatment for rotator cuff injury and frozen shoulder with concomitant rotator cuff injury: analysis of efficacy and factors influencing prognosis. Am J Transl Res 2024; 16:864-872. [PMID: 38586099 PMCID: PMC10994805 DOI: 10.62347/qlmc4456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/05/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To analyze the efficacy of arthroscopic treatment for patients with rotator cuff injuries and frozen shoulder combined with rotator cuff injuries and assess the factors influencing patient prognosis. METHODS A retrospective analysis was performed on 85 patients who underwent arthroscopic surgery at Hanzhong Central Hospital between October 2016 and October 2021, including 42 patients treated for rotator cuff injuries alone (Group A), and 43 patients for frozen shoulder combined with rotator cuff injuries (Group B). Both groups underwent general anesthesia with controlled hypotension during surgery. Treatment outcomes, including shoulder joint functional scores, pain scores, shoulder joint range of motion, and muscle strength were assessed and compared between the two groups before treatment, as well as at 2 weeks and 2 months post-treatment. Quality of life was also evaluated and compared at 2 months post-treatment. Patients were categorized into good and poor prognosis groups based on their outcome, and factors influencing patient prognosis were analyzed. RESULTS Before treatment, both groups exhibited relatively low shoulder joint function scores and external rotation angles, coupled with higher pain scores; however, these differences were not significant between groups (all P>0.05). The surgery duration for Group B was notably longer than that of Group A (P<0.05). Nevertheless, there was no significant variance in intraoperative blood loss between the two groups (P>0.05). After a 2-week treatment duration, both groups demonstrated a significant improvement in shoulder joint function score, pain score, and shoulder joint range of motion compared to baseline, but with no statistically significant intergroup differences. However, two months after the treatment, patients in Group A exhibited marked improvements in shoulder joint function score, pain score, shoulder joint range of motion, and overall quality of life compared to Group B (all P<0.05). Furthermore, the therapeutic efficacy in Group A was superior to that in Group B at the 2-month follow-up (P<0.05). Age, comorbid diabetes, metabolic disorders such as thyroid dysfunction, and the extent of shoulder cuff injury were identified as independent risk factors influencing prognosis. CONCLUSION Arthroscopic treatment is effective for both frozen shoulder combined with rotator cuff injury and rotator cuff injury alone, with better outcomes observed in patients with rotator cuff injury only. This technique warrants further promotion.
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Affiliation(s)
- Feng Dan
- Department of Bone and Joint Trauma, Hanzhong Central HospitalHanzhong 723000, Shaanxi, China
| | - Peng Xie
- Department of Bone and Joint Trauma, Hanzhong Central HospitalHanzhong 723000, Shaanxi, China
| | - Jianzhi Yang
- Department of Surgical Anesthesiology, Hanzhong Central HospitalHanzhong 723000, Shaanxi, China
| | - Wenhui Ruan
- Department of Bone and Joint Trauma, Hanzhong Central HospitalHanzhong 723000, Shaanxi, China
| | - Jiarui Li
- Department of Bone and Joint Trauma, Hanzhong Central HospitalHanzhong 723000, Shaanxi, China
| | - Xuedan Li
- Department of Surgical Anesthesiology, Hanzhong Central HospitalHanzhong 723000, Shaanxi, China
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16
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Weinberg D, McDaniel M, Pan J. Adhesive Capsulitis Following Improper Tetanus-Diphtheria (Td) Booster Administration. Cureus 2024; 16:e57113. [PMID: 38681273 PMCID: PMC11055470 DOI: 10.7759/cureus.57113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Adhesive capsulitis following vaccination is a rare complication secondary to improper intramuscular (IM) deltoid vaccine administration. It is considered a subset of the broad category known as shoulder injury related to vaccine administration (SIRVA). SIRVA typically results from improper shoulder anatomic localization prior to injection, leading to erroneous placement of the needle into the glenohumeral joint capsule or subacromial space. This can trigger a wide array of pathologies, including adhesive capsulitis. We present the first known case of adhesive capsulitis following improper tetanus-diphtheria (Td) vaccine administration. The patient, a previously healthy middle-aged female, began experiencing significant anterior left shoulder pain the day following a Td booster vaccination. She remarked receiving the injection "higher up" in the shoulder than normal. Over the next two weeks, she began noting significant shoulder stiffness, which was followed by a progressive loss of shoulder range of motion. Her symptoms persisted for four months without definitive diagnosis or treatment. After four months of symptoms, the patient visited an outpatient sports medicine clinic where the diagnosis of adhesive capsulitis was made. Although the patient was referred for physical therapy, focusing on gentle range of motion (ROM) and stretches, followed by a planned isometric strengthening program once ROM improved, she was eventually lost to follow-up, and her recovery is unclear. Given the rarity of the diagnosis, it is unclear if adhesive capsulitis, secondary to improper IM vaccination, follows the same temporal course as "classic" adhesive capsulitis or results in a different timeframe of recovery. Further studies are needed on this subject.
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Affiliation(s)
- David Weinberg
- Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, USA
| | - Mackinzie McDaniel
- Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, USA
| | - Jason Pan
- Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, USA
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17
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Wu SY, Hsu PC, Tsai YY, Huang JR, Wang KA, Wang JC. Efficacy of combined ultrasound-guided hydrodilatation with hyaluronic acid and physical therapy in patients with adhesive capsulitis: A randomised controlled trial. Clin Rehabil 2024; 38:202-215. [PMID: 37697666 DOI: 10.1177/02692155231200089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To evaluate the therapeutic effect of combining ultrasound-guided hydrodilatation with hyaluronic acid and physical therapy compared with physical therapy alone in patients with adhesive capsulitis. DESIGN A prospective, single-blinded, randomised controlled trial. SETTING Single medical centre. PARTICIPANTS Patients with adhesive capsulitis (N = 62) were divided into group A: ultrasound-guided hydrodilatation with hyaluronic acid + physical therapy (N = 31) and group B: physical therapy alone (N = 31). INTERVENTIONS Group A received three doses of ultrasound-guided hydrodilatation with hyaluronic acid-based injectates (20 mL in total). Both groups underwent structured physical therapy. OUTCOME MEASURES The primary outcome measure was Constant score, while secondary outcomes included Shoulder Pain and Disability Index score, numerical rating scale (at rest, night, and during motion), 36-item Short Form Health Survey, and range of motion of the shoulder. All measurements were collected at baseline, 6 weeks, and 12 weeks post-injection. RESULTS At week 12, the Constant scores were 68.29 ± 14.55 and 62.77 ± 14.44 for groups A and B, respectively. There was a greater reduction in the Constant score, Shoulder Pain and Disability Index, and numerical rating scale between the baseline and 6 weeks and between the baseline and 12 weeks in group A (Constant score: p < 0.05, Shoulder Pain and Disability Index: p < 0.01, and numerical rating scale: p < 0.05). CONCLUSION The combination of ultrasound-guided hydrodilatation with hyaluronic acid in conjunction with physical therapy provides additional benefits compared to physical therapy alone for the treatment of adhesive capsulitis at up to 12 weeks. TRIAL REGISTRATION ClinicalTrials.gov: NCT02708706.
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Affiliation(s)
- Shang-Yu Wu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Cheng Hsu
- Department of Physical Medicine and Rehabilitation, West Garden Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation Medicine, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan
| | - Yuan-Yuan Tsai
- Department of Physical Medicine and Rehabilitation Medicine, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan
| | - Jian-Ru Huang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kevin A Wang
- Divison of General Surgery, Department of Surgery, Shin-Kong Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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18
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Wu X, Li W, Luo Z, Chen Y. A comprehensive comparison of the safety and efficacy of drugs in the treatment of idiopathic pulmonary fibrosis: a network meta-analysis based on randomized controlled trials. BMC Pulm Med 2024; 24:58. [PMID: 38281037 PMCID: PMC10822186 DOI: 10.1186/s12890-024-02861-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/10/2024] [Indexed: 01/29/2024] Open
Abstract
OBJECTIVE Randomized controlled trials(RCTs) of multiple drugs for Idiopathic pulmonary fibrosis(IPF) have been reported and achieved a certain degree of efficacy, however, the difference in safety and efficacy of them for IPF is not yet well understood. The aim of this network meta-analysis is to assess their safety and efficacy in the treatment of IPF and differences in this safety and efficacy comprehensively. METHODS The PubMed, EMbase, CENTRAL and MEDLINE were retrieved to find out the RCTs of drugs in the treatment of IPF. The retrieval date is from construction to November 10, 2022. Stata 14.0 and RevMan 5.3 was used for statistical analysis. REGISTRATION NUMBER CRD42023385689. RESULTS Twenty-four studies with a total of 6208 patients were finally included, including RCTs of 13 drugs. The results of safety showed that there' s no difference in the incidence of SAEs of 13 drugs treated with IPF compared to placebo (P>0.05), and it's also found that Warfarin had a higher all-cause mortality for IPF than placebo (OR = 5.63, 95% CI [1.54 to 20.55]). SUCRA' s scatterplot showed that Pirfenidone, Nintedanib, Sildenafil and Imatinib were lower than placebo, and Warfarin, Ambrisentan and N-acetylcysteine were higher than placebo. The results of effectiveness showed that Nintedanib (MD = -0.08, 95% CI [-0.12 to -0.04]) improved FVC (L)absolute change from baseline in patients better than placebo, and Nintedanib (OR=1.81, 95% CI [1.23 to 2.66]), Pirfenidone (OR=1.85, 95%CI [1.26 to 2.71]) and Pamrevlumab (OR=4.11, 95% CI [1.25 to 13.58]) improved the proportion of patients with a decline in FVC ≥10% predicted better than placebo. SUCRA' s scatterplot showed that Pamrevlumab, Pirfenidone and Nintedanib were lower than placebo, and Warfarin and Ambrisentan were higher than placebo. CONCLUSION Compared with other drugs, Nintedanib and Pirfenidone can significantly slow the decline of lung function in patients with IPF, and the safety is higher. Therefore, they can be further promoted in clinical practice. Warfarin and Ambrisentan shouldn't be used clinically for IPF as the safety and efficacy of them are poor compared to other drugs and placebo. Pamrevlumab may become important drugs for the treatment of IPF in the future.
