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Gadgaard NR, Veres K, Henderson VW, Pedersen AB. Frozen Shoulder and the Risk of Parkinson's Disease: A Danish Registry-Based Cohort Study. Clin Epidemiol 2024; 16:447-459. [PMID: 38952571 PMCID: PMC11216321 DOI: 10.2147/clep.s463571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/20/2024] [Indexed: 07/03/2024] Open
Abstract
Background Frozen shoulder may be an early preclinical symptom of Parkinson's disease (PD). Objective To examine PD risk after frozen shoulder diagnosis and to evaluate this disorder as a possible manifestation of parkinsonism preceding the clinical recognition of PD and possible target for screening. Methods Danish population-based medical registries were used to identify patients aged ≥40 years with a first-time frozen shoulder diagnosis (1995-2016). A comparison cohort was randomly selected from the general population matched on age and sex. To address detection bias and the specificity of frozen shoulder diagnosis, we performed a sensitivity analysis, using similar matching criteria to select a cohort of patients with back pain diagnosis. The outcome was incident PD. Cumulative incidences and adjusted hazard ratios (HRs) were estimated with 95% confidence intervals (CIs). Results We identified 37,041 individuals with frozen shoulder, 370,410 general population comparators, and 111,101 back pain comparators. The cumulative incidence of PD at 0-22 years follow-up was 1.51% in the frozen shoulder cohort, 1.03% in the general population cohort, and 1.32% in the back pain cohort. For frozen shoulder versus general population, adjusted HRs were 1.94 (CI: 1.20-3.13) at 0-1 years and 1.45 (CI: 1.24-1.70) at 0-22 years follow-up. For frozen shoulder versus back pain, adjusted HRs were 0.89 (CI: 0.54-1.46) and 1.01 (CI: 0.84-1.21), respectively. Conclusion Patients with frozen shoulder had an increased PD risk compared with the general population, although the absolute risks were low. Frozen shoulder might sometimes represent early manifestations of PD. Detection bias probably cannot account for the increased PD risk during the long-term follow-up.
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Affiliation(s)
- Nadia R Gadgaard
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Katalin Veres
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Victor W Henderson
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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Xu T, Xia Q, Zhang L, Yang X, Fu W. Type 2 diabetes and fasting glycemic traits are causal factors of frozen shoulder: a 2-sample Mendelian randomization analysis. J Shoulder Elbow Surg 2024; 33:399-408. [PMID: 37748531 DOI: 10.1016/j.jse.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The causal relationship between type 2 diabetes (T2D) and frozen shoulder is unclear. This study aims to explore the genetic causal association between T2D and glycemic traits (fasting glucose [FG], fasting insulin [FI], glycated hemoglobin [HbA1c], and 2-hour postprandial glucose [2hGlu]) on frozen shoulder. METHODS Using 2-sample Mendelian randomization (MR), we analyzed nonconfounded estimates of the effects of T2D and glycemic traits on frozen shoulder. Single-nucleotide polymorphisms (SNPs) strongly associated (P < 5 × 10-8) with exposures from genome-wide association studies (GWAS) were identified. We employed fixed effect mode inverse variance weighting (IVW-FE), random effect mode IVW (IVW-MRE), MR-Egger, and weighted median to assess the association of exposures and outcome. Sensitivity analysis was conducted to test for heterogeneity and multidirectionality bias in MR. RESULTS We found a significant genetic causal correlation between T2D (IVW-MRE P = .007, odds ratio [OR] 1.093, 95% confidence interval [CI] 1.03-1.16), FG (IVW-FE P < .001, OR 1.455, 95% CI 1.173-1.806), and frozen shoulder, but no evidence for causal correlation between FI, HbA1c, and 2hGlu and frozen shoulder. Although there was certain heterogeneity, sensitivity analysis reveals no deviation from the MR assumptions. CONCLUSION This study supports a genetic causal relationship between T2D and FG and frozen shoulder.
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Affiliation(s)
- Tianhao Xu
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qinghong Xia
- Operating Room of Anesthesia Surgery Center, West China Hospital, Sichuan University West China School of Nursing, Chengdu, Sichuan, China
| | - Lei Zhang
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaolong Yang
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weili Fu
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Galasso O, Mercurio M, Luciano F, Mancuso C, Gasparini G, De Benedetto M, Orlando N, Castricini R. Arthroscopic capsular release for frozen shoulder: when etiology matters. Knee Surg Sports Traumatol Arthrosc 2023; 31:5248-5254. [PMID: 37702747 PMCID: PMC10598184 DOI: 10.1007/s00167-023-07561-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE No therapeutic intervention is universally accepted for frozen shoulder, and the most effective management to restore motion and diminish pain has yet to be defined. The aim of this study was to investigate functional and psychological outcomes in patients who underwent arthroscopic capsular release for a frozen shoulder. METHODS A retrospective study with prospective data collection was conducted with 78 patients suffering from frozen shoulder resistance to conservative treatment. Considering the etiology, there were 36 (46.2%) idiopathic, 31 (39.7%) postoperative, and 11 (14.1%) posttraumatic cases. Preoperatively, each patient was evaluated with the range of motion (ROM) assessment and the Constant-Murley score (CMS). At follow-up, the 4-point subjective satisfaction scale (SSS), the ROM assessment, the SF-12 questionnaire, the numerical rating scale (NRS) for the subjective assessment of pain, the CMS and the Hospital Anxiety and Depression Scale (HADS) were assessed. RESULTS After a mean follow-up of 54.2 ± 22.3 months, ROM and CMS showed a statistically significant improvement between pre- and postoperative values (all p < 0.001). Before surgery, the mean CMS was 36.9% that of sex- and age-matched healthy individuals, and all patients showed a CMS lower than the normative data. At the final follow-up visit, the mean CMS was 99.9% that of sex- and age-matched healthy individuals, and 49 (62.8%) patients showed a CMS equal to or higher than the normative data. The mean increase in the CMS was 56.1 ± 8.3 points. The mean SSS, HADS-A, HADS-D, and NRS were 3.7 ± 0.5, 2.5 ± 1.6, 2.2 ± 1.3, and 2.2 ± 1.0, respectively. All patients returned to their previous level of work and sports activity after 2 and 2.5 months, respectively. The multivariate analysis showed the association between a higher postoperative CMS and the idiopathic etiology of a frozen shoulder (p = 0.004, β = 3.971). No intraoperative complications occurred. Postoperatively, four patients (5.1%) were treated with intra-articular steroid injections to manage residual symptoms. One patient (1.3%) with a postoperative frozen shoulder showed persistent symptoms and underwent a new successful arthroscopic capsular release. CONCLUSION High patient satisfaction and statistically significant ROM and CMS recovery can be achieved after arthroscopic capsular release to manage frozen shoulder. Better functional outcomes are expected when the etiology is idiopathic. Results can help surgeons identify the patients who will most benefit from surgery and should be discussed with the patient. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, 88100, Catanzaro, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, 88100, Catanzaro, Italy
| | - Francesco Luciano
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, 88100, Catanzaro, Italy
| | - Claudia Mancuso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, 88100, Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, 88100, Catanzaro, Italy.
| | | | - Nicola Orlando
- Division of Orthopaedic and Trauma Surgery, "Villa Verde", 63900, Fermo, Italy
| | - Roberto Castricini
- Division of Orthopaedic and Trauma Surgery, "Villa Verde", 63900, Fermo, Italy
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Kim JH, Kim BS, Han KD, Kwon HS. The Risk of Shoulder Adhesive Capsulitis in Individuals with Prediabetes and Type 2 Diabetes Mellitus: A Longitudinal Nationwide Population-Based Study. Diabetes Metab J 2023; 47:869-878. [PMID: 37915186 PMCID: PMC10695720 DOI: 10.4093/dmj.2022.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/11/2022] [Indexed: 11/03/2023] Open
Abstract
BACKGRUOUND This study aimed to investigate the association between type 2 diabetes mellitus (T2DM) and shoulder adhesive capsulitis (AC) using a large-scale, nationwide, population-based cohort in the Republic of Korea. METHODS A total of 3,471,745 subjects aged over 20 years who underwent a National Health Insurance Service medical checkup between 2009 and 2010 were included in this study, and followed from the date of their medical checkup to the end of 2018. Subjects were classified into the following four groups based on the presence of dysglycemia and history of diabetes medication: normal, prediabetes, newly diagnosed T2DM (new-T2DM), and T2DM (claim history for antidiabetic medication). The endpoint was new-onset AC during follow-up. The incidence rates (IRs) in 1,000 person-years and hazard ratios (HRs) of AC for each group were analyzed using Cox proportional hazard regression models. RESULTS The IRs of AC were 9.453 (normal), 11.912 (prediabetes), 14.933 (new-T2DM), and 24.3761 (T2DM). The adjusted HRs of AC in the prediabetes, new-T2DM, and T2DM groups were 1.084 (95% confidence interval [CI], 1.075 to 1.094), 1.312 (95% CI, 1.287 to 1.337), and 1.473 (95% CI, 1.452 to 1.494) compared to the normal group, respectively. This secular trend of the HRs of AC according to T2DM status was statistically significant (P<0.0001). CONCLUSION This large-scale, longitudinal, nationwide, population-based cohort study of 3,471,745 subjects confirmed that the risk of AC increases in prediabetic subjects and is associated with T2DM status.
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Affiliation(s)
- Jong-Ho Kim
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bong-Seoung Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Kyung-do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Hyuk-Sang Kwon
- Department of Endocrinology and Metabolism, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Poku D, Hassan R, Migliorini F, Maffulli N. Efficacy of hydrodilatation in frozen shoulder: a systematic review and meta-analysis. Br Med Bull 2023; 147:121-147. [PMID: 37496207 PMCID: PMC10788845 DOI: 10.1093/bmb/ldad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION It is unclear whether hydrodilatation is beneficial in the management of frozen shoulder compared with other common conservative management modalities. This systematic review evaluates the efficacy of hydrodilatation for the management of frozen shoulder. SOURCES OF DATA A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An extensive search of PubMed, Embase, Scopus, Cochrane Central, Web of Science and CINAHL databases using multiple keyword combinations of 'shoulder', 'rotator', 'adhesive capsulitis', 'hydrodilatat*', 'distension' since inception of the databases to June 2023 was implemented. AREAS OF AGREEMENT Hydrodilatation leads to at least transient more marked improvements in shoulder disability and passive external rotation compared with intra-articular corticosteroid injections. AREAS OF CONTROVERSY Hydrodilatation improves passive external rotation in the longer term. Moreover, hydrodilatation may be a preferable option over manipulation under anaesthesia, given its lower cost and better patient convenience. GROWING POINTS Intensive mobilization after hydrodilatation is a promising adjuvant treatment option for patients suffering from a frozen shoulder. AREAS TIMELY FOR DEVELOPING RESEARCH Although current evidence suggests that hydrodilatation provides a transient improvement in disability in patients with frozen shoulder, its clinical relevance remains unclear. Further research is necessary to establish its role in the management of the condition.
