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Mertens MG, Meeus M, Lluch Girbes E, Dueñas L, Twickler MT, Verborgt O, Struyf F. Differences in biomechanical and metabolic factors between patients with frozen shoulder and asymptomatic individuals. A cross-sectional study. Musculoskelet Sci Pract 2024; 72:102980. [PMID: 38820869 DOI: 10.1016/j.msksp.2024.102980] [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: 10/06/2023] [Revised: 05/06/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND the pathogenesis of frozen shoulder (FS) is thought to be one of inflammation and fibrosis possibly influenced by hyperglycemia. Biomechanical changes of the shoulder joint in terms of muscle strength, scapular kinematics and proprioception might occur in FS. OBJECTIVES to compare muscle strength, scapular kinematics, proprioception, and blood glucose levels within patients with FS and to asymptomatic individuals. DESIGN cross-sectional study. METHOD Thirty-five patients with FS and 35 asymptomatic age and gender-matched individuals underwent physical assessment to determine muscle strength (abduction, external and internal rotation), scapular kinematics (both visually and with a plurimeter), proprioception (joint position sense), and blood glucose level. RESULTS Patients with FS showed a decrease in muscle strength in their affected shoulder compared to both the unaffected shoulder and asymptomatic individuals. Significant differences were found between the affected and unaffected shoulder in the FS group and between groups (FS versus controls) in scapular upward rotation (plurimeter) at 30° and 60° abduction. No difference in scapular kinematics (visual observation), proprioception, and blood glucose levels was found neither between shoulders in the FS group nor between groups. CONCLUSION A clinically relevant difference in muscle strength and increase in scapular upward rotation were found in the affected shoulder of patients with FS compared to their unaffected side and controls. However, no evidence of different levels of scapular kinematics (visual observation), proprioception, and blood glucose levels in the affected shoulder compared to the unaffected shoulder or controls is lacking.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium.
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
| | - Enrique Lluch Girbes
- Pain in Motion International Research Group, Belgium; Department of Physical Therapy, University of Valencia, Valencia, Spain; Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Lirios Dueñas
- Department of Physical Therapy, University of Valencia, Valencia, Spain.
| | - Marcel Tb Twickler
- Department of Endocrinology, Diabetology and Metabolic Disease, AZ Monica, Deurne/Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium.
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium; Department of Orthopedic Surgery, University Hospital Antwerp (UZA), Edegem, Belgium.
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
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Tamai K, Hamada J, Nagase Y, Morishige M, Naito M, Asai H, Tanaka S. Frozen shoulder. An overview of pathology and biology with hopes to novel drug therapies. Mod Rheumatol 2024; 34:439-443. [PMID: 37632764 DOI: 10.1093/mr/road087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/07/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Abstract
Frozen shoulder (FS) is a common disorder characterized by spontaneous onset of shoulder pain accompanied by progressive loss of range-of-motions. The cause of FS is still unclear, and radical therapy has not been established. With the final aim of preventing or curing FS at an earlier stage, we reviewed the pathological and biological features of this disease. Many studies indicate that the main pathology of FS is inflammation initially and fibrosis later. There are inflammatory cytokines, immune cells, fibrotic growth factors, and type-III collagen in the synovium and the joint capsule. The immune cell landscape switches from the macrophages to T cells. Activated fibroblasts seem to regulate the inflammatory and fibrotic processes. The imbalance between matrix metalloproteinases and tissue inhibitors of metalloproteases might promote fibrosis. Additionally, advanced glycation end-products are noted in the FS synovium. Diabetes mellitus and hypothyroidism are closely related to the development of FS. In terms of nonsurgical treatment, oral or intra-articular glucocorticoids are the only drugs that provide early benefit. Some other anti-inflammatory or antifibrotic drugs may potentially control the FS, but have not been proven effective in the clinical setting. Future studies should be targeted to develop steroid-sparing agents that inhibit biological events in FS.