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Affiliation(s)
- Xiaozheng Wu
- Department of Preclinical medicine, Guizhou University of Traditional Chinese Medicine, Guiyang, 510025, China
| | - Wen Li
- Department of Preclinical medicine, Guizhou University of Traditional Chinese Medicine, Guiyang, 510025, China
| | - Zhenliang Luo
- Department of Preclinical medicine, Guizhou University of Traditional Chinese Medicine, Guiyang, 510025, China
| | - Yunzhi Chen
- Department of Preclinical medicine, Guizhou University of Traditional Chinese Medicine, Guiyang, 510025, China.
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19
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Cucchi D, Di Giacomo G, Compagnoni R, Castricini R, Formigoni C, Radici M, Melis B, Brindisino F, De Giorgi S, De Vita A, Lisai A, Mangiavini L, Candela V, Carrozzo A, Pannone A, Menon A, Giudici LD, Klumpp R, Padua R, Carnevale A, Rosa F, Marmotti A, Peretti GM, Berruto M, Milano G, Randelli P, Bonaspetti G, De Girolamo L. A high level of scientific evidence is available to guide treatment of primary shoulder stiffness: The SIAGASCOT consensus. Knee Surg Sports Traumatol Arthrosc 2024; 32:37-46. [PMID: 38226696 DOI: 10.1002/ksa.12017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/21/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Shoulder stiffness (SS) is a condition characterised by active and passive restricted glenohumeral range of motion, which can occur spontaneously in an idiopathic manner or be associated with a known underlying aetiology. Several treatment options are available and currently no consensus has been obtained on which treatment algorithm represents the best choice for the patient. Herein we present the results of a national consensus on the treatment of primary SS. METHODS The project followed the modified Delphi consensus process, involving a steering, a rating and a peer-review group. Sixteen questions were generated and subsequently answered by the steering group after a thorough literature search. A rating group composed by professionals specialised in the diagnosis and treatment of shoulder pathologies rated the question-answer sets according to the scientific evidence and their clinical experience. RESULTS Recommendations were rated with an average of 8.4 points out of maximum 9 points. None of the 16 answers received a rating of less than 8 and all the answers were considered as appropriate. The majority of responses were assessed as Grade A, signifying a substantial availability of scientific evidence to guide treatment and support recommendations encompassing diagnostics, physiotherapy, electrophysical agents, oral and injective medical therapies, as well as surgical interventions for primary SS. CONCLUSIONS A consensus regarding the conservative and surgical treatment of primary SS could be achieved at a national level. This consensus sets basis for evidence-based clinical practice in the management of primary SS and can serve as a model for similar initiatives and adaptable guidelines in other European countries and potentially on a global scale. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
| | | | - Riccardo Compagnoni
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
| | - Roberto Castricini
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Casa di Cura Villa Verde, Fermo, Italy
| | - Chiara Formigoni
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- GIDIF-RBM - Italian Group of Information Specialist from Pharmaceutical Company and Biomedical Research Institutes, Milan, Italy
| | - Mattia Radici
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
| | - Barbara Melis
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Unità di Ortopedia e traumatologia dello sport, Casa di cura "Policlinico Città di Quartu", Quartu Sant'Elena, Italy
| | - Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, Italy
| | - Silvana De Giorgi
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari, Bari, Italy
| | - Andrea De Vita
- Concordia Hospital Roma, Rome, Italy
- SIAGASCOT "Shoulder" Committee, Rome, Italy
| | - Andrea Lisai
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Unità Funzionale Chirurgia della Spalla, Humanitas San Pio X, Milan, Italy
| | - Laura Mangiavini
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- IRCCS Istituto Ortopedico Galeazzi-Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Candela
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Alessandro Carrozzo
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Antonello Pannone
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Policlinico "Città di Udine", Udine, Italy
| | - Alessandra Menon
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Scuola di Specializzazione in Statistica Sanitaria e Biometria, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Luca Dei Giudici
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Casa di Cura "Villa dei Pini", Civitanova Marche, Italy
| | - Raymond Klumpp
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Department of Orthopaedics and Trauma Surgery, ASST Bergamo Ovest, Treviglio, Italy
| | | | - Arianna Carnevale
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Francesco Rosa
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Humanitas Clinical and Research Center -IRCCS, Rozzano, Italy
| | - Antongiulio Marmotti
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- Department of Orthopaedics and Traumatology, University of Torino, Turin, Italy
| | - Giuseppe M Peretti
- IRCCS Istituto Ortopedico Galeazzi-Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Massimo Berruto
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
| | - Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- ASST Spedali Civili, UOC Clinica Ortopedica, Brescia, Italy
| | - Pietro Randelli
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Bonaspetti
- Department of Orthopaedics and Traumatology, Clinica S. Anna, Brescia, Italy
| | - Laura De Girolamo
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- IRCCS Istituto Ortopedico Galeazzi-Sant'Ambrogio, Milan, Italy
- Laboratorio di Biotecnologie applicate all'Ortopedia, Milan, Italy
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20
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Hill JL. Evidence for Combining Conservative Treatments for Adhesive Capsulitis. Ochsner J 2024; 24:47-52. [PMID: 38510216 PMCID: PMC10949050 DOI: 10.31486/toj.23.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Background: Adhesive capsulitis, also known as frozen shoulder, is a challenge to treat clinically. Common first-line treatment options are suprascapular nerve block (SSNB), intra-articular corticosteroid (IACS) injection, hydrodilatation, and physical therapy. This literature review summarizes each of these conservative treatments and discusses the evidence base for combining treatment options for potential additive benefits to improve patient outcomes (ie, pain, range of motion [ROM], and shoulder function). Methods: The PubMed and Google Scholar databases were searched using the search terms "adhesive capsulitis," "frozen shoulder," "corticosteroids," "physical therapy," "suprascapular nerve block," "hydrodilatation," and "conservative care." Pertinent articles were identified and synthesized to provide a comprehensive review of 4 common conservative treatments for adhesive capsulitis. Results: Combining SSNB with physical therapy and/or IACS injection and combining IACS injection with physical therapy have support in the literature for improving shoulder pain, ROM, and function, while hydrodilatation and physical therapy seem to offer some additive benefits for improving shoulder ROM when used as adjunct treatments for adhesive capsulitis. Conclusion: Adhesive capsulitis remains a challenge to treat clinically with much still unknown regarding treatment optimization. For the foreseeable future, first-line conservative management will continue to be the mainstay of managing adhesive capsulitis. Thus, knowing how to best use and optimize these various options-both individually and in combination-is vital for effective treatment.
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Affiliation(s)
- Jordan L. Hill
- Ochsner Therapy and Wellness, Driftwood Clinic, Ochsner Clinic Foundation, Kenner, LA
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21
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Biglia A, Morandi V, Zanframundo G, Donati D, Maggiore F, Vita F, Sammarchi L, Pagani C, Cavagna L, Galletti S, Montecucco C. Adhesive capsulitis after COVID-19 vaccine injection: a peculiar case treated with combined bursa distention and glenohumeral capsular hydrodilatation. J Ultrasound 2023; 26:909-911. [PMID: 36595199 PMCID: PMC9809505 DOI: 10.1007/s40477-022-00739-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/01/2022] [Indexed: 01/04/2023] Open
Abstract
Frozen shoulder is a common and self-limiting condition affecting the soft tissues of the shoulders, characterized by severe pain, impaired range of motion (ROM) and limitation of daily activities. Its prevalence is 5% and it occurs most commonly in the fifth and sixth decades of life; women are more affected [DePalma in Clin Orthop Relat Res 466:552-560, 2008]. It can be idiopathic or associated with other conditions such as metabolic disorders, diabetes, thyroid diseases, prolonged immobilization, trauma [DePalma in Clin Orthop Relat Res 466:552-560, 2008], or complications after vaccine administration known as SIRVA (Shoulder injury related to vaccine administration). SIRVA is not caused by the vaccine itself but by inappropriate vaccination techniques [Martín Arias et al. in Vaccine 35:4870-4876, 2017]. The natural history of the frozen shoulder is a progression through three stages based on clinical and arthroscopic presentations: freezing, frozen and thawing [DePalma in Clin Orthop Relat Res 466:552-560, 2008; Do et al. in Orthop J Sport Med 9:232596712110036, 2021]. The onset is characterized by disabling pain, that worsens at night; it is induced by inflammation and hypervascularity and lasts from 10 to 36 weeks [Do et al. in Orthop J Sport Med 9:232596712110036, 2021]. The second stage is predominated by stiffness and severe reduction of ROM. This phase typically lasts from 9 to 12 months [Do et al. in Orthop J Sport Med 9:232596712110036, 2021]. Eventually, a recovery phase occurs, with a gradual recovery of the ROM that can last between 12 and 42 months. Ultrasound is an emerging diagnostic tool that contributes to differential diagnosis and treatment [Zappia et al. in Insights Imaging 7:365-371, 2016; Ricci et al. in J Ultrasound Med 39:633-635, 2020]: signs of adhesive capsulitis consist of thickening of the inferior recess of the glenohumeral joint capsule, thickening of the coracohumeral ligament and soft tissue structures in the rotator cuff interval, with hypervascularity. An unspecific sign is increased fluid in the tendon sheath of the long head of the biceps [Martín Arias et al. in Vaccine 35:4870-4876, 2017; Tandon et al. in J Ultrasound 20:227-236, 2017].
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Affiliation(s)
- Alessandro Biglia
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy
| | - Valentina Morandi
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy.
