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Dillon MT. In Freezing-Phase Frozen Shoulder, Adding Arthroscopic Release to Corticosteroid Hydrodilatation Improved Some Measures of ROM at 12 Months. J Bone Joint Surg Am 2023; 105:1281. [PMID: 37315122 DOI: 10.2106/jbjs.23.00495] [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: 06/16/2023]
Affiliation(s)
- Mark T Dillon
- Indiana University School of Medicine, Indianapolis, Indiana
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Uekama K, Miyazaki T, Maesako S, Kaieda H, Taniguchi N. Clinical significance of the elbow forward translation motion in patients with rotator cuff tears. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Leafblad N, Mizels J, Tashjian R, Chalmers P. Adhesive Capsulitis. Phys Med Rehabil Clin N Am 2023; 34:453-468. [PMID: 37003663 DOI: 10.1016/j.pmr.2022.12.009] [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: 03/06/2023]
Abstract
Adhesive capsulitis, colloquially known as "frozen shoulder," is a relatively common disorder, affecting approximately 2% to 5% of the general population. The incidence may be higher as the condition can be relatively mild and self-limited and thus many patients who experience it may never present for treatment. It involves a pathologic process of gradual fibrosis of the glenohumeral joint that leads to limited active and passive range of motion, contracture of the joint capsule, and shoulder pain.
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Affiliation(s)
- Nels Leafblad
- Department of Sports Medicine, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Josh Mizels
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Robert Tashjian
- Department of Shoulder and Elbow Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Peter Chalmers
- Department of Shoulder and Elbow Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
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Kim YS, Lee YG, Park HS, Cho RK, Lee HJ. Comparison of Gene Expression of Inflammation- and Fibrosis-Related Factors Between the Anterior and Posterior Capsule in Patients With Rotator Cuff Tear and Shoulder Stiffness. Orthop J Sports Med 2021; 9:23259671211032543. [PMID: 34660822 PMCID: PMC8511928 DOI: 10.1177/23259671211032543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background Arthroscopic capsular release is an effective treatment for refractory shoulder stiffness, yet there are no basic studies that can explain the extent of the release. Purpose This study aimed to compare the genetic expression of inflammation- and fibrosis-related factors between the anterior and posterior capsules in patients with shoulder stiffness and rotator cuff tear. Study Design Descriptive laboratory study. Methods Enrolled in this study were 35 patients who underwent arthroscopic capsular release for shoulder stiffness along with the rotator cuff repair. Anterior and posterior glenohumeral joint capsular tissues were obtained during the capsular release. For the control tissue, anterior capsule was obtained from 40 patients without stiffness who underwent arthroscopic rotator cuff repair. The gene expression of collagen types I and III, fibronectin, extracellular matrix, basic fibroblast growth factor, transforming growth factor-β, connective tissue growth factor, matrix metalloproteinase (MMP)-1, MMP-2, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-2, intercellular adhesion molecule 1, interleukin 1, and tumor necrotizing factor-α were analyzed using real-time reverse transcription polymerase chain reaction. Differences in gene expression between the anterior capsule, the posterior capsule, and the control tissue were compared with the Kruskal-Wallis test. Results The expression levels of collagen types I and III were significantly higher in the anterior capsule with stiffness com (pared with both the posterior capsule with stiffness (P = .010 for both) and the control (P = .038 and .010, respectively). The levels of fibronectin, MMP-2, and MMP-9 in the anterior capsule were significantly higher than in both the posterior capsule (P = .013, .003, and .006, respectively) and the control (P = .014, .003, and .005, respectively). Conclusion Genetic analysis of the shoulder capsule revealed that more fibrogenic processes occur in the anterior capsule compared with the posterior capsule in patients with shoulder stiffness. Clinical Relevance Capsular release for shoulder stiffness should be more focused on the anterior capsule than on the posterior capsule.
