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Park GY, Kwon DR, Cho HK, Kwon DY. Clinical Impairments and Rotator Cuff Tendon Pathology in Primary and Intrinsic Secondary Adhesive Capsulitis. Am J Phys Med Rehabil 2024; 103:340-345. [PMID: 37816189 DOI: 10.1097/phm.0000000000002345] [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: 10/12/2023]
Abstract
OBJECTIVE This study was conducted to compare the differences in clinical impairments between patients with primary and intrinsic secondary adhesive capsulitis and confirm rotator cuff tendon pathology in intrinsic secondary adhesive capsulitis. DESIGN This study included 130 patients with unilateral adhesive capsulitis in freezing or frozen stages. Clinical impairment was evaluated using visual analog scale score, shoulder passive range of motion, Cyriax stage, and Constant-Murley score. Plain radiography, ultrasonography, single-contrast arthrography, and intravenous gadolinium-enhanced magnetic resonance imaging were performed in all patients. RESULTS Among 130 patients, 77 patients were diagnosed as primary adhesive capsulitis and 53 patients as intrinsic secondary adhesive capsulitis. Among intrinsic secondary adhesive capsulitis patients, 44 rotator cuff tendon tears, 6 calcific tendinitis, and 3 rotator cuff tendon tears with calcific tendinitis were observed. No significant intergroup difference was observed in all clinical parameters, including shoulder passive range of motion, visual analog scale, Cyriax stage, and Constant-Murley score. The prevalence of subacromial subdeltoid bursitis was significantly higher in intrinsic secondary adhesive capsulitis compared with primary adhesive capsulitis. CONCLUSIONS There was no significant difference in all clinical parameters investigated between patients with primary and intrinsic secondary adhesive capsulitis caused by rotator cuff tendon pathology.
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Affiliation(s)
- Gi-Young Park
- From the Department of Rehabilitation Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
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Liang CW, Cheng HY, Lee YH, De Liao C, Huang SW. Corticosteroid Injection Methods for Frozen Shoulder: A Network Meta-analysis. Arch Phys Med Rehabil 2024; 105:750-759. [PMID: 38244851 DOI: 10.1016/j.apmr.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/16/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To investigate the efficacy of corticosteroid (CS) injection methods for frozen shoulder. DATA SOURCES PubMed, Embase, and Cochrane Library were searched up to May 6, 2023. STUDY SELECTION Randomized controlled trials (RCTs) that investigated CS injection methods for frozen shoulder were included. DATA EXTRACTION Data were extracted independently by 2 authors. Risk of bias was assessed using the RoB 2 tool. DATA SYNTHESIS A random-effects network meta-analysis was performed within a frequentist framework. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations approach. A total of 66 RCTs involving 4491 patients were included. For short-term outcomes, 4-site injection (vs placebo [PLA]: standardized mean difference [SMD]=-2.20, 95% confidence interval [CI], -2.81 to -1.59 in pain; SMD=2.02; 95% CI, 1.39-2.65 in global function) was the most effective (low certainty). Rotator interval injection was the optimal treatment with moderate to high certainty (vs PLA: SMD=-1.07, 95% CI, -1.51 to -0.64 in pain; SMD=0.94, 95% CI, 0.49-1.40 in global function). For midterm outcomes, 4-site injection was most effective (vs PLA: SMD=-1.71, 95% CI, -2.41 to -1.01 in pain; SMD=2.22, 95% CI, 1.34-3.09 in global function; low certainty). Distension via rotator interval (D-RI) was the optimal treatment with moderate to high certainty (vs PLA: SMD=-1.10, 95% CI, -1.69 to -0.51 in pain; SMD=1.46, 95% CI, 0.73-2.20 in global function). Distension and intra-articular injection via anterior or posterior approaches produced effects equivalent to those of rotator interval injection and D-RI. CONCLUSIONS Rotator interval injection, distension, and intra-articular injection had equivalent effects on symptom relief. More RCTs are required to validate the superiority of multisite injections.
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Affiliation(s)
- Chun-Wei Liang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei; Department of Primary Care Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei
| | - Hsiao-Yi Cheng
- School of Medicine, College of Medicine, Taipei Medical University, Taipei; Department of Primary Care Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
| | - Yu-Hao Lee
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Chun- De Liao
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei; Master's Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei.
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Sahu D, Gupta S, Shetty G, Choudhury HS. Frozen shoulder after COVID-19 vaccination versus idiopathic frozen shoulder: similar clinical features and functional improvement at 1-year follow-up. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:41-47. [PMID: 38323207 PMCID: PMC10840564 DOI: 10.1016/j.xrrt.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background Frozen shoulder after COVID-19 vaccination is sparsely discussed in the medical literature. We aimed to evaluate: (1) the differences in the baseline clinical features and functional outcomes of conservatively treated frozen shoulder following COVID-19 vaccination compared to idiopathic frozen shoulder (2) the improvements in pain scores, functional outcomes, and range of motion (ROM) at 6-10 months and at 1 year of follow-up in patients with frozen shoulder after COVID-19 vaccination treated by conservative therapy. Methods Between June 2021 and December 2021, 12 patients (13 shoulders) that were diagnosed with frozen shoulder after COVID-19 vaccination (vaccine related frozen shoulder [VRF] group) (final follow-up of 12.4 months ± 0.8 months) were compared with 20 patients that were diagnosed as idiopathic frozen shoulder unrelated to vaccination (unvaccinated frozen shoulder [UFS] group) (average follow-up of 13.4 ± 3.1 months). All patients were treated with home-based stretching exercises. Four (33%) patients in the VRF group and 15 (75%) patients in the UFS group underwent steroid injection in the suprascapular notch by an experienced radiologist. Results The left side was affected more frequently in the VRF group [n = 10 (83.3%)] than in the UFS group [n = 8 (40%), P = .03]. The VRF and the UFS groups were similar in the rest of the baseline clinical features, such as the age distribution, men/women ratio, baseline Oxford Shoulder Scores (OSS), ROM deficit, and pain visual analogue scale (VAS) scores. The OSS, VAS pain scores, and the ROM deficit significantly improved in the VRF group at the 6-10-month follow-up and then at the final (12.4 ± 0.8 months) follow-up compared to the baseline values. At the final follow-up, there were no significant differences in the average external rotation, external rotation deficit, elevation, elevation deficit, internal rotation, pain VAS scores, and OSS between the VRF and the UFS group. Conclusion To conclude, frozen shoulder following COVID-19 vaccination may present with clinical features similar to those of the idiopathic frozen shoulder. Furthermore, the patients with frozen shoulder following COVID-19 vaccination may continue to improve over one year with conservative treatment; the final improvements in function and ROM are similar to those with idiopathic frozen shoulder.
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Affiliation(s)
- Dipit Sahu
- Sir H.N. Reliance Foundation Hospital, Mumbai, India
- Mumbai Shoulder Institute, Mumbai, India
- Jupiter Hospital, Thane, India
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Cucchi D, Di Giacomo G, Compagnoni R, Castricini R, Formigoni C, Radici M, Melis B, Brindisino F, De Giorgi S, De Vita A, Lisai A, Mangiavini L, Candela V, Carrozzo A, Pannone A, Menon A, Giudici LD, Klumpp R, Padua R, Carnevale A, Rosa F, Marmotti A, Peretti GM, Berruto M, Milano G, Randelli P, Bonaspetti G, De Girolamo L. A high level of scientific evidence is available to guide treatment of primary shoulder stiffness: The SIAGASCOT consensus. Knee Surg Sports Traumatol Arthrosc 2024; 32:37-46. [PMID: 38226696 DOI: 10.1002/ksa.12017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/21/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Shoulder stiffness (SS) is a condition characterised by active and passive restricted glenohumeral range of motion, which can occur spontaneously in an idiopathic manner or be associated with a known underlying aetiology. Several treatment options are available and currently no consensus has been obtained on which treatment algorithm represents the best choice for the patient. Herein we present the results of a national consensus on the treatment of primary SS. METHODS The project followed the modified Delphi consensus process, involving a steering, a rating and a peer-review group. Sixteen questions were generated and subsequently answered by the steering group after a thorough literature search. A rating group composed by professionals specialised in the diagnosis and treatment of shoulder pathologies rated the question-answer sets according to the scientific evidence and their clinical experience. RESULTS Recommendations were rated with an average of 8.4 points out of maximum 9 points. None of the 16 answers received a rating of less than 8 and all the answers were considered as appropriate. The majority of responses were assessed as Grade A, signifying a substantial availability of scientific evidence to guide treatment and support recommendations encompassing diagnostics, physiotherapy, electrophysical agents, oral and injective medical therapies, as well as surgical interventions for primary SS. CONCLUSIONS A consensus regarding the conservative and surgical treatment of primary SS could be achieved at a national level. This consensus sets basis for evidence-based clinical practice in the management of primary SS and can serve as a model for similar initiatives and adaptable guidelines in other European countries and potentially on a global scale. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
| | | | - Riccardo Compagnoni
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
| | - Roberto Castricini
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Casa di Cura Villa Verde, Fermo, Italy
| | - Chiara Formigoni
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- GIDIF-RBM - Italian Group of Information Specialist from Pharmaceutical Company and Biomedical Research Institutes, Milan, Italy
| | - Mattia Radici
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
| | - Barbara Melis
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Unità di Ortopedia e traumatologia dello sport, Casa di cura "Policlinico Città di Quartu", Quartu Sant'Elena, Italy
| | - Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, Italy
| | - Silvana De Giorgi
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari, Bari, Italy
| | - Andrea De Vita
- Concordia Hospital Roma, Rome, Italy
- SIAGASCOT "Shoulder" Committee, Rome, Italy
| | - Andrea Lisai
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Unità Funzionale Chirurgia della Spalla, Humanitas San Pio X, Milan, Italy
| | - Laura Mangiavini
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- IRCCS Istituto Ortopedico Galeazzi-Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Candela
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Alessandro Carrozzo
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Department of Orthopaedic Surgery and Traumatology, AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Antonello Pannone
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Policlinico "Città di Udine", Udine, Italy
| | - Alessandra Menon
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Scuola di Specializzazione in Statistica Sanitaria e Biometria, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Luca Dei Giudici
- SIAGASCOT "Shoulder" Committee, Rome, Italy
- Casa di Cura "Villa dei Pini", Civitanova Marche, Italy
| | - Raymond Klumpp
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Department of Orthopaedics and Trauma Surgery, ASST Bergamo Ovest, Treviglio, Italy
| | | | - Arianna Carnevale
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Francesco Rosa
- SIAGASCOT "Guidelines" Work-group, Rome, Italy
- Humanitas Clinical and Research Center -IRCCS, Rozzano, Italy
| | - Antongiulio Marmotti
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- Department of Orthopaedics and Traumatology, University of Torino, Turin, Italy
| | - Giuseppe M Peretti
- IRCCS Istituto Ortopedico Galeazzi-Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Massimo Berruto
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
| | - Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- ASST Spedali Civili, UOC Clinica Ortopedica, Brescia, Italy
| | - Pietro Randelli
- U.O.C. 1° Clinica Ortopedica, ASST G. Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Bonaspetti
- Department of Orthopaedics and Traumatology, Clinica S. Anna, Brescia, Italy
| | - Laura De Girolamo
- SIAGASCOT "Basic Science" Committee, Rome, Italy
- IRCCS Istituto Ortopedico Galeazzi-Sant'Ambrogio, Milan, Italy
- Laboratorio di Biotecnologie applicate all'Ortopedia, Milan, Italy
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Kim YT, Kim TY, Lee JB, Hwang JT. Glenohumeral versus subacromial steroid injections for impingement syndrome with mild stiffness: a randomized controlled trial. Clin Shoulder Elb 2023; 26:390-396. [PMID: 37798841 DOI: 10.5397/cise.2023.00346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/12/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The subacromial (SA) space is a commonly used injection site for treatment of impingement syndrome. For shoulder stiffness, glenohumeral (GH) injections are commonly performed. However, in cases of impingement syndrome with mild shoulder stiffness, the optimal site of steroid injection has yet to be identified. METHODS This prospective, randomized study compared the short-term outcomes of ultrasound-guided GH and SA steroid injections in patients who were diagnosed with impingement syndrome and mild stiffness. Each group comprised 24 patients who received either a GH or SA injection of 40 mg of triamcinolone. Range of motion and clinical scores were assessed before and 3, 7, and 13 weeks after the injection. RESULTS GH and SA injections significantly improved the range of motion and clinical scores after 13 weeks of follow-up. Notably, targeting the GH joint resulted in an earlier gain of forward elevation, external rotation, and internal rotation in 3 weeks (P<0.001, P=0.012, and P=0.002, respectively) and of internal rotation and a Constant-Murley score in 7 weeks (P<0.001 and P=0.046). Subsequent measurements were similar between the groups and showed a steady improvement in all ranges of motion and clinical scores. CONCLUSIONS GH injections may be more favorable than SA injections for treatment of impingement syndrome with mild stiffness, especially in improving the range of motion in the early period. However, the procedures showed similar outcomes after 3 months. Level of evidence: I.