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Affiliation(s)
- Daryl Poku
- Faculty of Medicine, University of Southampton, Southampton, SO17 1TW, UK
| | - Rifat Hassan
- Faculty of Medicine, University of Southampton, Southampton, SO17 1TW, UK
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen 52074, Germany
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Bolzano 39100, Italy
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno 84084, Italy
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London E1 4DG, UK
- School of Pharmacy and Biotechnology, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, Keele ST5 5BG, UK
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Jacob L, Koyanagi A, Haro JM, Shin JI, Smith L, Gremke N, Kalder M, Kostev K. Is there an association between breast cancer and incident adhesive capsulitis of the shoulder? A retrospective cohort study from Germany. Support Care Cancer 2023; 31:347. [PMID: 37212901 DOI: 10.1007/s00520-023-07808-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Preliminary data suggest that women with breast cancer are at particularly high risk of adhesive capsulitis of the shoulder. Therefore, this study aimed to investigate the potential association between breast cancer and adhesive capsulitis in adults from Germany. METHODS This retrospective cohort study included all women aged ≥ 18 years who were diagnosed for the first time with breast cancer in one of 1,274 general practices in Germany between January 2000 and December 2018 (index date). Women without breast cancer were matched (1:1) to those with breast cancer using a propensity score based on age at the index date, index year, and the average number of medical consultations per year during the follow-up. In women without breast cancer, the index date was a randomly selected visit date between 2000 and 2018. The association between breast cancer and the 10-year incidence of adhesive capsulitis was studied using Kaplan-Meier curves and a Cox regression model adjusted for age and several comorbidities. RESULTS There were 52,524 women included in this study (mean [SD] age 64.2 [12.9] years). The 10-year incidence of adhesive capsulitis was 3.6% in both the group with and the group without breast cancer (log-rank p-value = 0.317). The Cox regression analysis further showed no significant association between breast cancer and adhesive capsulitis (HR = 0.96, 95% CI = 0.86-1.08). CONCLUSION In this sample of women from Germany, breast cancer was not significantly associated with adhesive capsulitis. Although the present preliminary findings are reassuring, general practitioners should regularly assess shoulder function in breast cancer survivors.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
- Department of Physical Medicine and Rehabilitation, Lariboisière-Fernand Widal Hospital, AP-HP, University Paris Cité, Paris, France
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluis Companys 23, Barcelona, Spain
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Niklas Gremke
- Department of Gynecology and Obstetrics, Philipps-University, Marburg, Germany
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, Philipps-University, Marburg, Germany
| | - Karel Kostev
- Epidemiology, IQVIA, Unterschweinstiege 2-14, 60549, Frankfurt am Main, Germany.
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7
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Frozen Shoulder. Tech Vasc Interv Radiol 2023; 26:100882. [PMID: 36889844 DOI: 10.1016/j.tvir.2022.100882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Adhesive capsulitis (AC) develops spontaneously without a known cause and is a common cause of painful shoulder. The natural history of AC can last until 36 months and it is classically considered a self-limiting entity, however there is a high rate of refractory cases to conventional treatment with residual deficits during years. There is no consensus on the therapeutic guidelines to be followed in patients with AC. Several authors have pointed out the relevance of hypervascularization of the capsule in the pathophysiology of AC, that is why the objective of transarterial embolization (TAE) is to decrease the abnormal vascularization responsible for the inflammatory-fibrotic state that occurs in AC. TAE has now emerged as a therapeutic option in refractory patients. We describe the most important technical aspects of TAE and review the current literature on arterial embolization as a treatment for AC.
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Dyer BP, Rathod-Mistry T, Burton C, van der Windt D, Bucknall M. Diabetes as a risk factor for the onset of frozen shoulder: a systematic review and meta-analysis. BMJ Open 2023; 13:e062377. [PMID: 36599641 PMCID: PMC9815013 DOI: 10.1136/bmjopen-2022-062377] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Summarise longitudinal observational studies to determine whether diabetes (types 1 and 2) is a risk factor for frozen shoulder. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, AMED, PsycINFO, Web of Science Core Collection, CINAHL, Epistemonikos, Trip, PEDro, OpenGrey and The Grey Literature Report were searched on January 2019 and updated in June 2021. Reference screening and emailing professional contacts were also used. ELIGIBILITY CRITERIA Longitudinal observational studies that estimated the association between diabetes and developing frozen shoulder. DATA EXTRACTION AND SYNTHESIS Data extraction was completed by one reviewer and independently checked by another using a predefined extraction sheet. Risk of bias was judged using the Quality In Prognosis Studies tool. For studies providing sufficient data, random-effects meta-analysis was used to derive summary estimates of the association between diabetes and the onset of frozen shoulder. RESULTS A meta-analysis of six case-control studies including 5388 people estimated the odds of developing frozen shoulder for people with diabetes to be 3.69 (95% CI 2.99 to 4.56) times the odds for people without diabetes. Two cohort studies were identified, both suggesting diabetes was associated with frozen shoulder, with HRs of 1.32 (95% CI 1.22 to 1.42) and 1.67 (95% CI 1.46 to 1.91). Risk of bias was judged as high in seven studies and moderate in one study. CONCLUSION People with diabetes are more likely to develop frozen shoulder. Risk of unmeasured confounding was the main limitation of this systematic review. High-quality studies are needed to confirm the strength of, and understand reasons for, the association. PROSPERO REGISTRATION NUMBER CRD42019122963.
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Affiliation(s)
- Brett Paul Dyer
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Trishna Rathod-Mistry
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Claire Burton
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Danielle van der Windt
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Milica Bucknall
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
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9
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Mens JMA, van Kalmthout RTM. Squishing sound heard following an intra-articular shoulder injection with fluid and air is associated with higher efficacy: A retrospective analysis. J Back Musculoskelet Rehabil 2022; 36:317-322. [PMID: 36530071 PMCID: PMC10041411 DOI: 10.3233/bmr-210360] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND Accuracy of blind intra-articular injections for the shoulder is rather low. It is unclear whether accurate injections for capsulitis of the shoulder are more effective than inaccurate injections. OBJECTIVE It has been hypothesized that a squishing sound following an intra-articular injection with a mixture of air and fluid means that the injection was accurately placed and that the efficacy of accurately placed injections is greater than that of inaccurate injections. The aim of the present study was to test the hypothesis that a squishing sound following an injection predicts a better clinical result. METHODS Files were selected of patients with capsulitis of the shoulder, who were treated with an intra-articular injection containing a mixture of triamcinolone, lidocaine, and air. After the injection, the shoulder was moved to determine whether a squishing sound could be produced. Efficacy was measured after two weeks according to the Patient Global Impression of Change scale. Differences in efficacy between injections with and without a squishing sound were expressed as an odds ratio. RESULTS Sixty-one patients were selected. Squishing was heard after 47 injections (77%). Two weeks after the injection, a positive outcome was reported by 49 patients (80%). When squishing was heard, the effect was positive in 42 of the 47 patients (89%) and when no squishing was heard, the effect was positive in 7 of the 14 patients (50%). The odds ratio was 8.4 (95% CI 2.1-34.0; p= 0.003). CONCLUSION Efficacy of injections with a mixture of triamcinolone, lidocaine, and air for capsulitis of the shoulder is significantly greater when a squishing sound was heard after the injection. We hypothesize that squishing is related to accuracy and accuracy to efficacy. A future study with X-ray arthrography is needed to verify both hypotheses.
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Affiliation(s)
- Jan M A Mens
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands.,MSK Clinic, Leiden, The Netherlands
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10
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Jacob L, Koyanagi A, Oh H, Smith L, Konrad M, Shin JI, Haro JM, Kostev K. Association between adhesive capsulitis and depression: A five-year retrospective cohort study including 58,516 adults from Germany. J Psychiatr Res 2022; 155:395-400. [PMID: 36182769 DOI: 10.1016/j.jpsychires.2022.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/14/2022] [Accepted: 09/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known on the longitudinal relationship between adhesive capsulitis and depression. Therefore, the aim of this study was to investigate the association between adhesive capsulitis and the five-year cumulative incidence of depression in adults from Germany. METHODS The present retrospective cohort study included all adults aged ≥18 years with a first diagnosis of adhesive capsulitis in one of 1198 general practices in Germany between January 2010 and December 2018 (index date). Patients with adhesive capsulitis were matched to those without adhesive capsulitis using a propensity score based on age, sex, index year, average number of visits per year, and diagnoses documented prior to or at the index date (i.e., thyroid gland disorders, diabetes mellitus, coronary heart disease, cerebrovascular diseases, and Parkinson's disease and secondary parkinsonism). In individuals without adhesive capsulitis, the index date was a randomly selected visit date. RESULTS This study included 29,258 patients with and 29,258 patients without adhesive capsulitis (mean [SD] age 55.9 [15.6] years; 53.2% men). Within five years of the index date, there were 17.5% of patients with adhesive capsulitis and 8.7% of those without adhesive capsulitis diagnosed with incident depression (log-rank p-value<0.001). This result was corroborated in the Cox regression analysis, as there was a positive and significant association between adhesive capsulitis and the cumulative incidence of depression (HR = 1.86, 95% CI: 1.78-1.95). CONCLUSION In this study, adhesive capsulitis was associated with an increased cumulative incidence of depression. Further research is warranted to better understand the mediating factors involved in this relationship.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain; Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluis Companys 23, Barcelona, Spain
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Marcel Konrad
- Health & Social, FOM University of Applied Sciences for Economics and Management, Frankfurt am Main, Germany
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
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11
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Choi JH, Kim HR, Song KH. Musculoskeletal complications in patients with diabetes mellitus. Korean J Intern Med 2022; 37:1099-1110. [PMID: 36300322 PMCID: PMC9666255 DOI: 10.3904/kjim.2022.168] [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: 05/07/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022] Open
Abstract
Musculoskeletal conditions are common in patients with diabetes. Several musculoskeletal disorders are viewed as chronic complications of diabetes because epidemiological studies have revealed high correlations between such complications and diabetes, but the pathophysiological links with diabetes remains unclear. Genetic predispositions, shared risk factors, microvascular impairments, progressive accumulation of advanced glycation end-products, and diabetic neuropathy may underlie the development of musculoskeletal disorders. Musculoskeletal complications of diabetics have received less attention than life-threatening microvascular or macrovascular complications. Here, we review several diabetic musculoskeletal complications with a focus on the clinical importance of early recognition and management, which would improve quality of life and physical function.
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Affiliation(s)
- Jong Han Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul,
Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul,
Korea
| | - Kee-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul,
Korea
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12
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Park HB, Gwark JY, Jung J, Jeong ST. Involvement of inflammatory lipoproteinemia with idiopathic adhesive capsulitis accompanying subclinical hypothyroidism. J Shoulder Elbow Surg 2022; 31:2121-2127. [PMID: 35447316 DOI: 10.1016/j.jse.2022.03.003] [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: 12/07/2021] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Thyroid functional abnormalities are considered risk factors for idiopathic adhesive capsulitis (IAC) though that relationship remains uncertain. Although dyslipidemias are associated with IAC, no readily accessible study has reported associations between dyslipidemias and IAC patients with subclinical hypothyroidism. The purposes of this study were to investigate whether subclinical hypothyroidism is an independently associated factor for IAC and to determine the differences in prevalence of dyslipidemias between two groups of persons with subclinical hypothyroidism: one composed of IAC patients and the other of individuals without IAC. METHODS This case-control study included a case group of 412 IAC patients without intrinsic shoulder lesions, extrinsic causes, or medication for thyroid dysfunction. The control group comprised 1236 age- and sex-matched persons seeking general checkups at the authors' health promotion center during the same period as the case group. Control subjects had normal shoulder function and no previously diagnosed adhesive capsulitis, no medication for thyroid dysfunction, and no history of trauma or of shoulder surgery. The studied variables were age, gender, obesity, diabetes, dyslipidemias, subclinical hypothyroidism, hypothyroidism, and hyperthyroidism. A conditional logistic regression analysis evaluated the matched sets of subjects to determine odds ratios and 95% confidence intervals for the studied variables. The differences in the prevalence of dyslipidemias between IAC patients with subclinical hypothyroidism and individuals with subclinical hypothyroidism but without IAC were determined with generalized estimating equations, using covariates of age, sex, and diabetes. The P values were set at < 0.05. RESULTS Subclinical hypothyroidism (odds ratio, 2.10; 95% confidence interval, 1.36-3.15; P = .001) was significantly associated with IAC. Patients with IAC and subclinical hypothyroidism had a significantly higher prevalence of hyper-low-density lipoproteinemia, an inflammatory lipoproteinemia, than individuals with subclinical hypothyroidism but without IAC (P = .002). CONCLUSIONS Subclinical hypothyroidism is significantly associated with IAC. Hyper-low-density lipoproteinemia, an inflammatory lipoproteinemia, is involved in IAC accompanied by subclinical hypothyroidism.