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy.
| | - Giovanni Zanframundo
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy
| | - Danilo Donati
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, BO, Italy
| | - Francesco Maggiore
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy
| | - Fabio Vita
- Department of Orthopedic and Traumatological Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luigi Sammarchi
- Department of Diagnostic and Interventional Radiology and Neuroradiology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - Chiara Pagani
- Department of Diagnostic and Interventional Radiology and Neuroradiology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - Lorenzo Cavagna
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy
| | - Stefano Galletti
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology, Bologna, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, V. le Golgi 19, 27100, Pavia, Italy
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22
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Marco E, Trépanier G, Chang E, Mauti E, Jones JM, Zhong T. Postmastectomy Functional Impairments. Curr Oncol Rep 2023; 25:1445-1453. [PMID: 37955831 PMCID: PMC10728246 DOI: 10.1007/s11912-023-01474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE OF REVIEW This narrative review aims to offer a thorough summary of functional impairments commonly encountered by breast cancer survivors following mastectomy. Its objective is to discuss the factors influencing these impairments and explore diverse strategies for managing them. RECENT FINDINGS Postmastectomy functional impairments can be grouped into three categories: neuromuscular, musculoskeletal, and lymphovascular. Neuromuscular issues include postmastectomy pain syndrome (PMPS) and phantom breast syndrome (PBS). Musculoskeletal problems encompass myofascial pain syndrome and adhesive capsulitis. Lymphovascular dysfunctions include lymphedema and axillary web syndrome (AWS). Factors such as age, surgical techniques, and adjuvant therapies influence the development of these functional impairments. Managing functional impairments requires a comprehensive approach involving physical therapy, pharmacologic therapy, exercise, and surgical treatment when indicated. It is important to identify the risk factors associated with these conditions to tailor interventions accordingly. The impact of breast reconstruction on these impairments remains uncertain, with mixed results reported in the literature.
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Affiliation(s)
- Eden Marco
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | | | - Eugene Chang
- Department of Medicine, Division of Physical Medicine & Rehabilitation, University of Toronto, Toronto, ON, Canada
- Department of Supportive Care, Cancer Rehab & Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Multisystem & Musculoskeletal Rehabilitation Program, Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Emma Mauti
- Department of Medicine, Division of Physical Medicine & Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Jennifer M Jones
- Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Toni Zhong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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23
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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] [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
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24
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Lin HW, Tam KW, Liou TH, Rau CL, Huang SW, Hsu TH. Efficacy of Platelet-Rich Plasma Injection on Range of Motion, Pain, and Disability in Patients With Adhesive Capsulitis: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2023; 104:2109-2122. [PMID: 37119955 DOI: 10.1016/j.apmr.2023.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To investigate the therapeutic effects of platelet-rich plasma (PRP) injection on range of motion, pain, and disability in patients with adhesive capsulitis (AC). DATA SOURCES The authors performed the literature search in the PubMed, Embase, and Cochrane Library databases in February 2023. STUDY SELECTION Prospective studies comparing the outcomes of PRP with other intervention in patients with AC. DATA EXTRACTION The quality of included randomized trials was assessed using the revised Cochrane Risk of Bias (RoB 2.0) tool. The Risk of Bias in Non-Randomized Studies of Interventions tool was applied to assess the quality of nonrandomized trials. The mean difference (MD) or standardized mean difference (SMD) was determined as the effect size for continuous outcomes, and outcome accuracy was determined using 95% confidence intervals (CIs). DATA SYNTHESIS Fourteen studies involving 1139 patients were included. Our meta-analysis revealed that PRP injection can significantly improve passive abduction (MD=3.91; 95% CI, 0.84-6.98), passive flexion (MD=3.90; 95% CI, 0.15-7.84), and disability (SMD=-0.50; 95% CI, -1.29 to -0.74) within 1 month after intervention. Moreover, PRP injection can significantly improve passive abduction (MD=17.19; 95% CI, 12.38-22.01), passive flexion (MD=17.74; 95% CI, 9.89-25.59), passive external rotation (MD=12.95; 95% CI, 10.04-15.87), pain (MD=-8.40; 95% CI, -16.73 to -0.06), and disability (SMD=-1.02; 95% CI, -1.29 to -0.74) 3 months after intervention. PRP injection can also significantly improve pain (MD=-18.98; 95% CI, -24.71 to -13.26), and disability (SMD=-2.01; 95% CI, -3.02 to -1.00) 6 months after intervention. In addition, no adverse effects of PRP injection were reported. CONCLUSIONS PRP injection may serve as an effective and safe treatment for patients with AC.
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Affiliation(s)
- Ho-Wei Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City
| | - Ka-Wai Tam
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City; Cochrane Taiwan, Taipei Medical University, Taipei City; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Chi-Lun Rau
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Tzu-Herng Hsu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
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25
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Song W, Guo X, Wang X, Yu J, Jiang W, Wei C, Zhao Y. A multi-center, single-blinded, randomized, parallel-group, superiority study to compare the efficacy of manipulation under anesthesia versus intra-articular steroid injection in the treatment of patients with frozen shoulder and a diagnosis of rotator cuff injury or tear by MRI: study protocol for a randomized controlled trial. Trials 2023; 24:765. [PMID: 38012777 PMCID: PMC10683184 DOI: 10.1186/s13063-023-07810-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Frozen shoulder (FS) is a common condition that can cause severe pain and limited range of motion in the shoulder joint. While intra-articular steroid injection has been shown to be an effective treatment for FS, manipulation under anesthesia (MUA) is an alternative treatment that has gained popularity in recent years. However, there is a lack of evidence regarding the effectiveness of MUA on FS patients with concomitant rotator cuff injury or tear. Though a few studies have shown that MUA is not associated with rotator cuff tears, and will not exacerbate the injury, more high-quality studies with bigger sample sizes are needed. Therefore, the aim of this multi-center, single-blinded, randomized, parallel-group, superiority study is to compare the efficacy of MUA versus intra-articular steroid injection in the treatment of FS patients with a diagnosis of rotator cuff injury or tear by MRI. METHODS A parallel, single-blinded, multi-center randomized controlled trial of 320 patients will be conducted at three hospitals of China. Eligible patients with frozen shoulder and rotator cuff injury or tear diagnosed by MRI will be randomly assigned to, in equal proportions, the manipulation under anesthesia group and the intra-articular steroid injection group via a central randomization system, undergoing a corresponding operation on day one and a sequent physical exercise for 14 days. The primary outcome is the comprehensive efficacy evaluation (total effective rate) and the change of Constant-Murley Score. Outcome assessors and data analysts will be blinded, and participants will be asked not to reveal their allocation to assessors. DISCUSSION This study aims to explore the superiority of manipulation under anesthesia in reducing pain and improving shoulder function in frozen shoulder patients accompanied with rotator cuff injury. To provide a scientific basis for the dissemination and application of manipulation under anesthesia, and a better knowledge for the role of MUA in the treatment of frozen shoulder accompanied with rotator cuff injury. TRIAL REGISTRATION Chictr.org.cn ChiCTR2200067122 . Registered on 27 December 2022. ChiCTR is a primary registry of the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) network and includes all items from the WHO Trial Registration data set in Trial registration.
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Affiliation(s)
- Wuwei Song
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoyu Guo
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang Wang
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Jiacheng Yu
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenyu Jiang
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen Wei
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuhao Zhao
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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26
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Saito T, Hamada J, Sasanuma H, Iijima Y, Saitsu A, Minagawa H, Kurashina W, Takeshita K. Clinical outcomes and cost-effectiveness of manipulation under brachial plexus block versus physiotherapy for refractory frozen shoulder: a prospective observational study. JSES Int 2023; 7:2410-2419. [PMID: 37969535 PMCID: PMC10638598 DOI: 10.1016/j.jseint.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Frozen shoulder (FS) is a pathological condition that involves a painful and stiff shoulder joint, most commonly in people aged 40-60 years. Most literature supports treatment with physical therapy (PT), although some studies have demonstrated years of continuing pain and functional deficits. Manipulation under anesthesia is effective at eliminating the contracture of intra-articular lesions for refractory FS. This study aimed to compare whether manipulation under anesthesia or PT is a more effective treatment in refractory FS. Methods This study was a prospective observational study. A total of 102 patients with refractory FS were enrolled in this study in the medical records, all of whom had severe and multidirectional loss of motion and thickening of the joint capsule and coracohumeral ligament on magnetic resonance imaging. Fifty-one patients were in the manipulation under brachial plexus block (MUB) group (34 females, median age: 57 years), and 51 patients were in the PT group (34 females, median age: 59 years). The MUB procedure consisted of the conventional method with additional adduction manipulation, in which one examiner initially abducted the shoulder joint as much as possible. We recorded the visual analog scale, shoulder range of motion, and American Shoulder and Elbow Surgeons and Constant Scores at the initial baseline visit and at the 1-, 3-, 6-, and 12-month follow-ups. The total cost was calculated from the medical records, and cost-effectiveness was evaluated using quality-adjusted life year and incremental cost-effectiveness ratio. Results Visual analog scale (P < .001), range of motion (P < .001), and American Shoulder and Elbow Surgeons and Constant Scores (P < .001) in the MUB group were significantly superior to those in the PT group at 1, 3, 6, and 12 months after treatment. The median cost and total quality-adjusted life year in the MUB and PT groups were $1375 versus $2751 and 2.95 versus 2.68, respectively, and the cost-effectiveness ratio between the MUB and PT groups was calculated as -$560. Conclusions The new MUB procedure provides a shorter treatment period, better clinical outcomes, and higher cost-effectiveness in patients with refractory FS compared to PT.
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Affiliation(s)
- Tomohiro Saito
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Junichiro Hamada
- Department of Orthopaedic Surgery, Kuwano Kyoritsu Hospital, Fukushima, Japan
| | - Hideyuki Sasanuma
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Yuki Iijima
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Akihiro Saitsu
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Hiroshi Minagawa
- Department of Orthopaedic Surgery, Joto Orthpedic Clinic, Akita, Japan
| | - Wataru Kurashina
- Department of Rehabilitation, Tochigi Medical Center Shimotsuga, Tochigi, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
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27
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Deodato M, Martini M, Buoite Stella A, Citroni G, Ajčević M, Accardo A, Murena L. Inertial Sensors and Pressure Pain Threshold to Evaluate People with Primary Adhesive Capsulitis: Comparison with Healthy Controls and Effects of a Physiotherapy Protocol. J Funct Morphol Kinesiol 2023; 8:142. [PMID: 37873901 PMCID: PMC10594492 DOI: 10.3390/jfmk8040142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/25/2023] Open
Abstract
Inertial sensors (IMUs) have been recently widely used in exercise and rehabilitation science as they can provide reliable quantitative measures of range of motion (RoM). Moreover, the pressure pain threshold (PPT) evaluation provides an objective measure of pain sensation in different body areas. The aim of this study was to evaluate the efficacy of physiotherapy treatment in people with adhesive capsulitis in terms of RoM and pain improvement measured by IMUs and the PPT. A combined prospective cohort/cross-sectional study was conducted. Nineteen individuals with adhesive capsulitis (10/19 females, 54 ± 8 years) and nineteen healthy controls (10/19 females, 51 ± 6 years) were evaluated for active glenohumeral joint RoM and PPT on shoulder body areas. Then, individuals with adhesive capsulitis were invited to 20 sessions of a physiotherapy protocol, and the assessments were repeated within 1 week from the last session. The range of motion in the flexion (p = 0.001) and abduction (p < 0.001) of the shoulder increased significantly after the physiotherapy protocol. Similarly, the PPT was found to increase significantly in all the assessed shoulder body areas, leading to no significant differences compared to the healthy controls. IMU and PPT assessments could be used to evaluate the efficacy of physical therapy in people with adhesive capsulitis.