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Affiliation(s)
- Yong-Tae Kim
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Tae-Yeong Kim
- Department of Orthopedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Jun-Beom Lee
- Department of Orthopedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Jung-Taek Hwang
- Department of Orthopedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
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Flintoft-Burt M, Stanier P, Planner A, Thahal H, Woods D. Recurrence of the frozen shoulder after hydrodilatation, what is the true incidence? Shoulder Elbow 2023; 15:610-618. [PMID: 37981967 PMCID: PMC10656972 DOI: 10.1177/17585732221124914] [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: 02/16/2022] [Revised: 06/05/2022] [Accepted: 08/23/2022] [Indexed: 11/21/2023]
Abstract
Purpose of the study To assess the outcome and recurrence rates of frozen shoulder treated by hydrodilatation in an independent hospital setting. Method Patients presenting to a shoulder clinic from August 2019 to July 2021 with a diagnosis of frozen shoulder were offered hydrodilatation. Data included primary or secondary frozen shoulder, length of symptoms, and diabetic status. An Oxford Shoulder Score was completed prior to hydrodilatation. Using ultrasound guidance, 40 mg Triamcinolone and local anaesthetic (10-25 mL depending on patient tolerance) were injected into the rotator interval. At a mean of 9 months, patients recorded their tolerance of the procedure, subsequent progress, the need for further treatment, and their current Oxford Shoulder Score. Results From 55 shoulders, six patients had a failure to improve and 10 patients had a transient improvement followed by recurrence (29%). 2/21 (9.5%) patients had 25 mL injected compared to 14/34 (41%) who had < = 20 mL (p = 0.012). 14/43 (33%) of primary frozen shoulder patients had a recurrence, compared with 2/12 (16%) secondary frozen shoulder patients, p = 0.019. Conclusion Further treatment was indicated in 14/34 (41%) of patients who underwent hydrodilatation in the frozen stage of frozen shoulder and could not tolerate more than 20 mL of injection, and was more commonly required in primary (33%) versus secondary (16%) frozen shoulder.
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Affiliation(s)
| | - Paul Stanier
- Trauma and Orthopaedics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Andy Planner
- Radiology, BMI The Ridgeway Hospital, Swindon, UK
| | | | - David Woods
- Orthopaedics, BMI The Ridgeway Hospital, Swindon UK
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Wise SR, Seales P, Houser AP, Weber CB. Frozen Shoulder: Diagnosis and Management. Curr Sports Med Rep 2023; 22:307-312. [PMID: 37678349 DOI: 10.1249/jsr.0000000000001097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
ABSTRACT Frozen shoulder is a common condition that causes pain and restriction of movement of the shoulder unrelated to secondary causes. It has three classic phases (freezing, frozen, and thawing), and is resolved in most cases within 1 to 2 years. Diagnosis is clinical based on global motion restriction and pain. Imaging plays an ancillary role to narrow the differential diagnosis. Physical therapy, nonsteroidal anti-inflammatories, and injection therapies are standard treatments, although none have been shown to alter the long-term course of the condition. Ultrasound guidance is recommended for injection-based therapy, although not required. Further study should focus on long-term outcomes and treatments that significantly alter the natural course of the disease.
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Affiliation(s)
- Sean R Wise
- National Capital Consortium Military Sports Medicine Fellowship, Fort Belvoir Community Hospital, Fort Belvoir, VA
| | | | | | - Chase B Weber
- National Capital Consortium Family Medicine Residency, Fort Belvoir Community Hospital, Fort Belvoir, VA
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Kayaokay K, Arslan Yurtlu D. A Comparison of the Treatment Outcomes With and Without the Use of Intra-articular Corticosteroids for Frozen Shoulder Manipulation. Cureus 2023; 15:e44427. [PMID: 37664340 PMCID: PMC10469773 DOI: 10.7759/cureus.44427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/05/2023] Open
Abstract
Background Manipulation under anesthesia is known to be an effective treatment method for a frozen shoulder. However, this process is painful and causes difficulty in early physiotherapy. Intra-articular corticosteroids may relieve pain after manipulation. This study compared patients who underwent manipulation under anesthesia with those who only underwent physiotherapy and those who received intra-articular corticosteroid administration and physiotherapy. Methodology A total of 33 patients presenting with frozen shoulders were included in this study. Those who underwent manipulation after anesthesia were determined as group 1 (16 patients) and those who received intra-articular corticosteroids in addition to manipulation under anesthesia were determined as group 2 (17 patients). Pain was evaluated using the Visual Analog Scale (VAS) scores. Functional outcomes were assessed using the University of California-Los Angeles (UCLA) scores and shoulder range of motion (ROM). Results VAS and UCLA scores of both groups were similar at 12 weeks and six months. ROM improved significantly after manipulation in both group 1 and group 2 (p < 0.05). There was no significant difference between the ROM in the two groups after manipulation and physiotherapy. Only the external rotation ROM value was better in group 2 (p = 0.032) Conclusions Physiotherapy after manipulation is a successful treatment method for frozen shoulder patients. It reduces pain in the early period compared to patients who are not administered intra-articular corticosteroids. However, it has no functional superiority.
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Affiliation(s)
- Kemal Kayaokay
- Department of Orthopaedics and Traumatology, Izmir Katip Çelebi University, Izmir, TUR
| | - Derya Arslan Yurtlu
- Department of Anaesthesiology and Reanimation, Izmir Katip Çelebi University, Ataturk Training and Research Hospital, Izmir, TUR
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Yi JW. Isolated acromioclavicular osteoarthritis and steroid injection. Clin Shoulder Elb 2023; 26:107-108. [PMID: 37316172 DOI: 10.5397/cise.2023.00311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/02/2000] [Indexed: 06/16/2023] Open
Affiliation(s)
- Jin Woong Yi
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea
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Nudelman B, Song B, Higginbotham DO, Piple AS, Montgomery WH. Platelet-Rich Plasma Injections Are at Least Equivalent to Corticosteroid Injections for Adhesive Capsulitis: A Systematic Review of Prospective Cohort Studies. Arthroscopy 2023; 39:1320-1329. [PMID: 36708748 DOI: 10.1016/j.arthro.2023.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate the role of platelet-rich plasma (PRP) for adhesive capsulitis (AC) as compared with other injectables. METHODS A literature search of the PubMed and Embase online databases was performed to identify articles evaluating injection therapy for the treatment of AC. The inclusion criteria included prospective studies comparing PRP against alternative injectables with a minimum of 15 patients in each treatment arm and a minimum 12-week follow-up period. Pain scores, range of motion, and function scores were the primary outcomes assessed. RESULTS Five articles comparing PRP with corticosteroid or saline solution injections met the inclusion criteria. A total of 157 patients were treated with PRP, with a follow-up duration ranging from 3 to 6 months. All 5 studies showed statistically significant improvements in pain scores, motion, and function scores in patients receiving PRP, corticosteroid, and saline solution injections. However, PRP was consistently superior on intergroup analyses in all but 1 study. In 4 studies, pain and function scores favored PRP over control at final follow-up (range in mean difference, -2.2 to 0.69 for visual analog scale pain score [n = 5] and -50.5 to -4.0 for Shoulder Pain and Disability Index score [n = 3]), whereas 3 studies found greater improvement in shoulder motion after PRP (range in mean difference, 0.7° to 34.3° for forward flexion and -2.3° to 20.4° for external rotation [n = 4]). One study found no significant difference between PRP and corticosteroid injections but noted that the results were comparable. CONCLUSIONS According to a limited number of prospective studies, PRP injections for AC are at least equivalent to corticosteroid or saline solution injections and often lead to improved pain, motion, and functional outcomes at 3- to 6-month follow-up. Given the small number of studies, with design heterogeneity, there is insufficient evidence to routinely recommend PRP for AC. However, the results are promising and do support considering PRP as an adjunct treatment option for AC, especially for patients refractory and/or averse to corticosteroids or alternative treatment modalities. LEVEL OF EVIDENCE Level II, systematic review of Level I and II studies.
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Affiliation(s)
- Brandon Nudelman
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California, U.S.A..
| | - Bowen Song
- St. Mary's Medical Center, San Francisco, California, U.S.A
| | | | - Amit S Piple
- The Taylor Collaboration, San Francisco, California, U.S.A
| | - William H Montgomery
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California, U.S.A
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Miyamoto R, Shitara H, Ichinose T, Sasaki T, Hamano N, Kamiyama M, Nakase K, Chikuda H. Triamcinolone acetonide with arthroscopic capsular release for frozen shoulder promotes early recovery of shoulder abduction. JSES Int 2023. [DOI: 10.1016/j.jseint.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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12
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Ziradkar R, Best TM, Quintero D, Paultre K. Nonsteroidal Anti-inflammatory and Corticosteroid Injections for Shoulder Impingement Syndrome: A Systematic Review and Meta-analysis. Sports Health 2022:19417381221108726. [PMID: 35897160 PMCID: PMC10293554 DOI: 10.1177/19417381221108726] [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: 11/16/2022] Open
Abstract
CONTEXT To determine optimal treatment strategies for shoulder impingement syndrome (SIS). OBJECTIVE To compare subacromial nonsteroidal anti-inflammatory injections (SNIs) and subacromial corticosteroid injections (SCIs) on pain relief and functional improvement in individuals with SIS. Second, to perform a cost analysis of the 2 injections. DATA SOURCES MEDLINE, SPORTDiscus, CINAHL, Embase, Web of Science, and SCOPUS databases were searched for randomized controlled trials using several keywords. STUDY SELECTION The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized, and 10 studies comparing changes in pain or function in humans with SIS receiving SNIs or SCIs were included. Quality and risk of bias were assessed using the Consolidated Standards of Reporting Trials (CONSORT) 2010 scale and the Cochrane Collaboration tool. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 1. DATA EXTRACTION Baseline and follow-up scores of the visual analog, Constant-Murley, and University of California Los Angeles shoulder scales were extracted to calculate effect sizes (ESs), represented as Cohen d. Metaregression and publication bias analyses were performed. Procedural and medication costs were extracted from Medicare guidelines. RESULTS A total of 7 high and 3 good quality studies were included, with a mean score of 21.1. Only 1 study had a high risk of bias. The meta-analyses produced pooled ESs of 0.05 (P = 0.83), 0.12 (P = 0.71), and 0.07 (P = 0.79) for each scale, respectively, with CIs crossing 0. Procedural costs were equal between groups, whereas ketorolac was the least costly medication ($0.47). There was no significant difference in side effects between the 2 injections. CONCLUSION SNIs are as effective as SCIs for short-term pain relief and improving function in patients with subacromial impingement syndrome. In addition, they are less expensive and cause no major difference in complications, providing a viable, cost-effective alternative for injection therapy in patients with SIS.
