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Gómez-Muñoz E, Sánchez-Ibáñez I, Garríguez-Pérez D, García-Fernández C, Marco F, Lópiz Y. Functional results of Circumferential Capsular Release in adhesive shoulder capsulitis. Comparative study of patients over and under fifty years of age. Arch Orthop Trauma Surg 2024; 144:1303-1310. [PMID: 38153437 DOI: 10.1007/s00402-023-05175-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION The aim of our study is to evaluate the functional and mobility outcomes in patients who have undergone arthroscopic circumferential arthrolysis of the shoulder and to find out if there are differences in the results in relation to the patient's age. MATERIALS AND METHODS This is a retrospective case series of patients with idiopathic adhesive capsulitis treated by arthroscopic 360º circumferential capsulotomy in lateral position and followed for a minimum of 2 years. Range of motion (ROM), functional outcomes using the Constant Score (CS), health-related quality of life outcomes with the EuroQol Five Dimensions tool (EQ-5D), pain using the Visual Analogue Scale (VAS). RESULTS A total of 26 shoulders were included, 10 men (41.7%) and 14 women (58.3%), with 2 patients being bilateral. The mean age was 48.64 ± 7.5 years, and the mean follow-up was 50.2 months. Postoperative ROM improved significantly compared to preoperative ROM (p < 0.05). Shoulder forward flexion improved by 38.6° (95%CI 22.3-54.9, p < 0.01), abduction by 35.2° (95%CI 17.6-52.8, p < 0.01) and external rotation by 21.9° (95%CI 12.8-30.9, p < 0.01 p < 0.01). Median internal rotation improved from buttock to T12 (p < 0.01). The mean improvement in CS was 54.3 ± 24.4 points (p < 0.01). The EQ-5D and VAS scores at the end of follow-up were 0.73 ± 0.23 and 2.73 ± 2.55, respectively. There were no statistical differences between young patients and patients aged 50 years or older in ROM or functional results. CONCLUSIONS Patient age did not affect outcomes significantly, with patients older than 50 years showing similar results to younger patients.
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Affiliation(s)
- Eduardo Gómez-Muñoz
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Investigation Performed at Hospital Clínico San Carlos Hospital, Madrid, Spain.
| | - Ivan Sánchez-Ibáñez
- Department of Physical Medicine and Rehabilitation, Clínico San Carlos Hospital, Madrid, Spain
| | - Daniel Garríguez-Pérez
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Investigation Performed at Hospital Clínico San Carlos Hospital, Madrid, Spain
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Investigation Performed at Hospital Clínico San Carlos Hospital, Madrid, Spain
| | - Fernando Marco
- Department of Surgery, Complutense University, Madrid, Spain
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Yaiza Lópiz
- Department of Surgery, Complutense University, Madrid, Spain
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
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Kapoor R, Husseini JS, Staffa SJ, Palmer WE, Torriani M, Chang CY, Joseph Simeone F. Posterior capsule edema in adhesive capsulitis: comparison with established non-contrast MRI findings and multivariable analysis. Eur Radiol 2024; 34:260-269. [PMID: 37542655 DOI: 10.1007/s00330-023-09966-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/26/2023] [Accepted: 05/26/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES To evaluate posterior glenohumeral capsule edema compared to other MRI findings in adhesive capsulitis (AC). METHODS This study was approved by the local Institutional Review Board and it is HIPAA compliant. A retrospective search identified subjects who received fluoroscopically guided intra-articular corticosteroid injections for AC and had an MRI within 6 months prior to injection. The study group was compared with an age-, sex-, and side-matched control group who underwent the same procedures but did not have AC. MRIs were evaluated for edema of posterior capsule, anterior capsule, axillary pouch, coracohumeral ligament (CHL) and rotator interval (RI), thickness of axillary pouch and CHL, thickness of anterior capsule, RI and subcoracoid fat replacement, and teres minor atrophy and edema. Multivariable analysis was performed. RESULTS A total of 57 subjects with AC and 57 matched controls were studied: mean age 52 ± 7 (range 31-71) years, 37 female and 20 male, 22 right and 35 left. Posterior capsule edema was more common in the AC group vs. control group (66.7 vs 17.5%, p < 0.001). Multivariable analysis showed posterior capsule edema, CHL edema, and axillary pouch (glenoid) thickness (optimum cutoff = 4 mm) were significant independent predictors of AC. Simplified analysis using these three variables had an area under the curve of 0.860 (95%CI: 0.792-0.928). With all three variables present, the sensitivity and specificity for AC were 32% and 98%, respectively. CONCLUSIONS Posterior joint capsule edema may be helpful to confirm AC. Posterior capsule edema, CHL edema, and axillary pouch (glenoid) thickness produce a strong model for distinguishing AC from controls. CLINICAL RELEVANCE STATEMENT Edema involving the posterior shoulder joint capsule is an imaging marker of capsulitis and is useful in differentiating patients with adhesive capsulitis from those without in conjunction with other proven MRI findings. KEY POINTS • Posterior capsule edema has a sensitivity of 66.7% and a specificity of 82.5% for the detection of adhesive capsulitis. • Posterior capsule edema, coracohumeral ligament (CHL) edema, and axillary pouch (glenoid) thickness were significant independent predictors of adhesive capsulitis, and combining these variables together produces a very strong model for distinguishing cases from controls (AUC = 0.860). • Optimal cutoff values for CHL, axillary pouch (humeral), axillary pouch (glenoid), and axillary pouch (total) thickness were 2.5, 2.6, 4, and 6.3 mm, respectively.
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Affiliation(s)
- Rajdeep Kapoor
- Gainesville Radiology Group, Gainesville, FL, USA
- Northeast Georgia Health System, Gainesville, FL, USA
| | - Jad S Husseini
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - William E Palmer
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street - YAW 6046, Boston, MA, 02114, USA.