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Affiliation(s)
- Kazuya Tamai
- Department of Orthopedic Surgery, Tohto Bunkyo Hospital, Tokyo, Japan
| | - Junichiro Hamada
- Department of Orthopedic Surgery, Kuwano Kyoritsu Hospital, Fukushima, Japan
| | - Yuichi Nagase
- Department of Rheumatology Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | | | - Masashi Naito
- Department of Orthopedic Surgery, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Hideaki Asai
- Department of Orthopedic Surgery, Yashio Central General Hospital, Yashio, Saitama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
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van Hattem S, Regener EM, Prangenberg C, Strauss AC, de Girolamo L, Burger C, Wirtz DC, Cucchi D. An Updated Overview of Risk Factors for Shoulder Stiffness. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024. [PMID: 38458225 DOI: 10.1055/a-2245-4896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
A painful reduction in shoulder mobility, known as "shoulder stiffness", can occur both as a primary idiopathic condition and as a secondary condition, for example, following surgical procedures. Various factors can contribute to the development of primary shoulder stiffness. In this review we summarize the pathophysiological mechanisms, genetic influences, endocrine disorders, metabolic conditions, as well as other diseases and medical-therapeutic approaches that might have an impact on the development of primary shoulder stiffness.
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Affiliation(s)
- Suncana van Hattem
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Eva-Maria Regener
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Christian Prangenberg
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Andreas Christian Strauss
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Laura de Girolamo
- Orthopaedics Biotechnology Laboratory, IRCCS Istituto Ortopedico Galeazzi, Mailand, Italien
| | - Christof Burger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Dieter Christian Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Davide Cucchi
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
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Xu T, Xia Q, Zhang L, Yang X, Fu W. Type 2 diabetes and fasting glycemic traits are causal factors of frozen shoulder: a 2-sample Mendelian randomization analysis. J Shoulder Elbow Surg 2024; 33:399-408. [PMID: 37748531 DOI: 10.1016/j.jse.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The causal relationship between type 2 diabetes (T2D) and frozen shoulder is unclear. This study aims to explore the genetic causal association between T2D and glycemic traits (fasting glucose [FG], fasting insulin [FI], glycated hemoglobin [HbA1c], and 2-hour postprandial glucose [2hGlu]) on frozen shoulder. METHODS Using 2-sample Mendelian randomization (MR), we analyzed nonconfounded estimates of the effects of T2D and glycemic traits on frozen shoulder. Single-nucleotide polymorphisms (SNPs) strongly associated (P < 5 × 10-8) with exposures from genome-wide association studies (GWAS) were identified. We employed fixed effect mode inverse variance weighting (IVW-FE), random effect mode IVW (IVW-MRE), MR-Egger, and weighted median to assess the association of exposures and outcome. Sensitivity analysis was conducted to test for heterogeneity and multidirectionality bias in MR. RESULTS We found a significant genetic causal correlation between T2D (IVW-MRE P = .007, odds ratio [OR] 1.093, 95% confidence interval [CI] 1.03-1.16), FG (IVW-FE P < .001, OR 1.455, 95% CI 1.173-1.806), and frozen shoulder, but no evidence for causal correlation between FI, HbA1c, and 2hGlu and frozen shoulder. Although there was certain heterogeneity, sensitivity analysis reveals no deviation from the MR assumptions. CONCLUSION This study supports a genetic causal relationship between T2D and FG and frozen shoulder.
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Affiliation(s)
- Tianhao Xu
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qinghong Xia
- Operating Room of Anesthesia Surgery Center, West China Hospital, Sichuan University West China School of Nursing, Chengdu, Sichuan, China
| | - Lei Zhang
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaolong Yang
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weili Fu