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Affiliation(s)
- Rhushi Ziradkar
- Department of Orthopedics and Family Medicine, University of Miami Sports Medicine Institute, Coral Gables, Florida
| | - Thomas M Best
- Department of Orthopedics and Family Medicine, University of Miami Sports Medicine Institute, Coral Gables, Florida
| | - Daniel Quintero
- University of Miami Miller School of Medicine, Miami, Florida
| | - Kristopher Paultre
- Department of Orthopedics and Family Medicine, University of Miami Sports Medicine Institute, Coral Gables, Florida
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13
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Karbowiak M, Holme T, Mirza M, Siddiqui N. Frozen shoulder. BMJ 2022; 377:e068547. [PMID: 35450852 DOI: 10.1136/bmj-2021-068547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Thomas Holme
- Kingston Hospital NHS Foundation Trust, Kingston upon Thames, UK
| | - Maisum Mirza
- Warlingham Green Medical Practice, Warlingham, UK
| | - Nashat Siddiqui
- Kingston Hospital NHS Foundation Trust, Kingston upon Thames, UK
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14
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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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Zikria BA. CORR Insights®: Is the Anterior Injection Approach Without Ultrasound Guidance Superior to the Posterior Approach for Adhesive Capsulitis of the Shoulder? A Sequential, Prospective Trial. Clin Orthop Relat Res 2021; 479:2490-2492. [PMID: 34166274 PMCID: PMC8509942 DOI: 10.1097/corr.0000000000001876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/07/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Bashir Ahmed Zikria
- Associate Professor, Department of Orthopaedics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Chief of Surgery, Aspetar Sports Medicine Hospital, Doha, Qatar
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16
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Ha JW, Kim H, Kim SH. Effects of steroid injection during rehabilitation after arthroscopic rotator cuff repair. Clin Shoulder Elb 2021; 24:166-171. [PMID: 34488297 PMCID: PMC8423524 DOI: 10.5397/cise.2021.00332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022] Open
Abstract
Background This study aims to compare the clinical outcomes of steroid injections during the rehabilitation period after arthroscopic rotator cuff repair (ACRC). Methods Among patients who underwent ARCR, 117 patients who met the inclusion and exclusion criteria were enrolled. Pain and range of motion (ROM) recovery at the 3-, 6-, and 24-month follow-up visits and functional outcome at the 24-month follow-up were compared between 45 patients who received ultrasound-guided subacromial steroid injection at postoperative week 4 or 6 and 72 patients who did not. Functional outcome was assessed using the American Shoulder and Elbow Surgeons (ASES) score and Constant score. Healing of the repaired tendon and retear were observed at the 6-month follow-up via magnetic resonance imaging (MRI) or computed tomography (CT) arthrography. Results At the 3-month follow-up, the steroid injection group showed lower visual analog scale scores than the control group (p<0.05) and showed faster recovery of forward flexion and internal rotation (p<0.05). From the 6-month follow-up, the two groups did not show differences in pain and ROM, and the ASES score and Constant score also did not significantly differ at the 24-month follow-up. The two groups did not differ in retear rate as determined by MRI or CT arthrography at the 6-month follow-up. Conclusions This study demonstrated that ultrasound-guided subacromial steroid injection at 4 or 6 weeks after ARCR leads to quick pain reduction and ROM recovery until 3 months after surgery. Therefore, subacromial steroid injection is speculated to be an effective and relatively safe method to assist rehabilitation.
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Affiliation(s)
- Joong-Won Ha
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyunkyo Kim
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Seong Hun Kim
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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17
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Jeong JY, Khil EK, Kim TS, Kim YW. Effect of co-administration of atelocollagen and hyaluronic acid on rotator cuff healing. Clin Shoulder Elb 2021; 24:147-155. [PMID: 34488295 PMCID: PMC8423525 DOI: 10.5397/cise.2021.00234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/23/2021] [Indexed: 12/15/2022] Open
Abstract
Background This study aimed to evaluate the co-administration effect of atelocollagen combined with hyaluronic acid (HA) injections for treatment of full-thickness rotator cuff tear (RCT). Methods Eighty patients who underwent arthroscopic rotator cuff repair for full-thickness RCT from March 2018 to November 2019 were enrolled. The patients were randomly allocated to the following groups: combined atelocollagen and HA injection (group I, n=28), only HA injection (group II, n=26), and no injection (group III, n=26). Clinical outcomes were assessed at 3, 6, and 12 months after surgery using the American Shoulder and Elbow Surgeons score, visual analog scale pain score , functional scores (pain visual analog scale, function visual analog score), and range of motion. Magnetic resonance imaging was performed 12 months after surgery to evaluate rotator cuff integrity. Results Preoperative demographic data and postoperative clinical outcomes did not differ significantly among the three groups (p>0.05). However, in group I, the number of steroid injections after surgery was significantly lower than that in the other groups (p=0.011). The retear rate on follow-up magnetic resonance imaging was significantly higher in group II (9.5%, n=2) and group III (13.6%, n=3) than in group I (0%) (p=0.021). Conclusions Co-administration of atelocollagen and HA improves healing of the rotator cuff and increases the integrity of the rotator cuff repair site. This study provides encouraging evidence for use of combined atelocollagen-HA injections to treat patients with full-thickness RCT.
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Affiliation(s)
- Jeung Yeol Jeong
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Hwaseong, Korea
| | - Eun Kyung Khil
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Hwaseong, Korea
| | - Tae Soung Kim
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Hwaseong, Korea
| | - Young Woo Kim
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Hwaseong, Korea
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18
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Lesevic M, Awowale JT, Moran TE, Diduch DR, Brockmeier SF, Werner BC. Immediate Pain Relief at Time of Corticosteroid Injection for Idiopathic Adhesive Capsulitis as a Predictor of Eventual Outcomes. Orthop J Sports Med 2021; 9:23259671211019353. [PMID: 34345633 PMCID: PMC8283233 DOI: 10.1177/23259671211019353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background Corticosteroid injection and physical therapy remain the mainstay of treatment for idiopathic adhesive capsulitis of the shoulder; however, a certain percentage of patients will not improve using these interventions and will require manipulation under anesthesia (MUA) and/or lysis of adhesions (LOA). Purpose To evaluate whether the immediate pain reduction after fluoroscopic-guided, mixed anesthetic-corticosteroid injection for idiopathic adhesive capsulitis is related to the eventual need for LOA/MUA or a repeat glenohumeral steroid injection. Study Design Case-control study; Level of evidence, 3. Methods This single-institution study involved patients undergoing fluoroscopic glenohumeral corticosteroid injection for a diagnosis of idiopathic adhesive capsulitis between 2010 and 2017. Included were patients with a minimum of 1-year postinjection follow-up and visual analog scale (VAS) pain scores from immediately before and after the injection. The primary analysis was the relationship between patients with an immediate change in VAS score after injection and those who underwent LOA/MUA. A repeat glenohumeral injection was also evaluated as an outcome. Receiver operator characteristic curves and a multivariate binomial logistic regression analysis were performed. Results Overall, 739 shoulders in 728 patients (mean age, 52.6 years; 68% women) were included, of which 38 (5.1%) underwent LOA/MUA and 209 (28%) underwent repeat injections. The immediate change in the VAS score was not significantly associated with the eventual need for LOA/MUA. Preinjection VAS and immediate postinjection VAS scores were not significant predictors of eventual LOA/MUA or subsequent injection. For all 3 predictors, the area under the receiver operator characteristic curve classified them as extremely poor discriminators. Conclusion The immediate pain response to a fluoroscopic-guided glenohumeral injection for idiopathic shoulder adhesive capsulitis was not predictive of the eventual need for LOA/MUA or subsequent injection. Patients can be counseled that even if their initial pain response to an injection is poor, they still have an excellent chance of avoiding surgery, as the overall rate of LOA/MUA was low (5.1%).
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Affiliation(s)
- Milos Lesevic
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, Virginia USA
| | - John T Awowale
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, Virginia USA
| | - Thomas E Moran
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, Virginia USA
| | - David R Diduch
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, Virginia USA
| | - Stephen F Brockmeier
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, Virginia USA
| | - Brian C Werner
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, Virginia USA
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19
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Forsythe B, Lavoie-Gagne O, Patel BH, Lu Y, Ritz E, Chahla J, Okoroha KR, Allen AA, Nwachukwu BU. Efficacy of Arthroscopic Surgery in the Management of Adhesive Capsulitis: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Arthroscopy 2021; 37:2281-2297. [PMID: 33221429 DOI: 10.1016/j.arthro.2020.09.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine which interventions optimize clinical outcomes in adhesive capsulitis by performing a network meta-analysis of randomized controlled trials. METHODS A systematic review was conducted of all clinical trials on adhesive capsulitis published since 2008. Patient cohorts were grouped into treatment categories; data collected included range of motion (ROM) and patient-reported outcome measures (PROMs). Interventions were compared across groups by means of arm-based Bayesian network meta-analysis in a random-effects model. RESULTS Sixty-six studies comprising 4042 shoulders (57.6% female patients, age 54.8 ± 3.2 years [mean ± standard deviation]) were included. The most commonly studied interventions were physical therapy (PT) or shoulder injections. Network meta-analysis demonstrated that arthroscopic surgical capsular release was the most effective treatment in increasing ROM. This effect was apparent in forward flexion (effect difference [ED] versus placebo, 44°, 95% confidence interval [CI] 31° to 58°), abduction (ED 58°, 45° to 71°), internal rotation (ED 34°, 24° to 44°), and external rotation (ED 59°, 37° to 80°). Interventions most effective for pain relief included PT supplemented with either medical therapy (ED -4.50, -9.80 to 2.80) or ultrasound therapy (ED -5.10, -5.10 to -1.40). Interventions most effective for improvement of functional status included PT, manipulation under anesthesia (MUA), intra-articular or subacromial steroid injection, surgical capsular release, and supplementation of PT with alternative therapy. CONCLUSIONS No one treatment emerged superior in regard to ROM, pain symptoms, and functional status. Surgery (after failure of conservative treatment) ranked highest across all ROM domains. Treatments that ranked highest for treatment of pain included PT supplemented with either medical therapy or ultrasound. Finally, treatments that ranked highest for improvements in functional status included MUA, PT with medical therapy, surgical intervention, PT with ultrasound, PT with injection, and injection alone. LEVEL OF EVIDENCE II, systematic review and network meta-analysis of level I and II studies.