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Erdogan S, Sakha S, Shanmugaraj A, Prada C, Frank RM, Leroux T, Khan M. Comparing surgical outcomes of anterior capsular release vs circumferential release for persistent capsular stiffness. Shoulder Elbow 2023; 15:360-372. [PMID: 37538519 PMCID: PMC10395412 DOI: 10.1177/17585732221092016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 08/05/2023]
Abstract
Purpose To consolidate the existing literature evaluating anterior capsular release and circumferential capsular release in the treatment of adhesive capsulitis (AC) of the shoulder. Methods The electronic databases PUBMED, EMBASE, MEDLINE and CENTRAL (Cochrane Central Register of Controlled Trials) were searched from data inception to October 8, 2020. Data are presented descriptively where appropriate. A meta-analysis was conducted for patient-reported outcomes. Results Overall, there were forty-six articles included. The majority of patients underwent circumferential release compared to anterior release (80.1% vs. 19.9%). Concomitant Manipulation Under Anesthesia (MUA) was employed in 25 studies, with a higher occurrence in the anterior compared to the circumferential release group (70% vs 60%). Both groups experienced significant improvements postoperatively in range of motion (ROM) and patient-reported outcomes. Complication rates were low for both anterior release (0.67%) and 360° release (0.44%). Conclusion Both anterior and circumferential release are effective techniques for treating AC with low complication rates. Future studies should improve documentation of patient demographics, surgical techniques and outcomes to determine an individualized treatment protocol for patients. Level of evidence Level IV, Systematic Review of Level I-IV studies.
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Affiliation(s)
- Safiya Erdogan
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Seaher Sakha
- Faculty of Life Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Carlos Prada
- Division of Orthopaedics, McMaster University, Hamilton, Ontario, Canada
| | | | - Timothy Leroux
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedics, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Wang JC, Hsu PC, Wang KA, Wu WT, Chang KV. Comparative Effectiveness of Corticosteroid Dosages for Ultrasound-Guided Glenohumeral Joint Hydrodilatation in Adhesive Capsulitis: A Randomized Controlled Trial. Arch Phys Med Rehabil 2022; 104:745-752. [PMID: 36521580 DOI: 10.1016/j.apmr.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the efficacy of hydrodilatation with 40 mg triamcinolone acetonide (TA) compared with the same procedure with 10 mg TA in patients with adhesive capsulitis (AC) of the shoulders. DESIGN Prospective, double-blind, randomized controlled trial with 12 weeks of follow-up. SETTING Tertiary care rehabilitation center. PARTICIPANTS Eighty-four patients diagnosed with AC (N=84). INTERVENTIONS Ultrasound guidance using (A) hydrodilatation with 4 mL of TA (40 mg)+4 mL 2% lidocaine hydrochloride+12 mL normal saline or (B) hydrodilatation with 1 mL of TA (10 mg)+4 mL 2% lidocaine hydrochloride+15 mL normal saline through the posterior glenohumeral recess. MAIN OUTCOME MEASURES Shoulder Pain and Disability Index (SPADI), visual analog scale (VAS) for pain, and range of motion (ROM) at baseline and at 6 and 12 weeks after injection. RESULTS Both groups experienced improvements in the SPADI score, VAS scores for pain, and ROM throughout the study period. However, group-by-time interactions were not significant for any outcome measurement at any follow-up time point. No adverse events were reported in either group. CONCLUSION Ultrasound-guided hydrodilatation with 40 and 10 mg TA yielded similar improvements in SPADI, VAS score, and ROM at the 12-week follow-up. Considering the potential detrimental effects of corticosteroids on the adjacent cartilage and tendons, a low dose of TA would be preferable for ultrasound-guided hydrodilatation for AC.
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Affiliation(s)
- Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Cheng Hsu
- Department of Physical Medicine and Rehabilitation, West Garden Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kevin A Wang
- Division of General Surgery, Department of Surgery, Shin-Kong Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan; Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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Abstract
Frozen shoulder is a common debilitating disorder characterized by shoulder pain and progressive loss of shoulder movement. Frozen shoulder is frequently associated with other systemic conditions or occurs following periods of immobilization, and has a protracted clinical course, which can be frustrating for patients as well as health-care professionals. Frozen shoulder is characterized by fibroproliferative tissue fibrosis, whereby fibroblasts, producing predominantly type I and type III collagen, transform into myofibroblasts (a smooth muscle phenotype), which is accompanied by inflammation, neoangiogenesis and neoinnervation, resulting in shoulder capsular fibrotic contractures and the associated clinical stiffness. Diagnosis is heavily based on physical examination and can be difficult depending on the stage of disease or if concomitant shoulder pathology is present. Management consists of physiotherapy, therapeutic modalities such as steroid injections, anti-inflammatory medications, hydrodilation and surgical interventions; however, their effectiveness remains unclear. Facilitating translational science should aid in development of novel therapies to improve outcomes among individuals with this debilitating condition.
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Wang YD, Ming YX, Pang YH, Chen WN, Zong XH, Wu JY, Deng YK. Effectiveness of arthroscopic management of idiopathic shoulder stiffness: A meta-analysis. J Back Musculoskelet Rehabil 2021; 34:565-572. [PMID: 33554887 DOI: 10.3233/bmr-200267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Persisting shoulder stiffness adversely affects quality of life by causing pain and motion restrictions especially in patients with diabetes. OBJECTIVE The aim of this study was to evaluate the outcomes of arthroscopic capsular release in patients with idiopathic shoulder stiffness. METHOD A literature search was conducted in electronic databases and studies were selected by following precise eligibility criteria. Random-effects meta-analyses were performed to estimate the changes at latest follow-up in scores of the Constant, American Shoulder and Elbow Surgeons (ASES), and University of California at Los Angelis (UCLA) scales, Visual Analogue Scale (VAS), and shoulder range of motion. RESULTS Nineteen studies were included. The follow-up duration was 42 months [95% confidence interval (CI): 32, 51]. Improvements in scores of the Constant, ASES, UCLA scales, and VAS were 48.3 [95% CI: 38.0, 58.6], 44.6 [95% CI: 24.6, 64.6], 19.3 [95% CI: 16.6, 22.0], and -6.1 [95% CI: -6.9, -5.4] respectively (P< 0.05 all). Improvements in the shoulder range of motion were: abduction 82.0 [95% CI: 65.0, 98.9]; forward flexion 75.9 [95% CI: 59.7, 92.1]; external rotation 43.2 [95% CI: 37.5, 49.0]; and internal rotation 25.4 [95% CI: 15.2, 35.5] degrees; P< 0.05 all). CONCLUSION Arthroscopic capsular release effectively improves shoulder function in patients with idiopathic shoulder stiffness.