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Park HB, Gwark JY, Jung J. Associations of normal fasting glucose levels and of insulin resistance with degenerative rotator cuff tear : Normoglycemia and rotator cuff tear. BMC Musculoskelet Disord 2023; 24:973. [PMID: 38102571 PMCID: PMC10724963 DOI: 10.1186/s12891-023-06899-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/20/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The upper normoglycemic range has been proposed as a risk factor for degenerative rotator cuff tendon tear (RCT), and insulin resistance has been suggested as a risk factor for tendinopathy. However, no research has established their association with degenerative RCT in the general population. This study aimed to determine whether fasting glucose levels and insulin resistance are risk factors for degenerative RCT in the normoglycemic population and identify the risk range for fasting glucose. METHODS This study included 418 normoglycemic participants from a rural cohort. Participants completed questionnaires, physical exams, blood tests, and MRI evaluations of both shoulders. Insulin resistance was assessed using a triglyceride/high-density-lipoprotein (TG/HDL) ≥ 3.5. Logistic regression analysis was used to determine the association between fasting glucose level, TG/HDL ≥ 3.5, and other factors and degenerative RCT. The study calculated the areas under the receiver operating characteristic curve (AUC) to determine the more appropriate predicting value between the scale and categorical values of fasting glucose levels, and compared the AUCs using the DeLong method. RESULTS In the multivariable analyses, both scale and categorical values of fasting glucose levels, and TG/HDL ≥ 3.5 were significantly associated with degenerative RCT. Fasting glucose levels ≥ 90.5 mg/dL (OR: 3.87, 95% CI: 2.10-7.06) in scale value and 90-99 mg/dL (OR: 4.13, 95% CI: 2.87-8.12) in categorical value were significantly associated with degenerative RCT (P < .001). The AUC of the scale value of fasting glucose levels ≥ 90.5 mg/dL was 0.68. The AUC of the categorical value of fasting glucose levels of 90-99 mg/dL was 0.70. Because of the significantly larger AUC of the categorical value of fasting glucose levels of 90-99 mg/dL, those fasting glucose levels were determined to be independently associated with degenerative RCT (P < .001). CONCLUSIONS High fasting glucose levels within the normal range may link to increase insulin resistance and risk of degenerative RCT. Normoglycemic levels of 90-99 mg/dL and insulin resistance may be risk factors for degenerative RCT. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Hyung Bin Park
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro Seongsan- gu, Changwon, 51472, Republic of Korea.
- Gyeongsang institute of medical sciences, Gyeongsang national university, Jinju, Republic of Korea.
| | - Ji-Yong Gwark
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro Seongsan- gu, Changwon, 51472, Republic of Korea
- Gyeongsang institute of medical sciences, Gyeongsang national university, Jinju, Republic of Korea
| | - Jaehoon Jung
- Division of Endocrinology, Department of Internal Medicine, School of Medicine, Gyeongsang National University, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Jadon A, Sanyal S, Pavan S, Bakshi A, Bharadwaj A, Singh AP. Suprascapular Nerve Block (SSNB) improves the outcome in exercise based management of Primary Adhesive Capsulitis (PAC): A prospective randomized comparative study. J Anaesthesiol Clin Pharmacol 2023; 39:195-200. [PMID: 37564834 PMCID: PMC10410031 DOI: 10.4103/joacp.joacp_263_21] [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: 05/28/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 08/12/2023] Open
Abstract
Background and Aims Increased pain and associated stiffness hinders the advantages of exercise and process of recovery in primary adhesive capsulitis. We hypothesized that suprascapular nerve block may positively affect the outcome due to its role in pain relief of acute or chronic shoulder pain. We compared the effect of suprascapular nerve block and exercise with only exercise on the recovery of primary adhesive capsulitis. Material and Methods A total of 96 patients of both sexes presenting with primary adhesive capsulitis were divided by computer randomization in two equal groups (n = 48). Group A received exercise only and Group B received suprascapular nerve block followed by exercise. Oral paracetamol was given for analgesia as desired. Patients were followed up at 4, 8, 16, and 24 weeks. Pain was assessed by visual analog scale; functional outcome by Shoulder Pain and Disability Index and range of movement by goniometer. Results The pain scores and Shoulder Pain and Disability Index scores were significantly lower at all observation points of 4, 8,16, and 24 weeks in Group B than Group A (P < 0.05). The range of movement in all the ranges of forward flexion, extension, internal and external rotation, and abduction at all observation points was significantly higher in Group-B (P < 0.05) compared to Group A. The consumption of analgesics was significantly more in Group A than Group B at 4 and 8 weeks (P = 0.020 and P = 0.044) but comparable at 12 and 24 weeks (P = 0.145 and P = 0.237 respectively). Conclusion Combining SSNB with exercise is more effective in treatment of primary adhesive capsulitis than exercise alone and reduces the use of analgesics. SSNB it is effective and safe to use in primary adhesive capsulitis.