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Affiliation(s)
- Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Ophelie Lavoie-Gagne
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bhavik H Patel
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, U.S.A
| | - Yining Lu
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ethan Ritz
- Bioinformatics and Biostatistics Core, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Kelechi R Okoroha
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Answorth A Allen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
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20
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Cucchi D, De Giorgi S, Saccomanno MF, Uboldi F, Menon A, Friedrich MJ, Walter SG, de Girolamo L. Treatment of Primary Shoulder Stiffness: Results of a Survey on Surgeon Practice Patterns in Italy. JOINTS 2021; 7:165-173. [PMID: 34235381 PMCID: PMC8253610 DOI: 10.1055/s-0041-1730983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 04/19/2021] [Indexed: 11/20/2022]
Abstract
Objectives
Shoulder stiffness is a condition of restricted glenohumeral range of motion (ROM), which can arise spontaneously or as consequence of a known cause. Several treatment options are available and currently no consensus has been obtained on which treatment algorithm represents the best choice for the patient. The aim of this study was to investigate surgeon practice patterns in Italy regarding treatment of primary shoulder stiffness.
Methods
A literature review was performed to identify randomized controlled trials reporting results of shoulder stiffness treatment. The following controversial or critical points in the treatment of primary shoulder stiffness were identified: modalities of physical therapy; indication for oral corticosteroid; indication and frequency for injective corticosteroid; technique and site of injection; and indication, timing, and technique for surgery. A survey composed by 14 questions was created and administrated to the members of a national association specialized in orthopaedics and sports traumatology (SIGASCOT at the time of survey completion, recently renamed SIAGASCOT after the fusion of the societies SIGASCOT and SIA).
Results
A total of 204 completed questionnaires were collected. Physical therapy was recommended by 98% of the interviewed. The use of oral corticosteroids was considered by 51%, and injections of corticosteroids by 72%. The posterior injection approach was the one preferred and a number of three was considered the upper limit for repeated injections. Injective therapy with local anesthetics and hyaluronic acid was considered by more than 20% of the interviewed. Thirty percent of the interviewed did not treat shoulder stiffness surgically.
Conclusion
Several approaches to shoulder stiffness have been proposed and high-level evidence is available to analyze and discuss their results. Several controversial points emerged both from a literature review and from this national survey. Treatment of shoulder stiffness should be tailored to the patient's clinical situation and the stage of its pathology and should aim at pain reduction, ROM restoration, functional regain, and shortening of symptoms duration, with conservative therapy remaining the mainstay of treatment.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Silvana De Giorgi
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari, Bari, Italy
| | | | - Francesco Uboldi
- UOC Ortopedia e Traumatologia Pediatrica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Alessandra Menon
- Department of Biomedical Sciences for Health, Laboratory of Applied Biomechanics, Università degli Studi di Milano, Milan, Italy.,1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Max J Friedrich
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Sebastian G Walter
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Laura de Girolamo
- Laboratorio di Biotecnologie applicate all Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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21
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Thu AC, Kwak SG, Shein WN, Htun LM, Htwe TTH, Chang MC. Comparison of ultrasound-guided platelet-rich plasma injection and conventional physical therapy for management of adhesive capsulitis: a randomized trial. J Int Med Res 2021; 48:300060520976032. [PMID: 33296615 PMCID: PMC7731701 DOI: 10.1177/0300060520976032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE We evaluated the effect of ultrasound (US)-guided injection of platelet-rich plasma (PRP) into the shoulder joint in patients with adhesive capsulitis (AC) and compared its effect with that of conventional physiotherapy (CPT). METHODS Sixty-four subjects with AC were included and randomly allocated into two groups, as follows: PRP (n=32; intra-articular [IA] PRP [4 mL] was injected); and CPT (n=32; short wave diathermy and exercise therapy were performed at three sessions/week for 6 weeks). Treatment outcomes evaluated therapeutic effectiveness before and at 1, 3, and 6 weeks after PRP injection and CPT initiation. RESULTS Subjects in both groups showed a significant decrease in the visual analogue scale score for pain and shoulder and hand scores, and they a significant increase in shoulder passive range of motion at all evaluation time points. There was no significant difference in the measured outcomes between the two groups. However, there was less acetaminophen consumption after IA PRP injection compared with that after CPT. CONCLUSIONS IA PRP injection is a useful option for treating patients with AC, particularly those who have low therapeutic compliance for exercise therapy or have contraindications for corticosteroid injection or oral pain reduction medication.
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Affiliation(s)
- Aung Chan Thu
- Department of Physical Medicine and Rehabilitation, University of Medicine, Mandalay, Myanmar
| | - Sang Gyu Kwak
- Department of Medical Statistics, College of Medicine, Catholic University of Daegu, Daegu, South Korea
| | - Win Nyi Shein
- Department of Physical Medicine and Rehabilitation, University of Medicine, Mandalay, Myanmar
| | - La Min Htun
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Hospital, Yangon, Myanmar
| | - Thae Thae Han Htwe
- Department of Preventive and Social Medicine, University of Medicine, Mandalay, Myanmar
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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22
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Cho CH, Min BW, Bae KC, Lee KJ, Kim DH. A prospective double-blind randomized trial on ultrasound-guided versus blind intra-articular corticosteroid injections for primary frozen shoulder. Bone Joint J 2021; 103-B:353-359. [PMID: 33517741 DOI: 10.1302/0301-620x.103b2.bjj-2020-0755.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS Ultrasound (US)-guided injections are widely used in patients with conditions of the shoulder in order to improve their accuracy. However, the clinical efficacy of US-guided injections compared with blind injections remains controversial. The aim of this study was to compare the accuracy and efficacy of US-guided compared with blind corticosteroid injections into the glenohumeral joint in patients with primary frozen shoulder (FS). METHODS Intra-articular corticosteroid injections were administered to 90 patients primary FS, who were randomly assigned to either an US-guided (n = 45) or a blind technique (n = 45), by a shoulder specialist. Immediately after injection, fluoroscopic images were obtained to assess the accuracy of the injection. The outcome was assessed using a visual analogue scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, the subjective shoulder value (SSV) and range of movement (ROM) for all patients at the time of presentation and at three, six, and 12 weeks after injection. RESULTS The accuracy of injection in the US and blind groups was 100% (45/45) and 71.1% (32/45), respectively; this difference was significant (p < 0.001). Both groups had significant improvements in VAS pain score, ASES score, SSV, forward flexion, abduction, external rotation, and internal rotation throughout follow-up until 12 weeks after injection (all p < 0.001). There were no significant differences between the VAS pain scores, the ASES score, the SSV and all ROMs between the two groups at the time points assessed (all p > 0.05). No injection-related adverse effects were noted in either group. CONCLUSION We found no significant differences in pain and functional outcomes between the two groups, although an US-guided injection was associated with greater accuracy. Considering that it is both costly and time-consuming, an US-guided intra-articular injection of corticosteroid seems not always to be necessary in the treatment of FS as it gives similar outcomes as a blind injection. Cite this article: Bone Joint J 2021;103-B(2):353-359.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Keimyung University, Daegu, South Korea
| | - Byung-Woo Min
- Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Keimyung University, Daegu, South Korea
| | - Ki-Cheor Bae
- Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Keimyung University, Daegu, South Korea
| | - Kyung-Jae Lee
- Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Keimyung University, Daegu, South Korea
| | - Du Hwan Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
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Lee JJ, Kim DY, Hwang JT, Song DK, Lee HN, Jang JS, Lee SS, Hwang SM, Moon SH, Shim JH. Dexmedetomidine combined with suprascapular nerve block and axillary nerve block has a synergistic effect on relieving postoperative pain after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2021; 29:4022-4031. [PMID: 32975624 PMCID: PMC7517062 DOI: 10.1007/s00167-020-06288-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/14/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Suprascapular nerve block (SSNB) is the most commonly used block for the relief of postoperative pain from arthroscopic rotator cuff repair and can be used in combination with axillary nerve block (ANB). Dexmedetomidine (DEX) is a type of alpha agonist that can elongate the duration of regional block. The aim of this study was to compare the effects of the use of dexmedetomidine combined with SSNB and ANB with those of the use of SSNB and ANB alone on postoperative pain, satisfaction, and pain-related cytokines within the first 48 h after arthroscopic rotator cuff repair. METHODS Forty patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this single-center, double-blinded randomized controlled trial study. Twenty patients were randomly allocated to group 1 and received ultrasound-guided SSNB and ANB using a mixture of 0.5 ml (50 μg) of DEX and 9.5 ml of 0.75% ropivacaine preemptively. The other 20 patients were allocated to group 2 and underwent ultrasound-guided SSNB and ANB alone using a mixture of 0.5 ml of normal saline and 9.5 ml of ropivacaine. The visual analog scale (VAS) for pain and patient satisfaction (SAT) scores were postoperatively checked within 48 h. The plasma interleukin (IL)-6, IL-8, IL-1β, cortisol, and serotonin levels were also postoperatively measured within 48 h. RESULTS Group 1 showed a significantly lower mean VAS (visual analog scale of pain) score 1, 3, 6, 12, 18 and 24 h after operation, and a significantly higher mean SAT (patient satisfaction) score 1, 3, 6, 12, 18, 24 and 36 h after the operation than group 2. Group 1 showed a significantly lower mean plasma IL-8 level 1 and 48 h after the operation, and a significantly lower mean IL-1β level 48 h after the operation than group 2. Group 1 showed a significantly lower mean plasma serotonin level 12 h after the operation than group 2. The mean timing of rebound pain in group 1 was significantly later than that in group 2 (36 h > 23 h, p = 0.007). Six patients each in groups 1 and 2 showed rebound pain. The others did not show rebound pain. CONCLUSIONS Ultrasound-guided SSNA and ANB with DEX during arthroscopic rotator cuff repair resulted in a significantly lower mean VAS score and a significantly higher mean SAT score within 48 h after the operation than SSNB and ANB alone. Additionally, SSNB and ANB with DEX tended to result in a later mean timing of rebound pain accompanied by significant changes in IL-8, IL-1β, and serotonin levels within 48 h after the operation. The present study could provide the basis for selecting objective parameters of postoperative pain in deciding the optimal use of medication for relieving pain. LEVEL OF EVIDENCE Level I. TRIAL REGISTRATION 2015-20, ClinicalTrials.gov Identifier: NCT04398589. IRB NUMBER 2015-20, Hallym University Chuncheon Sacred Heart Hospital.
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Affiliation(s)
- Jae Jun Lee
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Do-Young Kim
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Jung-Taek Hwang
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea.
| | - Dong-Keun Song
- Department of Pharmacology, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Han Na Lee
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Ji Su Jang
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Sang-Soo Lee
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Sung Mi Hwang
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Sung Hoon Moon
- Department of Orthopedic Surgery, Kangwon National University Hospital, Kangwon National University Medical College, Chuncheon-si, Republic of Korea
| | - Jae-Hoon Shim
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
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Challoumas D, Biddle M, McLean M, Millar NL. Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2029581. [PMID: 33326025 PMCID: PMC7745103 DOI: 10.1001/jamanetworkopen.2020.29581] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE There are a myriad of available treatment options for patients with frozen shoulder, which can be overwhelming to the treating health care professional. OBJECTIVE To assess and compare the effectiveness of available treatment options for frozen shoulder to guide musculoskeletal practitioners and inform guidelines. DATA SOURCES Medline, EMBASE, Scopus, and CINHAL were searched in February 2020. STUDY SELECTION Studies with a randomized design of any type that compared treatment modalities for frozen shoulder with other modalities, placebo, or no treatment were included. DATA EXTRACTION AND SYNTHESIS Data were independently extracted by 2 individuals. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Random-effects models were used. MAIN OUTCOMES AND MEASURES Pain and function were the primary outcomes, and external rotation range of movement (ER ROM) was the secondary outcome. Results of pairwise meta-analyses were presented as mean differences (MDs) for pain and ER ROM and standardized mean differences (SMDs) for function. Length of follow-up was divided into short-term (≤12 weeks), mid-term (>12 weeks to ≤12 months), and long-term (>12 months) follow-up. RESULTS From a total of 65 eligible studies with 4097 participants that were included in the systematic review, 34 studies with 2402 participants were included in pairwise meta-analyses and 39 studies with 2736 participants in network meta-analyses. Despite several statistically significant results in pairwise meta-analyses, only the administration of intra-articular (IA) corticosteroid was associated with statistical and clinical superiority compared with other interventions in the short-term for pain (vs no treatment or placebo: MD, -1.0 visual analog scale [VAS] point; 95% CI, -1.5 to -0.5 VAS points; P < .001; vs physiotherapy: MD, -1.1 VAS points; 95% CI, -1.7 to -0.5 VAS points; P < .001) and function (vs no treatment or placebo: SMD, 0.6; 95% CI, 0.3 to 0.9; P < .001; vs physiotherapy: SMD 0.5; 95% CI, 0.2 to 0.7; P < .001). Subgroup analyses and the network meta-analysis demonstrated that the addition of a home exercise program with simple exercises and stretches and physiotherapy (electrotherapy and/or mobilizations) to IA corticosteroid may be associated with added benefits in the mid-term (eg, pain for IA coritocosteriod with home exercise vs no treatment or placebo: MD, -1.4 VAS points; 95% CI, -1.8 to -1.1 VAS points; P < .001). CONCLUSIONS AND RELEVANCE The findings of this study suggest that the early use of IA corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes. This treatment should be accompanied by a home exercise program to maximize the chance of recovery.