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Affiliation(s)
- Hyung Bin Park
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea; Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.
| | - Ji-Yong Gwark
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jaehoon Jung
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Soon-Taek Jeong
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea; Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
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13
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Kim DM, Jeon IH, Kim HY, Park JH, Kim H, Koh KH. The Patient Acceptable Symptom State as a Predictor of the Sports Activity Available State After Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2022; 10:23259671221084978. [PMID: 35340729 PMCID: PMC8943612 DOI: 10.1177/23259671221084978] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/23/2021] [Indexed: 01/08/2023] Open
Abstract
Background The patient acceptable symptom state (PASS) has emerged as a metric for evaluating patient satisfaction after treatment. There is little research on the relationship between sports activity and PASS values after arthroscopic rotator cuff repair (ARCR). Purpose To (1) introduce the sports activity available state (SAAS) as an indicator of whether sports activities are possible based on patient symptoms after ARCR, (2) investigate the correlation between the SAAS and PASS, (3) predict the SAAS using derived PASS values, and (4) identify factors for achieving the PASS and SAAS. Study Design Case-control study; Level of evidence, 3. Methods Included were 201 patients who underwent ARCR between January 2015 and December 2016. At a mean follow-up of 38.7 ± 7.0 months, anchor questions were used to classify patients as SAAS+ (sports group) or SAAS- (nonsports group) and derive the PASS values for the pain visual analog scale (pVAS), American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE). The authors analyzed the correlation and difference between PASS and SAAS acquisition, and univariate and multivariate logistic regression analyses were performed to determine factors for PASS and SAAS achievement. Results The final PASS values for the pVAS, ASES, and SANE were 0.5, 93.5, and 82.5, respectively. A significant correlation existed between PASS and SAAS acquisition (phi correlation coefficient, 0.647; P < .001). Sensitivity and specificity were >0.7 for all outcome scores when predicting SAAS using PASS values. A higher preoperative ASES score was significantly associated with achieving both the SAAS (OR, 1.032 [95% CI, 1.005-1.059]; P = .018) and PASS (OR, 2.556 [95% CI, 1.753-3.726]; P < .001). Diabetes (OR, 0.348 [95% CI, 0.130-0.931], P = .036) and a large to massive tear (OR, 0.378 [95% CI, 0.162-0.884]; P = .025) were significantly negatively associated with achieving the SAAS. Conclusion The authors found the SAAS to be significantly correlated with the PASS. Also, SAAS was able to be predicted using the PASS value. Patients with higher preoperative ASES scores had higher odds of achieving both the PASS and SAAS, and patients with diabetes and those with large to massive tears had lower odds of achieving the SAAS.
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Affiliation(s)
- Dong Min Kim
- Department of Orthopedic Surgery, Sarang Plus Hospital, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Yeon Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hee Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyojune Kim
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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14
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Cole WW, Familia M, Miskimin C, Mulcahey MK. Preoperative Optimization and Tips to Avoiding Surgical Complications Before the Incision. Sports Med Arthrosc Rev 2022; 30:2-9. [PMID: 35113836 DOI: 10.1097/jsa.0000000000000336] [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: 11/26/2022]
Abstract
In preparation for surgery, it is important for surgeons to have a detailed discussion with patients about the risks, benefits, and alternatives to surgery. Patient optimization, ensuring the patient is in the best medical condition before surgery, is also an important aspect of patient care that the surgeon must consider. Although complications cannot be eliminated, there are often opportunities to optimize patients, so these risks can be minimized based on current evidence-based medicine. To minimize the risk of complications, the surgeon should take an active role in each step of the patient's care beginning with the history and physical examination, obtaining the correct preoperative labs, and continuing through positioning, draping, and prepping before making an incision.
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Affiliation(s)
- Wendell W Cole
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
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15
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Digge VK, kumar V, Kar S, Sai Krishna M, Chaudhury B, Jain VK, Desai J. Is there evidence to recommend transcatheter arterial embolisation in adhesive capsulitis: A review of literature. J Orthop 2022; 30:77-82. [PMID: 35241893 PMCID: PMC8867055 DOI: 10.1016/j.jor.2022.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 01/26/2022] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypervascularity of the rotator interval with increased expression of the vascular endothelial growth factor may be the causative factor of conventionally managed adhesive capsulitis. Hence, transcatheter arterial embolisation(TAE) has emerged as an alternative treatment option to occlude the target neovessels by infusing an embolic agent. The present study reviews the literature regarding the efficacy of the TAE for adhesive capsulitis. MATERIAL AND METHODS The systematic review was performed following PRISMA guidelines. MEDLINE, Google Scholar, Scopus and Cochrane database of systemic reviews (CDSR) were searched for relevant publication (from 1960 to 2021). The search algorithm used was Transcatheter arterial embolisation and resistant adhesive capsulitis or refractory adhesive capsulitis or vascular adhesive capsulitis. The database search produced a total of 12026 publications. After exclusion of the non relevant titles, 113 abstracts were reviewed. From these abstracts, three full-text articles were obtained for final review. RESULTS All the studies were analyzed in depth. Patients with no or minimal improvement with conservative treatment for at least 3 months underwent TAE. Pre and post embolisation visual analog score(VAS), shoulder range of motion(ROM) were noted. Any additional therapy was also taken into account. Significant improvement of the VAS score and shoulder ROM was noted immediately after surgery and maintained till final follow up at 24.5 months. CONCLUSION Resistant cases of adhesive capsulitis can be managed successfully with TAE. But ample evidence is lacking regarding the appropriate patient selection and efficacy of TAE as a sole management option of resistant AC.
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Affiliation(s)
| | - Vijay kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - Santanu Kar
- All India Institute of Medical Sciences, New Delhi, India
- Corresponding author. K24, Green Park Extension, 110016, New Delhi, India.
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16
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Kim KI, Lee YS, Kim JY, Chung SW. Effect of diabetes and corticosteroid injection on glenohumeral joint capsule in a rat stiffness model. J Shoulder Elbow Surg 2021; 30:2814-2823. [PMID: 34273535 DOI: 10.1016/j.jse.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE To evaluate the effects of diabetes and corticosteroid injected in the joints on the shoulder motion, gait, and joint capsular properties in a rat stiffness model. METHODS A total of 27 rats were randomly distributed into 3 groups-nondiabetes group (group A), diabetes group (group B), and diabetes plus steroid injection group (group C). The diabetes model was developed by inducing hyperglycemia with a submaximal dose of streptozotocin and the stiffness model by completely immobilizing the right shoulder of each animal in all groups with sutures passed between the scapula and humeral shaft. The left shoulder was used as an untreated control in all groups. Three weeks after immobilization, the sutures were removed in all groups, and a single dose of triamcinolone acetonide (0.5 mg/kg) was injected into the glenohumeral joint in group C. After 3 weeks of free activity, range of motion (ROM) evaluation, gait analysis by stride length, and capsular area measurement were performed in all rats. RESULTS Hyperglycemia was successfully induced with a mean blood glucose level of 448.9±55.9 mg/dL in group B and 431.6±17.8 mg/dL in group C, which were significantly higher than 136.5±13.4 mg/dL in group A (P < .001). A significantly smaller ROM and stride length were found in the right (stiffness-induced) shoulder than that in the left (control) shoulder only in group B, and significantly larger capsular area in the right shoulder than that in the left shoulder in groups A and B (all P < .05). However, in group C, there were no differences between the right and left shoulders in all measurements (all P > .05). In case of the right shoulders in each group, group C showed significantly larger ROM (68° ± 11° vs. 42° ± 7°) and smaller capsular area (3934.4 ± 537.1 pixels vs. 7402.3 ± 1840.3 pixels) than group B (all P < .0167). CONCLUSIONS The diabetic model had a detrimental effect on the development of stiffness by thickening the joint capsule, and an intra-articular steroid injection resolved the thickened joint capsule and restored shoulder motion.
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Affiliation(s)
- Kwang Il Kim
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Yong Soo Lee
- Joint Center, Barunsesang Hospital, Seongnam, Republic of Korea
| | - Ja Yeon Kim
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea.
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17
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Hodgetts C, Walker B. Epidemiology, common diagnoses, treatments and prognosis of shoulder pain: A narrative review. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Green HD, Jones A, Evans JP, Wood AR, Beaumont RN, Tyrrell J, Frayling TM, Smith C, Weedon MN. A genome-wide association study identifies 5 loci associated with frozen shoulder and implicates diabetes as a causal risk factor. PLoS Genet 2021; 17:e1009577. [PMID: 34111113 PMCID: PMC8191964 DOI: 10.1371/journal.pgen.1009577] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/04/2021] [Indexed: 11/19/2022] Open
Abstract
Frozen shoulder is a painful condition that often requires surgery and affects up to 5% of individuals aged 40-60 years. Little is known about the causes of the condition, but diabetes is a strong risk factor. To begin to understand the biological mechanisms involved, we aimed to identify genetic variants associated with frozen shoulder and to use Mendelian randomization to test the causal role of diabetes. We performed a genome-wide association study (GWAS) of frozen shoulder in the UK Biobank using data from 10,104 cases identified from inpatient, surgical and primary care codes. We used data from FinnGen for replication and meta-analysis. We used one-sample and two-sample Mendelian randomization approaches to test for a causal association of diabetes with frozen shoulder. We identified five genome-wide significant loci. The most significant locus (lead SNP rs28971325; OR = 1.20, [95% CI: 1.16-1.24], p = 5x10-29) contained WNT7B. This variant was also associated with Dupuytren's disease (OR = 2.31 [2.24, 2.39], p<1x10-300) as were a further two of the frozen shoulder associated variants. The Mendelian randomization results provided evidence that type 1 diabetes is a causal risk factor for frozen shoulder (OR = 1.03 [1.02-1.05], p = 3x10-6). There was no evidence that obesity was causally associated with frozen shoulder, suggesting that diabetes influences risk of the condition through glycemic rather than mechanical effects. We have identified genetic loci associated with frozen shoulder. There is a large overlap with Dupuytren's disease associated loci. Diabetes is a likely causal risk factor. Our results provide evidence of biological mechanisms involved in this common painful condition.
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Affiliation(s)
- Harry D. Green
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, United Kingdom
| | - Alistair Jones
- Shoulder Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Jonathan P. Evans
- Shoulder Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Andrew R. Wood
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, United Kingdom
| | - Robin N. Beaumont
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, United Kingdom
| | - Jessica Tyrrell
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, United Kingdom
| | - Timothy M. Frayling
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, United Kingdom
| | - Christopher Smith
- Shoulder Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Michael N. Weedon
- Shoulder Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, United Kingdom
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19
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Zhang J, Zhong S, Tan T, Li J, Liu S, Cheng R, Tian L, Zhang L, Wang Y, Liu F, Zhou P, Ye X. Comparative Efficacy and Patient-Specific Moderating Factors of Nonsurgical Treatment Strategies for Frozen Shoulder: An Updated Systematic Review and Network Meta-analysis. Am J Sports Med 2021; 49:1669-1679. [PMID: 32941053 DOI: 10.1177/0363546520956293] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Frozen shoulder is a common shoulder disorder characterized by pain and restriction. Various nonsurgical treatments have been reported, but there is no consensus about their comparative efficacy and the effects of moderators. PURPOSE To compare the efficacy of different nonsurgical interventions and identify potential patient-specific moderating factors for frozen shoulder. STUDY DESIGN Systematic review and network meta-analysis. METHODS PubMed, Embase, Cochrane Library, and Web of Science databases were searched from their inception to February 18, 2019. The search was supplemented by manual review of relevant reference lists. Randomized controlled trials of participants with frozen shoulder that compared nonsurgical interventions were selected. Measured outcomes included pain, shoulder function in daily activities, and range of motion. RESULTS Of 3136 records identified, 92 trials were eligible, evaluating 32 nonsurgical interventions in 5946 patients. Intra-articular injection improved pain (pooled standardized mean difference [95% CI]: steroid injection, 1.68 [1.03-2.34]; capsular distension, 2.68 [1.32-4.05]) and shoulder function (steroid injection, 2.16 [1.52-2.81]; distension, 2.89 [1.71-4.06]) to a greater extent than placebo. Capsular distension and extracorporeal shockwave therapy showed the highest ranking for pain relief and functional improvement, respectively. Laser therapy also showed benefits for pain relief (3.02 [1.84-4.20]) and functional improvement (3.66 [1.65-5.67]). Subgroup analyses by disease stages revealed that steroid injection combined with physical therapy provided more benefits during the freezing phase, whereas joint manipulation provided more benefits in the adhesive phase. Adjunctive therapies, female sex, and diabetes were also identified as moderators of effectiveness. CONCLUSION Capsular distension is a highly recommended choice for treatment of frozen shoulder, contributing greatly to pain relief and functional improvement; steroid injection is also a prevailing effective intervention. Among new options, extracorporeal shockwave therapy and laser therapy show potential benefits for multiple outcomes. Individualized optimal intervention should be considered, given that treatment effect is moderated by factors including the disease stage, time of assessment, adjunctive therapies, female sex, and diabetes.