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Sivasubramanian H, Chua CXK, Lim SY, Manohara R, Ng ZWD, V PK, Poh KS. Arthroscopic capsular release to treat idiopathic frozen shoulder: How much release is needed? Orthop Traumatol Surg Res 2021; 107:102766. [PMID: 33333264 DOI: 10.1016/j.otsr.2020.102766] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/31/2020] [Accepted: 06/15/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE This systematic review and meta-analysis aims to provide consensus regarding the degree of optimal extended arthroscopic capsular release in addition to a standard rotator interval release in the treatment of idiopathic frozen shoulder. MATERIALS AND METHODS The systematic review was conducted using the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. All articles that reported the outcomes of capsular release in idiopathic frozen shoulder were included. A total of 18 articles with 629 patients and 811 shoulders were included. Clinical outcomes analysed include differences between pre and postoperative ranges of motion (ROM), Visual Analog Score (VAS) reduction, Simple Shoulder Test (SST) scores and Constant scores. Patients were grouped by technique: anterior-inferior capsular release (Group 1), anterior-inferior-posterior capsular release (Group 2), and 360-degree capsular release (Group 3) at follow up points 3,6 and 12 months. RESULTS Comparing ROM, Group 1 had greater early abduction (p<0.01), early (p<0.01) and overall external rotation (p<0.01) than Group 2, as well as greater early flexion (p<0.01), early abduction (p<0.01), early (p<0.01) and overall internal rotation (p<0.01) than Group 3. Group 2 had greater early (p=0.03) and overall flexion (p<0.01) than Group 1, as well as greater early (p<0.01) and overall flexion (p<0.01), early abduction (p<0.01) and early internal rotation (p<0.01) than Group 3. Group 3 had greater overall flexion (p<0.01) than Group 1 and greater overall external rotation (p<0.01) than Group 2. Comparing VAS scores, the less extensive releases saw the greatest significant postoperative reduction. Group 2 had greater mean improvements in postoperative Constant scores than Group 1 (p<0.01) and Group 3 (p<0.01), while SST scores were significantly higher in Group 1 (p<0.01). CONCLUSION This systematic review and meta-analysis suggests that less extensive releases may result in better functional and pain scores. Addition of a posterior release offers increased early internal rotation, which was not sustained over time, but provides early and sustained flexion improvements. A complete 360 release may not provide any further benefit. There were no significant differences in the complication rates amongst the 3 techniques. LEVEL OF STUDY II; Meta-analysis and systematic review.
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Affiliation(s)
- Harish Sivasubramanian
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Chen Xi Kasia Chua
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore.
| | - Sheng Yang Lim
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Ruben Manohara
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Zhao Wen Dennis Ng
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Prem Kumar V
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Keng Soon Poh
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
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Houck DA, Belk JW, Vidal AF, McCarty EC, Bravman JT, Seidl AJ, Frank RM. Outcomes of Arthroscopic Capsular Release in the Beach-Chair Versus Lateral Decubitus Position: A Systematic Review. Orthop J Sports Med 2019; 7:2325967119888173. [PMID: 31903397 PMCID: PMC6923698 DOI: 10.1177/2325967119888173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Arthroscopic capsular release (ACR) for the treatment of adhesive capsulitis of the
shoulder can be performed in either the beach-chair (BC) or lateral decubitus (LD)
position. Purpose: To determine the clinical outcomes and recurrence rates after ACR in the BC versus LD
position. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analyses) guidelines was performed by searching PubMed, Embase, and the Cochrane
Library databases for studies reporting clinical outcomes of patients undergoing ACR in
either the BC or LD position. All English-language literature from 1990 through 2017
reporting on clinical outcomes after ACR with a minimum 3-month follow-up were reviewed
by 2 independent reviewers. Recurrence rates, range of motion (ROM) results, and
patient-reported outcome (PRO) scores were collected. Study methodological quality was
evaluated using the modified Coleman Methodology Score (MCMS). Results: A total of 30 studies (3 level 1 evidence, 2 level 2 evidence, 4 level 3 evidence, 21
level 4 evidence) including 665 shoulders undergoing ACR in the BC position (38.1% male;
mean age, 52.0 ± 3.9 years; mean follow-up, 35.4 ± 18.4 months) and 603 shoulders in the
LD position (41.8% male; mean age, 53.0 ± 2.3 years; mean follow-up, 37.2 ± 16.8 months)
were included. There were no significant differences in overall mean recurrence rates
between groups (BC, 2.5%; LD, 2.4%; P = .81) or in any PRO scores
between groups (P > .05). There were no significant differences in
improvement in ROM between groups, including external rotation at the side (BC, 36.4°;
LD, 42.8°; P = .91), forward flexion (BC, 64.4°; LD, 79.3°;
P = .73), abduction (BC, 77.8°; LD, 81.5°; P = .82),
or internal rotation in 90° of abduction (BC, 40.8°; LD, 45.5°; P =
.70). Significantly more patients in the BC group (91.6%) underwent concomitant
manipulation than in the LD group (63%) (P < .0001). There were
significantly more patients with diabetes in the LD group (22.4%) versus the BC group
(9.6%) (P < .0001). Conclusion: Low rates of recurrent shoulder stiffness and excellent improvements in ROM can be
achieved after ACR in either the LD or BC position. Concomitant manipulation under
anesthesia is performed more frequently in the BC position compared with the LD
position.
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Affiliation(s)
- Darby A Houck
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John W Belk
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Eric C McCarty
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan T Bravman
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Adam J Seidl
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rachel M Frank
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
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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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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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Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow 2017; 9:75-84. [PMID: 28405218 PMCID: PMC5384535 DOI: 10.1177/1758573216676786] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 10/09/2016] [Indexed: 12/12/2022]
Abstract
Adhesive shoulder capsulitis, or arthrofibrosis, describes a pathological process in which the body forms excessive scar tissue or adhesions across the glenohumeral joint, leading to pain, stiffness and dysfunction. It is a debilitating condition that can occur spontaneously (primary or idiopathic adhesive capsulitis) or following shoulder surgery or trauma (secondary adhesive capsulitis). Here, we review the pathophysiology of adhesive shoulder capsulitis, highlighting its clinical presentation, natural history, risk factors, pathoanatomy and pathogenesis. Both current non-operative and operative treatments for adhesive capsulitis are described, and evidence-based studies are presented in support for or against each corresponding treatment. Finally, the review also provides an update on the gene expression profile of adhesive capsulitis and how this new understanding can help facilitate development of novel pharmacological therapies.