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Affiliation(s)
- Ashok Jadon
- Department of Anaesthesia and Pain Relief Service, Tata Motors Hospital, Telco Colony, Jamshedpur, Jharkhand, India
| | - Subhojit Sanyal
- Department of Orthopaedics, IPGMER, Kolkata, West Bengal, India
| | - Sudarshan Pavan
- Department of Orthopaedics, Tata Motors Hospital, Telco Colony, Jamshedpur, Jharkhand, India
| | - Apoorva Bakshi
- Department of Anaesthesia and Pain Relief Service, Tata Motors Hospital, Telco Colony, Jamshedpur, Jharkhand, India
| | - Arvind Bharadwaj
- Department of Orthopaedics, Tata Motors Hospital, Telco Colony, Jamshedpur, Jharkhand, India
| | - Abhay Pratap Singh
- Department of Orthopaedics, Tata Motors Hospital, Telco Colony, Jamshedpur, Jharkhand, India
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Pandey V, Chidambaram R, Modi A, Babhulkar A, Pardiwala DN, Willems WJ, Thilak J, Maheshwari J, Narang K, Kamat N, Gupta P, Reddy R, Desai S, Sundararajan S, Samanta S. Trends in Practice Among Shoulder Specialists in the Management of Frozen Shoulder: A Consensus Survey. Orthop J Sports Med 2022; 10:23259671221118834. [PMID: 36250030 PMCID: PMC9561673 DOI: 10.1177/23259671221118834] [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: 03/06/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022] Open
Abstract
Background: The management of frozen shoulder (FS) differs depending on experience level
and variation between scientific guidelines and actual practice. Purpose: To determine the current trends and practices in the management of FS among
shoulder specialists and compare them with senior shoulder specialists. Study Design: Consensus statement. Methods: A team of 15 senior shoulder specialists (faculty group) prepared a
questionnaire comprising 26 questions regarding the definition, terminology,
clinical signs, investigations, management, and prognosis of FS. The
questionnaire was mailed to all the registered shoulder specialists of
Shoulder and Elbow Society, India (SESI) (specialist group; n = 230), as
well as to the faculty group (n = 15). The responses of the 2 groups were
compared, and levels of consensus were determined: strong (>75%), broad
(60%-74.9%), inconclusive (40%-59.9%), or disagreement (<40%). Result: Overall, 142 of the 230 participants in the specialist group and all 15
participants in the faculty group responded to the survey. Both groups
strongly agreed that plain radiographs are required to rule out a secondary
cause of FS, routine magnetic resonance imaging is not indicated to confirm
FS, nonsteroidal anti-inflammatory drugs should be administered at bedtime,
steroid injection (triamcinolone or methylprednisolone) is the next best
option if analgesics fail to provide pain relief, passive physical therapy
should be avoided in the freezing phase, <10% of patients would require
any surgical intervention, and patients with diabetes and thyroid
dysfunction tend to fare poorly. There was broad agreement that routine
thyroid dysfunction screening is unnecessary for women, a single 40-mg
steroid injection via intra-articular route is preferred, and arthroscopic
capsular release (ACR) results in a better outcome than manipulation under
anesthesia (MUA). Agreement was inconclusive regarding the use of combined
random blood sugar (RBS) and glycosylated hemoglobin versus lone RBS to
screen for diabetes in patients with FS, preference of ACR versus MUA to
treat resistant FS, and the timing of surgical intervention. There was
disagreement over the most appropriate term for FS, the preferred physical
therapy modality for pain relief, the most important movement restriction
for early diagnosis of FS, and complications seen after MUA. Conclusion: This survey summarized the trend in prevalent practices regarding FS among
the shoulder specialists and senior shoulder surgeons of SESI.