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Affiliation(s)
- Jie Zhang
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Shuchang Zhong
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Tongcai Tan
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Juebao Li
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Shuang Liu
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Ruidong Cheng
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Liang Tian
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Li Zhang
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yuanjiao Wang
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Fei Liu
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Panpan Zhou
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xiangming Ye
- Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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20
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Kolade O, Ghosh N, Luthringer TA, Rosenthal Y, Kwon YW, Rokito AS, Zuckerman JD, Virk MS. Correlation of Patient Reported Outcome Measurement Information System (PROMIS) with American Shoulder and Elbow Surgeon (ASES), and Constant (CS) scores in idiopathic adhesive capsulitis. J Shoulder Elbow Surg 2021; 30:554-560. [PMID: 32650070 DOI: 10.1016/j.jse.2020.05.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/18/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE To correlate the Patient Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) score with pre-existing validated outcome scores, American Shoulder and Elbow Surgeons score (ASES), and Constant score (CS) in patients with idiopathic adhesive capsulitis (AC). METHODS Patients with a clinical diagnosis of idiopathic AC ("freezing" or "frozen" phases) who agreed to complete the ASES, CS, and PROMIS UE scores during their office visit were included in this study. Trained researchers performed the objective clinical assessments on the included patients. Responses to the 3 outcome scores were statistically analyzed and compared using Pearson correlation coefficients. Floor and ceiling effects were calculated. RESULTS The final cohort included 100 patients with AC, of whom there were 72% female and 87% right hand dominant, with a mean age of 55 years. The PROMIS UE required fewer question responses (5.02 ± 1.84) compared with the fixed question burden with ASES (12) and CS (9). The mean outcome scores were 34.6 ± 2.5 (PROMIS UE), 55 ± 22 (ASES), and 51 ± 16 (CS). The PROMIS UE displayed an excellent correlation with both the ASES (r = 0.80, 95% confidence interval [0.72, 0.86], P < .001) and CS (r = 0.76, 95% confidence interval [0.67, 0.83], P < .001). Neither ceiling nor floor effects were present. CONCLUSION The PROMIS UE displayed comparable efficacy to commonly used legacy outcome scores (ASES and CS) in AC. A lower question burden with the PROMIS UE carries potential for wider acceptability with the researchers and patients with shoulder pathology.
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Affiliation(s)
- Oluwadamilola Kolade
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Niloy Ghosh
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Tyler A Luthringer
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Yoav Rosenthal
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Young W Kwon
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Andrew S Rokito
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Joseph D Zuckerman
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Mandeep S Virk
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.
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21
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Fernández Martínez AM, Baldi S, Alonso-Burgos A, López R, Vallejo-Pascual ME, Cuesta Marcos MT, Romero Alonso D, Rodríguez Prieto J, Mauriz JL. Mid-Term Results of Transcatheter Arterial Embolization for Adhesive Capsulitis Resistant to Conservative Treatment. Cardiovasc Intervent Radiol 2020; 44:443-451. [PMID: 33135118 DOI: 10.1007/s00270-020-02682-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/07/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the mid-term clinical outcomes of transcatheter arterial embolization (TAE) for adhesive capsulitis (AC) resistant to medical treatments. MATERIALS AND METHODS This is a prospective analysis performed between February 2016 and February 2020. Inclusion criteria for TAE were shoulder pain, restriction of movement and no response to conservative treatment for at least 3 months. Demographic variables, risk factors, technical aspects, adverse events, changes by visual analogue scale (VAS) for pain and physical examination before and after TAE were assessed. RESULTS This study included 40 patients with AC (35 women and 5 men; mean age 50 ± 9 years old). Abnormal vessels were observed in 31/40 (77.5%) procedures. As embolic agent, imipenem/cilastatin was used. The mean follow-up was 21.2 ± 10.5 months. Significant differences were obtained in terms of pain reduction before and 6 months after TAE with the median visual analogue scale (VAS) of 8 vs. 0.5, P = 0.0001. Substantial differences were found regarding mobility in flexion and abduction before and 6 months after embolization, respectively (79.5° ± 18.5° vs. 133° ± 24.5°, P = 0.0001; 72.4° ± 18.8° vs. 129.7° ± 27.9°, P = 0.0001). No complications occurred. Complete recovery was obtained in 37/40 (92.5%) patients and partial recovery in 2/40 (5%). No clinical recurrence appeared. CONCLUSIONS Clinical results of transcatheter arterial embolization with imipenem/cilastatin are effective and stable in the mid-term follow-up for patients presenting with AC resistant to conservative treatments.
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Affiliation(s)
| | - Sebastián Baldi
- Interventional Radiology, Universitary Hospital of León, León, Spain
| | | | - Roberto López
- Physical Chemistry Area, Faculty of Biology and Environmental Sciences, University of León, León, Spain
| | | | | | | | | | - Jose Luis Mauriz
- Institute of Biomedicine (IBIOMED), University of León, León, Spain
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22
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Breckenridge JD, McAuley JH, Ginn KA. Motor Imagery Performance and Tactile Spatial Acuity: Are They Altered in People with Frozen Shoulder? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207464. [PMID: 33066655 PMCID: PMC7602509 DOI: 10.3390/ijerph17207464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 12/24/2022]
Abstract
Frozen shoulder (adhesive capsulitis) is a severe chronic pain condition that is not well understood and current treatment is suboptimal. In several other chronic pain conditions motor imagery and tactile acuity deficits are present, which are thought to represent associated neuroplastic changes. The aims of this study were to determine if motor imagery performance assessed by the left/right judgement task, and tactile acuity assessed by two-point discrimination, are altered in people with unilateral frozen shoulder. In this cross-sectional, prospective study eighteen adults diagnosed with frozen shoulder in a physiotherapy clinic setting completed a left/right judgement task, response times (RT) and accuracy for the left/right judgement task were determined. Next, tactile acuity over both shoulders was assessed with a novel, force-standardised two-point discrimination test. Results corresponding to the affected side were compared to the pain free shoulder; Left/right judgement task: mean RT (SD) corresponding to the affected shoulder was significantly slower than RT for the healthy shoulder (p = 0.031). There was no side-to-side difference in accuracy (p > 0.05). Neither RT nor accuracy was related to pain/disability scores or duration of symptoms (p > 0.05). Two-point discrimination: mean two-point discrimination threshold of the affected shoulder was significantly larger than the contralateral healthy shoulder (p < 0.001). Two-point discrimination threshold was not related to pain/disability scores or pain duration (p > 0.05); One explanation for these findings is altered sensorimotor processing and/or disrupted sensorimotor cortex representations of the affected shoulder. A case then exists for the use of treatments aimed at reversing these changes, training the brain to reduce chronic shoulder pain.
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Affiliation(s)
- John D. Breckenridge
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia;
- The Clinical Research Institute, Sydney 2145, Australia
- Correspondence: ; Tel.: +61-2-9672-3511
| | - James H. McAuley
- Neuroscience Research Australia (NeuRA), Hospital Rd, Randwick 2013, Australia;
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney 2033, Australia
| | - Karen A. Ginn
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia;
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Hsu CY, Ke DS, Lin CL, Kao CH. Risk of Herpes Zoster in Patients with Adhesive Capsulitis of the Shoulder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103592. [PMID: 32443791 PMCID: PMC7277430 DOI: 10.3390/ijerph17103592] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023]
Abstract
Background: Physical diseases, such as infection, and emotional distress are associated with herpes zoster (HZ). However, the relationship between adhesive capsulitis of the shoulder (ACoS) and HZ remains unknown. Objective: This study investigated the risk of HZ development in patients with ACoS. Methods: We analyzed the Longitudinal Health Insurance Database, a subset of 1 million beneficiaries from the National Health Insurance Research Database. Patients newly diagnosed with ACoS during the 2000–2012 period were the case group. Each patient with ACoS was matched to a control, according to age and index year, through frequency matching. HZ was the primary event in this study. Results: A total of 60,478 patients were included and each group contained 30,239 patients. The risk of HZ infection in the case cohort was 1.28 times that of the control cohort. ACoS increased the risk of HZ infection in each age group, particularly among patients aged younger than 50 [adjusted hazard ratio (aHR) = 1.52, 95% confidence interval (CI): 1.31–1.75]. Relative to the control group, the hazard ratio of HZ for male patients (aHR = 1.40, 95% CI: 1.26–1.55) in the case group was higher than that for female patients (aHR = 1.22, 95% CI: 1.13–1.32). Conclusion: Patients with ACoS have a higher risk of HZ development, particularly among those aged younger than 50 years. The effect of ACoS on HZ development among young adults requires attention.
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Affiliation(s)
- Chao-Yu Hsu
- Department of Medical Education, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (C.-Y.H.); (D.-S.K.)
- Department of Family Medicine, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan
- Department of Optometry, Central Taiwan University of Science and Technology, Taichung 40601, Taiwan
- Center for General Education, National Taichung University of Science and Technology, Taichung 40401, Taiwan
- The General Education Center, Chaoyang University of Technology, Taichung 41349, Taiwan
- Department of General Education, National Chin-Yi University of Technology, Taichung 41170, Taiwan
- Center for General Education, National Chi Nan University, Puli 54561, Taiwan
- Rural Generalist Program Japan, GENEPRO, Asahi Shi 289-2505, Japan
| | - Der-Shin Ke
- Department of Medical Education, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 60002, Taiwan; (C.-Y.H.); (D.-S.K.)
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 40447, Taiwan;
- College of Medicine, China Medical University, Taichung 40447, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung 40447, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung 40447, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung 40447, Taiwan
- Correspondence: or ; Tel.: +886-4-2205-2121 (ext. 7412); Fax: +886-4-2233-6174
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Tzeng CY, Chiang HY, Huang CC, Lin WS, Hsiao TH, Lin CH. The impact of pre-existing shoulder diseases and traumatic injuries of the shoulder on adhesive capsulitis in adult population: A population-based nested case-control study. Medicine (Baltimore) 2019; 98:e17204. [PMID: 31574829 PMCID: PMC6775364 DOI: 10.1097/md.0000000000017204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Adhesive capsulitis (AC) is a common chronic disorder for adult patients; however, whether a history of pre-existing shoulder diseases may affect the development of AC is still not fully understood. We aimed to investigate the incidence and prevalence of AC and to assess the association of pre-existing shoulder diseases and traumatic injuries of the shoulder with the development of AC in adults.This retrospective population-based cohort and nested case-control study used data from the National Health Institute Research Database of Taiwan. A total of 24,414 patients aged 20 years or older and with a diagnosis of AC were identified between 2000 and 2013. We calculated the incidence of AC for each year during the study period. In addition, these AC patients were matched with controls (n = 97,656) in a ratio of 1:4 based on age, gender, and index date. Univariate and multivariate logistic regression models were performed to identify variables associated with AC.Females and patients aged 50 to 69 years had higher age-gender standardized incidence and prevalence of AC than their counterparts. Multivariate analyses showed that after adjusting for relevant covariates, pre-existing shoulder diseases of calcific tendinitis (odds ratio [OR] = 8.74, 95% confidence interval [CI] = 5.66-13.5), biceps tendinitis (OR = 7.93, 95% CI = 5.33-11.79), rotator cuff syndrome (OR = 6, 95% CI = 5.26-6.85), osteoarthritis (OR = 4.27, 95% CI = 3.44-5.3), and impingement syndrome (OR = 3.13, 95% CI = 2.64-3.71), as well as fracture (OR = 4.51, 95% CI = 3.82-5.34) and dislocation (OR = 3.57, 95% CI = 2.35-5.45) of the shoulder were significantly associated with AC risk.Higher odds of AC were observed among patients with pre-existing shoulder conditions. This study highlights the need to consider differences in AC risk among patients with various types of shoulder diseases and traumatic injuries of the shoulder.