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Affiliation(s)
- Hai V. Le
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA,Hai V. Le, Beth Israel Deaconess Medical Center (BIDMC), 330 Brookline Ave, Boston, MA 02215, USA.
| | - Stella J. Lee
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA
| | - Edward K. Rodriguez
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA
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Ranalletta M, Rossi LA, Zaidenberg EE, Campos C, Ignacio T, Maignon GD, Bongiovanni SL. Midterm Outcomes After Arthroscopic Anteroinferior Capsular Release for the Treatment of Idiophatic Adhesive Capsulitis. Arthroscopy 2017; 33:503-508. [PMID: 27866795 DOI: 10.1016/j.arthro.2016.08.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/01/2016] [Accepted: 08/19/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to report the early and midterm functional outcomes and complications of a consecutive series of patients with primary adhesive capsulitis who were treated with isolated anteroinferior arthroscopic capsular release after they did not respond to conservative treatment. METHODS Thirty-two consecutive patients with idiopathic adhesive capsulitis who did not respond to conservative physiotherapy were included in the study. Arthroscopic anteroinferior capsular release was performed in all cases. The primary outcome was improvement in range of motion in the short- and midterm follow-up. We also evaluated pain relief with the visual analog scale, functional outcomes with the Constant-Murley score, and we registered postoperative complications. RESULTS The mean age was 49.6 years (range, 33-68 years) and the mean follow-up was 63 months (range, 18-84). Overall, there was significant improvement in the Constant-Murley score from 42.4 to 86 points (P < .001). The visual analog scale decreased by approximately 6.3 points compared with the preoperative value (P < .001). All parameters improved significantly the first 6 months and then remained stable until the end of follow-up (P < .001). There was an additional minor improvement in both parameters between the sixth month and the final follow-up; however, this improvement was less than in the first 6 months and it was not statistically significant. CONCLUSIONS In patients who don't respond to conservative treatment for primary adhesive capsulitis, isolated anteroinferior capsular release provides a reliable improvement in pain and range of motion that is maintained in the mid-term follow-up. LEVEL OF EVIDENCE Level IV, therapeutic, case series study.
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Affiliation(s)
- Maximiliano Ranalletta
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Luciano Andrés Rossi
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
| | - Ezequiel Ernesto Zaidenberg
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Carlos Campos
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Tanoira Ignacio
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Gastón Daniel Maignon
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Santiago Luis Bongiovanni
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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McGrath JP, Lam PH, Tan MTS, Murrell GAC. The effect of concomitant glenohumeral joint capsule release during rotator cuff repair--a comparative study. J Shoulder Elbow Surg 2016; 25:714-22. [PMID: 26826766 DOI: 10.1016/j.jse.2015.10.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/20/2015] [Accepted: 10/19/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is debate as to whether to operate or to defer surgery on patients with concomitant rotator cuff tear and shoulder stiffness. The purpose of this study was therefore to compare the outcomes in those patients who had both their rotator cuff tear and shoulder stiffness treated with the outcomes of patients who had a rotator cuff repair but no stiffness. METHODS Twenty-five patients formed the stiffness group (receiving a concomitant rotator cuff repair and manipulation under anesthesia ± arthroscopic capsular release for preoperative ipsilateral stiffness), and a chronologically matched group of 170 rotator cuff repair-only patients formed the nonstiffness group. Patients ranked their pain and function scores preoperatively and at 1 week, 6 weeks, 12 weeks, 6 months, and 2 years postoperatively; examiners recorded range of motion, strength, and presence of impingement signs. Repair integrity was determined using ultrasound. RESULTS Patients from both groups had significantly improved clinical outcomes at the 2-year follow-up compared with preoperative values. Range of motion was similar between groups at 2 years for forward flexion, abduction, and external rotation, whereas the nonstiffness group had a superior range of internal rotation (P = .014). Stiffness patients had 0 of 25 (0%) retears at 2 years compared with 34 of 170 (20%) in the nonstiffness group (P = .009). CONCLUSIONS The good outcomes of rotator cuff repair with glenohumeral capsular release disproved our hypothesis and suggest that there is no advantage in delaying repair of a rotator cuff tear to allow stiffness to resolve and that stiffness confers an advantage in terms of repair integrity. LEVEL OF EVIDENCE Level III; Retrospective Cohort Design; Treatment Study.
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Affiliation(s)
- Jordan P McGrath
- The Orthopaedic Research Institute, St. George Hospital, The University of New South Wales, Kogarah, Sydney, NSW, Australia
| | - Patrick H Lam
- The Orthopaedic Research Institute, St. George Hospital, The University of New South Wales, Kogarah, Sydney, NSW, Australia
| | - Martin T S Tan
- The Orthopaedic Research Institute, St. George Hospital, The University of New South Wales, Kogarah, Sydney, NSW, Australia
| | - George A C Murrell
- The Orthopaedic Research Institute, St. George Hospital, The University of New South Wales, Kogarah, Sydney, NSW, Australia.
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Kwaees TA, Charalambous CP. Rates of surgery for frozen shoulder: an experience in England. Muscles Ligaments Tendons J 2016; 5:276-9. [PMID: 26958535 DOI: 10.11138/mltj/2015.5.4.276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIM the aim of this study was to identify the incidence of surgical treatment for frozen shoulder in a western population. METHODS patients included in this study all resided within a well-defined area in the North West of England, all had surgery for frozen shoulder over a 3-year period and were identified from theatre logbooks of two local hospitals. Cases having surgery for shoulder stiffness other than frozen shoulder were excluded. Local and national population size estimates were based on data obtained from the UK Office for National Statistics. RESULTS 117 patients underwent surgery for frozen shoulder during the period examined; of these 101 had arthroscopic arthrolysis and 16 had manipulation under anaesthesia. The overall incidence of frozen shoulder surgery was calculated at 2.67 procedures per 10,000 general population per year, and at 7.55 for those aged 40-60. CONCLUSION surgical intervention for frozen shoulder is common, estimated at over 14,180 cases per year in England. Given the variation in costs associated with arthroscopic arthrolysis and manipulation under anaesthesia, comparative studies of the cost effectiveness of the two procedures would be of great value. LEVEL OF EVIDENCE 2C (outcome research).