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Affiliation(s)
- Dimitris Challoumas
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Scotland, United Kingdom
| | - Mairiosa Biddle
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Scotland, United Kingdom
| | - Michael McLean
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Scotland, United Kingdom
| | - Neal L. Millar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Scotland, United Kingdom
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Shin HR, Seo J, Park K, Ann SH, Park SJ, Lee S, Yeom SR. Effectiveness and safety of fluoroscopy-guided acupuncture for subacromial impingement syndrome: A randomized, patient-assessor blind, parallel clinical trial. Integr Med Res 2020; 10:100693. [PMID: 33665091 PMCID: PMC7907818 DOI: 10.1016/j.imr.2020.100693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 11/22/2022] Open
Abstract
Background Subacromial impingement syndrome (SIS) is one of the most common causes of shoulder pain, and acupuncture treatment is widely used as treatment. However, no studies have examined image-guided acupuncture for SIS. This study evaluated the effectiveness and safety of low-dose X-ray guided acupuncture (LA) in patients with SIS. Methods A total of 54 patients with SIS were randomly allocated to the LA group and the conventional acupuncture (CA) group. Two acupuncture treatment sessions were conducted for a week, and follow up was conducted after three weeks. The primary outcome was pain intensity measured by the visual analogue scale (VAS) during the Neer and Hawkins test. The incidence rate of shoulder impingement sign, the modified Constant-Murley score (CMS) and the Shoulder Pain and Disability Index (SPADI) were assessed as other outcomes. All indicators were assessed at baseline and after one week and three weeks. For safety evaluation, adverse events were monitored in both groups. Results The change in pain during the Neer test after one week from baseline was more significant in the LA group than in the CA group (p=0.008). However, the Hawkins test did not show a difference between the two groups. The incidence rate of shoulder impingement sign and the changes in CMS and SPADI were not significantly different between the two groups at one week, but after three weeks, SPADI was more significantly improved in the LA group (p=0.024). No adverse events were related to this trial. Conclusion LA was more effective than CA in relieving pain and improving function in terms of VAS and SPADI. Trial registration This study was registered on 23 March 2018 at the Clinical Research Information Service: KCT0002751.
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Affiliation(s)
- Hee-Ra Shin
- Department of Korean Rehabilitation Medicine, Jangheung Integrative Medical Hospital, Wonkwang University, Republic of Korea
| | - Jihye Seo
- College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Kyungtae Park
- Department of Korean Rehabilitation Medicine, Gwangju Medical Center, College of Korean Medicine, Wonkwang University, Gwangju, Republic of Korea
| | - Sung-Hu Ann
- Department of Korean Rehabilitation Medicine, Gwangju Medical Center, College of Korean Medicine, Wonkwang University, Gwangju, Republic of Korea
| | - Soo-Ji Park
- Clinical Trial center, Gwangju Medical Center, College of Korean Medicine, Wonkwang University, Gwangju, Republic of Korea
| | - Sangkwan Lee
- Clinical Trial center, Gwangju Medical Center, College of Korean Medicine, Wonkwang University, Gwangju, Republic of Korea
| | - Seung-Ryong Yeom
- Department of Korean Rehabilitation Medicine, Gwangju Medical Center, College of Korean Medicine, Wonkwang University, Gwangju, Republic of Korea
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Hwang JT, Jang JS, Lee JJ, Song DK, Lee HN, Kim DY, Lee SS, Hwang SM, Kim YB, Lee S. Dexmedetomidine combined with interscalene brachial plexus block has a synergistic effect on relieving postoperative pain after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2020; 28:2343-2353. [PMID: 31773201 DOI: 10.1007/s00167-019-05799-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 11/12/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Interscalene brachial plexus block (ISB) is one of the most commonly used regional blocks in relieving postoperative pain after arthroscopic rotator cuff repair. Dexmedetomidine (DEX) is an alpha 2 agonist that can enhance the effect of regional blocks. The aim of this study was to compare the effects of DEX combined with ISB with ISB alone on postoperative pain, satisfaction, and pain-related cytokines within the first 48 h after arthroscopic rotator cuff repair. METHODS Fifty patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this single center, double-blinded randomized controlled trial study. Twenty-five patients were randomly allocated to group 1 and received ultrasound-guided ISB using a mixture of 1 ml (100 μg) of DEX and 8 ml of 0.75% ropivacaine preemptively. The other 25 patients were allocated to group 2 and underwent ultrasound-guided ISB alone using a mixture of 1 ml of normal saline and 8 ml of ropivacaine. The visual analog scale (VAS) for pain and patient satisfaction (SAT) scores were checked within 48 h postoperatively. The plasma interleukin (IL)-6, -8, -1β, cortisol, and substance P levels were also measured within 48 h, postoperatively. RESULTS Group 1 showed a significantly lower mean VAS score and a significantly higher mean SAT score than group 2 at 1, 3, 6, 12, and 18 h postoperatively. Compared with group 2, group 1 showed a significantly lower mean plasma IL-6 level at 1, 6, 12, and 48 h postoperatively and a significantly lower mean IL-8 level at 1, 6, 12, 24, and 48 h postoperatively. The mean timing of rebound pain in group 1 was significantly later than that in group 2 (12.7 h > 9.4 h, p = 0.006). CONCLUSIONS Ultrasound-guided ISB with DEX in arthroscopic rotator cuff repair led to a significantly lower mean VAS score and a significantly higher mean SAT score within 48 h postoperatively than ISB alone. In addition, ISB with DEX showed lower mean plasma IL-6 and IL-8 levels than ISB alone within 48 h postoperatively, with delayed rebound pain. LEVEL OF EVIDENCE I. TRIAL REGISTRATION 2013-112, ClinicalTrials.gov Identifier: NCT02766556.
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Affiliation(s)
- Jung-Taek Hwang
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Ji Su Jang
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Jae Jun Lee
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea.
| | - Dong-Keun Song
- Department of Pharmacology, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Han Na Lee
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Do-Young Kim
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Sang-Soo Lee
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Sung Mi Hwang
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Yong-Been Kim
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Sanghyeon Lee
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
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Wang Y, Gong J. The effectiveness of intra-articular vs subacromial corticosteroid injection for frozen shoulder: Study protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e19706. [PMID: 32311954 PMCID: PMC7440081 DOI: 10.1097/md.0000000000019706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Intra-articular (IA) corticosteroid injection is a commonly used therapy for frozen shoulder (FS), but controversy still exists regarding the injection site with the best outcome. This randomized controlled trial is designed to determine whether corticosteroid injection into the subacromial space was not inferior to IA injection in patients with FS. METHODS This study will be a single-center, randomized, and double-blinded trial. Sixty patients who meet inclusion criteria will be randomized in a ratio of 1:1 to either subacromial injection or IA injection group. The outcome evaluations will be conducted at 4 time points (baseline, 4, 8, and 12 weeks after the injection) by an independent physical therapist. The primary outcome measure is visual analog scale for pain, whereas the secondary outcomes include Constant score, and shoulder passive range of motion including abduction, forward elevation, external rotation at the side, and internal rotation at the side. DISCUSSION This study has limited inclusion and exclusion criteria and a well-controlled intervention. This clinical trial is expected to provide evidence of proper site of corticosteroid injection for the treatment of FS. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry5368).
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Affiliation(s)
- Yanbiao Wang
- Department of Orthopedics, Affiliated Hospital of Shandong Academy of Medical Sciences, Shandong First Medical University
| | - Jing Gong
- Department of Anesthesiology, The 960th Hospital of the People's Liberation Army Joint Logistice Support Force, Shandong, China
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Is frozen shoulder completely resolved at 2 years after the onset of disease? J Orthop Sci 2020; 25:224-228. [PMID: 30952550 DOI: 10.1016/j.jos.2019.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/02/2019] [Accepted: 03/17/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although numerous studies have suggested that frozen shoulder (FS) is a self-limiting disease with most patients recovering within 2 years, its long-term outcome is still controversial. The aims of this study were to evaluate the clinical outcomes after conservative treatment for FS and to determine the predictors of its clinical outcome. METHODS This study included 234 shoulders of 215 patients who received conservative treatment for FS. The mean follow-up period was 41.8 months (range 27-117 months). Initial evaluation included demographics, detailed medical history, and clinical assessments of shoulder status. Questionnaires, which included the Visual Analogue Scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV) and satisfaction grading for the current shoulder status were assessed at the final follow-up. RESULTS The mean VAS pain score, ASES score, and SSV significantly improved from 6.7, 37.0, and 40.1% at the time of initial evaluation to 1.5, 87.6, and 85.0% at the final follow-up evaluation (all p < 0.001). According to satisfaction grading, the shoulder status at the final follow-up was very satisfied in 101 shoulders (43.2%), satisfied in 68 (29.1%), fair in 37 (15.8%), unsatisfied in 20 (8.5%), and very unsatisfied in 8 (3.4%). Univariate analysis revealed that gender, diabetes, simultaneous bilateral involvement, overall bilateral involvement and duration of symptoms were associated with clinical outcomes at the final follow-up. Multivariate analysis revealed that duration of symptoms (p = 0.002) was an independent risk factor for unsuccessful outcome. CONCLUSIONS At the mean follow-up period of 41.8 months, 72.3% of patients revealed subjective satisfaction for the current shoulder status. Duration of symptoms was an independent risk factor for poor prognosis.