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Affiliation(s)
- Chung-Yuh Tzeng
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung
- Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung
| | - Chun-Che Huang
- Department of Healthcare Administration, I-Shou University, Kaohsiung
- Department of Medical Research, Taichung Veterans General Hospital, Taichung
| | - Wei-Szu Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung
| | - Tzu-Hung Hsiao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung
- Department of Public Health, Fu-Jen Catholic University, New Taipei
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung
- Department of Public Health, Fu-Jen Catholic University, New Taipei
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
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Pease B, Ross M. Defining subgroups of patients with a stiff and painful shoulder: an analytical model using cluster analysis. Disabil Rehabil 2019; 43:537-544. [PMID: 31268741 DOI: 10.1080/09638288.2019.1631891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The primary purpose of this research was to develop a classification system for patients with stiff and painful shoulders using hierarchical cluster analysis. METHODS Medical charts of 52 patients treated for stiff and painful shoulders were reviewed for descriptive and clinical data after completion of their rehabilitation. A clinician-reported outcome was derived from ratings of three members of the American Society of Shoulder and Elbow Therapists. Data were subjected to cluster analysis using the hierarchical method. Analysis of difference tests was performed to determine if differences between clusters could be found with either initial examination or outcome data. RESULTS Two clusters emerged from the clustering process: a healthy, strong, and mobile group of 32 patients, and an unhealthy, weak, and immobile groups consisting of 20 patients. Significant differences in initial examination measures between clusters were found for the presence of co-morbidities, range of motion for shoulder flexion, abduction, external rotation, and internal rotation, and strength of the shoulder external rotators and in the empty can position. Significant differences between clusters were found for shoulder flexion, abduction, and external rotation range of motion, and clinician-reported outcome at the time of patient discharge. CONCLUSION Patients with stiff and painful shoulders in this study were classified into two distinct subgroups using hierarchical cluster analysis based on demographic attributes and initial examination findings. The findings from this study also suggest that patients who may be at risk for a poorer outcome can be identified based on initial examination measures. By identifying these patients early in rehabilitation who have a poorer prognosis, improved patient education, alternative interventions or diagnostic tests may be utilized on their behalf.Implications for rehabilitationPatients with stiff and painful shoulders were classified into two subgroups using hierarchical cluster analysis based on demographic attributes and initial examination findings.Significant differences in mean clinician-reported outcome was also noted between clusters, with the patients who were healthier, stronger, and more mobile having a significantly better outcome than those patients who were more unhealthy, weak, and immobile.The findings from this study suggest that patients can be identified on initial examination who may be at risk for a poorer outcome.By identifying these patients early in rehabilitation who have a poorer prognosis, improved patient education, alternative interventions, or diagnostic tests may be utilized on their behalf sooner in the course of care.
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Affiliation(s)
- Brian Pease
- Body One Physical Therapy, Indianapolis, IN, USA
| | - Michael Ross
- Department of Physical Therapy, Daemen College, Amherst, NY, USA
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Toprak M, Erden M. Sleep quality, pain, anxiety, depression and quality of life in patients with frozen shoulder1. J Back Musculoskelet Rehabil 2019; 32:287-291. [PMID: 30347591 DOI: 10.3233/bmr-171010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nocturnal shoulder pain could play an essential role in frozen shoulder (FS) and can lead to disturbed sleep, anxiety, depression and reduced quality of life (QoL). OBJECTIVE The aim of this study was to examine anxiety, depression, sleep quality and quality of life in patients with FS and compare these to healthy controls. METHODS We prospectively evaluated 148 participants (76 FS patients and 72 healthy controls). We obtained Visual Analogue Scale (VAS) pain score, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI) and World Health Organization Quality of Life Scale short form (WHOQoL-BREF). RESULTS FS patients had significantly higher scores for VAS and BAI (p< 0.001) than the control group. There was no significant difference between the BDI scores of the groups (p= 0.067). The WHOQoL-BREF scale of the physical, mental and environmental fields were significantly lower in the FS group (p< 0.001). FS patients had significantly lower sleep efficiency, and sleep disorders in terms of PSQI section scores (p< 0.001). CONCLUSION Our study demonstrated that there is a high prevalence and close relationships of pain, anxiety and sleep disturbance in patients with FS. Adding a psychiatric evaluation to the treatment of patients with FS may be beneficial.
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Affiliation(s)
- M Toprak
- Department of Physical Medicine and Rehabilitation, Toprak Medical Faculty, Yüzüncü Yıl University, Van, Turkey
| | - M Erden
- Department of Physical Medicine and Rehabilitation, Van Training and Research Hospital, Van, Turkey
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Usher KM, Zhu S, Mavropalias G, Carrino JA, Zhao J, Xu J. Pathological mechanisms and therapeutic outlooks for arthrofibrosis. Bone Res 2019; 7:9. [PMID: 30937213 PMCID: PMC6433953 DOI: 10.1038/s41413-019-0047-x] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/17/2019] [Accepted: 02/26/2019] [Indexed: 02/07/2023] Open
Abstract
Arthrofibrosis is a fibrotic joint disorder that begins with an inflammatory reaction to insults such as injury, surgery and infection. Excessive extracellular matrix and adhesions contract pouches, bursae and tendons, cause pain and prevent a normal range of joint motion, with devastating consequences for patient quality of life. Arthrofibrosis affects people of all ages, with published rates varying. The risk factors and best management strategies are largely unknown due to a poor understanding of the pathology and lack of diagnostic biomarkers. However, current research into the pathogenesis of fibrosis in organs now informs the understanding of arthrofibrosis. The process begins when stress signals stimulate immune cells. The resulting cascade of cytokines and mediators drives fibroblasts to differentiate into myofibroblasts, which secrete fibrillar collagens and transforming growth factor-β (TGF-β). Positive feedback networks then dysregulate processes that normally terminate healing processes. We propose two subtypes of arthrofibrosis occur: active arthrofibrosis and residual arthrofibrosis. In the latter the fibrogenic processes have resolved but the joint remains stiff. The best therapeutic approach for each subtype may differ significantly. Treatment typically involves surgery, however, a pharmacological approach to correct dysregulated cell signalling could be more effective. Recent research shows that myofibroblasts are capable of reversing differentiation, and understanding the mechanisms of pathogenesis and resolution will be essential for the development of cell-based treatments. Therapies with significant promise are currently available, with more in development, including those that inhibit TGF-β signalling and epigenetic modifications. This review focuses on pathogenesis of sterile arthrofibrosis and therapeutic treatments.
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Affiliation(s)
- Kayley M. Usher
- School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia Australia
| | - Sipin Zhu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Georgios Mavropalias
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia Australia
| | | | - Jinmin Zhao
- Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi China
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi China
| | - Jiake Xu
- School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia Australia
- Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi China
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Takahashi R, Iwahori Y, Kajita Y, Harada Y, Muramatsu Y, Ikemoto T, Deie M. Clinical Results and Complications of Shoulder Manipulation under Ultrasound-Guided Cervical Nerve Root Block for Frozen Shoulder: A Retrospective Observational Study. Pain Ther 2019; 8:111-120. [PMID: 30742255 PMCID: PMC6513960 DOI: 10.1007/s40122-018-0109-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction Manipulation under ultrasound-guided fifth and sixth cervical nerve root block (MUC) is a recognized form of treatment for patients with persistent frozen shoulder (FS). This study aimed to investigate the confirmatory hypothesis testing that the MUC has a significant clinical effect on FS refractory to conservative treatments and to assess its adverse events. Methods This is a retrospective observational study on patients with FS treated in the past 8 years. Although 77 patients were eligible for this study, only 68 were enrolled. The patients were evaluated immediately before the MUC and at 1, 3, and 6 months after with the use of the Japanese Orthopaedic Association shoulder score. Simultaneously, ranges of motion of the affected shoulder were measured in two directions: forward flexion and external rotation. A paired t test or a Wilcoxon signed-rank test was used to compare differences in outcomes between before and 6 months after MUC. We also assessed any adverse events during and after the MUC. Results Regarding the primary outcome, confirmatory testing showed statistically significant improvements in every outcome value at 6 months after MUC (p < 0.001). In terms of adverse events, two patients (2.9%) had vasovagal reflex, one (1.5%) had a panic attack during the block procedure, and a 72-year-old female patient (1.2%) had an avulsion fracture of the inferior glenoid during the manipulation procedure, although all of them recovered spontaneously without any residual functional impairment. Conclusion The results showed that significant clinical effects of the MUC on FS were observed through a confirmatory analysis with a sufficient sample size. However, several complications that could occur during the block and manipulation procedures should be considered.
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Affiliation(s)
- Ryosuke Takahashi
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan.
| | - Yusuke Iwahori
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yukihiro Kajita
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yohei Harada
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yoshitaka Muramatsu
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tatsunori Ikemoto
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Masataka Deie
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
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Gundtoft PH, Kristensen AK, Attrup M, Vobbe JW, Luxhøi T, Rix FG, Hölmich P, Sørensen L. Prevalence and Impact of Diabetes Mellitus on the Frozen Shoulder. South Med J 2018; 111:654-659. [PMID: 30391999 DOI: 10.14423/smj.0000000000000886] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The objective of this study was to estimate the prevalence of undiagnosed diabetes mellitus in patients with newly diagnosed frozen shoulder (FS) and study whether diabetes mellitus increases the severity of FS disease. METHODS Patients with newly diagnosed FS were consecutively included in this case-control study. Patients who were not already diagnosed as having diabetes mellitus were invited to be tested with the hemoglobin A1c blood sample test. The study population was compared with a control group, consisting of five individuals from the general population matched on age and sex. The passive range of motion, Oxford Shoulder Score, and visual analog scale (VAS) for average and maximum daily pain was recorded for all of the patients in the study group. RESULTS A total of 235 patients were included, 34 (14%) of whom were diagnosed as having diabetes mellitus before the examination. Of the remaining 201 patients, 122 (61%) agreed to be tested for diabetes mellitus. None of the tested patients had undiagnosed diabetes mellitus. This was not significantly different from the prevalence in the matched control population (P = 0.09). There was no difference between patients with and without diabetes mellitus in average daily VAS (P = 0.46) nor maximum daily VAS (P = 0.44). The Oxford Shoulder Score was similar in the two groups (P = 0.23) as was the range of motion. CONCLUSIONS The prevalence of undiagnosed diabetes mellitus is low in patients with FS and does not differ from the general population. Diabetes mellitus does not seem to affect patients' perceived severity of an FS.