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Affiliation(s)
- Tariq A Kwaees
- Department of Trauma & Orthopedics, Blackpool Victoria Hospital, UK
| | - Charalambos P Charalambous
- Department of Orthopaedics, Blackpool Victoria Hospital; School of Medicine and Dentistry, University of Central Lancashire; Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, UK
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Addition of lidocaine injection immediately before physiotherapy for frozen shoulder: a randomized controlled trial. PLoS One 2015; 10:e0118217. [PMID: 25714415 PMCID: PMC4340950 DOI: 10.1371/journal.pone.0118217] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/06/2015] [Indexed: 11/19/2022] Open
Abstract
The intraarticular injection of lidocaine immediately before a physiotherapy session may relieve pain during the stretching and mobilization of the affected joint in patients with a frozen shoulder, thus enhancing the treatment effect. To compare the effects of intraarticular injection of lidocaine plus physiotherapy to that of physiotherapy alone in the treatment of a frozen shoulder, a prospective randomized controlled trial was conducted in the rehabilitation department of a private teaching hospital. Patients with a frozen shoulder were randomized into the physiotherapy group or the lidocaine injection plus physiotherapy (INJPT) group. The subjects in the INJPT group underwent injection of 3 ml of 1% lidocaine into the affected shoulder 10 to 20 minutes before each physiotherapy session. In each group, the treatment lasted 3 months. The primary outcome measures were the active and passive range of motion of the affected shoulder. The secondary outcome measures were the results of the Shoulder Disability Questionnaire, the Shoulder Pain and Disability Index, and the 36-item Short-Form Health Survey (SF-36). The outcome measures were evaluated before treatment and 1, 2, 3, 4, and 6 months after the start of treatment. The group comparisons showed significantly greater improvement in the INJPT group, mainly in active and passive shoulder range of motion in flexion and external rotation and improvements in pain and disability (P < 0.05); however, no significant group difference was seen in the SF-36 results. The intraarticular injection of lidocaine immediately before a physiotherapy session might be superior to physiotherapy alone in the treatment of a frozen shoulder. Trial registration: ClinicalTrials.gov NCT01817348.
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Smith CD, Hamer P, Bunker TD. Arthroscopic capsular release for idiopathic frozen shoulder with intra-articular injection and a controlled manipulation. Ann R Coll Surg Engl 2014; 96:55-60. [PMID: 24417832 PMCID: PMC5137660 DOI: 10.1308/003588414x13824511650452] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The aim of this prospective study was to assess the immediate and long-term effectiveness of arthroscopic capsular release in a large cohort of patients with a precise and isolated diagnosis of stage II idiopathic frozen shoulder. METHODS All patients underwent a preoperative evaluation. Patients with secondary frozen shoulder and those with concurrent pathology at arthroscopy were excluded. This left 136 patients with a stage II arthroscopically confirmed idiopathic frozen shoulder. At each postoperative attendance, a record was made of pain, function and range of motion. At 12 months, the Oxford shoulder score was calculated, and pain and range of motion were assessed. RESULTS Fifty per cent achieved good pain relief within a week and eighty per cent within six weeks of arthroscopic capsular release. The mean preoperative visual analogue scale pain score was 6.6 and the mean postoperative score was 1.0. The mean time to achieving good pain relief was 16 days following surgery. No patient could sleep through the night prior to surgery while 90% reported having a complete night's sleep at a mean of 12 days after surgery. The mean postoperative Oxford shoulder score was 38/48 and the mean improvement was 19.2. CONCLUSIONS This large series demonstrates that arthroscopic capsular release is a safe procedure, with rapid improvement in pain and a marked improvement in range of motion.
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Affiliation(s)
- CD Smith
- Royal Devon and Exeter NHS Foundation Trust,UK
| | - P Hamer
- Royal Devon and Exeter NHS Foundation Trust,UK
| | - TD Bunker
- Royal Devon and Exeter NHS Foundation Trust,UK
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Jerosch J, Nasef NM, Peters O, Mansour AMR. Mid-term results following arthroscopic capsular release in patients with primary and secondary adhesive shoulder capsulitis. Knee Surg Sports Traumatol Arthrosc 2013; 21:1195-202. [PMID: 22763569 DOI: 10.1007/s00167-012-2124-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 06/21/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to assess the effectiveness of arthroscopic capsular release carried out for refractory cases of both primary and secondary adhesive shoulder capsulitis that were not responsive to at least 6 months of prior conservative therapy. METHODS Arthroscopic 360-degree capsular release was performed on 167 patients (173 shoulders) with adhesive shoulder capsulitis. Ninety-one shoulders (52.6%) had primary and 82 shoulders (47.4%) secondary adhesive capsulitis. The median follow-up period was 36 months (range 14-67 months). RESULTS All patients were evaluated according to the constant score. Both groups (primary and secondary adhesive capsulitis) experienced a significant improvement for all ranges of motion immediately postoperative, as well as at the time of follow-up. The median preoperative constant score was 41 (range 18-61) points and increased significantly to a median of 83 (range 27-100) at the time of follow-up. In the group of primary adhesive capsulitis, median preoperative score was 42 points (range 19-58) and increased to 85 points (range 36-100) at follow-up. In the group of secondary adhesive capsulitis, the preoperative mean increased from 41 points (range 18-61) to 74 points (range 27-100) at the time of the follow-up. The constant score component for pain and the visual analogue scale (VAS) score were also significantly increased. CONCLUSION Arthroscopic capsular release in patients with primary and secondary adhesive shoulder capsulitis represents a valuable therapeutic choice with minimal complications, to effectively reduce pain and improve movement in all planes of motion. LEVEL OF EVIDENCE Therapeutic retrospective case series study, Level IV.
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Affiliation(s)
- Joerg Jerosch
- Orthopedic Department, Johanna-Etienne-Hospital, Am Hasenberg 46, 41462, Neuss, Germany
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Beimers L, Murrell GAC. Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis. JBJS Essent Surg Tech 2013; 3:e2. [PMID: 30881733 DOI: 10.2106/jbjs.st.l.00024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Introduction Our technique of arthroscopic capsular release involving two posterior portals and one anterior portal, to accomplish a complete 360° release, improves motion and reduces pain in patients with idiopathic adhesive capsulitis. Step 1 Position the Patient Place the patient in a beach-chair position for shoulder joint arthroscopy. Step 2 Establish a Routine Posterior Glenohumeral Joint Arthroscopy Portal Use a routine posterior glenohumeral arthroscopy portal to introduce the arthroscope. Step 3 Establish an Anterior Portal Establish the anterior portal under direct vision using a spinal needle. Step 4 Release the Rotator Cuff Interval and Subscapularis Tendon Release the rotator cuff interval, dividing no more than the upper half of the intra-articular subscapularis tendon. Step 5 Release the Anterior-Inferior Aspect of the Capsule Cut the anterior-inferior aspect of the capsule completely. Step 6 Establish a Posterior-Inferior Portal Determine the location of the posterior-inferior portal with a spinal needle. Step 7 Release the Posterior-Inferior Aspect of the Capsule Release or perforate the posterior-inferior capsule of the joint with the arthroscopic wand. Step 8 Gently Manipulate the Arm Manipulate the arm in abduction, then forward and backward flexion, and then external and internal rotation. Results An arthroscopic capsular release with use of the technique described here was performed in forty-nine shoulders in forty-three patients with idiopathic adhesive capsulitis4. What to Watch For IndicationsContraindicationsPitfalls & Challenges.