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Affiliation(s)
- Manuela Deodato
- Department of Medicine, Surgery, and Health Sciences, School of Physiotherapy, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (M.D.); (M.M.); (G.C.); (L.M.)
| | - Miriam Martini
- Department of Medicine, Surgery, and Health Sciences, School of Physiotherapy, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (M.D.); (M.M.); (G.C.); (L.M.)
| | - Alex Buoite Stella
- Department of Medicine, Surgery, and Health Sciences, School of Physiotherapy, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (M.D.); (M.M.); (G.C.); (L.M.)
| | - Giulia Citroni
- Department of Medicine, Surgery, and Health Sciences, School of Physiotherapy, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (M.D.); (M.M.); (G.C.); (L.M.)
| | - Miloš Ajčević
- Department of Engineering and Architecture, University of Trieste, Via Alfonso Valerio 10, 34100 Trieste, Italy; (M.A.); (A.A.)
| | - Agostino Accardo
- Department of Engineering and Architecture, University of Trieste, Via Alfonso Valerio 10, 34100 Trieste, Italy; (M.A.); (A.A.)
| | - Luigi Murena
- Department of Medicine, Surgery, and Health Sciences, School of Physiotherapy, University of Trieste, Via Pascoli 31, 34100 Trieste, Italy; (M.D.); (M.M.); (G.C.); (L.M.)
- Orthopedics and Traumatology Unit, Department of Medicine, Surgery, and Health Sciences, Cattinara Hospital—ASUGI, Strada di Fiume 447, 34149 Trieste, Italy
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Kirker K, O’Connell M, Bradley L, Torres-Panchame RE, Masaracchio M. Manual therapy and exercise for adhesive capsulitis: a systematic review with meta-analysis. J Man Manip Ther 2023; 31:311-327. [PMID: 36861780 PMCID: PMC10566414 DOI: 10.1080/10669817.2023.2180702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/08/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Adhesive capsulitis (AC) affects approximately 1% of the general population. Current research lacks clear guidance on the dosage of manual therapy and exercise interventions. OBJECTIVE The purpose of this systematic review was to assess the effectiveness of manual therapy and exercise in the management of AC, with a secondary aim of describing the available literature present on the dosage of interventions. METHODS Eligible studies were randomized clinical/quasi-experimental trials with complete data analysis and no limits on date of publication, published in English, recruited participants >18 years of age with primary adhesive capsulitis, that had at least two groups with one group receiving manual therapy (MT) alone, exercise alone, or MT and exercise, that included at least one outcome measure of pain, disability, or external rotation range of motion, and that had dosage of visits clearly defined. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias 2 Tool. The Grading of Recommendations Assessment, Development, and Evaluation was used to provide an overall assessment of the quality of evidence. Meta-analyses were conducted when possible, and dosage was discussed in narrative form. RESULTS Sixteen studies were included. All meta-analyses revealed non-significant effects of pain, disability, and external rotation range of motion at short- and long-term follow-up, with an overall level of evidence ranging from very low to low. CONCLUSION Non-significant findings with low-to-very-low-quality of evidence were found across meta-analyses, preventing seamless transition of research evidence to clinical practice. Lack of consistency in study designs, manual therapy techniques, dosing parameters, and duration of care impedes the ability to make strong recommendations regarding optimal dosage of physical therapy for individuals with AC.
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Affiliation(s)
- Kaitlin Kirker
- Department of Physical Therapy, Long Island University, 1 University Plaza, Brooklyn, NY, United States
| | - Melanie O’Connell
- Department of Physical Therapy, Long Island University, 1 University Plaza, Brooklyn, NY, United States
| | - Lisa Bradley
- Department of Physical Therapy, Long Island University, 1 University Plaza, Brooklyn, NY, United States
| | | | - Michael Masaracchio
- Department of Physical Therapy, Long Island University, 1 University Plaza, Brooklyn, NY, United States
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Brindisino F, Girardi G, Crestani M, Fiore A, Giovannico G, Garzonio F, Venturin D, Struyf F. Effectiveness of electrophysical agents in subjects with frozen shoulder: a systematic review and meta-analysis. Disabil Rehabil 2023:1-22. [PMID: 37667875 DOI: 10.1080/09638288.2023.2251880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE This systematic review with meta-analysis aimed to assess the effectiveness of electrophysical agents in improving pain, function, disability, range of motion, quality of life, perceived stiffness, and time to recovery in subjects with frozen shoulder (FS). METHODS A thorough search of MEDLINE, Cochrane Library, PEDro, and EMBASE yielded 1143 articles, of which 23 randomized controlled trials were included. Risk of bias (RoB) was assessed through Cochrane Risk of Bias 2 tool. The certainty of evidence was evaluated through the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS The analysis included a total of 1073 subjects. None of the studies were judged as low RoB. Potentially clinically significant differences were observed in pain at 6 weeks and 5 months after extracorporeal shockwave therapy (ESWT), and in disability up to 3 months with laser therapy, albeit with uncertain results due to the high RoB and to the study heterogeneity. Ultrasound (US) therapy did not yield significant differences in any outcomes. The certainty of evidence was very low. CONCLUSIONS Based on the high heterogeneity and low quality and certainty of evidence, ESWT, laser, and US cannot be recommended for FS treatment. Caution should be exercised in interpreting the findings.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy
| | - Giuseppe Girardi
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy
| | - Mauro Crestani
- Rehabilitation Unit, Azienda ULSS n.9 Scaligera, Verona, Italy
| | | | - Giuseppe Giovannico
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy
| | - Fabiola Garzonio
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy
| | - Davide Venturin
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
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Whelan G, Yeowell G, Littlewood C. The impact of introducing hydrodistension as a treatment for frozen shoulder in a primary care musculoskeletal service: A retrospective audit. Musculoskeletal Care 2023; 21:953-957. [PMID: 36694385 DOI: 10.1002/msc.1736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Hydrodistension, where a relatively high volume of local anaesthetic, corticosteroid, and sterile saline are injected into the shoulder joint, is a treatment of interest for frozen shoulder. In the UK National Health Service this is typically provided in the hospital setting. In 2017 we introduced hydrodistension into our physiotherapy led musculoskeletal service. This report describes the findings from our audit of onward referral for orthopaedic assessment following the introduction of hydrodistension to our frozen shoulder treatment pathway. METHODS A retrospective audit of data from 102 patients who followed our hydrodistension treatment pathway for frozen shoulder since 2017 was conducted. All 102 patients received at least one hydrodistension procedure performed by a physiotherapist. This involved injecting the glenohumeral joint with a combination of local anaesthetic, corticosteroid, and saline under ultrasound guidance with a total volume of 25-35 mls. This data was compared to the outcomes of 102 patients who presented with frozen shoulder prior to 2017 who did not receive hydrodistension. RESULTS Of 102 patients who received hydrodistension within the musculoskeletal service, six patients required onward referral to orthopaedics. Of the 102 patients who did not receive hydrodistension prior to 2017, 58 required onward referral to orthopaedics. CONCLUSION We report a reduction in onward referral to orthopaedics following the introduction of hydrodistension to our physiotherapist-led treatment pathway for patients with frozen shoulder. This preliminary data identifies the need to further evaluate the clinical and cost-effectiveness of hydrodistension performed by physiotherapists for patients with frozen shoulder.
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Affiliation(s)
- Gareth Whelan
- York and Scarborough Teaching Hospitals NHS FT, York, UK
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Wise SR, Seales P, Houser AP, Weber CB. Frozen Shoulder: Diagnosis and Management. Curr Sports Med Rep 2023; 22:307-312. [PMID: 37678349 DOI: 10.1249/jsr.0000000000001097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
ABSTRACT Frozen shoulder is a common condition that causes pain and restriction of movement of the shoulder unrelated to secondary causes. It has three classic phases (freezing, frozen, and thawing), and is resolved in most cases within 1 to 2 years. Diagnosis is clinical based on global motion restriction and pain. Imaging plays an ancillary role to narrow the differential diagnosis. Physical therapy, nonsteroidal anti-inflammatories, and injection therapies are standard treatments, although none have been shown to alter the long-term course of the condition. Ultrasound guidance is recommended for injection-based therapy, although not required. Further study should focus on long-term outcomes and treatments that significantly alter the natural course of the disease.