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Affiliation(s)
- Per H Gundtoft
- From the Orthopedic Department, Kolding Hospital, Kolding, the Orthopedic Department, Vejle Hospital, Vejle, the Sports Orthopaedic Research Centre-Copenhagen, Copenhagen, and the Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen, Denmark
| | - Anne K Kristensen
- From the Orthopedic Department, Kolding Hospital, Kolding, the Orthopedic Department, Vejle Hospital, Vejle, the Sports Orthopaedic Research Centre-Copenhagen, Copenhagen, and the Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen, Denmark
| | - Mikkel Attrup
- From the Orthopedic Department, Kolding Hospital, Kolding, the Orthopedic Department, Vejle Hospital, Vejle, the Sports Orthopaedic Research Centre-Copenhagen, Copenhagen, and the Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen, Denmark
| | - Jette W Vobbe
- From the Orthopedic Department, Kolding Hospital, Kolding, the Orthopedic Department, Vejle Hospital, Vejle, the Sports Orthopaedic Research Centre-Copenhagen, Copenhagen, and the Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen, Denmark
| | - Torben Luxhøi
- From the Orthopedic Department, Kolding Hospital, Kolding, the Orthopedic Department, Vejle Hospital, Vejle, the Sports Orthopaedic Research Centre-Copenhagen, Copenhagen, and the Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen, Denmark
| | - Flemming G Rix
- From the Orthopedic Department, Kolding Hospital, Kolding, the Orthopedic Department, Vejle Hospital, Vejle, the Sports Orthopaedic Research Centre-Copenhagen, Copenhagen, and the Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen, Denmark
| | - Per Hölmich
- From the Orthopedic Department, Kolding Hospital, Kolding, the Orthopedic Department, Vejle Hospital, Vejle, the Sports Orthopaedic Research Centre-Copenhagen, Copenhagen, and the Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen, Denmark
| | - Lilli Sørensen
- From the Orthopedic Department, Kolding Hospital, Kolding, the Orthopedic Department, Vejle Hospital, Vejle, the Sports Orthopaedic Research Centre-Copenhagen, Copenhagen, and the Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen, Denmark
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Abstract
BACKGROUND Adhesive capsulitis is common and can cause stiffness and pain. Diabetes and dyslipidemia are known to be associated with adhesive capsulitis. However, there is no report of any association between serum lipid profiles and adhesive capsulitis accompanied by diabetes. QUESTION/PURPOSE Which serum lipid abnormalities are associated with adhesive capsulitis accompanied by diabetes? METHODS This is a case-control study with two control groups. Our case group included 37 patients with newly diagnosed adhesive capsulitis accompanied by newly diagnosed diabetes who had no other diagnosed systemic diseases or rotator cuff tears. The two control groups each had 111 age- and sex-matched individuals with normal shoulder function (bilaterally pain-free, with full range of motion and no shoulder muscle weakness), no thyroid dysfunction, and no previously diagnosed systemic diseases. Individuals in the first control group had neither adhesive capsulitis nor diabetes. Individuals in the second control group had newly diagnosed diabetes without adhesive capsulitis. We evaluated any association between adhesive capsulitis accompanied by diabetes and serum lipid profile, including total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, and nonhigh-density lipoprotein (nonHDL). Conditional logistic regression analysis was used to evaluate the strengths of associations between serum lipid levels and adhesive capsulitis accompanied by diabetes, as determined by odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Low-density lipoprotein and nonHDL were associated with adhesive capsulitis accompanied by diabetes. Specifically, patients with adhesive capsulitis and diabetes had greater odds ratios of hyperlow-density lipoproteinemia when compared with individuals with neither adhesive capsulitis nor diabetes (OR, 3.19; 95% CI, 1.21-8.38; p = 0.019) and when compared with individuals without adhesive capsulitis but with newly diagnosed diabetes (OR, 5.76; 95% CI, 1.67-19.83; p = 0.005). Similarly, patients with adhesive capsulitis accompanied by diabetes had greater odds ratios of hypernonhigh-density lipoproteinemia when compared with individuals with neither adhesive capsulitis nor diabetes (OR, 7.39; 95% CI, 2.72-20.09; p < 0.001) and when compared with individuals without adhesive capsulitis but with newly diagnosed diabetes (OR, 3.26; 95% CI, 1.40-7.61; p = 0.006). CONCLUSIONS Inflammatory lipoproteinemias, particularly hyperlow-density lipoproteinemia and hypernonhigh-density lipoproteinemia, are associated with adhesive capsulitis accompanied by diabetes. Further research is needed to evaluate whether inflammatory lipoproteinemias are a cause, a related cofactor, or an aggravating factor in the development of adhesive capsulitis in people who have diabetes. LEVEL OF EVIDENCE Level III, prognostic study.
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Sözen T, Başaran NÇ, Tınazlı M, Özışık L. Musculoskeletal problems in diabetes mellitus. Eur J Rheumatol 2018; 5:258-265. [PMID: 30388074 PMCID: PMC6267753 DOI: 10.5152/eurjrheum.2018.18044] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/27/2018] [Indexed: 12/13/2022] Open
Abstract
Diabetic patients may suffer from a wide range of musculoskeletal disorders that can cause pain and some dysfunctions in the patient and affect the treatment negatively or reduce the quality of life by causing problems in the implementation of exercise programs, which are very important in the treatment of patients with Diabetes Mellitus. Although most of these problems are also seen in non-diabetics, they are more frequently observed but are not specific to diabetics. Their physiopathology is not fully understood; there is some evidence suggesting that macro- and microvascular complications of diabetes are responsible. A diagnosis of musculoskeletal dysfunctions in diabetic patients is made by clinical findings, and there is currently no specific treatment. If the treatment of problems requires corticosteroid use, diabetes can be hard to manage. In this review, we summarized the general features, diagnosis, and treatment modalities of frequent and important musculoskeletal disorders in diabetic patients.
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Affiliation(s)
- Tümay Sözen
- Private Ankara Endomer Endocrinology Center, Ankara, Turkey
| | - Nursel Çalık Başaran
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mehtap Tınazlı
- Department of Internal Medicine, Near East University School of Medicine, Nicosia, Turkish Republic of Northern Cyprus
| | - Lale Özışık
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
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Hsu KC, Sun CH, Wu YY, Chen LC, Wu YT, Chien WC. Increased risk of adhesive capsulitis among patients with gout: A nationwide population-based matched-cohort study. Int J Rheum Dis 2018; 21:1716-1722. [PMID: 30345644 DOI: 10.1111/1756-185x.13347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM The pathophysiology of adhesive capsulitis (AC) is uncertain. We noted patients with gout seemed to have higher incidence rates of AC than other people in our clinic. We did not know the true relationship between gout and AC because there are no published reports so far. The aim of this study is to verify the risk of developing AC following gout exposure. METHOD The authors used the National Health Insurance Research Database of Taiwan to select 39 094 subjects with newly diagnosed gout and randomly extracted 78 188 matched control subjects. All of the subjects in study and control groups were followed until the event of AC. Cox proportional hazard regression analyses were performed to evaluate the subsequent risk of AC. RESULTS There was significance since the 8th year of tracking that patients with gout had a higher risk for AC (log-rank test P < .001). Cox regression showed the adjusted hazard ratio of developing AC for patients with gout was 1.71 (95% CI = 1.451-2.565, P < .001) than the control group. Stratified analysis showed that gout patients have a higher risk for AC regardless of diabetes mellitus, stroke or carotid artery disease (P < .05). CONCLUSIONS This study showed that gout is an independent risk factor for developing AC.
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Affiliation(s)
- Kao-Chih Hsu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Hung Sun
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan
| | - Yin-Yin Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Liang-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
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Alsubheen SA, Nazari G, Bobos P, MacDermid JC, Overend TJ, Faber K. Effectiveness of Nonsurgical Interventions for Managing Adhesive Capsulitis in Patients With Diabetes: A Systematic Review. Arch Phys Med Rehabil 2018; 100:350-365. [PMID: 30268804 DOI: 10.1016/j.apmr.2018.08.181] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/21/2018] [Accepted: 08/13/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This systematic review evaluated the effectiveness of nonsurgical interventions for managing adhesive capsulitis (AC) in patients with diabetes on pain, function, and range of motion. DATA SOURCES MEDLINE and other databases were searched for studies published in the last 20 years. STUDY SELECTION Randomized controlled trials (RCTs) that assessed AC in people with diabetes and implemented 1 or a combination of physiotherapeutic interventions, corticosteroids, and manipulation under anesthesia (MUA) were eligible for inclusion. DATA EXTRACTION The Cochrane Risk of Bias was used by 2 independent raters who met to achieve consensus. The quality of trials was assessed using Grading of Recommendations, Assessment, Development and Evaluations. Data extracted from the eligible studies included study design, participant characteristics and duration of symptoms, type of intervention, outcome measures, follow-up intervals, and research findings. DATA SYNTHESIS Because of the lack of similar interventions, a narrative synthesis was conducted, and meta-analyses were not performed. The effect sizes or between-group differences of the interventions were reported. A total of 8 RCTs met the inclusion criteria: 4 addressed physiotherapeutic interventions, 3 corticosteroid injections, and 1 MUA. The effect sizes for physiotherapeutic interventions were 0.8-2.0, 0.9-2.0, and 1.0 for ROM, function, and pain, respectively, with the largest effect size (2.0) being reported for joint mobilization plus exercises. The effect sizes for corticosteroids were 0.2-0.5 and 0.1 for ROM and pain. The between-group improvement for MUA was 5.6 points on Constant Shoulder Score. CONCLUSION Low-quality evidence suggests large effects of joint mobilization plus exercises on AC in people with diabetes, although confidence in this conclusion is limited due to the high risk of bias. Even weaker support was available for corticosteroid and MUA. Future high-quality RCTs are needed to determine the best intervention for managing AC in patients with diabetes.
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Affiliation(s)
- Sana'a A Alsubheen
- School of Physical Therapy, Western University, London, Ontario, Canada.
| | - Goris Nazari
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Pavlos Bobos
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Western University, London, Ontario, Canada; Hand and Upper Limb Center, St. Joseph's Health Care London, London, Ontario, Canada
| | - Tom J Overend
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Kenneth Faber
- Hand and Upper Limb Center, St. Joseph's Health Care London, London, Ontario, Canada
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Longo UG, Ciuffreda M, Locher J, Buchmann S, Maffulli N, Denaro V. The effectiveness of conservative and surgical treatment for shoulder stiffness: a systematic review of current literature. Br Med Bull 2018; 127:111-143. [PMID: 30137234 DOI: 10.1093/bmb/ldy025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/15/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Currently, no therapeutic intervention is universally accepted, and the most effective management for restoring motion and diminishing pain in patients with shoulder stiffness has yet to be defined. This systematic review analyses outcomes of conservative and surgical interventions to treat shoulder stiffness. SOURCE OF DATA A systematic review of literature according to the PRISMA guidelines was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, Ovid and Google Scholar databases using various combinations of the keywords 'shoulder', 'shoulder stiffness', 'stiff shoulder', 'conservative', since inception of databases to June 2018 was performed. AREAS OF AGREEMENT Shoulder stiffness could be treated with conservative means including nonsteroidal anti-inflammatory medications, corticosteroid injections, or transcutaneous electrical nerve stimulation, manipulation under anaesthesia, and arthroscopic capsular release. AREAS OF CONTROVERSY No therapeutic intervention is universally accepted, and the most effective management to restore motion and diminish pain in patients with shoulder stiffness has yet to be defined. GROWING POINTS The rate of failure after treatment for stiff shoulder is higher in the surgical group than in the conservative group. AREAS TIMELY FOR DEVELOPING RESEARCH There is insufficient evidence to establish whether surgical or conservative management is the best choice to manage shoulder stiffness. Prospective, randomized studies are needed to establish whether surgical or conservative management produce a clinically relevant difference in functional outcome.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria, Rome, Italy
| | - Mauro Ciuffreda
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria, Rome, Italy
| | - Joel Locher
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria, Rome, Italy
| | - Stefan Buchmann
- Department of Orthopaedic Sports Medicine, Klinikumrechts der Isar, Technical University of Munich, Ismaningerstr. 22, Munich, Germany
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria, Rome, Italy
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Musculoskeletal Disorders in Patients with Diabetes Mellitus: A Cross-Sectional Study. Int J Rheumatol 2018; 2018:3839872. [PMID: 30018643 PMCID: PMC6029479 DOI: 10.1155/2018/3839872] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/11/2018] [Accepted: 05/17/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction A variety of musculoskeletal disorders (MS) have been associated with diabetes mellitus (DM). This study aimed at assessing the prevalence and associated factors of MS disorders in Moroccan diabetic patients. Methods A cross-sectional study enrolled consecutive patients with DM. We recorded demographic features of patients and characteristics of DM. MS disorders and vascular complications were assessed by clinical examinations and investigations. Associated factors of MS disorders were assessed by univariate and multivariate analyses. Result 376 subjects were included; 84.6% had type 2 DM. The participants' median age was 54 years [45-62]; 41% had one or more vascular complications. 34.4% had one or more MS disorders. Osteoarthritis was present in 19.4% of patients. Hand disorders were seen in 14.4%. Shoulder capsulitis was present in 12.5%. Long duration of diabetes and dyslipidemia were associated with increased prevalence of hand abnormalities (P = 0.017; P = 0.019, respectively). Age and dyslipidemia were associated with shoulder capsulitis (P = 0.019; P = 0.047, respectively). Female gender, overweight, and nephropathy were associated with increased odds of osteoarthritis (P = 0.009, P = 0.004, and P = 0.032, respectively). Conclusion MS disorders are frequent in this population and associated with various factors. HbA1c level does not appear to be associated with development of MS disorders.