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Affiliation(s)
- Lijkele Beimers
- Orthopaedic Research Institute, St George Hospital, Level 2, 4-10 South Street, Kogarah NSW 2217, Australia. E-mail address for L. Beimers: . E-mail address for G.A.C. Murrell:
| | - George A C Murrell
- Orthopaedic Research Institute, St George Hospital, Level 2, 4-10 South Street, Kogarah NSW 2217, Australia. E-mail address for L. Beimers: . E-mail address for G.A.C. Murrell:
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Beimers L, Murrell GA. Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis. JBJS Essent Surg Tech 2013. [DOI: 10.2106/01709766-201303010-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Le Lievre HMJ, Murrell GAC. Long-term outcomes after arthroscopic capsular release for idiopathic adhesive capsulitis. J Bone Joint Surg Am 2012; 94:1208-16. [PMID: 22760389 DOI: 10.2106/jbjs.j.00952] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND One management strategy for the treatment of idiopathic adhesive capsulitis, or frozen shoulder, is arthroscopic capsular release. While there are long-term data regarding nonoperative treatment and good short-term outcomes following a release for idiopathic adhesive capsulitis, little is known about the outcomes five years or more after arthroscopic capsular release. METHODS Patients with idiopathic adhesive capsulitis treated with a circumferential arthroscopic capsular release of the glenohumeral joint by a single surgeon were assessed with use of patient-reported pain scores, shoulder functional scores with use of a Likert scale, and shoulder range of motion at the preoperative evaluation and at one, six, twelve, twenty-four, and fifty-two weeks and a mean of seven years after surgery. RESULTS At a mean follow-up of seven years (range, five through thirteen years), forty-three patients (forty-nine shoulders) had significant improvement with regard to pain frequency and severity, patient-reported shoulder function, stiffness, and difficulty in completing activities compared with the findings at the initial presentation (p < 0.001) and the one-year follow-up evaluation (p < 0.01 to p < 0.001). Shoulder motion also improved (p < 0.001) and was comparable with that of the contralateral shoulder. There were no complications. CONCLUSIONS Patients with idiopathic adhesive capsulitis treated with an arthroscopic capsular release had early significant improvements in shoulder range of motion, pain frequency and severity, and function. These improvements were maintained and/or enhanced at seven years. In contrast to results reported for nonoperative treatment, shoulder range of motion at seven years was equivalent to that in the contralateral shoulder.
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Affiliation(s)
- Hugh M J Le Lievre
- Orthopaedic Research Institute, St George Hospital, University of New South Wales, Kogarah NSW 2217, Australia
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Lafosse L, Boyle S, Kordasiewicz B, Aranberri-Gutiérrez M, Fritsch B, Meller R. Arthroscopic arthrolysis for recalcitrant frozen shoulder: a lateral approach. Arthroscopy 2012; 28:916-23. [PMID: 22421567 DOI: 10.1016/j.arthro.2011.12.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 12/12/2011] [Accepted: 12/13/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate a new all-arthroscopic technique in the management of recalcitrant globally stiff frozen shoulders. This adopts an initial extra-articular approach followed by intra-articular entry to perform a 360° capsular release. METHODS Ten patients with global adhesive capsulitis were prospectively evaluated. All patients had not improved after undergoing a minimum of 6 months of physiotherapy, and 5 received intra-articular injections of steroids. The mean age was 47 years (range, 33 to 56 years). Patients were examined preoperatively and postoperatively for range of motion. A Constant score and visual analog scale score for pain were recorded. We described an all-arthroscopic technique by entering the subacromial space laterally and opening the rotator interval from the outside in, followed by a complete 360° capsular release and biceps tenotomy. RESULTS The mean follow-up was 42 months (range, 18 to 90 months), and the mean Constant score improved from 21 to 72 (P < .01). Preoperative abduction improved from a mean of 40° to 165°, elevation improved from 55° to 175°, and external rotation improved from 6° to 58°. The visual analog scale pain score improved from 7 to 1.6, and all patients reported an excellent outcome after surgery. There were no complications particularly regarding axillary nerve injury, fracture, or infection. CONCLUSIONS This study shows a combined extra-articular and intra-articular approach that is controlled and anatomic and achieves excellent results that were maintained at the midterm. The technique permits anatomic debridement of the rotator interval, enabling excellent intra-articular access, a circumferential capsular release, and biceps tenotomy. There were no complications, and no manipulations were required, which pose a risk of creating soft-tissue lesions, fractures, or dislocations. We recommend this 360° capsular release technique for releasing globally stiff shoulders where the surgeon is experienced in arthroscopy.
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Abstract
Frozen shoulder is commonly encountered in general orthopaedic practice. It may arise spontaneously without an obvious predisposing cause, or be associated with a variety of local or systemic disorders. Diagnosis is based upon the recognition of the characteristic features of the pain, and selective limitation of passive external rotation. The macroscopic and histological features of the capsular contracture are well-defined, but the underlying pathological processes remain poorly understood. It may cause protracted disability, and imposes a considerable burden on health service resources. Most patients are still managed by physiotherapy in primary care, and only the more refractory cases are referred for specialist intervention. Targeted therapy is not possible and treatment remains predominantly symptomatic. However, over the last ten years, more active interventions that may shorten the clinical course, such as capsular distension arthrography and arthroscopic capsular release, have become more popular. This review describes the clinical and pathological features of frozen shoulder. We also outline the current treatment options, review the published results and present our own treatment algorithm.
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Affiliation(s)
- C M Robinson
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SA, UK.