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Affiliation(s)
- Sean R Wise
- National Capital Consortium Military Sports Medicine Fellowship, Fort Belvoir Community Hospital, Fort Belvoir, VA
| | | | | | - Chase B Weber
- National Capital Consortium Family Medicine Residency, Fort Belvoir Community Hospital, Fort Belvoir, VA
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Bi AS, Papalia AG, Romeo PV, Schoof LH, Kwon YW, Rokito AS, Zuckerman JD, Virk MS. Effect of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers on need for operative intervention for idiopathic adhesive capsulitis. JSES Int 2023; 7:793-798. [PMID: 37719830 PMCID: PMC10499842 DOI: 10.1016/j.jseint.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background The exact pathogenesis of idiopathic adhesive capsulitis (IAC) is not fully understood, but an inflammatory profibrotic cascade, largely mediated by transforming growth factor-beta 1 (TGF- β1) has been implicated. Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACE-Is) both decrease the activity of TGF-β1. The aim of this study was to determine the impact of ACE-Is or ARBs use on the need for operative intervention in IAC. Methods This was a retrospective cohort study of patients from a single institutional database with IAC, divided into two cohorts, with and without ACE-I and/or ARB use as the primary exposure and a minimum 2-year follow-up. The primary outcome measured was the incidence of operative intervention including manipulation under anesthesia (MUA) and arthroscopic capsular release (ACR). Additional multivariable logistic regression analysis was performed to evaluate associations between ACE-I/ARB use and likelihood of undergoing an operative procedure. Results A total of 17,645 patients met inclusion criteria, with 5424 patients in the ACE-I/ARB cohort and 12,221 in the non-ACE-I/ARB cohort. Overall, 422 (2.4%) patients underwent surgical treatment, 378 (2.1%) ACR, and 74 (0.4%) MUA. There was no significant difference between cohorts in the frequency of surgical procedures or time to procedure since diagnosis. There were no significant differences between individual ACE-Is or ARBs, although Losartan was found to have a trend of decreased rate of intervention (31.7% vs. 36.8%, P = .209) when compared to patients not on losartan that did not reach statistical significance. Patient factors predictive of undergoing MUA/ACR were diabetes (P = .013), obesity (P < .001), and male sex (P < .001). Increasing patient age reduces the likelihood of undergoing operative intervention, with patients aged 50-70 years (P = .022) and age >70 years (P < .001) demonstrating reduced odds as compared to patients aged <30 years. Conclusion Patients with IAC have an overall low (2.4%) rate of requiring surgical intervention. While the antifibrotic mechanism of ACE inhibitors and ARBs did not significantly affect the rate of requiring surgical intervention, male gender, obesity, younger age, and diabetes, all increased the risk for operative intervention. Losartan, specifically, may have a disease modifying effect on IAC that should be investigated with larger controlled trials.
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Affiliation(s)
- Andrew S. Bi
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Aidan G. Papalia
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Paul V. Romeo
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Lauren H. Schoof
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Young W. Kwon
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Andrew S. Rokito
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Joseph D. Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Mandeep S. Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
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Zheng Z, Huang J, Xiang Z, Wu T, Lan X, Xie S, Lin Z, Tang K, Morice A, Li S, Song WJ, Chen R. Efficacy and safety of pharmacotherapy for refractory or unexplained chronic cough: a systematic review and network meta-analysis. EClinicalMedicine 2023; 62:102100. [PMID: 37538538 PMCID: PMC10393600 DOI: 10.1016/j.eclinm.2023.102100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 08/05/2023] Open
Abstract
Background Refractory chronic cough (RCC) has a significant impact on patient's health-related quality of life and represents a challenge in clinical management. However, the optimal treatment for RCC remains controversial. This study aimed to investigate and compare the efficacy and safety of the current pharmacological therapeutic options for RCC. Methods A systematic review was performed by searching PubMed, Web of Science, Embase, and Ovid databases from January 1, 2008 to March 1, 2023. All randomised control trials (RCTs) reporting outcomes of efficacy or/and safety were included in the Bayesian network meta-analysis. Here, we compared the effects on Leicester Cough Questionnaire (LCQ), Visual Analogue Scale (VAS), and objective cough frequency of patients with RCC. Besides, we also compared the incidence of adverse events (AEs) for analysis of safety. PROSPERO registration: CRD42022345940. Findings 19 eligible RCTs included 3326 patients and 7 medication categories: P2X3 antagonist, GABA modulator, Transient Receptor Potential (TRP) modulator, NK-1 agonist, opioid analgesic, macrolide, and sodium cromoglicate. Compared with placebo, mean difference (MD) of LCQ and 24 h cough frequency for P2X3 antagonist relief were 1.637 (95% CI: 0.887-2.387) and -11.042 (P = 0.035). Compared with placebo, effect sizes (MD for LCQ and cough severity VAS) for GABA modulator were 1.347 (P = 0.003) and -7.843 (P = 0.003). In the network meta-analysis, gefapixant is the most effective treatment for patients with RCC (The Surface Under the Cumulative Ranking Curves (SUCRA) is 0.711 in LCQ, 0.983 in 24 h cough frequency, and 0.786 in cough severity VAS). Lesogaberan had better efficacy than placebo (SUCRA: 0.632 vs. 0.472) in 24 h cough frequency. Eliapixant and lesogaberan had better efficacy than placebo in cough severity VAS. However, TRP modulator had worse efficacy than placebo. In the meta-analysis of AEs, the present study found P2X3 antagonist had a significant correlation to AEs (RR: 1.129, 95% CI: 1.012-1.259), especially taste-related AEs (RR: 6.216, P < 0.05). Interpretation In this network meta-analysis, P2X3 antagonist showing advantages in terms of efficacy is currently the most promising medication for treatment of RCC. GABA modulator also showed potential efficacy for RCC but with AEs of the central system. Nevertheless, the role of TRP modulator needed to be revisited. Further research is needed to determine the potential beneficiary population for optimizing the pharmacological management of chronic cough. Funding National Natural Science Foundation of China (81870079), Guangdong Science and Technology Project (2021A050520012), Incubation Program of National Science Foundation for Distinguished Young Scholars (GMU2020-207).
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Affiliation(s)
- Ziwen Zheng
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Junfeng Huang
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ziyuan Xiang
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tong Wu
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaoqing Lan
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shuojia Xie
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zikai Lin
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Kailun Tang
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Clinical Medical College of Henan University, Zhengzhou, Henan, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Alyn Morice
- Centre for Clinical Sciences, Hull York Medical School, University of Hull, Hull, UK
| | - Shiyue Li
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ruchong Chen
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Kayaokay K, Arslan Yurtlu D. A Comparison of the Treatment Outcomes With and Without the Use of Intra-articular Corticosteroids for Frozen Shoulder Manipulation. Cureus 2023; 15:e44427. [PMID: 37664340 PMCID: PMC10469773 DOI: 10.7759/cureus.44427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/05/2023] Open
Abstract
Background Manipulation under anesthesia is known to be an effective treatment method for a frozen shoulder. However, this process is painful and causes difficulty in early physiotherapy. Intra-articular corticosteroids may relieve pain after manipulation. This study compared patients who underwent manipulation under anesthesia with those who only underwent physiotherapy and those who received intra-articular corticosteroid administration and physiotherapy. Methodology A total of 33 patients presenting with frozen shoulders were included in this study. Those who underwent manipulation after anesthesia were determined as group 1 (16 patients) and those who received intra-articular corticosteroids in addition to manipulation under anesthesia were determined as group 2 (17 patients). Pain was evaluated using the Visual Analog Scale (VAS) scores. Functional outcomes were assessed using the University of California-Los Angeles (UCLA) scores and shoulder range of motion (ROM). Results VAS and UCLA scores of both groups were similar at 12 weeks and six months. ROM improved significantly after manipulation in both group 1 and group 2 (p < 0.05). There was no significant difference between the ROM in the two groups after manipulation and physiotherapy. Only the external rotation ROM value was better in group 2 (p = 0.032) Conclusions Physiotherapy after manipulation is a successful treatment method for frozen shoulder patients. It reduces pain in the early period compared to patients who are not administered intra-articular corticosteroids. However, it has no functional superiority.
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Affiliation(s)
- Kemal Kayaokay
- Department of Orthopaedics and Traumatology, Izmir Katip Çelebi University, Izmir, TUR
| | - Derya Arslan Yurtlu
- Department of Anaesthesiology and Reanimation, Izmir Katip Çelebi University, Ataturk Training and Research Hospital, Izmir, TUR
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Mena-Del Horno S, Balasch-Bernat M, Louw A, Luque-Suarez A, Rodríguez-Brazzarola P, Navarro-Ledesma S, Murillo C, Dueñas L, Lluch E. Is there any benefit of adding a central nervous system-focused intervention to a manual therapy and home stretching program for people with frozen shoulder? A randomized controlled trial. J Shoulder Elbow Surg 2023; 32:1401-1411. [PMID: 37001795 DOI: 10.1016/j.jse.2023.02.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Frozen shoulder (FS) is a highly disabling pathology of poorly understood etiology, which is characterized by the presence of intense pain and progressive loss of range of motion. The aim of this study was to evaluate the effect of adding a central nervous system (CNS)-focused approach to a manual therapy and home stretching program in people with FS. METHODS A total of 34 patients with a diagnosis of primary FS were randomly allocated to receive a 12-week manual therapy and home stretching program or manual therapy and home stretching program plus a CNS-focused approach including graded motor imagery and sensory discrimination training. The Shoulder Pain and Disability Index score, self-perceived shoulder pain (visual analog scale score), shoulder range of motion, and the Patient-Specific Functional Scale score were measured at baseline, after a 2-week washout period just before starting treatment, after treatment, and at 3 months' follow-up. RESULTS No significant between-group differences in any outcome were found either after treatment or at 3 months' follow-up. CONCLUSION A CNS-focused approach provided no additional benefit to a manual therapy and home stretching program in terms of shoulder pain and function in people with FS.
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Affiliation(s)
- Silvia Mena-Del Horno
- Department of Physiotherapy, University of Valencia, Valencia, Spain; Universidad Internacional de Valencia, Valencia, Spain
| | - Mercè Balasch-Bernat
- Department of Physiotherapy, University of Valencia, Valencia, Spain; Physiotherapy in Motion, Multi-speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.
| | - Adriaan Louw
- Evidence in Motion, San Antonio, TX, USA; Physical Therapy Department, St. Ambrose University, Davenport, IA, USA
| | - Alejandro Luque-Suarez
- Facultad de Ciencias de la Salud, Universidad de Malaga, Malaga, Spain; Instituto de la Investigación Biomedica de Malaga (IBIMA), Malaga, Spain
| | | | - Santiago Navarro-Ledesma
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
| | - Carlos Murillo
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Lirios Dueñas
- Department of Physiotherapy, University of Valencia, Valencia, Spain; Physiotherapy in Motion, Multi-speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Enrique Lluch
- Department of Physiotherapy, University of Valencia, Valencia, Spain; Physiotherapy in Motion, Multi-speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Departments of Human Physiology and Rehabilitation Sciences, "Pain in Motion" International Research Group, Brussels, Belgium
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Donati D, Vita F, Tedeschi R, Galletti S, Biglia A, Gistri T, Arcuri P, Origlio F, Castagnini F, Faldini C, Pederiva D, Benedetti MG. Ultrasound-Guided Infiltrative Treatment Associated with Early Rehabilitation in Adhesive Capsulitis Developed in Post-COVID-19 Syndrome. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1211. [PMID: 37512023 PMCID: PMC10386626 DOI: 10.3390/medicina59071211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Post-COVID-19 syndrome is commonly used to describe signs and symptoms that continue or develop after acute COVID-19 for more than 12 weeks. The study aimed to evaluate a treatment strategy in patients with adhesive capsulitis (phase 1) developed in post-COVID-19 syndrome. Materials and Methods: The method used was an interventional pilot study in which 16 vaccinated patients presenting with the clinical and ultrasound features of adhesive capsulitis (phase 1) developed during post-COVID-19 syndrome were treated with infiltrative hydrodistension therapy under ultrasound guidance associated with early rehabilitation treatment. Results: Sixteen patients with post-COVID-19 syndrome treated with ultrasound-guided infiltration and early rehabilitation treatment showed an important improvement in active joint ROM after 10 weeks, especially in shoulder elevation and abduction movements. The VAS mean score before the treatment was 6.9 ± 1.66. After 10 weeks of treatment, the VAS score was 1 ± 0.63. Conclusions: The study demonstrated that the management of adhesive capsulitis (phase 1) developed in post-COVID-19 syndrome, as conducted by physiotherapists in a primary care setting using hydrodistension and a rehabilitation protocol, represented an effective treatment strategy.