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Yip M, Francis AM, Roberts T, Rokito A, Zuckerman JD, Virk MS. Treatment of Adhesive Capsulitis of the Shoulder. JBJS Rev 2018; 6:e5. [DOI: 10.2106/jbjs.rvw.17.00165] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Wong CK, Strang BL, Schram GA, Mercer EA, Kesting RS, Deo KS. A pragmatic regional interdependence approach to primary frozen shoulder: a retrospective case series. J Man Manip Ther 2018; 26:109-118. [PMID: 29686485 DOI: 10.1080/10669817.2018.1432524] [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: 10/17/2022] Open
Abstract
Objectives Although the shoulder is known to move together with the scapula and other upper quarter joints, the current frozen shoulder clinical practice guidelines describe only physical therapy study treatments directed to the shoulder. None received a strong recommendation, highlighting the need for alternate interventions. This retrospective case series describes a pragmatic regional interdependence approach to frozen shoulder with impairment and functional outcomes, noting whether final ROM approached normal. Methods Five consecutive patients referred with frozen shoulder diagnoses attended 11-21 sessions over 5-10 weeks with one physical therapist. Treatment addressed inter-related regions (shoulder, shoulder girdle, scapulothoracic/humerothoracic, and spine) following a pragmatic approach using impairment-based interventions (joint/soft tissue mobilization, muscle stretching/strengthening) as well as patient education, modalities and warm up that addressed individual presentations. Results All patients improved on all outcomes. Mean shoulder ROM at discharge, the impairment outcome, demonstrated large effect size increases: flexion (117 ± 10-179 ± 12, d = 5.9), abduction (74 ± 8-175 ± 9, d = 9.3), external rotation (23 ± 7-89 ± 2, d = 12.0). The Disability of Arm Shoulder Hand functional outcome score upon follow up demonstrated a large effect size improvement (d = 1.5) from 40.0 ± 19.4-6.2 ± 3.7. Final ROM approached normal. Discussion This case series utilized a regional interdependence approach to frozen shoulder that included manual therapy interventions directed to consistent upper quarter body segments. Shoulder ROM was returned to near normal with functional improvements evident months after discharge. A pragmatic regional interdependence approach addressing multiple joints related to shoulder function may benefit other people with frozen shoulder. Level of Evidence 4.
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Affiliation(s)
- Christopher Kevin Wong
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA
| | - Bryanna L Strang
- Program in Physical Therapy, Columbia University, New York, NY, USA
| | - Galen A Schram
- Program in Physical Therapy, Columbia University, New York, NY, USA
| | | | | | - Kabi S Deo
- Program in Physical Therapy, Columbia University, New York, NY, USA
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Prodromidis AD, Charalambous CP. Is There a Genetic Predisposition to Frozen Shoulder?: A Systematic Review and Meta-Analysis. JBJS Rev 2018; 4:01874474-201602000-00004. [PMID: 27490134 DOI: 10.2106/jbjs.rvw.o.00007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Frozen shoulder is a common disorder that leads to substantial functional loss for patients by impairing activities of daily living. It also adversely affects patients and society by impairing the ability to work. Its pathogenesis is not fully understood. The aim of the present study was to perform a systematic review and meta-analysis to assess the evidence suggesting a genetic link to frozen shoulder. METHODS A literature search of MEDLINE, EMBASE, and CINAHL databases using relevant keywords revealed 5506 studies. After appropriate screening of titles, abstracts, and full studies, seven studies were analyzed. RESULTS Three studies investigated rates of frozen shoulder among relatives. One study (n = 1828 twin pairs) showed an 11.6% prevalence in twin pairs and demonstrated a heritability of 42% for frozen shoulder after adjusting for age. A second study (n = 273) showed that 20% of patients with frozen shoulder had a positive family history involving a first-degree relative. The relative risk of frozen shoulder was 4:1 when all patients with frozen shoulder were compared with a control population. A third study (n = 87) showed that 29% of patients with frozen shoulder had a first-degree relative with frozen shoulder. Two studies evaluated racial predilection for frozen shoulder. One study (n = 50) reported a substantially higher number of white patients (76%) with frozen shoulder than black patients (24%). A second study (n = 87) showed that being born or having parents or grandparents born in the British Isles were risk factors for frozen shoulder. Four immunological studies investigated human leukocyte antigen (HLA)-B27 as a risk factor for frozen shoulder. Meta-analysis of two of these studies with clearly defined controls showed significantly higher rates of HLA-B27 positivity in patients with frozen shoulder as compared with controls (p < 0.001). CONCLUSION The limited evidence points toward a genetic link to frozen shoulder. We used family history and racial predilection as markers for genetic association, both of which indicated the presence of a genetic predisposition to frozen shoulder. However, as there is a lack of unbiased genetic approaches, there is an opportunity for genome-wide association studies to address definitively the molecular genetics of frozen shoulder. Such studies may eventually lead to a better understanding of the pathogenesis of frozen shoulder and the development of novel therapeutic interventions. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Apostolos D Prodromidis
- Orthopaedic Department, Blackpool Victoria Hospital, Blackpool, UK.,School of Medicine and Dentistry, University of Central Lancashire, Preston, UK
| | - Charalambos P Charalambous
- Orthopaedic Department, Blackpool Victoria Hospital, Blackpool, UK.,School of Medicine and Dentistry, University of Central Lancashire, Preston, UK.,Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
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Juel NG, Brox JI, Hellund JC, Holte KB, Berg TJ. The prevalence of radiological glenohumeral osteoarthritis in long-term type 1 diabetes: the Dialong shoulder study. Scand J Rheumatol 2017; 47:325-330. [PMID: 29239667 DOI: 10.1080/03009742.2017.1397189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study compares the prevalence of radiological osteoarthritis (OA) in patients with type 1 diabetes mellitus (DM1) for > 45 years and controls, and explores the association with shoulder pain and glycaemic burden in patients with DM1. METHOD The Dialong study is a cross-sectional, observational study with 30 years of historical data on long-term glycaemic control. We included 102 patients with DM1 and 73 diabetes-free controls. Demographic data, worst shoulder pain last week [numeric rating scale (NRS) 0-10], pain on abduction at examination (NRS 0-10), and current and historical glycosylated haemoglobin (HbA1c) levels were collected. Standardized shoulder X-rays were taken and interpreted for OA applying the Kellgren-Lawrence classification. RESULTS In the diabetes group (49% women), the mean ± sd duration of DM1 was 50.6 ± 4.8 years, mean 30 year HbA1c 7.4%, and age 61.9 ± 7.1 years. The mean age of controls (57% women) was 62.6 ± 7.0 years. Radiological glenohumeral OA was found in 36 diabetes patients (35%) and 10 controls (14%) [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.6 to 7.5; p = 0.002]. Few persons had moderate and severe OA [6.9% vs 1.3%, OR 5.3 (95% Cl 0.6 to 44.1); p = 0.1]. Fifteen diabetes patients had painful OA versus two controls (adjusted OR 5.4, 95% CI 0.6 to 47.9; p = 0.13). There was no association between OA and long-term glycaemic burden (mean 30 year HbA1c) in the diabetes group (p > 0.2). CONCLUSIONS Radiological glenohumeral OA was more common in patients with DM1 than in controls for mild, but not moderate and severe OA. The radiological findings were not associated with shoulder pain or long-term glycaemic burden.
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Affiliation(s)
- N G Juel
- a Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway.,b Department of Physical Medicine and Rehabilitation , Oslo University Hospital , Oslo , Norway
| | - J I Brox
- b Department of Physical Medicine and Rehabilitation , Oslo University Hospital , Oslo , Norway.,c Institute of Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - J C Hellund
- d Department of Radiology , Oslo University Hospital , Oslo , Norway
| | - K B Holte
- a Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway
| | - T J Berg
- a Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway.,c Institute of Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo , Norway.,e The Norwegian Diabetics Center , Oslo , Norway
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40
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Frozen shoulder and risk of cancer: a population-based cohort study. Br J Cancer 2017; 117:144-147. [PMID: 28524156 PMCID: PMC5520209 DOI: 10.1038/bjc.2017.146] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 12/20/2022] Open
Abstract
Background: Frozen shoulder might be a complication or a presenting symptom of cancer. We examined the risk of a cancer diagnosis after an incident diagnosis of frozen shoulder. Methods: We used prospectively collected data from Danish registries to identify patients with frozen shoulder during 1995–2013 and followed them for the development of cancer. Results: We observed 2572 incident cancers among 29 098 frozen shoulder patients. The expected number of incident cancers in the general population was 2434. The 6-month cumulative incidence of any cancer was 0.70%, corresponding to a standardised incidence ratio (SIR) of 1.38 (95% confidence interval (CI): 1.19–1.58). Risk increases were highest for lung cancer (SIR=2.19, 95% CI: 1.48–3.13), breast cancer (SIR=1.51, 95% CI: 1.02–2.15), and non-Hodgkin’s lymphoma (SIR=2.28, 95% CI: 1.09–4.20). The cumulative incidence of any cancer during the remainder of follow-up (>6 months to a maximum 18.9 years) was 24.8% with an SIR of 1.04 (95% CI: 1.00–1.08). Conclusions: Frozen shoulder might be an early predictor for a subsequent cancer diagnosis.
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Wong C, Levine W, Deo K, Kesting R, Mercer E, Schram G, Strang B. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy 2017; 103:40-47. [DOI: 10.1016/j.physio.2016.05.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 05/19/2016] [Indexed: 12/11/2022]
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Georgiannos D, Markopoulos G, Devetzi E, Bisbinas I. Adhesive Capsulitis of the Shoulder. Is there Consensus Regarding the Treatment? A Comprehensive Review. Open Orthop J 2017; 11:65-76. [PMID: 28400876 PMCID: PMC5366387 DOI: 10.2174/1874325001711010065] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 04/14/2016] [Accepted: 04/20/2016] [Indexed: 12/11/2022] Open
Abstract
Background: Adhesive capsulitis of the shoulder (ACS) is a common self-limiting condition characterized by disabling pain and restricted movements. Its pathophysiology is poorly understood, clinically it is characterized by stages of pain and stiffness, and finally often patients never recover fully. However, there is no consensus about available methods of treatment for ACS. The aims of this paper are to discuss and develop issues regarding approaches to management in ACS in the stages of it. Methods: A review of the literature was performed and guidelines for the treatment of that clinical entity for doctors and health care professionals are provided. Results: Anti-inflammatory medications, steroid and/or hyaluronate injections and physiotherapy is the mainstay of conservative management either alone in the first stages or in combination with other treatment modalities in the later stages. Next line of treatment, involving minor to moderate intervention, includes suprascapular nerve block, distension arthrography and manipulation under anaesthesia. In order to avoid complications of “blind intervention”, arthroscopic capsular release is gradually more commonly applied, and in recalcitrant severe cases open release is a useful option. Conclusion: Various modalities of conservative management and gradually more surgical release are applied. However, often clinicians choose on personal experience and training rather than on published evidence.
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Affiliation(s)
| | - George Markopoulos
- Orthopaedics and Trauma Surgery 424 Military General Hospital, Thessaloniki, Greece
| | - Eirini Devetzi
- Rheumatology 424 Military General Hospital, Thessaloniki, Greece
| | - Ilias Bisbinas
- Orthopaedics and Trauma Surgery 424 Military General Hospital, Thessaloniki, Greece
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43
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Juel NG, Brox JI, Brunborg C, Holte KB, Berg TJ. Very High Prevalence of Frozen Shoulder in Patients With Type 1 Diabetes of ≥45 Years' Duration: The Dialong Shoulder Study. Arch Phys Med Rehabil 2017; 98:1551-1559. [PMID: 28219686 DOI: 10.1016/j.apmr.2017.01.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/11/2017] [Accepted: 01/15/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the prevalence of shoulder disorders and self-reported shoulder disability in patients with long-term type 1 diabetes mellitus and diabetes-free subjects; and to explore the association between the long-term glycemic burden and shoulder disability in the diabetes group. DESIGN Cross-sectional study of shoulder diagnoses with 30 years' historical data on glycemic burden in patients with diabetes. SETTING Diabetics center and a university hospital. PARTICIPANTS Subjects attending the Norwegian Diabetics Center in 2015 with type 1 diabetes since 1970 or earlier were eligible (N=136). One hundred and five patients were included, and 102 (50% women; mean age, 61.9y) completed the study together with 73 diabetes-free subjects (55% women; mean age, 62.5y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Shoulder diagnoses decided through clinical examination according to scientific diagnostic criteria. RESULTS Frozen shoulder was diagnosed in 60 (59%) patients with diabetes and 0 diabetes-free subjects, with a lifetime prevalence of 76% in the diabetes group versus 14% in the diabetes-free subjects. Patients with diabetes had higher disability and higher mean QuickDASH scores (23.0±19.9) than diabetes-free subjects (8.9±12.0), with a mean difference of -14.2 (95% confidence interval, -19.3 to -9.0) points (P<.001). We found an association between chronic hyperglycemia and QuickDASH scores, with a 6.16-point increase in QuickDASH scores per unit increase in glycated hemoglobin A1c (HbA1c) (P=.014). CONCLUSIONS The point prevalence of frozen shoulder in patients with long-lasting type 1 diabetes was 59%, and the lifetime prevalence was 76%. The diabetes group had more shoulder disability than diabetes-free subjects. The historical HbA1c level was associated with increased shoulder disability.