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Affiliation(s)
- Vivek Pandey
- Vivek Pandey, MS(Orth), Department of Orthopaedics, Kasturba
Medical College, Manipal Academy of Higher Education, Manipal, India 576104
() (Twitter: @vivekortho007)
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Park HB, Gwark JY, Jung J, Jeong ST. Involvement of inflammatory lipoproteinemia with idiopathic adhesive capsulitis accompanying subclinical hypothyroidism. J Shoulder Elbow Surg 2022; 31:2121-2127. [PMID: 35447316 DOI: 10.1016/j.jse.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Thyroid functional abnormalities are considered risk factors for idiopathic adhesive capsulitis (IAC) though that relationship remains uncertain. Although dyslipidemias are associated with IAC, no readily accessible study has reported associations between dyslipidemias and IAC patients with subclinical hypothyroidism. The purposes of this study were to investigate whether subclinical hypothyroidism is an independently associated factor for IAC and to determine the differences in prevalence of dyslipidemias between two groups of persons with subclinical hypothyroidism: one composed of IAC patients and the other of individuals without IAC. METHODS This case-control study included a case group of 412 IAC patients without intrinsic shoulder lesions, extrinsic causes, or medication for thyroid dysfunction. The control group comprised 1236 age- and sex-matched persons seeking general checkups at the authors' health promotion center during the same period as the case group. Control subjects had normal shoulder function and no previously diagnosed adhesive capsulitis, no medication for thyroid dysfunction, and no history of trauma or of shoulder surgery. The studied variables were age, gender, obesity, diabetes, dyslipidemias, subclinical hypothyroidism, hypothyroidism, and hyperthyroidism. A conditional logistic regression analysis evaluated the matched sets of subjects to determine odds ratios and 95% confidence intervals for the studied variables. The differences in the prevalence of dyslipidemias between IAC patients with subclinical hypothyroidism and individuals with subclinical hypothyroidism but without IAC were determined with generalized estimating equations, using covariates of age, sex, and diabetes. The P values were set at < 0.05. RESULTS Subclinical hypothyroidism (odds ratio, 2.10; 95% confidence interval, 1.36-3.15; P = .001) was significantly associated with IAC. Patients with IAC and subclinical hypothyroidism had a significantly higher prevalence of hyper-low-density lipoproteinemia, an inflammatory lipoproteinemia, than individuals with subclinical hypothyroidism but without IAC (P = .002). CONCLUSIONS Subclinical hypothyroidism is significantly associated with IAC. Hyper-low-density lipoproteinemia, an inflammatory lipoproteinemia, is involved in IAC accompanied by subclinical hypothyroidism.
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Affiliation(s)
- Hyung Bin Park
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea; Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.
| | - Ji-Yong Gwark
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jaehoon Jung
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Soon-Taek Jeong
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea; Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
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Saldiran TÇ, Yazgan P, Akgöl AC, Mutluay FK. Radial shock-wave therapy for frozen shoulder patients with type 2 diabetes mellitus: a pilot trial comparing two different energy levels. Eur J Phys Rehabil Med 2022; 58:412-422. [PMID: 35191654 PMCID: PMC9980541 DOI: 10.23736/s1973-9087.22.07087-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Extracorporeal shock-wave therapy (ESWT) is highly recommended for the management of orthopedic shoulder pathologies. Yet, the clinical relevance of the dose difference effect of radial ESWT approaches in the management of frozen shoulder patients with type 2 diabetes mellitus remains uncertain. AIM The aim was to examine the short-term effects of medium-and high-energy levels of radial ESWT (rESWT) in the treatment of frozen shoulder patients with type 2 diabetes mellitus. DESIGN Prospective clinical pilot study. SETTING This study was conducted in an outpatient clinic. POPULATION Thirty-nine patients who had frozen shoulder untreated for at least 3 months, diagnosed with type 2 diabetes mellitus for ≥3 years were included. METHODS The patients were randomly allocated to receive either high-energy rESWT (hrESWT), or medium-energy rESWT (mrESWT) or placebo at 8 Hz twice a week for six weeks. The primary outcome measure was pain, evaluated by the Visual Analog Scale (VAS) Score. Secondary outcome measures were function evaluated by the Shoulder Pain and Disability Index (SPADI) Score, and shoulder active range of motion (AROM). The mechanical properties of the deltoid and trapezius muscles were assessed using the MyotonPRO (Myoton AS, Tallinn, Estonia). RESULTS The mrESWT resulted in statistically significant reductions in night pain at 6 weeks (η<inf>p</inf>2=0.27, P=0.003). Significantly improved function (SPADI scores: -35.42±21.29 vs.-29.59±22.60; η<inf>p</inf>2=0.39, P˂0.001) was found in both hrESWT and mrESWT group by 6 weeks. Significantly higher mean shoulder AROM values were recorded for external rotation (η<inf>p</inf>2=0.53, P<0.001), and internal rotation (η<inf>p</inf>2=0.21, P=0.020), in the hrESWT group at the 6th week. A significantly improved resting tone (η<inf>p</inf>2=0.58) and stiffness of deltoid muscle (η<inf>p</inf>2=0.62) were found in the mrESWT group (P<0.001). The trapezius muscle resting tone reduced with hrESWT (η<inf>p</inf>2=0.17, P=0.033). CONCLUSIONS Regardless of the energy levels, rESWT appears to be an effective therapeutic intervention for frozen shoulder patients with type 2 diabetes mellitus in the short-term results. CLINICAL REHABILITATION IMPACT Our results suggest that this rESWT can be a useful strategy for the rehabilitation of frozen shoulder patients with type 2 diabetes mellitus. This is the first study on dose difference effectiveness in terms of the clinical significance of rESWT which is key to transfer research evidence into practice.