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Affiliation(s)
- Danilo Donati
- Physical Therapy and Rehabilitation Unit, Policlinico di Modena, 41125 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Fabio Vita
- Department of Orthopedic and Traumatological Surgery, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, 40136 Bologna, Italy
| | - Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40136 Bologna, Italy
| | - Stefano Galletti
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology, 40136 Bologna, Italy
| | - Alessandro Biglia
- Rheumatology Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Tommaso Gistri
- Family Medicine Department, ASL Tuscany, 55049 Viareggio, Italy
| | - Pasquale Arcuri
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40136 Bologna, Italy
| | - Flavio Origlio
- Physical Therapy and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, 40136 Bologna, Italy
| | - Francesco Castagnini
- Department of Orthopedic and Traumatological Surgery, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, 40136 Bologna, Italy
| | - Cesare Faldini
- Department of Orthopedic and Traumatological Surgery, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, 40136 Bologna, Italy
| | - Davide Pederiva
- Department of Orthopedic and Traumatological Surgery, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, 40136 Bologna, Italy
| | - Maria Grazia Benedetti
- Physical Therapy and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, 40136 Bologna, Italy
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Jo HS, Kim HM, Han JY, Park HK. Atypical progress of frozen shoulder after COVID-19 vaccination: A case report. World J Clin Cases 2023; 11:3637-3642. [PMID: 37383894 PMCID: PMC10294196 DOI: 10.12998/wjcc.v11.i15.3637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/22/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND After vaccination was mandated worldwide, various adverse effects associated with the coronavirus disease 2019 (COVID-19) vaccination, including shoulder pain, have been reported. Here, we report a case of new-onset shoulder pain after BNT162b2 (Comirnaty, Pfizer-BioNTech) mRNA vaccination.
CASE SUMMARY A 50-year-old man visited our rehabilitation center with left shoulder range of motion (ROM) limitation that had persisted for more than 5 mo. The history included no specific noteworthy events, except vaccination. The pain in the patient’s left deltoid muscle appeared 1 day after the second BNT162b2 vaccination and intensified to severe pain. The patient self-administered aspirin, with which the pain subsided immediately, whereas ROM limitation persisted. At the first visit, the patient complained of dull pain and ROM restriction of the left shoulder (flexion 130°, abduction 110°, and external rotation 40°). Among the diagnostic studies conducted for the evaluation of the shoulder, magnetic resonance imaging showed a thickened coracohumeral ligament. Nerve conduction studies and needle electromyography showed no electrodiagnostic abnormalities. The patient received comprehensive rehabilitation for 7 mo and had an overall improvement in pain and ROM of the left shoulder.
CONCLUSION In this case of severe shoulder pain after COVID-19 vaccination that subsided immediately with aspirin treatment, the exact cause and mechanism of pain are unclear. However, the clinical symptoms and diagnostic workups in our report suggest the possibility that the COVID-19 vaccination triggered an immunochemical response that resulted in shoulder pathology.
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Affiliation(s)
- Hyun-Seok Jo
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Heart Research Center, Chonnam National University, Chonnam National University Medical School & Hospital, Gwangju City 61469, South Korea
| | - Hyeong-Min Kim
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Heart Research Center, Chonnam National University, Chonnam National University Medical School & Hospital, Gwangju City 61469, South Korea
| | - Jae-Young Han
- Department of Physical and Rehabilitation Medicine, Regional Cardiocerebrovascular Center, Center for Aging and Geriatrics, Research Institute of Medical Sciences, Heart Research Center, Chonnam National University, Chonnam National University Medical School & Hospital, Gwangju City 61469, South Korea
| | - Hyeng-Kyu Park
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Heart Research Center, Chonnam National University, Chonnam National University Medical School & Hospital, Gwangju City 61469, South Korea
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Kunze KN, Kay J, Pareek A, Dahmen J, Chahla J, Nho SJ, Williams RJ, de Sa D, Karlsson J. A guide to appropriately planning and conducting meta-analyses: part 3. Special considerations-the network meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07419-7. [PMID: 37193822 DOI: 10.1007/s00167-023-07419-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/14/2023] [Indexed: 05/18/2023]
Abstract
The meta-analysis has become one of the predominant studies designs in orthopaedic literature. Within recent years, the network meta-analysis has been implicated as a powerful approach to comparing multiple treatments for an outcome of interest when conducting a meta-analysis (as opposed to two competing treatments which is typical of a traditional meta-analysis). With the increasing use of the network meta-analysis, it is imperative for readers to possess the ability to independently and critically evaluate these types of studies. The purpose of this article is to provide the necessary foundation of knowledge to both properly conduct and interpret the results of a network meta-analysis.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA.
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ayoosh Pareek
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Riley J Williams
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Naye F, Décary S, Houle C, LeBlanc A, Cook C, Dugas M, Skidmore B, Tousignant-Laflamme Y. Six Externally Validated Prognostic Models Have Potential Clinical Value to Predict Patient Health Outcomes in the Rehabilitation of Musculoskeletal Conditions: A Systematic Review. Phys Ther 2023; 103:7066982. [PMID: 37245218 DOI: 10.1093/ptj/pzad021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/21/2022] [Accepted: 01/06/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to identify and appraise externally validated prognostic models to predict a patient's health outcomes relevant to physical rehabilitation of musculoskeletal (MSK) conditions. METHODS We systematically reviewed 8 databases and reported our findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. An information specialist designed a search strategy to identify externally validated prognostic models for MSK conditions. Paired reviewers independently screened the title, abstract, and full text and conducted data extraction. We extracted characteristics of included studies (eg, country and study design), prognostic models (eg, performance measures and type of model) and predicted clinical outcomes (eg, pain and disability). We assessed the risk of bias and concerns of applicability using the prediction model risk of bias assessment tool. We proposed and used a 5-step method to determine which prognostic models were clinically valuable. RESULTS We found 4896 citations, read 300 full-text articles, and included 46 papers (37 distinct models). Prognostic models were externally validated for the spine, upper limb, lower limb conditions, and MSK trauma, injuries, and pain. All studies presented a high risk of bias. Half of the models showed low concerns for applicability. Reporting of calibration and discrimination performance measures was often lacking. We found 6 externally validated models with adequate measures, which could be deemed clinically valuable [ie, (1) STart Back Screening Tool, (2) Wallis Occupational Rehabilitation RisK model, (3) Da Silva model, (4) PICKUP model, (5) Schellingerhout rule, and (6) Keene model]. Despite having a high risk of bias, which is mostly explained by the very conservative properties of the PROBAST tool, the 6 models remain clinically relevant. CONCLUSION We found 6 externally validated prognostic models developed to predict patients' health outcomes that were clinically relevant to the physical rehabilitation of MSK conditions. IMPACT Our results provide clinicians with externally validated prognostic models to help them better predict patients' clinical outcomes and facilitate personalized treatment plans. Incorporating clinically valuable prognostic models could inherently improve the value of care provided by physical therapists.
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Affiliation(s)
- Florian Naye
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Simon Décary
- Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Université Laval, Quebec, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Quebec, Quebec, Canada
| | - Catherine Houle
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Université Laval, Quebec, Quebec, Canada
| | - Chad Cook
- Physical Therapy Division, Duke University, Durham, North Carolina, USA
| | - Michèle Dugas
- VITAM Research Center, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
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Lakra C, Higgins R, Beare B, Farrell R, Ajina S, Burns S, Lee M, Swayne O. Managing painful shoulder after neurological injury. Pract Neurol 2023; 23:229-238. [PMID: 36882323 DOI: 10.1136/pn-2022-003576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 03/09/2023]
Abstract
Shoulder pain is common after neurological injury and can be disabling, lead to poor functional outcomes and increase care costs. Its cause is multifactoral and several pathologies contribute to the presentation. Astute diagnostic skills and a multidisciplinary approach are required to recognise what is clinically relevant and to implement appropriate stepwise management. In the absence of large clinical trial data, we aim to provide a comprehensive, practical and pragmatic overview of shoulder pain in patients with neurological conditions. We use available evidence to produce a management guideline, taking into account specialty opinions from neurology, rehabilitation medicine, orthopaedics and physiotherapy.