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Cho CH, Lee YH, Kim DH, Lim YJ, Baek CS, Kim DH. Definition, Diagnosis, Treatment, and Prognosis of Frozen Shoulder: A Consensus Survey of Shoulder Specialists. Clin Orthop Surg 2020; 12:60-67. [PMID: 32117540 PMCID: PMC7031440 DOI: 10.4055/cios.2020.12.1.60] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/26/2019] [Indexed: 11/11/2022] Open
Abstract
Background The objective of this study was to identify a consensus on definition, diagnosis, treatment, and prognosis of frozen shoulder (FS) among shoulder specialists. Methods A questionnaire composed of 18 questions about FS—definition, classification, utilization of diagnostic modalities, the propriety of treatment at each stage, and prognosis—was sent to 95 shoulder specialists in Korea. Most questions (15 questions) required an answer on a 5-point analog scale (1, strongly disagree; 5, strongly agree); three questions about the propriety of treatment were binary. Results We received 71 responses (74.7%). Of the 71 respondents, 84.5% agreed with the proposed definition of FS, and 88.8% agreed that FS should be divided into primary and secondary types according to the proposed definition. Only 43.7% of the respondents agreed that FS in patients with systemic disease should be classified as secondary FS. For the diagnosis of FS, 71.9% agreed that plain radiography should be used and 64.8% agreed ultrasonography should be used. There was a high consensus on proper treatment of FS: 97.2% agreed on education, 94.4%, on the use of nonsteroidal anti-inflammatory drugs; 76.1%, on intra-articular steroid injections; and 97.2%, on stretching exercise. Among all respondents, 22.5% answered that more than 10% of the patients with FS do not respond to conservative treatment. Conclusions The survey revealed a general consensus among shoulder specialists on the definition and treatment of FS. However, classification of FS was found controversial.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yong-Ho Lee
- Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Du-Hwan Kim
- Department of Rehabilitation Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Young-Jae Lim
- Department of Orthopedic Surgery, The Open Hospital, Daegu, Korea
| | - Chung-Sin Baek
- Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Kitridis D, Tsikopoulos K, Bisbinas I, Papaioannidou P, Givissis P. Efficacy of Pharmacological Therapies for Adhesive Capsulitis of the Shoulder: A Systematic Review and Network Meta-analysis. Am J Sports Med 2019; 47:3552-3560. [PMID: 30735431 DOI: 10.1177/0363546518823337] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several pharmacological interventions are used for the management of adhesive capsulitis of the shoulder, although the optimal treatment has yet to be defined. PURPOSE To conduct a network meta-analysis to compare the effects of different pharmacological interventions for adhesive capsulitis, administered either alone or after distension of the shoulder capsule. STUDY DESIGN Network meta-analysis. METHODS The authors searched Scopus, PubMed, and the Cochrane Central Register of Controlled Trials up to April 22, 2018, for completed studies. They enrolled trials that assessed the results of different pharmacological treatments for the primary management of adhesive capsulitis. The primary outcome was pain relief as measured by self-administered questionnaires. The secondary outcome included the assessment of composite instruments that evaluated, at a minimum, pain and function. The authors clinically interpreted the results after back-transforming the standardized mean differences into mean differences in simple instruments and assessed the quality of the source studies using the Cochrane "risk of bias" tool. RESULTS The authors considered 30 trials with a total of 2010 participants in this systematic review. For pain relief, there was a significant difference in favor of intra-articular corticosteroids and distension of the shoulder capsule with steroids as compared with control in the short term (mean difference in visual analog scale (VAS): -1.4 [95% CI, -2.5 to -0.4] and -1.7 [95% CI, -3.2 to -0.1], respectively). Furthermore, rotator-interval injections were found to be superior to placebo (mean difference in VAS: -7.2; 95% CI, -10.1 to -4.4), although the intervention was considered in only 1 trial. Finally, there was a statistically significant difference in favor of multiple-site corticosteroid injections compared to placebo in both the short- (mean difference in Shoulder Pain and Disability Index [SPADI]: -86.7; 95% CI, -133.6 to -40) and intermediate-term assessment (mean difference in SPADI: -102.9; 95% CI, -163.9 to -41.8). CONCLUSION Intra-articular corticosteroid intervention, administered either alone or after distension of the shoulder capsule, provided clinically meaningful improvements in the short term. Likewise, rotator-interval corticosteroid injections yielded promising results in terms of pain relief. However, these short-term benefits of steroids dissipated over time. Multiple-site corticosteroid injections showed clinical advantage over placebo for short- and intermediate-term composite outcome assessments.
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Affiliation(s)
- Dimitrios Kitridis
- 1st Orthopaedic Department, 424 Army General Training Hospital, Thessaloniki, Greece.,1st Orthopaedic Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Konstantinos Tsikopoulos
- 1st Orthopaedic Department, 424 Army General Training Hospital, Thessaloniki, Greece.,2nd Orthopaedic Department, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Ilias Bisbinas
- 1st Orthopaedic Department, 424 Army General Training Hospital, Thessaloniki, Greece
| | - Paraskevi Papaioannidou
- 1st Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Givissis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Thessaloniki, Greece
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Intra-Articular versus Subacromial Corticosteroid Injection for the Treatment of Adhesive Capsulitis: A Meta-Analysis and Systematic Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1274790. [PMID: 31737653 PMCID: PMC6815644 DOI: 10.1155/2019/1274790] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/21/2019] [Indexed: 02/05/2023]
Abstract
Background Adhesive capsulitis is one of the most well-known causes of pain and stiffness of the shoulder. Corticosteroid injections have been used for many years. However, it is still controversial where corticosteroid should be injected, whether subacromial or intra-articular. Objective The objective of this meta-analysis was to compare the effects of intra-articular (IA) and subacromial (SA) corticosteroid injections for the treatment of adhesive capsulitis. Materials and Methods Four foreign databases and two Chinese databases were searched for RCTs and quasi-RCTs involving the comparison of IA and SA corticosteroid injection for the treatment of adhesive capsulitis. The Cochrane risk of bias tool and PEDro score were used to evaluate the quality of the studies. The primary clinical outcomes including VAS, Constant score, ASES score, and ROM were collected. The secondary outcome of corticosteroid-related adverse reactions was also compared between the two groups. The results were evaluated and compared at five time points. Subgroup analyses were performed to further explore the differences between groups. Results Eight RCTs and one quasi-RCT, involving 512 participants, were identified and included in this meta-analysis. All studies were of low risk of bias and medium-high quality with the PEDro score ≥5 points. The pooled effect showed that there was no significant difference in the primary outcomes between IA injection and SA injection, with an exception of VAS at 2-3 weeks (P=0.02) and ROM of internal rotation at 8–12 weeks (P=0.02). According to the results of subgroup analyses, the differences of VAS and ROM of internal rotation did not last beyond the 2-3-week time period. Additionally, SA injection had the advantage of avoiding adverse reactions from the corticosteroid, especially in avoiding a large fluctuation of serum blood glucose levels. Conclusions When corticosteroid injection is used to treat adhesive capsulitis, both injection sites can be selected. However, due to the scarcity of related studies, more rigorous trials are needed to confirm the current findings.
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Abstract
Frozen shoulder (FS) is a common shoulder disorder characterized by a gradual increase of pain of spontaneous onset and limitation in range of motion of the glenohumeral joint. The pathophysiology of FS is relatively well understood as a pathological process of synovial inflammation followed by capsular fibrosis, but the cause of FS is still unknown. Treatment modalities for FS include medication, local steroid injection, physiotherapy, hydrodistension, manipulation under anesthesia, arthroscopic capsular release, and open capsular release. Conservative management leads to improvement in most cases. Failure to obtain symptomatic improvement and continued functional disability after 3 to 6 months of conservative treatment are general indications for surgical management. However, there is no consensus as to the most efficacious treatments for this condition. In this review article, we provide an overview of current treatment methods for FS.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Ki-Choer Bae
- Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Comparison of intra-articular and subacromial corticosteroid injection in frozen shoulder: A meta-analysis of randomized controlled trials. Int J Surg 2019; 68:92-103. [DOI: 10.1016/j.ijsu.2019.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 12/14/2022]
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Value of MR arthrography findings for pain relief after glenohumeral corticosteroid injections in the short term. Eur Radiol 2019; 29:6416-6424. [DOI: 10.1007/s00330-019-06237-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/09/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
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Majdalani C, Boudier-Revéret M, Pape J, Brismée JM, Michaud J, Luong DH, Grabs D, Chang KV, Chen WS, Wu CH, Sobczak S. Accuracy of Two Ultrasound-Guided Coracohumeral Ligament Injection Approaches: A Cadaveric Study. PM R 2019; 11:989-995. [PMID: 30690914 DOI: 10.1002/pmrj.12079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 12/05/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Glenohumeral idiopathic adhesive capsulitis is a common shoulder condition that hinders functionality. Addressing the pathology has been extensively researched. Ultrasound (US)-guided injections have shown their efficacy. However, no study has been conducted to compare anatomical accuracy between different approaches in targeting the coracohumeral ligament (CHL). OBJECTIVE To investigate whether US-guided injection of the CHL can be performed accurately using either the rotator interval (RI) or the coracoidal (CO) approach. METHODS An experimental cadaveric case series. SETTING Anatomy laboratory. SPECIMENS Both shoulders of 13 Thiel-embalmed cadavers. INTERVENTIONS Three physiatrists each injected a 0.1 mL bolus of colored dye in both shoulders of each cadaver using either the RI or the CO approach under US guidance. Each cadaver received a total of six injections (three injections per shoulder). The accuracy of the injection was determined following shoulder dissection by an anatomist. MAIN OUTCOME MEASURE The accuracy of the US-guided injection of the CHL. RESULTS The RI approach yielded 36 accurate injections, giving it an accuracy of 100%. With the CO approach two injections were deemed inaccurate yielding an accuracy of 94%. There was no significant difference in accuracy between all operators. CONCLUSIONS US-guided injection of the CHL can be performed accurately with both the RI and CO approaches. The RI approach was likely to be more accurate.
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Affiliation(s)
- Carl Majdalani
- Department of Physical Medicine and Rehabilitation, Centre hospitalier de l'Université de Montréal, Montréal, Canada
| | - Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, Centre hospitalier de l'Université de Montréal, Montréal, Canada
| | - John Pape
- Department of Physiotherapy, University Hospital of North Tees, Stockton on Tees, United Kingdom
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Johan Michaud
- Department of Physical Medicine and Rehabilitation, Centre hospitalier de l'Université de Montréal, Montréal, Canada
| | - Dien Hung Luong
- Department of Physical Medicine and Rehabilitation, Centre hospitalier de l'Université de Montréal, Montréal, Canada
| | - Detlev Grabs
- Département d'Anatomie, Université du Québec à Trois-Rivières, Québec, Canada.,Research Unit of Clinical and Functional Anatomy, Université du Québec à Trois-Rivières, Québec, Canada
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Chueh Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Stéphane Sobczak
- Département d'Anatomie, Université du Québec à Trois-Rivières, Québec, Canada.,Research Unit of Clinical and Functional Anatomy, Université du Québec à Trois-Rivières, Québec, Canada
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Park GY. Role of Ultrasonography in Diagnosis and Treatment of Frozen Shoulder. JOURNAL OF RHEUMATIC DISEASES 2019. [DOI: 10.4078/jrd.2019.26.3.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Gi-Young Park
- Department of Rehabilitation Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
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Editorial Commentary: "Doctor, Are You Sure the Steroid Injection Won't Harm My Shoulder?" Perhaps We Should Stop Injecting Corticosteroids and Just Repair Those Rotator Cuffs. Arthroscopy 2019; 35:51-53. [PMID: 30611363 DOI: 10.1016/j.arthro.2018.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 10/04/2018] [Indexed: 02/02/2023]
Abstract
Analysis of insurance records indicates that 2 or more corticosteroid injections before rotator cuff repair could triple the odds of revision. The cause-and-effect relationship cannot be ascertained because it remains unclear whether steroids worsen outcomes or are injected in shoulders that are worse to start with. Registry studies cannot adjust for lesional determinants of prognosis and should be interpreted with caution to avoid depriving patients from safe and simple treatments to delay or circumvent surgery. The risks of corticosteroids could be mitigated using radiographically guided infiltration and, ultimately, by rapid surgical repair in young patients before the advent of fatty infiltration and tendon retraction.