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Rill BK, Fleckenstein CM, Levy MS, Nagesh V, Hasan SS. Predictors of outcome after nonoperative and operative treatment of adhesive capsulitis. Am J Sports Med 2011; 39:567-74. [PMID: 21160014 DOI: 10.1177/0363546510385403] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies regarding adhesive capsulitis have concurrently evaluated nonoperative and operative treatment. PURPOSE The objectives were to evaluate the efficacy of operative and nonoperative treatment of adhesive capsulitis and to determine predictors of clinical outcome. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS At minimum 24 months' follow-up, 85 patients underwent self-assessment using the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) score, including 24 patients treated operatively. RESULTS Mean number of yes responses on the SST improved from 4.0 ± 2.7 at initial presentation to 9.9 ± 2.8 at final follow-up (P < .0001). Patients who received nonoperative treatment and patients who underwent surgery demonstrated similar improvements on the SST. For the entire cohort, forward elevation and external rotation at the side improved from 119° ± 20° to 152° ± 15° and from 29° ± 18° to 46° ± 11° (P < .0001), respectively, between initial presentation and discharge from treatment. Internal rotation to the back improved from the gluteal area to the thoracolumbar junction (P < .0001). Improvements in forward elevation and external rotation were greater for patients undergoing surgery. After nonoperative treatment, patients with diabetes had a lower final SST than patients without diabetes (P < .05). For the entire cohort, initial SST predicted final SST (P < .05), and a shorter duration of symptoms predicted a higher final ASES score (P < .05). Younger patients (P < .001) and those with a lower initial SST (P < .05) were more likely to undergo surgery. CONCLUSIONS A multimodal nonoperative treatment program is effective for most patients with adhesive capsulitis. Patients who do not improve, including those with diabetes, respond well to manipulation and arthroscopic release. Residual motion deficits at discharge from treatment do not appear to affect longer-term clinical outcome.
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Affiliation(s)
- Brian K Rill
- Cincinnati Sports Medicine Research and Education Foundation, 10663 Montgomery Road, Cincinnati, OH 45242, USA
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Børglum J, Bartholdy A, Hautopp H, Krogsgaard MR, Jensen K. Ultrasound-guided continuous suprascapular nerve block for adhesive capsulitis: one case and a short topical review. Acta Anaesthesiol Scand 2011; 55:242-7. [PMID: 21226866 DOI: 10.1111/j.1399-6576.2010.02370.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present a case with an ultrasound-guided (USG) placement of a perineural catheter beneath the transverse scapular ligament in the scapular notch to provide a continuous block of the suprascapular nerve (SSN). The patient suffered from a severe and very painful adhesive capsulitis of the left shoulder secondary to an operation in the same shoulder conducted 20 weeks previously for impingement syndrome and a superior labral anterior-posterior tear. Following a new operation with capsular release, the placement of a continuous nerve block catheter subsequently allowed for nearly pain-free low impact passive and guided active mobilization by the performing physiotherapist for three consecutive weeks. This case and a short topical review on the use of SSN block in painful shoulder conditions highlight the possibility of a USG continuous nerve block of the SSN as sufficient pain management in the immediate post-operative period following capsular release of the shoulder. Findings in other painful shoulder conditions and suggestions for future studies are discussed in the text.
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Affiliation(s)
- J Børglum
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Bispebjerg, Denmark.
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Interventions associated with an increased or decreased likelihood of pain reduction and improved function in patients with adhesive capsulitis: a retrospective cohort study. Phys Ther 2009; 89:419-29. [PMID: 19270045 DOI: 10.2522/ptj.20080250] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to determine whether physical therapy interventions predicted meaningful short-term improvement in 4 measures of physical health, pain, and function for patients diagnosed with adhesive capsulitis. PARTICIPANTS Data were examined from 2,370 patients (mean age=55.3 years, SD=12.4; 65% female, 35% male) classified into ICD-9 code 726.0 who had completed an episode of outpatient physical therapy. METHODS Principal components factor analysis was used to define intervention categories from specific treatments applied during the episode of care. A nested logistic regression model was used to identify intervention categories that predicted a 50% or greater change in Physical Component Summary-12 (PCS-12), physical function (PF), bodily pain (BP), and hybrid function (HF) scores. RESULTS None of the patients achieved a 50% or greater improvement in PCS-12 scores. Improvement in BP scores was more likely in patients who received joint mobility interventions (odds ratio=1.35, 95% confidence interval=1.10-1.65). Improvement in HF scores was more likely in patients who received exercise interventions (odds ratio=1.50, 95% confidence interval=1.03-2.17). Use of iontophoresis, phonophoresis, ultrasound, or massage reduced the likelihood of improvement in these 3 outcome measures by 19% to 32%. LIMITATIONS The authors relied on clinician-identified ICD-9 coding for the diagnosis. Impairment measures were not available to support the diagnosis, and some interventions were excluded because of infrequent use by participating therapists. DISCUSSION AND CONCLUSION These results are consistent with findings from randomized clinical trials that demonstrated the effectiveness of joint mobilization and exercise for patients with adhesive capsulitis. Ultrasound, massage, iontophoresis, and phonophoresis reduced the likelihood of a favorable outcome, which suggests that use of these modalities should be discouraged.
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Abstract
UNLABELLED Frozen shoulder or adhesive capsulitis describes the common shoulder condition characterized by painful and limited active and passive range of motion. The etiology of frozen shoulder remains unclear; however, patients typically demonstrate a characteristic history, clinical presentation, and recovery. A classification schema is described, in which primary frozen shoulder and idiopathic adhesive capsulitis are considered identical and not associated with a systemic condition or history of injury. Secondary frozen shoulder is defined by 3 subcategories: systemic, extrinsic, and intrinsic. We also propose another classification system based on the patient's irritability level (low, moderate, and high), that we believe is helpful when making clinical decisions regarding rehabilitation intervention. Nonoperative interventions include patient education, modalities, stretching exercises, joint mobilization, and corticosteroid injections. Glenohumeral intra-articular corticosteroid injections, exercise, and joint mobilization all result in improved short- and long-term outcomes. However, there is strong evidence that glenohumeral intra-articular corticosteroid injections have a significantly greater 4- to 6-week beneficial effect compared to other forms of treatment. A rehabilitation model based on evidence and intervention strategies matched with irritability levels is proposed. Exercise and manual techniques are progressed as the patient's irritability reduces. Response to treatment is based on significant pain relief, improved satisfaction, and return of functional motion. Patients who do not respond or worsen should be referred for an intra-articular corticosteroid injection. Patients who have recalcitrant symptoms and disabling pain may respond to either standard or translational manipulation under anesthesia or arthroscopic release. LEVEL OF EVIDENCE Level 5.