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Affiliation(s)
- Celine Lakra
- Department of Therapy and Rehabilitation, National Hospital for Neurology and Neurosurgery, London, UK
| | - Rachel Higgins
- Department of Therapy and Rehabilitation, National Hospital for Neurology and Neurosurgery, London, UK
| | - Benjamin Beare
- Department of Therapy and Rehabilitation, National Hospital for Neurology and Neurosurgery, London, UK
| | - Rachel Farrell
- Department of Therapy and Rehabilitation, National Hospital for Neurology and Neurosurgery, London, UK.,Department of Neuro-inflammation, Queen Square Institute of Neurology, University College London, London, UK
| | - Sara Ajina
- Department of Therapy and Rehabilitation, National Hospital for Neurology and Neurosurgery, London, UK
| | - Sophia Burns
- Department of Orthopaedics, University College London, London, UK
| | - Marcus Lee
- Department of Orthopaedics, University College London, London, UK
| | - Orlando Swayne
- Department of Therapy and Rehabilitation, National Hospital for Neurology and Neurosurgery, London, UK.,Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
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Joint and soft tissue injections in Irish primary care: a survey of GPs' attitudes and practices. BJGP Open 2023:BJGPO.2022.0093. [PMID: 36720561 DOI: 10.3399/bjgpo.2022.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/20/2022] [Accepted: 11/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Musculoskeletal conditions are common in primary care, causing significant morbidity. Intra-articular and soft tissue corticosteroid injections are commonly performed by GPs internationally. It is unknown how commonly they are performed by GPs in the Republic of Ireland. AIM To determine the frequency and type of joint and soft tissue injections performed by GPs in the Republic of Ireland and investigate factors affecting their use. DESIGN & SETTING A cross-sectional online questionnaire, which was based on previous international research, was devised for completion by GPs practising in the Republic of Ireland. METHOD GPs were invited to electronically complete a questionnaire on their practices and attitudes regarding joint and soft tissue injections. RESULTS A total of 147 of 204 GPs (72.1%) had performed an intra-articular or soft tissue injection in the preceding year. GPs who were principals or partners, male, or worked in a rural or mixed urban and rural practice setting were more likely to perform these procedures. The most common injection sites were the shoulder and knee. Participants were confident about performing joint and soft tissue injections. It was found that 80.4% had received prior training in this treatment modality, most commonly during their GP training programme. A prolonged wait for secondary care intervention, symptom duration, and symptom severity were factors that increased the likelihood of performing injections. Difficulty maintaining skills and medicolegal concerns were common barriers to performing joint and soft tissue injections. CONCLUSION Most GPs surveyed carried out joint and soft tissue injections, most commonly injecting the shoulder and knee. Irish GPs experience many of the same barriers to performing intra-articular injection as experienced internationally.
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Burke KM, Ellrodt AS, Joslin BC, Sanpitak PP, MacAdam C, Deo P, Ozment K, Shea C, Johnson SA, Ho D, Chu SK, Babu AN, Franz CK, Paganoni S. Ultrasound-guided glenohumeral joint injections for shoulder pain in ALS: A case series. Front Neurol 2023; 13:1067418. [PMID: 36814537 PMCID: PMC9940635 DOI: 10.3389/fneur.2022.1067418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/30/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Shoulder pain is a common secondary impairment for people living with ALS (PALS). Decreased range of motion (ROM) from weakness can lead to shoulder pathology, which can result in debilitating pain. Shoulder pain may limit PALS from participating in activities of daily living and may have a negative impact on their quality of life. This case series explores the efficacy of glenohumeral joint injections for the management of shoulder pain due to adhesive capsulitis in PALS. Methods People living with ALS and shoulder pain were referred to sports medicine-certified physiatrists for diagnostic evaluation and management. They completed the Revised ALS Functional Rating Scale and a questionnaire asking about their pain levels and how it impacts sleep, function, and quality of life at baseline pre-injection, 1-week post-injection, 1 month post-injection, and 3 months post-injection. Results We present five cases of PALS who were diagnosed with adhesive capsulitis and underwent glenohumeral joint injections. Though only one PALS reported complete symptom resolution, all had at least partial symptomatic improvement during the observation period. No complications were observed. Conclusions People living with ALS require a comprehensive plan to manage shoulder pain. Glenohumeral joint injections are safe and effective for adhesive capsulitis in PALS, but alone may not completely resolve shoulder pain. Additional therapies to improve ROM and reduce pain should be considered.
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Affiliation(s)
- Katherine M. Burke
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA, United States,*Correspondence: Katherine M. Burke ✉
| | - Amy S. Ellrodt
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Benjamin C. Joslin
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Pia P. Sanpitak
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Claire MacAdam
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Prabhav Deo
- Shirley Ryan AbilityLab, Chicago, IL, United States,Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kevin Ozment
- Shirley Ryan AbilityLab, Chicago, IL, United States,Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Cristina Shea
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Stephen A. Johnson
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Doreen Ho
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Samuel K. Chu
- Shirley Ryan AbilityLab, Chicago, IL, United States,Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ashwin N. Babu
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States,Massachusetts General Hospital Department of Orthopedics, Sports Medicine, Boston, MA, United States
| | - Colin K. Franz
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States,Shirley Ryan AbilityLab, Chicago, IL, United States,Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sabrina Paganoni
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA, United States,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States,VA Boston Healthcare System, Boston, MA, United States
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Li J, Tian X, Wang K, Jia Y, Ma F. Transdermal delivery of celecoxib and α-linolenic acid from microemulsion-incorporated dissolving microneedles for enhanced osteoarthritis therapy. J Drug Target 2023; 31:206-216. [PMID: 36093744 DOI: 10.1080/1061186x.2022.2123492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Dissolving microneedles, the promising vehicles for transdermal delivery, are incapable of directly loading hydrophobic components that limit the application of transdermal drug delivery. Microemulsion holds great potential in the solubilisation of water-insoluble drugs but is limited by the high epidermal retention. In this study, we fabricated microemulsion-incorporated dissolving microneedles co-loading celecoxib and α-linolenic acid (Cel-MEs@MNs) for enhancing osteoarthritis (OA) therapy via synergistic anti-inflammation and potent transdermal delivery. Cel-MEs@MNs composed of celecoxib & α-linolenic acid-coloaded microemulsion (Cel-MEs) and hyaluronic acid-based microneedles (MNs) can be completely dissolved in 90 s with a particle size of ∼30 nm. Each microneedle array with a hardness exceeding 30 N contained 57.9 ± 2.5 μg of celecoxib and 442.5 ± 24.2 μg of α-linolenic acid. The 8 h-cumulative transdermal of celecoxib from Cel-MEs@MNs was 89.2 ± 5.1 μg celecoxib/cm2, which is 2.98-fold higher than that from Cel-MEs. Combinational celecoxib and α-linolenic acid with a weight ratio of 1/5 can synergistically induce M1-like macrophage to M2 repolarization, reduce M1-like macrophages-resulted chondrocytes apoptosis, and lower serum prostaglandin E-2 (PGE-2). Notably, Cel-MEs@MNs amplified such collaborated anti-inflammatory effects. More importantly, in the treatment of OA-bearing rat models, Cel-MEs@MNs with a half-dose of celecoxib and α-linolenic acid significantly shrunk the paw swelling, reduced inflammatory cytokines, and improved cartilage damage compared with the oral administration of celecoxib and α-linolenic acid, as well as transdermal administration of Cel-MEs. Such an integrational strategy of microemulsion-incorporated dissolving MNs offers the feasibility of combinational celecoxib and α-linolenic acid in transdermal permeation and boosted OA therapy.
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Affiliation(s)
- Jian Li
- Nanjing Jiangning District Hospital of TCM, Nanjing, China
| | - Xin Tian
- Nanjing Jiangning District Hospital of TCM, Nanjing, China
| | - Kang Wang
- Nanjing Jiangning District Hospital of TCM, Nanjing, China
| | - Yong Jia
- Nanjing Jiangning District Hospital of TCM, Nanjing, China
| | - Fuguang Ma
- Nanjing Jiangning District Hospital of TCM, Nanjing, China
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Alben MG, Gambhir N, Shankar D, Gordon D, Zuckerman JD, Virk MS. Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) of upper extremity PROMIS scores in idiopathic adhesive capsulitis. Clin Rheumatol 2023; 42:579-589. [PMID: 36547817 DOI: 10.1007/s10067-022-06479-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/04/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The purpose of this study is to calculate the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) of Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Testing v2.0 (UE), Pain Interference (P-Interference), and Pain Intensity (P-Intensity) in patients treated nonoperatively for idiopathic adhesive capsulitis (IAC). METHODS The anchor-based MCID, SCB, and PASS were calculated as the change in PROMIS scores representing the optimal cutoff for a ROC curve with an area under the curve (AUC) analysis. The distribution-based MCID was calculated as a range between the average standard error of measurement multiplied by two different constants: 1 and 2.77. Effect sizes and standardized response means (SRM) were calculated to assess the responsiveness of each PROMIS instrument while regression analyses were performed to identify factors associated with achieving these thresholds. RESULTS This study enrolled 115 patients. The anchor-based MCID for PROMIS UE, P-Interference, and P-Intensity was 5.11, 4.16, and 8.16, respectively. The respective SCB was 8.44, 6.65, and 10.05. The respective PASS was 8.47, 7.01, and 10.41. The odds of achieving MCID values in adhesive capsulitis were negatively affected by gender (male), higher forward elevation at the time of presentation, higher pain scores (P-Interference), need for ≥ 2 corticosteroid injections, and a concomitant diagnosis of diabetes. CONCLUSION The MCID, SCB, and PASS parameters for PROMIS scores can be utilized to determine the clinical meaningfulness of patient-reported improvements in these instruments during the nonoperative treatment and as a research tool to compare the efficacy of new treatments for adhesive capsulitis. LEVEL OF EVIDENCE Level III, basic science study, validation of outcome instruments. Key points • This is the first study to calculate the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for the Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity and Pain instruments in patients with idiopathic adhesive capsulitis (IAC) of the shoulder.• This study determined the impact of symptom severity, demographics, and comorbidities on achieving the MCID, SCB, and PASS for PROMIS instruments in IAC patients treated nonoperatively.
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Affiliation(s)
- Matthew G Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Neil Gambhir
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Dhruv Shankar
- Division of Sports Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Dan Gordon
- Department of Orthopedic Surgery, Baylor University Medical Center Dallas, Dallas, TX, USA
| | - Joseph D Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA.
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Karnawat S, Harikesavan K, Venkatesan P. Effect of Functional Scapular Stabilization Training on Function and Pain in Frozen Shoulder Syndrome: A Randomized Controlled Trial. J Manipulative Physiol Ther 2023; 46:86-97. [PMID: 37452810 DOI: 10.1016/j.jmpt.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 10/17/2022] [Accepted: 05/15/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the effect of functional scapular stabilization training compared with the standard physical therapy on function and pain in people with frozen shoulder syndrome (FSS). METHODS In a single-blind randomized controlled trial, 86 people with FSS were randomly allocated into the intervention group (functional stabilization training [n = 43]) and control group (standard physical therapy [n = 43]) using block randomization for 12 weeks. The primary outcome measures were the Shoulder Pain and Disability Index and the numeric pain rating scale. The secondary outcome measures were range of motion (ROM), range of passive abduction, and coracoid pain test. All the outcome measures were carried out by an independent blind outcome assessor at baseline and at the end of 12 weeks. RESULTS A significant group × time interaction effect was observed for the Shoulder Pain and Disability Index (95% CI, 2.95-16.74; P < .01) and the numeric pain rating scale (95% CI, 0.67-2.07; P < .01) at the end of 12 weeks. The external rotation ROM showed a statistical significance with a mean change of 7.8° and P value of <.01. CONCLUSION The present findings show that scapular functional stabilization training resulted in improvement of function, reduction in pain, and greater improvement in external rotation ROM in patients with FSS. Also, our study findings suggest the involvement of rotator interval and inferior soft-tissue structures as indicated by the coracoid pain test and range of passive abduction.