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Affiliation(s)
- Tülay Ç Saldiran
- School of Health Sciences, Department of Physiotherapy and Rehabilitation, Bitlis Eren University, Bitlis, Turkey -
| | - Pelin Yazgan
- Department of Physical Therapy and Medicine, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Ahmet C Akgöl
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Okan University, Istanbul, Turkey
| | - Fatma K Mutluay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
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Causes of Shoulder Dysfunction in Diabetic Patients: A Review of Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106228. [PMID: 35627764 PMCID: PMC9140829 DOI: 10.3390/ijerph19106228] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 12/15/2022]
Abstract
Objective: Understanding the underlying mechanisms behind shoulder dysfunctions in patients with diabetes mellitus. Study Design: Systematic qualitative literature review. Participants: Patients with shoulder dysfunctions and diagnosed with impaired glucose tolerance or diabetes mellitus. Intervention: Published scientific literature containing evidence about the mechanisms of shoulder dysfunctions in the diabetic population. Articles were selected based on criteria containing diabetic population, shoulder dysfunction, methodological quality ≥ 6/9 and >20 subjects. Main Outcome measures: range of motion; questionnaires (QoL, UCLA-m, SPADI, DASH); blood glucose, blood HbA1C; calculated capsular stiffness (Kcap); calcification shoulder joint; shoulder dysfunction in patients with glucose metabolism disorders and diabetes mellitus. Results: We found 17 published articles with level 2 and 3 evidence. Multiple factors such as age, duration of diabetes mellitus (DM), glycated hemoglobin (HbA1c), advanced glycation end products (AGE), vascular endothelial growth factor (VEGF), interleukin-1ß (IL-1ß) were shown to be associated with tendon changes and increased capsular stiffness (Kcap) conceivably leading to limited range of motion (ROM) or frozen shoulder. Decreased ROM and frozen shoulder have a significantly higher prevalence in DM than in non-DM. Conclusions: Based on the current literature we confirm a high prevalence of shoulder dysfunctions in patients with diabetes mellitus. The cause of the shoulder complications is unknown, and more research is mandatory to shed more light on the complex interplay between the multifactorial causes of shoulder dysfunction in diabetes mellitus.
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Ricci M. Adhesive capsulitis: A review for clinicians. JAAPA 2021; 34:12-14. [PMID: 34772852 DOI: 10.1097/01.jaa.0000800236.81700.d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Adhesive capsulitis, a common primary care and orthopedic diagnosis often referred to as frozen shoulder, is a painful inflammatory process that leads to a mechanical block in active and passive range of shoulder motion. Risk factors include diabetes and thyroid dysfunction. Diagnosis is made based on physical examination, but can be augmented by diagnostic imaging. Nonsurgical management is the mainstay of treatment because the disease is self-limiting. However, some patients may need surgical intervention.
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Affiliation(s)
- Monica Ricci
- Monica Ricci practices in orthopedic surgery and sports medicine at Arthritis and Sports Orthopaedics in Sterling, Va. The author has disclosed no potential conflicts of interest, financial or otherwise.\
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Li P, Zheng J, Xu J, Zhang M. Keratin-inorganic hybrid nanoflowers decorated with Fe 3O 4 nanoparticles as enzyme mimics for colorimetric detection of glucose. Dalton Trans 2021; 50:14753-14761. [PMID: 34590661 DOI: 10.1039/d1dt02301b] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fe3O4 magnetic nanoparticles (MNPs) are highly active enzyme-like catalysts. However, low stability is still a big challenge for Fe3O4-based enzyme mimics because the Fe3O4 MNPs can be easily dissolved when exposed to acidic conditions. Inspired by the numerous catalytic sites of a flower-like structure and the biological functions of amino acids in structural proteins, herein, by employing keratin as a protein component, stable Fe3O4-based MNP embedded keratin-Cu3(PO4)2 nanoflowers were constructed, from which hierarchical nanostructures with a three-dimensional petal-like morphology were selected for subsequent studies owing to their excellent enzymic catalytic activity. The keratin-nanoflower@Fe3O4 exhibited significantly enhanced catalytic activity compared with that of keratin-Cu3(PO4)2 nanoflowers and individual Fe3O4 MNPs. Remarkably, keratin-nanoflower@Fe3O4 exhibited superior long-term stability to Fe3O4 MNPs under more acidic conditions and favorable reusability. This method has been successfully exploited for the colorimetric determination of glucose in human serum with satisfactory sensitivity and specificity, offering a novel approach for glucose detection.