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Affiliation(s)
- Niels Gunnar Juel
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Kristine Bech Holte
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Tore Julsrud Berg
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; The Norwegian Diabetics Center, Oslo, Norway
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Itoi E, Arce G, Bain GI, Diercks RL, Guttmann D, Imhoff AB, Mazzocca AD, Sugaya H, Yoo YS. Shoulder Stiffness: Current Concepts and Concerns. Arthroscopy 2016; 32:1402-14. [PMID: 27180923 DOI: 10.1016/j.arthro.2016.03.024] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/04/2016] [Accepted: 03/10/2016] [Indexed: 02/02/2023]
Abstract
UNLABELLED Shoulder stiffness can be caused by various etiologies such as immobilization, trauma, or surgical interventions. The Upper Extremity Committee of ISAKOS defined the term "frozen shoulder" as idiopathic stiff shoulder, that is, without a known cause. Secondary stiff shoulder is a term that should be used to describe shoulder stiffness with a known cause. The pathophysiology of frozen shoulder is capsular fibrosis and inflammation with chondrogenesis, but the cause is still unknown. Conservative treatment is the primary choice. Pain control by oral medication, intra-articular injections with or without joint distension, and physical therapy are commonly used. In cases with refractory stiffness, manipulation under anesthesia or arthroscopic capsular release may be indicated. Because of various potential risks of complications with manipulations, arthroscopic capsular release is preferred. After the capsular release, stepwise rehabilitation is mandatory to achieve satisfactory outcome. LEVEL OF EVIDENCE Level V, evidence-based review.
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Affiliation(s)
- Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
| | - Guillermo Arce
- Department of Orthopaedic Surgery, Instituto Argentino de Diagnóstico y Tratamiento, Buenos Aires, Argentina
| | - Gregory I Bain
- Department of Orthopedic Surgery, Flinders University, Adelaide, South Australia, Australia
| | - Ronald L Diercks
- Sports Medicine Center, Department of Orthopaedic Surgery, University of Groningen, Groningen, the Netherlands
| | - Dan Guttmann
- Taos Orthopaedic Institute, Shoulder and Elbow Service, Taos, New Mexico, U.S.A
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, University of Munich (TUM), Hospital Rechts der Isar, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, Farmington, Connecticut, U.S.A
| | - Hiroyuki Sugaya
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
| | - Yon-Sik Yoo
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Gyeonggi-Do, Republic of Korea
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Pons-Villanueva J, Escalada San Martín J. The stiff shoulder in diabetic patients. Int J Rheum Dis 2016; 19:1226-1236. [DOI: 10.1111/1756-185x.12890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Juan Pons-Villanueva
- Department of Orthopedic Surgery and Traumatology; Clínica Universidad de Navarra; Pamplona Spain
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46
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Noten S, Meeus M, Stassijns G, Van Glabbeek F, Verborgt O, Struyf F. Efficacy of Different Types of Mobilization Techniques in Patients With Primary Adhesive Capsulitis of the Shoulder: A Systematic Review. Arch Phys Med Rehabil 2016; 97:815-25. [DOI: 10.1016/j.apmr.2015.07.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 01/31/2023]
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47
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Park M, Park JS, Ahn SE, Ryu KN, Park SY, Jin W. Sonographic Findings of Common Musculoskeletal Diseases in Patients with Diabetes Mellitus. Korean J Radiol 2016; 17:245-54. [PMID: 26957910 PMCID: PMC4781764 DOI: 10.3348/kjr.2016.17.2.245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/28/2015] [Indexed: 12/18/2022] Open
Abstract
Diabetes mellitus (DM) can accompany many musculoskeletal (MSK) diseases. It is difficult to distinguish the DM-related MSK diseases based on clinical symptoms alone. Sonography is frequently used as a first imaging study for these MSK symptoms and is helpful to differentiate the various DM-related MSK diseases. This pictorial essay focuses on sonographic findings of various MSK diseases that can occur in diabetic patients.
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Affiliation(s)
- Minho Park
- Department of Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Hospital, Seoul 02447, Korea
| | - Sung Eun Ahn
- Department of Radiology, Kyung Hee University Hospital, Seoul 02447, Korea
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Hospital, Seoul 02447, Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
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Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles Ligaments Tendons J 2016; 6:26-34. [PMID: 27331029 PMCID: PMC4915459 DOI: 10.11138/mltj/2016.6.1.026] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND adhesive capsulitis (AC) results in progressive painful restriction in range of movement and can reduce function and quality of life. Whilst it has been associated with diabetes mellitus (DM), there is considerable variation in the reported prevalence of AC in the diabetic population. The aim of this study is to determine through meta-analysis the prevalence of AC in DM and examine whether it is influenced by type of DM or insulin therapy. We also aim to further establish the prevalence of DM in patients presenting with AC. METHODS we conducted a literature search for terms regarding AC and DM on Embase and Pubmed NCBI. RESULTS of 5411 articles identified, 18 were selected. Meta-analysis showed that patients with DM were 5 (95% CI 3.2-7.7) times more likely than controls to have AC. The overall prevalence of AC in DM was estimated at 13.4% (95% CI 10.2-17.2%). Comparison of prevalence in patients on insulin vs other treatments showed no significant difference between the two. Meta-analysis estimated the prevalence of DM in AC at 30% (95% CI 24-37%). CONCLUSION to our knowledge this is the first meta-analysis to estimate the overall prevalence of diabetes in a population with AC. A high prevalence of AC exists in DM and equally a high prevalence of DM is present in AC. Screening for DM should be considered in patients presenting with AC.
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Affiliation(s)
- Nasri Hani Zreik
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, UK
| | - Rayaz A. Malik
- Weill Cornell Medical College, Doha, Qatar
- Centre for Endocrinology & Diabetes, Institute of Human Development, University of Manchester, Manchester, UK
| | - Charalambos P. Charalambous
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, UK
- School of Medicine, University of Central Lancashire, Preston, UK
- Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
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Bidwai AS, Mayne AIW, Nielsen M, Brownson P. Limited capsular release and controlled manipulation under anaesthesia for the treatment of frozen shoulder. Shoulder Elbow 2016; 8:9-13. [PMID: 27582995 PMCID: PMC4935169 DOI: 10.1177/1758573215578590] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/26/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND In light of recent interest in the cost-effectiveness of the treatment options available for frozen shoulder, we aimed to determine the results of limited anterior capsular release and controlled manipulation under anaesthesia (MUA) in the treatment of primary frozen shoulder in terms of patient-related outcomes measure, range of motion and re-intervention rates. METHODS This single-surgeon series included prospectively collected data on all patients undergoing capsular release with MUA from March 2011 until June 2013, with a minimum follow-up of 6 months from the index procedure. Outcome measures included pre- and postoperative Oxford Shoulder Score (OSS), range of motion and need for re-intervention. RESULTS Fifty-four procedures were performed in 52 patients. Mean age 50 years (range 42 years to 59 years); male: female ratio = 11: 41. There was a highly statistically significant improvement in both pain and function modules of the OSS (p < 0.005) and range of motion (p < 0.005) at 6 months. The median postoperative score was 41 from a maximum of 48 points, with an average mean improvement of 24 points. Seventeen patients were diabetics. There was no significant difference in pre-operative and postoperative OSS or range of motion between the diabetic group and the non-diabetic groups. No patients required surgical re-intervention. CONCLUSIONS A combination of limited capsular release and MUA for the treatment of primary frozen shoulder is a safe and effective procedure resulting in marked improvement in pain, function and range of motion.
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Affiliation(s)
| | - Alistair IW Mayne
- Alistair Mayne, Royal Liverpool & Broadgreen University Hospitals, Prescot Street, Liverpool L7 8XP, UK. Tel: 07940062214.
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Lin TTL, Lin CH, Chang CL, Chi CH, Chang ST, Sheu WHH. The effect of diabetes, hyperlipidemia, and statins on the development of rotator cuff disease: a nationwide, 11-year, longitudinal, population-based follow-up study. Am J Sports Med 2015; 43:2126-32. [PMID: 26085191 DOI: 10.1177/0363546515588173] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The intrinsic risk factors of rotator cuff disease (RCD) include degeneration, inflammation, oxidative stress, and circulation impairment. Both diabetes and hyperlipidemia are thought to increase these risk factors and therefore potentially enhance RCD development. However, few studies, and few longitudinal follow-up studies in particular, exist to prove this. HYPOTHESIS Both diabetes and hyperlipidemia can increase a patient's risk of developing RCD. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 498,678 participants, including 28,391 diagnosed with diabetes and 25,621 with hyperlipidemia in the year 2000, were followed for an 11-year period. Multivariate Cox proportional hazards models were used to explore the effect of (1) diabetes, (2) hyperlipidemia, (3) diabetes with/without insulin use, and (4) hyperlipidemia with/without statin use on the development of RCD. In the subgroup of patients with hyperlipidemia, multivariate Cox proportional hazards models were also performed to explore the relationship between statin use and RCD development. RESULTS During an 11-year follow-up period, 26,664 patients developed RCD. The crude hazard ratio (HR) for RCD in patients with diabetes as compared with those without diabetes was 2.11 (95% CI, 2.02-2.20; P < .0001). The crude HR for RCD in patients with hyperlipidemia as compared with those without hyperlipidemia was 2.00 (95% CI, 1.92-2.08; P < .0001). Multivariate Cox proportional hazards analysis revealed that, in addition to older age and female sex, both diabetes and hyperlipidemia increased the risk of RCD (diabetes: HR, 1.47 [95% CI, 1.41-1.54]; P < .0001) (hyperlipidemia: HR, 1.48 [95% CI, 1.42-1.55]; P < .0001). An elevated risk still existed in patients with diabetes with/without insulin use (diabetes with insulin use: HR, 1.43 [95% CI, 1.35-1.51]; P < .0001) (diabetes without insulin use: HR, 1.64 [95% CI, 1.53-1.75]; P < .0001). An increased risk also existed in patients with hyperlipidemia with/without statin use (hyperlipidemia with statin use: HR, 1.16 [95% CI, 1.10-1.23]; P < .0001) (hyperlipidemia without statin use: HR, 2.01 [95% CI, 1.89-2.13]; P < .0001). In the subgroup of patients with hyperlipidemia, statin use was associated with a lower risk of developing RCD when compared with no statin use (rosuvastatin: HR, 0.41 [95% CI, 0.35-0.49]; P < .0001) (simvastatin: HR, 0.62 [95% CI, 0.54-0.71]; P < .0001) (other statins: HR, 0.66 [95% CI, 0.60-0.72]; P < .0001). CONCLUSION The present longitudinal, population-based follow-up study showed that either diabetes or hyperlipidemia alone was an independent risk factor for RCD development. Statin use might provide protection against RCD in patients with hyperlipidemia.
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Affiliation(s)
- Tony Tung-Liang Lin
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan Department of Statistics, Feng Chia University, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Li Chang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Han Chi
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wayne Huey-Herng Sheu
- School of Medicine, National Defense Medical Center, Taipei, Taiwan Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Medical Technology, National Chung-Hsing University, Taichung, Taiwan
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