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Affiliation(s)
- Saloni Karnawat
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal Hospitals, Bangalore, Karnataka, India
| | - Karvannan Harikesavan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal Hospitals, Bangalore, Karnataka, India.
| | - Prem Venkatesan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal Hospitals, Bangalore, Karnataka, India
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Nudelman B, Song B, Higginbotham DO, Piple AS, Montgomery WH. Platelet-Rich Plasma Injections Are at Least Equivalent to Corticosteroid Injections for Adhesive Capsulitis: A Systematic Review of Prospective Cohort Studies. Arthroscopy 2023; 39:1320-1329. [PMID: 36708748 DOI: 10.1016/j.arthro.2023.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate the role of platelet-rich plasma (PRP) for adhesive capsulitis (AC) as compared with other injectables. METHODS A literature search of the PubMed and Embase online databases was performed to identify articles evaluating injection therapy for the treatment of AC. The inclusion criteria included prospective studies comparing PRP against alternative injectables with a minimum of 15 patients in each treatment arm and a minimum 12-week follow-up period. Pain scores, range of motion, and function scores were the primary outcomes assessed. RESULTS Five articles comparing PRP with corticosteroid or saline solution injections met the inclusion criteria. A total of 157 patients were treated with PRP, with a follow-up duration ranging from 3 to 6 months. All 5 studies showed statistically significant improvements in pain scores, motion, and function scores in patients receiving PRP, corticosteroid, and saline solution injections. However, PRP was consistently superior on intergroup analyses in all but 1 study. In 4 studies, pain and function scores favored PRP over control at final follow-up (range in mean difference, -2.2 to 0.69 for visual analog scale pain score [n = 5] and -50.5 to -4.0 for Shoulder Pain and Disability Index score [n = 3]), whereas 3 studies found greater improvement in shoulder motion after PRP (range in mean difference, 0.7° to 34.3° for forward flexion and -2.3° to 20.4° for external rotation [n = 4]). One study found no significant difference between PRP and corticosteroid injections but noted that the results were comparable. CONCLUSIONS According to a limited number of prospective studies, PRP injections for AC are at least equivalent to corticosteroid or saline solution injections and often lead to improved pain, motion, and functional outcomes at 3- to 6-month follow-up. Given the small number of studies, with design heterogeneity, there is insufficient evidence to routinely recommend PRP for AC. However, the results are promising and do support considering PRP as an adjunct treatment option for AC, especially for patients refractory and/or averse to corticosteroids or alternative treatment modalities. LEVEL OF EVIDENCE Level II, systematic review of Level I and II studies.
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Affiliation(s)
- Brandon Nudelman
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California, U.S.A..
| | - Bowen Song
- St. Mary's Medical Center, San Francisco, California, U.S.A
| | | | - Amit S Piple
- The Taylor Collaboration, San Francisco, California, U.S.A
| | - William H Montgomery
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California, U.S.A
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Deng Z, Li Z, Li X, Chen Z, Shen C, Sun X, Shu H, Wu J, Tang K. Comparison of Outcomes of Two Different Corticosteroid Injection Approaches for Primary Frozen Shoulder: A Randomized Controlled Study. J Rehabil Med 2023; 55:jrm00361. [PMID: 36597664 PMCID: PMC9828646 DOI: 10.2340/jrm.v55.2201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 11/08/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Corticosteroid injection is a common treatment for primary frozen shoulder, but controversy remains regarding whether different injection approaches to the glenohumeral joint have similar clinical benefits. DESIGN Randomized controlled clinical trial. PATIENTS A total of 60 patients with primary frozen shoulder were divided randomly into either anterior or posterior approach groups. METHODS Both groups received a 5-mL drug injection, including 1 mL 40 mg/mL triamcinolone acetonide and 4 mL 2% lidocaine. Follow-up time-points were 4, 8 and 12 weeks post-injection. Outcome measures included visual analogue scale score, Constant-Murley score, and passive range of motion of the shoulder joint. RESULTS All outcome measures improved over the follow-up period compared with those of previous follow-up time-points within the groups. The primary finding was that the visual analogue scale score in the anterior group was better than that in the posterior group at each follow-up time-point (all p < 0.05). In addition, improvement in function score and external rotation was faster and significant in the anterior group in the early stages (p = 0.02). CONCLUSION The anterior approach achieves more satisfactory results in pain control and offers better recovery of functional activity than posterior approach in the early period for primary frozen shoulder.
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Affiliation(s)
- Zhibo Deng
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi Li
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiangwei Li
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhongqiu Chen
- Department of Information Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chen Shen
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xianding Sun
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Han Shu
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiangping Wu
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kaiying Tang
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Miyamoto R, Shitara H, Ichinose T, Sasaki T, Hamano N, Kamiyama M, Nakase K, Chikuda H. Triamcinolone acetonide with arthroscopic capsular release for frozen shoulder promotes early recovery of shoulder abduction. JSES Int 2023. [DOI: 10.1016/j.jseint.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Pavlou K, Korakakis V, Whiteley R, Karagiannis C, Ploutarchou G, Savva C. The effects of upper body blood flow restriction training on muscles located proximal to the applied occlusive pressure: A systematic review with meta-analysis. PLoS One 2023; 18:e0283309. [PMID: 36952451 PMCID: PMC10035935 DOI: 10.1371/journal.pone.0283309] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Blood flow restriction combined with low load resistance training (LL-BFRT) is associated with increases in upper limb muscle strength and size. The effect of LL-BFRT on upper limb muscles located proximal to the BFR cuff application is unclear. OBJECTIVE The aim of this systematic review was to evaluate the effect of LL-BFRT compared to low load, or high load resistance training (LL-RT, HL-RT) on musculature located proximal to cuff placement. METHODS Six electronic databases were searched for randomized controlled trials (RCTs). Two reviewers independently evaluated the risk of bias using the PEDro scale. We performed a meta-analysis using a random effects model, or calculated mean differences (fixed-effect) where appropriate. We judged the certainty of evidence using the GRADE approach. RESULTS The systematic literature searched yielded 346 articles, of which 9 studies were eligible. The evidence for all outcomes was of very low to low certainty. Across all comparisons, a significant increase in bench press and shoulder flexion strength was found in favor of LL-BFRT compared to LL-RT, and in shoulder lean mass and pectoralis major thickness in favor of the LL-BFRT compared to LL-RT and HL-RT, respectively. No significant differences were found between LL-BFRT and HL-RT in muscle strength. CONCLUSION With low certainty LL-BFRT appears to be equally effective to HL-RT for improving muscle strength in upper body muscles located proximal to the BFR stimulus in healthy adults. Furthermore, LL-BFRT may induce muscle size increase, but these adaptations are not superior to LL-RT or HL-RT.
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Affiliation(s)
- Kyriakos Pavlou
- Department of Health Science, European University Cyprus, Engomi, Nicosia, Cyprus
| | - Vasileios Korakakis
- Department of Population Health Sciences, School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Rod Whiteley
- Aspetar, Orthopaedic and Sport Medicine Hospital, Doha, Qatar
| | - Christos Karagiannis
- Department of Health Science, European University Cyprus, Engomi, Nicosia, Cyprus
| | - George Ploutarchou
- Department of Health Science, European University Cyprus, Engomi, Nicosia, Cyprus
| | - Christos Savva
- Department of Health Science, European University Cyprus, Engomi, Nicosia, Cyprus
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50
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Sam N, Yusuf I, Idris I, Adnan E, Haryadi RD, Hamid F, Usman MA, Johan MP, Zainuddin AA. A Case Series: Effect of Comorbidities on the Outcomes of Prolotherapy Injection for Frozen Shoulder Patients. Int Med Case Rep J 2023; 16:257-263. [PMID: 37143964 PMCID: PMC10153529 DOI: 10.2147/imcrj.s407723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023] Open
Abstract
Frozen shoulder (FS) is a disease caused by an inflammatory condition that causes severe pain and decreased range of motion by loss of glenohumeral mobility. Frozen Shoulder restricts daily life's functional aspect, increasing morbidity. Hypertension and diabetes mellitus are risk factors that make an FS poor prognosis during treatment because of the diabetes glycation process and hypertension-enhanced vascularization. Prolotherapy injects an irritant solution into the tendon, joints, ligaments, and joint spaces to release growth factors and collagen deposition, reducing pain, restoring joint stability, and increasing the quality of life. We report 3 cases of patients with confirmed FS. Patient A with no comorbidity, patient B with diabetes mellitus, and patient C with hypertension, with all patient's chief complaints of shoulder pain and limited ROM, and symptoms affected the general quality of daily life. This patient was provided injection with Prolotherapy treatment combined with physical therapy intervention. Patient A had significantly improved ROM to maximum after 6 weeks with relieved pain and improved shoulder function. Patients B and C showed increased ROM, still tiny, decreased pain, and improved shoulder function. In conclusion, prolotherapy demonstrated a beneficial effect in a patient with FS with comorbidities, although not to the maximum extent in patients without comorbidity.
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Affiliation(s)
- Nuralam Sam
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Correspondence: Nuralam Sam, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hasanuddin University, Perintis Kemerdekaan Street KM.11, Makassar, South Sulawesi, 90245, Indonesia, Email
| | - Irawan Yusuf
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Irfan Idris
- Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Endy Adnan
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Ratna Darjanti Haryadi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Firdaus Hamid
- Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muhammad Andry Usman
- Department of Orthopedic, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muhammad Phetrus Johan
- Department of Orthopedic, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Andi Alfian Zainuddin
- Department of Public Health, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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