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Seo J, Yeom SR, Shin HR, Park K, Kim JK, Park SJ, Lee S. Effectiveness and safety of fluoroscopy-guided acupuncture for subacromial impingement syndrome: A protocol for a randomized, patient-assessor blind, parallel clinical trial. Medicine (Baltimore) 2018; 97:e12386. [PMID: 30235704 PMCID: PMC6160190 DOI: 10.1097/md.0000000000012386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Subacromial impingement syndrome (SIS) is one of the most common diseases inducing shoulder pain. Acupuncture is a source of pain relief that has been used for SIS; however, there is no clinical study about image-guided acupuncture for SIS. The aim of this study is to evaluate the effectiveness and safety of fluoroscopy-guided acupuncture in patients with SIS. METHODS This is the protocol for a randomized, patient-assessor blind, parallel clinical trial comparing fluoroscopy-guided acupuncture to acupuncture without fluoroscopy. There will be a 1-week run-in period before random allocation to 2 groups. The total duration of the clinical trial will be 3 weeks including 2 weeks for the follow-up period. A total of 57 participants will be enrolled for the clinical trial. Acupuncture will be conducted in 2 sessions for each group, once at baseline and once at the 1-week mark. The primary outcome will be 100 mm pain visual analogue scale. Secondary outcomes will include the Neer and Hawkins test, the Modified Constant Murley Score scale, the Shoulder Pain And Disability Index, the patient satisfaction degree, and the accuracy rate of acupuncture. For the evaluation of safety, adverse events will be monitored. DISCUSSION We designed the clinical trial using image-guided acupuncture. This will be the first trial to study the effectiveness of image-guided acupuncture for SIS compared with acupuncture using the proportional measurements. TRIAL REGISTRATION Clinical Research Information Service Registration Number is KCT0002751. Registered on March 23, 2018.
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Affiliation(s)
| | - Seung-Ryong Yeom
- Department of Korean Medicine Rehabilitation, Gwangju Medical Center, College of Korean Medicine, Wonkwang University, Gwangju
| | - Hee-Ra Shin
- Department of Korean Medicine Rehabilitation, Gwangju Medical Center, College of Korean Medicine, Wonkwang University, Gwangju
| | - Kyungtae Park
- Department of Korean Medicine Rehabilitation, Gwangju Medical Center, College of Korean Medicine, Wonkwang University, Gwangju
| | - Jae Kyoun Kim
- Clinical Trial Center
- Department of Global Public Health and Korean Medicine Management, Graduate School, Kyung Hee University, Seoul
| | | | - Sangkwan Lee
- Clinical Trial Center
- Department of Internal Medicine, College of Korean Medicine, Wonkwang University, Iksan, Jeonbuk, Republic of Korea
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Lamplot JD, Lillegraven O, Brophy RH. Outcomes From Conservative Treatment of Shoulder Idiopathic Adhesive Capsulitis and Factors Associated With Developing Contralateral Disease. Orthop J Sports Med 2018; 6:2325967118785169. [PMID: 30023406 PMCID: PMC6047247 DOI: 10.1177/2325967118785169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background: Idiopathic adhesive capsulitis is a common condition resulting in painful multidirectional restriction of motion without other identifiable shoulder abnormality. First-line therapies for this condition are nonoperative, but limited data are available regarding which treatments are most effective. Factors associated with contralateral disease are not well established. Hypothesis: Younger patients will have a better response to treatments, and older patients and patients with diabetes will be more likely to develop contralateral disease. Study Design: Cohort study; Level of evidence, 3. Methods: Patients diagnosed with idiopathic adhesive capsulitis were treated with a single intra-articular glenohumeral injection of local anesthetic and corticosteroid as well as 4 weeks of supervised physical therapy (PT). Patients were re-evaluated monthly and received additional conservative treatment based on failure to restore normal motion. Patient-reported outcome scores and range of motion were used to assess treatment efficacy. Results: Minimum 2-year follow-up data (mean, 3.4 years) were available for 60 of 75 eligible patients (80%). Patients who did not attend supervised PT as prescribed were more likely to undergo repeat injection due to a lack of adequate range of motion at follow-up (P = .003). Conservative therapy failed in 2 patients (3.3%), and they underwent arthroscopic release and manipulation under anesthesia. Twenty-two patients (36.7%) were subsequently diagnosed with contralateral idiopathic adhesive capsulitis, with a higher incidence in patients with diabetes (P = .009) and patients younger than 50 years (P = .005). American Shoulder and Elbow Surgeons score improved from 41.2 (95% CI, 33.0-49.4) at baseline to 92.0 (95% CI, 88.4-95.6) at final follow-up (P < .0001). Patients with diabetes had a decrease in Shoulder Activity Scale score at final follow-up (P = .049). Conclusion: Conservative treatment for idiopathic adhesive capsulitis resulted in good clinical outcomes with a low incidence of surgical intervention. Physical therapy reduced the use of a second injection as part of treatment in this treatment algorithm. Young patients and patients with diabetes may be more likely to develop contralateral disease.
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Affiliation(s)
- Joseph D Lamplot
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Olivia Lillegraven
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Comparison Between Image-Guided and Landmark-Based Glenohumeral Joint Injections for the Treatment of Adhesive Capsulitis: A Cost-Effectiveness Study. AJR Am J Roentgenol 2018; 210:1279-1287. [DOI: 10.2214/ajr.17.19011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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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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Goyal T, Singh A, Negi P, Kharkwal B. Comparative functional outcomes of patients with adhesive capsulitis receiving intra-articular versus sub-acromial steroid injections: case-control study. Musculoskelet Surg 2018; 103:31-35. [PMID: 29796762 DOI: 10.1007/s12306-018-0538-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 04/08/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE This is a prospective case-control study comparing short- and medium-term outcomes between sub-acromial and gleno-humeral corticosteroid injections in adhesive capsulitis. METHODS The study population consisted of 105 patients (33 males, 72 females; mean age, 56.1 years). They were divided into three groups: (1) patients receiving 40 mg of methylprednisolone acetate as intra-articular injection (n = 35) followed by physical therapy; (2) patients receiving 40 mg of methylprednisolone acetate as sub-acromial injection (n = 35) followed by physical therapy; (3) patients receiving only physical therapy (heat, passive stretching exercises and wall climbing) and no injections (n = 35). Functional outcome scores (Constant shoulder score and Shoulder Pain and Disability Index), visual analogue scale for pain and range of motion of shoulder joint were noted at 3, 6 and 12 weeks and 6 months. RESULTS There was a statistically significant improvement in VAS scores in group 1 and 2 at 3, 6, 12 weeks and 6 months compared to that before the injections. There was no statistically significant improvement in the group 3 at 3 and 6 weeks, but improvement was noticed at 12 weeks and 6 months. There was no statistically significant difference in VAS, CS score, SPADI and ROM between groups 1 and 2 at 3, 6, 12 weeks and 6 months. These scores were significantly better in group 1 and 2 compared to group 3 at 3, 6, 12, weeks and 6 months. CONCLUSIONS Corticosteroid injections into the sub-acromial space and into the gleno-humeral joint produce similar results in terms of pain relief and improvement in function in patients with adhesive capsulitis.
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Affiliation(s)
- T Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Virbhadra Marg, Rishikesh, 248201, India.
| | - A Singh
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Virbhadra Marg, Rishikesh, 248201, India
| | - P Negi
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Virbhadra Marg, Rishikesh, 248201, India
| | - B Kharkwal
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Virbhadra Marg, Rishikesh, 248201, India
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Park GY, Kwon DR, Kwon DG, Rim JH. Comparison of Therapeutic Effectiveness Between Shoulder Distention Arthrography With Translation Mobilization and Distention Arthrography Alone in Patients With Frozen Shoulder. Ann Rehabil Med 2018; 42:76-84. [PMID: 29560327 PMCID: PMC5852232 DOI: 10.5535/arm.2018.42.1.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/28/2017] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate the efficacy of distention arthrography (DA) alone and in combination with translational mobilization (TM) for treatment of patients with frozen shoulder (FS). Methods Eighty-five patients diagnosed with unilateral FS (freezing or frozen stage) were included. Forty-one patients were treated with DA and TM (group 1) and 44 patients with DA alone (group 2). Clinical assessments including visual analogue scale (VAS), Cyriax stage, and shoulder passive range of motion (PROM) including forward flexion, abduction, external rotation, and internal rotation were measured at baseline, 1 month, and 3 months following treatment. Results There were no significant differences in gender, side affected, symptom duration, presence of diabetes mellitus, VAS score, Cyriax stage, or shoulder PROM between the two patient groups at baseline. Compared with baseline metrics, patients in both groups demonstrated significantly improved outcome parameters at two post-treatment time points. However, mean all shoulder PROMs were significantly greater, and mean VAS score and Cyriax stage were lower in patients treated with DA and TM than in those treated with DA alone group at two post-treatment time points. At these times, mean interval change of all outcome parameters was significantly greater with DA and TM than DA alone. No serious complications were observed following treatment in either patient group. Conclusion Compared with DA alone, DA combined with TM more effectively alleviates shoulder pain and increases PROM in patients with freezing or frozen stage FS.
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Affiliation(s)
- Gi Young Park
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Dong Rak Kwon
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Dae Gil Kwon
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jae Hwal Rim
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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Sun Y, Liu S, Chen S, Chen J. The Effect of Corticosteroid Injection Into Rotator Interval for Early Frozen Shoulder: A Randomized Controlled Trial. Am J Sports Med 2018; 46:663-670. [PMID: 29268022 DOI: 10.1177/0363546517744171] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Corticosteroid injection is a common treatment for frozen shoulder, but controversy still exists regarding the injection site with the best outcome. HYPOTHESIS To treat the frozen shoulder in the freezing stage with corticosteroid injection, a single injection into the rotator interval (RI) could yield better effects in terms of improvement in pain, passive range of motion (ROM), and function than would an injection into the intra-articular (IA) or subacromial (SA) space. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients with primary frozen shoulder in the freezing stage were randomized into 3 groups: RI injection, IA injection, or SA injection with corticosteroid. Clinical outcomes were documented at baseline and at 4, 8, and 12 weeks after intervention, including visual analog scale (VAS) for pain; passive ROM measurements, including external rotation, internal rotation, forward flexion, and abduction; and evaluation with the Disability of Arm, Hand, and Shoulder (DASH) score and Constant score. RESULTS There were no significant differences in the basic properties of the 3 groups (27 in RI group, 24 in IA group, and 26 in SA group) before injection. Improvements in pain VAS, passive ROM, Constant score, and DASH score were faster and significant in the RI group from 4 weeks after injection, followed by those in the IA group. Passive ROM decreased and DASH score did not change significantly in the SA group, although pain VAS and Constant score improved significantly. CONCLUSION To treat frozen shoulder in the freezing stage with corticosteroid injection, a single injection into the RI yielded better effects in terms of improvement in pain, passive ROM, and function than did injections into the IA or SA space.