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Snow M, Boutros I, Funk L. Posterior arthroscopic capsular release in frozen shoulder. Arthroscopy 2009; 25:19-23. [PMID: 19111214 DOI: 10.1016/j.arthro.2008.08.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Revised: 07/30/2008] [Accepted: 08/18/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE The aims of our study were to assess the overall effectiveness of arthroscopic capsular release and to determine if the addition of a posterior capsular release had any benefit, particularly in relation to internal rotation. METHODS Forty-eight consecutive patients with primary or secondary frozen shoulder in whom conservative physiotherapy had failed were included in the study. Arthroscopic capsular release was performed in all cases. Group 1 had an anterior and inferior release only; group 2 included a posterior release. All data were collected prospectively. Constant-Murley functional scores were used to assess outcome. Overall satisfaction and patient reported outcomes were also measured. RESULTS The mean patient age was 51 years (range, 28 to 65 years), with no difference between the 2 groups. There were 27 patients in group 1 and 21 patients in group 2. The mean follow-up was 5 months. Etiology of the frozen shoulder was primary (22), diabetic (7), post-traumatic (7), and postoperative (11). Overall across both groups, there was a highly significant improvement in Constant score (P < .001) postoperatively. A similar pattern was noted in the range of motion (P < .001). The mean satisfaction score was 7 of 10 postoperatively. The patients reported overall outcome as much better (24), better (15), the same (1), and worse (4). There was no significant difference in Constant score between the 2 groups, and no significant difference in the improvement of the range of motion, in particular internal rotation. CONCLUSIONS We have shown an overall rapid significant improvement following arthroscopic capsular release for primary and secondary frozen shoulder. There was no significant difference in the overall outcome with the addition of a posterior release. LEVEL OF EVIDENCE Level III, therapeutic, retrospective comparative study.
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Affiliation(s)
- Martyn Snow
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, England.
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Liem D, Meier F, Thorwesten L, Marquardt B, Steinbeck J, Poetzl W. The influence of arthroscopic subscapularis tendon and capsule release on internal rotation strength in treatment of frozen shoulder. Am J Sports Med 2008; 36:921-6. [PMID: 18272795 DOI: 10.1177/0363546507313090] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic release of the capsule is a popular treatment option for chronic refractory frozen shoulder. Additional release of the intra-articular part of the subscapularis is controversial regarding possible impairment of subscapularis function. HYPOTHESIS Arthroscopic release of the intra-articular part of the subscapularis produces good clinical results and does not lead to reduced internal rotation strength. STUDY DESIGN Case series; Level of evidence, 4. METHODS Twenty-two patients were retrospectively evaluated 53 months (range, 12-106) after undergoing arthroscopic anterior capsular release, including release of the intra-articular portion of the subscapularis. Clinical outcome was evaluated using the American Shoulder and Elbow Surgeons score and the Constant score. Isometric and isokinetic strength for internal and external rotation were determined at the time of follow-up in both shoulders using a Cybex dynamometer. RESULTS The Constant score was improved significantly from 17.7 points to 82.8 points (P < .0001) and the American Shoulder and Elbow Surgeons score increased significantly from 23.5 points to 76.8 points (P < .0001). The mean range of motion was significantly improved for external rotation from 16 degrees to 58 degrees , from 66 degrees to 142 degrees for abduction, and from 76 degrees to 155 degrees for forward flexion. Isometric and isokinetic strength in the standard abduction position of the Cybex dynamometer showed no significant side-to-side difference. CONCLUSION Arthroscopic capsular release combined with a release of the intra-articular portion of the subscapularis tendon revealed good clinical results in the arthroscopic treatment of adhesive capsulitis without significant loss of internal rotation strength.
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Affiliation(s)
- Dennis Liem
- Department of Orthopaedics, University Hospital of Muenster, Albert Schweizer Street 33, 48149 Muenster, Germany.
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Cohen MS, Schimmel DR, Masuda K, Hastings H, Muehleman C. Structural and biochemical evaluation of the elbow capsule after trauma. J Shoulder Elbow Surg 2007; 16:484-90. [PMID: 17368926 PMCID: PMC2080784 DOI: 10.1016/j.jse.2006.06.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 06/14/2006] [Accepted: 06/14/2006] [Indexed: 02/01/2023]
Abstract
This study evaluates the structural and biochemical alterations of the elbow capsule after trauma through microscopy and immunohistochemistry. We compared capsules from 37 patients undergoing surgery for elbow contracture with normal capsules from 7 donors. Contracture capsules were significantly thicker than control capsules (P < .05) and exhibited extensive disorganization of collagen fiber bundle arrangement. Levels of specific cytokines involved in connective tissue turnover were measured. The results showed that the levels of cytokines matrix metalloproteinase (MMP) 1, MMP-2, and MMP-3 were greater as compared with control capsules (P < .05). This was associated with collagen disorganization, fibroblast infiltration, and in some specimens, lymphocytic infiltration in the capsular tissue. In contracture specimens, there was a localization of tissue inhibitor of matrix metalloproteinase 2 staining only in the vicinity of the synovial membrane and in blood vessels. Immunohistochemistry for type III collagen showed a greater presence in the control capsules compared with contracture capsules. This study demonstrates pathologic thickening, disorganization of the collagen fiber arrangement, and involvement of cytokines in the pathology of post-traumatic contracture of the elbow.
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Affiliation(s)
- Mark S Cohen
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
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Abstract
Wrist arthrofibrosis is a condition of decreased range of wrist motion due to intrinsic adhesions and extrinsic contracture. It is clinically characterized by restricted wrist range of motion, pain, swelling, and a plateau in improvement after at least 6 months of intensive physiotherapy. Other conditions must be excluded, such as articular incongruity, arthritis, spasticity, skin and subcutaneous scarring, and loose bodies. We have devised a classification system based on pathologic anatomic location, where Type I represents intrinsic adhesions, and Type II represents extrinsic contracture. The types are subdivided according to where the pathology is present. The operative approach should be wrist arthroscopy for Types IA (radiocarpal adhesions) and IB (midcarpal adhesions) where intraarticular adhesions are present. Types IC (distal radioulnar joint adhesions) and II C (distal radioulnar joint capsular contracture) are best approached in an open manner where dorsal and palmar capsulectomies of the distal radioulnar joint are performed. For Types IIA, B, and D (dorsal, palmar, and combination extrinsic contracture, respectively), both open and arthroscopic methods are described.
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Affiliation(s)
- Steve K Lee
- New York University Hospital for Joint Diseases Orthopaedics Institute, The New York University School of Medicine, New York, NY 10003, USA.
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