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Affiliation(s)
- Peiyu Li
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China.
| | - Jing Zheng
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China.
| | - Jingli Xu
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China.
| | - Min Zhang
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China.
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Abstract
Among all the prevalent painful conditions of the shoulder, frozen shoulder remains one of the most debated and ill-understood conditions. It is a condition often associated with diabetes and thyroid dysfunction, and which should always be investigated in patients with a primary stiff shoulder. Though the duration of 'traditional clinicopathological staging' of frozen shoulder is not constant and varies with the intervention(s), the classification certainly helps the clinician in planning the treatment of frozen shoulder at various stages. Most patients respond very well to combination of conservative treatment resulting in gradual resolution of symptoms in 12-18 months. However, the most effective treatment in isolation is uncertain. Currently, resistant cases that do not respond to conservative treatment for 6-9 months could be offered surgical treatment as either arthroscopic capsular release or manipulation under anaesthesia. Though both invasive options are not clinically superior to another, but manipulation could result in unwarranted complications like fractures of humerus or rotator cuff tear.
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Sun Y, Lin J, Luo Z, Zhang Y, Chen J. The Serum from Patients with Secondary Frozen Shoulder Following Rotator Cuff Repair Induces Shoulder Capsule Fibrosis and Promotes Macrophage Polarization and Fibroblast Activation. J Inflamm Res 2021; 14:1055-1068. [PMID: 33790620 PMCID: PMC8001608 DOI: 10.2147/jir.s304555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/10/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Disorders with systematic inflammation were prognostic for secondary frozen shoulder (sFS) following rotator cuff repair (RCR); however, how systematic inflammation affects sFS remains unclear. The aim of this study was to observe the effect of pre-operative serum from patients with sFS and the serum from those without on shoulder capsule in mice, and on macrophages and fibroblasts in vitro. METHODS Serum samples of a consecutive cohort of patients for RCR were collected pre-operatively. Three months after RCR, patients who developed sFS (Group S) were identified. Serum samples from gender- and age-matched controls without sFS (group NS) were also picked out. Firstly, the effect of serum on shoulder capsule fibrosis was observed histologically and biomechanically in a mouse model of RCR. Secondly, the roles of the serum on macrophage polarization and fibroblast activation were investigated, and the potentially involved signaling pathways were identified. Finally, inflammation and fibrosis-related cytokines in serum were quantified. RESULTS In our cohort, all patients had free pre-operative shoulder range of motion. Seven patients developed sFS at 3 months after surgery. Seven matched patients without sFS were selected as control. The inter-group difference of basic characteristics was not significant. Compared to the serum of group NS, the serum of group S significantly induced hypercellularity, capsular thickening, and range of motion deficiency in mice shoulders after RCR. Compared to the serum of group NS, samples of group S significantly promoted M2 polarization of THP-1 human macrophages and the activation of human capsule-derived fibroblasts. Meanwhile, Smad3 and p-Smad3 in macrophages and fibroblasts were significantly up-regulated. On the other hand, levels of inflammation and fibrosis-related cytokines were not significantly different between serum in group S and group NS. CONCLUSION Although all patients in this cohort had free range of motion pre-operatively, the pre-operative serum from patients with sFS at 3 months after RCR could act as a trigger of shoulder capsule fibrosis post-operatively. This effect may be related to its promotion on macrophage polarization to M2 phenotype and fibroblast activation.
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Affiliation(s)
- Yaying Sun
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jinrong Lin
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Zhiwen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Yuhan Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
- Correspondence: Jiwu Chen Department of Sports Medicine, Huashan Hospital, Fudan University, 12# Middle Wulumuqi Road, Jing’an District, Shanghai, 200040, People’s Republic of ChinaFax +86 21 52888255 Email
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