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Affiliation(s)
- Yaying Sun
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shaohua Liu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Baverel L, Boutsiadis A, Reynolds RJ, Saffarini M, Barthélémy R, Barth J. Do corticosteroid injections compromise rotator cuff tendon healing after arthroscopic repair? JSES OPEN ACCESS 2017; 2:54-59. [PMID: 30675568 PMCID: PMC6334978 DOI: 10.1016/j.jses.2017.11.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Rotator cuff tears are associated with capsular contraction and stiffness that should be restored before surgical repair. Corticosteroid injections (CSIs) are frequently used as conservative treatments before surgical repair. This study aimed to determine the influence of preoperative and postoperative CSIs on clinical and anatomic outcomes after rotator cuff repair. Methods The authors analyzed the records of 257 patients who had arthroscopic rotator cuff repair, of whom 212 were evaluated at 3.1 ± 1.0 years (median, 2.9 years; range, 1.4-7.1 years) by clinical (Constant score) and ultrasound (Sugaya classification) examinations. Univariable and multivariable regressions were performed to determine associations between outcomes and administration of preoperative and postoperative CSIs, patient characteristics, and tendon characteristics. Results The Constant scores improved from 56.4 ± 15.1 to 80.8 ± 12.5. Multivariable regression confirmed that postoperative scores were associated with postoperative CSIs (P < .001), preoperative scores (P < .001), gender (P < .001), and fatty infiltration (P < .005). Retears (Sugaya types IV-V) were observed in 27 shoulders (13%). Multivariable regression clarified that retear rates were associated only with postoperative CSIs (P = .007) and stage 3 fatty infiltration (P = .001). Adjusting for confounders, an additional postoperative CSI would decrease scores by 4.7 points and double retear risks. Discussion Preoperative CSIs had no influence on clinical scores and retear rates, whereas postoperative CSIs were associated with lower scores and more retears. Although we can infer that preoperative CSIs do not affect outcomes, we cannot determine whether postoperative CSIs compromised outcomes or were administered in patients who had already poor outcomes. Our findings may resolve controversies about the administration of preoperative CSIs.
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Affiliation(s)
- Laurent Baverel
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | - Achilleas Boutsiadis
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
| | | | | | | | - Johannes Barth
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France
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Shiota Y, Yamamoto N, Kawakami J, Nagamoto H, Muraki T, Kaneko K, Itoi E. Contact pressure of the coracoacromial arch in shoulders with joint contracture: A cadaveric study. J Orthop Sci 2017; 22:1031-1041. [PMID: 28838704 DOI: 10.1016/j.jos.2017.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/10/2017] [Accepted: 07/05/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUNDS There have been many reports describing that the capsular fibrosis of the shoulder joint is the main cause of frozen shoulder, whereas others reported the significance of subacromial impingement as an etiological factor. The purpose of this study was to investigate the contact pressure between the coracoacromial arch and the rotator cuff tendons to clarify the contact phenomenon in shoulders with joint contracture. METHODS Fourteen fresh-frozen cadaveric shoulders were used. Specimens were divided into two groups: normal group (8 shoulders, definition: more than 61° of flexion and abduction and more than 21° of external rotation) and joint contracture group (6 shoulders, definition: less than 60° of flexion and abduction and less than 20° of external rotation). Contact pressure and area beneath the coracoacromial arch were measured by a flexible force sensor during flexion, abduction, internal and external rotation in adduction and abduction, extension and horizontal extension motions. RESULTS The peak contact pressure under the acromion was observed at 90° in flexion and abduction in the normal group, whereas that in the contracture group was observed at 30° in flexion (P = 0.037) and at 30° in abduction (P = 0.041). Contact pressure in the contracture group was significantly higher than that in the normal group at 20° and 30° of abduction (P = 0.043, P = 0.041, respectively). There were no significant differences of contact pressure during other motions. Although no significant differences of contact pressure beneath the coracoacromial ligament were observed, contact area significantly increased in extension and horizontal extension motion. CONCLUSION The contact between the acromion and the rotator cuff was observed in lower angles of flexion and abduction in shoulders with contracture than in those without. When treating patients with shoulder contracture, we need to perform rehabilitation taking such an abnormal movement into consideration.
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Affiliation(s)
- Yuki Shiota
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan; Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Kawakami
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Hideaki Nagamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Takayuki Muraki
- Department of Physical Medicine and Rehabilitation, Tohoku University School of Medicine, Sendai, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
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Correlations of magnetic resonance imaging findings with clinical symptom severity and prognosis of frozen shoulder. Knee Surg Sports Traumatol Arthrosc 2017; 25:3242-3250. [PMID: 26611904 DOI: 10.1007/s00167-015-3887-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the correlation between indirect magnetic resonance (MR) arthrographic imaging findings and the clinical symptoms and prognosis of patients with frozen shoulder. METHODS Indirect MR arthrography was performed for 52 patients with primary frozen shoulder (mean age 55.1 ± 9.0 years) and 52 individuals without frozen shoulder (mean age 53.1 ± 10.7 years); capsular thickening and enhancement of the axillary recess as well as soft tissue thickening of the rotator interval were evaluated. Clinical symptom severity was assessed using the Visual Analogue Scale for Pain (VAS Pain), simple shoulder test (SST), Constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM). At 6-month follow-up, we evaluated whether MR arthrography findings correlated with the clinical symptoms and prognosis. RESULTS Capsular thickening and enhancement of the axillary recess as well as soft tissue thickening of the rotator interval were significantly greater in the patient group than in the controls (p < 0.001). Capsular thickening of the axillary recess did not correlate with clinical symptoms or ROM (n.s.); however, capsular enhancement correlated with clinical symptom severity according to VAS Pain (p = 0.005), SST (p = 0.046), and ASES scores (p = 0.009). Soft tissue thickening of the rotator interval did not correlate with clinical symptom severity, but was associated with external rotation limitation (p = 0.002). However, none of the parameters correlated with clinical symptoms at 6-month follow-up. CONCLUSIONS Indirect MR arthrography provided ancillary findings, especially with capsular enhancement, for evaluating clinical symptom severity of frozen shoulder, but did not reflect the prognosis. MR findings in frozen shoulder should not replace clinical judgments regarding further prognosis and treatment decisions. LEVEL OF EVIDENCE IV.
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Kim DY, Lee SS, Nomkhondorj O, Cho MG, Lee JJ, Hwang JT, Hong MS. Comparison Between Anterior and Posterior Approaches for Ultrasound-Guided Glenohumeral Steroid Injection in Primary Adhesive Capsulitis: A Randomized Controlled Trial. J Clin Rheumatol 2017; 23:51-57. [PMID: 28002160 DOI: 10.1097/rhu.0000000000000475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Do-Young Kim
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon, Gangwon, Republic of Korea Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon, Gangwon, Republic of Korea Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon, Gangwon, Republic of Korea Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon, Gangwon, Republic of Korea Department of Diagnostic Radiology, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon, Gangwon, Republic of Korea
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Sun Y, Zhang P, Liu S, Li H, Jiang J, Chen S, Chen J. Intra-articular Steroid Injection for Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis. Am J Sports Med 2017; 45:2171-2179. [PMID: 28298050 DOI: 10.1177/0363546516669944] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intra-articular steroid injection is a common intervention for frozen shoulder (FS). PURPOSE This review aimed to illustrate the effects of intra-articular steroid injection for FS. STUDY DESIGN Systematic review and meta-analysis. METHODS PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) comparing intra-articular steroid injection with no injection or sham injections for FS. Visual analog scale (VAS) pain scores were the primary outcome measure. Secondary outcome measures included passive external rotation, abduction, flexion, internal rotation, and functional scores. Complication rates were the safety outcome measure. Comparisons were performed with mean differences (MDs) and 95% confidence intervals (95% CIs). Three time intervals were analyzed: 4 to 6 weeks, 12 to 16 weeks, and 24 to 26 weeks postintervention. Trial sequential analysis was used to verify the pooled results. Line charts were drawn to view the recovery trend in both the intervention and control groups. RESULTS Eight RCTs with 416 patients were included. Compared with controls, patients who received intra-articular steroid injection had significantly reduced VAS pain scores at 4 to 6 weeks (MD, 1.28 cm [95% CI, 0.75 to 1.82]), 12 to 16 weeks (MD, 1.00 cm [95% CI, 0.47 to 1.52]), and 24 to 26 weeks (MD, 0.65 cm [95% CI, 0.19 to 1.10]) postinjection. Trial sequential analysis confirmed the pooled results at 4 to 6 weeks and 12 to 16 weeks but not at 24 to 26 weeks. Patients who received intra-articular steroid injection had improved passive external rotation, abduction, and flexion and Shoulder Pain and Disability Index (SPADI) scores at all 3 time intervals, as well as improved American Shoulder and Elbow Surgeons (ASES) scores at 12 to 16 weeks (MD, 12.20 [95% CI, 2.55 to 21.85]). No difference was noticed in Constant scores (MD, 5.70 [95% CI, -0.59 to 11.99]) or internal rotation except at 12 to 16 weeks (MD, 0.81° [95% CI, 0.18° to 1.44°]) and 24 to 26 weeks (MD, 3.88° [95% CI, 0.51° to 7.25°]) between steroid injection and placebo. Complication rates were 1.78% for facial flushing, 0.71% for dizziness owing to vasovagal reactions during injection, 1.07% for chest or shoulder pain, and 0.36% for nausea. Line charts improved in both groups. CONCLUSION Intra-articular steroid injection is effective and safe for FS and relieves pain, improves functional performance, and increases range of motion. The effects are significant at 4 to 6 and 12 to 16 weeks postintervention and may last as long as 24 to 26 weeks.
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Affiliation(s)
- Yaying Sun
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Peng Zhang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shaohua Liu
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Jia Jiang
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
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Effects of arthroscopy-guided suprascapular nerve block combined with ultrasound-guided interscalene brachial plexus block for arthroscopic rotator cuff repair: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:2121-2128. [PMID: 27311449 DOI: 10.1007/s00167-016-4198-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to compare the pain relieving effect of ultrasound-guided interscalene brachial plexus block (ISB) combined with arthroscopy-guided suprascapular nerve block (SSNB) with that of ultrasound-guided ISB alone within the first 48 h after arthroscopic rotator cuff repair. METHODS Forty-eight patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled. The 24 patients in group 1 received ultrasound-guided ISB and arthroscopy-guided SSNB; the remaining 24 patients in group 2 underwent ultrasound-guided ISB alone. Visual analogue scale pain score and patient satisfaction score were checked at 1, 3, 6, 12, 18, 24, and 48 h post-operatively. RESULTS Group 1 had a lower visual analogue scale pain score at 3, 6, 12, 18, 24, and 48 h post-operatively (1.7 < 2.6, 1.6 < 4.0, 3.5 < 5.8, 3.6 < 5.2, 3.2 < 4.2, 1.3 < 2.0), and a higher patient satisfaction score at 6, 12, 18, 24, and 36 h post-operatively than group 2 (7.8 > 6.0, 6.2 > 4.3, 6.4 > 5.1, 6.9 > 5.9, 7.9 > 7.1). Six patients in group 1 developed rebound pain twice, and the others in group 1 developed it once. All of the patients in group 2 had one rebound phenomenon each (p = 0.010). The mean timing of rebound pain in group 1 was later than that in group 2 (15.5 > 9.3 h, p < 0.001), and the mean size of rebound pain was smaller in group 1 than that in group 2 (2.5 > 4.0, p = 0.001). CONCLUSION Arthroscopy-guided SSNB combined with ultrasound-guided ISB resulted in lower visual analogue scale pain scores at 3-24 and 48 h post-operatively, and higher patient satisfaction scores at 6-36 h post-operatively with the attenuated rebound pain compared to scores in patients who received ultrasound-guided ISB alone after arthroscopic rotator cuff repair. The combined blocks may relieve post-operative pain more effectively than the single block within 48 h after arthroscopic cuff repair. LEVEL OF EVIDENCE Randomized controlled trial, Level I. ClinicalTrials.gov Identifier: NCT02424630.
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