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Affiliation(s)
- Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yun-Gyoung Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyung-Seok Park
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ryu-Kyoung Cho
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyo-Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Sivasubramanian H, Chua CXK, Lim SY, Manohara R, Ng ZWD, V PK, Poh KS. Arthroscopic capsular release to treat idiopathic frozen shoulder: How much release is needed? Orthop Traumatol Surg Res 2021; 107:102766. [PMID: 33333264 DOI: 10.1016/j.otsr.2020.102766] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/31/2020] [Accepted: 06/15/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE This systematic review and meta-analysis aims to provide consensus regarding the degree of optimal extended arthroscopic capsular release in addition to a standard rotator interval release in the treatment of idiopathic frozen shoulder. MATERIALS AND METHODS The systematic review was conducted using the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. All articles that reported the outcomes of capsular release in idiopathic frozen shoulder were included. A total of 18 articles with 629 patients and 811 shoulders were included. Clinical outcomes analysed include differences between pre and postoperative ranges of motion (ROM), Visual Analog Score (VAS) reduction, Simple Shoulder Test (SST) scores and Constant scores. Patients were grouped by technique: anterior-inferior capsular release (Group 1), anterior-inferior-posterior capsular release (Group 2), and 360-degree capsular release (Group 3) at follow up points 3,6 and 12 months. RESULTS Comparing ROM, Group 1 had greater early abduction (p<0.01), early (p<0.01) and overall external rotation (p<0.01) than Group 2, as well as greater early flexion (p<0.01), early abduction (p<0.01), early (p<0.01) and overall internal rotation (p<0.01) than Group 3. Group 2 had greater early (p=0.03) and overall flexion (p<0.01) than Group 1, as well as greater early (p<0.01) and overall flexion (p<0.01), early abduction (p<0.01) and early internal rotation (p<0.01) than Group 3. Group 3 had greater overall flexion (p<0.01) than Group 1 and greater overall external rotation (p<0.01) than Group 2. Comparing VAS scores, the less extensive releases saw the greatest significant postoperative reduction. Group 2 had greater mean improvements in postoperative Constant scores than Group 1 (p<0.01) and Group 3 (p<0.01), while SST scores were significantly higher in Group 1 (p<0.01). CONCLUSION This systematic review and meta-analysis suggests that less extensive releases may result in better functional and pain scores. Addition of a posterior release offers increased early internal rotation, which was not sustained over time, but provides early and sustained flexion improvements. A complete 360 release may not provide any further benefit. There were no significant differences in the complication rates amongst the 3 techniques. LEVEL OF STUDY II; Meta-analysis and systematic review.
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Affiliation(s)
- Harish Sivasubramanian
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Chen Xi Kasia Chua
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore.
| | - Sheng Yang Lim
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Ruben Manohara
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Zhao Wen Dennis Ng
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Prem Kumar V
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Keng Soon Poh
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
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Nicholson JA, Slader B, Martindale A, Mckie S, Robinson CM. Distension arthrogram in the treatment of adhesive capsulitis has a low rate of repeat intervention. Bone Joint J 2020; 102-B:606-610. [PMID: 32349602 DOI: 10.1302/0301-620x.102b5.bjj-2020-0082] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIMS The primary aim of this study was to evaluate the efficacy of distension arthrography in the treatment of adhesive capsulitis of the shoulder. The secondary aim was to assess which patient and procedural factors predicted the recurrence of symptoms after the procedure. METHODS All patients referred to our shoulder clinic over a ten-year period, between 2008 and 2018, with a clinical diagnosis of capsulitis and symptoms persisting for more than six months, were offered treatment with a distension arthrogram. All procedures were performed by one of five musculoskeletal radiologists, with a combination of steroid, local anaesthetic, and a distention volume of 10 ml, 30 ml, or 50 ml. Patient demographics, procedural details, recurrence of symptoms, and the need for further intervention were evaluated. RESULTS A total of 2,432 distension arthrograms were performed during the study period. The mean time between arthrography and analysis was 5.4 years (SD 4.4; 1 to 11). Recurrent symptoms occurred in 184 cases (7.6%), all of whom had a repeat distension arthrogram at a median of nine months (interquartile range (IQR) 6.0 to 15.3). The requirement for further intervention for persistent symptoms following arthrography was significantly associated with diabetes (p < 0.001) and bilateral capsulitis (p < 0.001). The volume of distension, either with air or saline, showed a dose-dependent advantage. Distension of 50 ml versus 30 ml showed a significantly decreased odds ratio for recurrence of 2.2 (95% confidence interval (CI) 1.6 to 3.0; p < 0.001). Capsule rupture (p = 0.615) or steroid dose (p = 0.275) did not significantly affect the rate of recurrence. There were no infections or neurovascular injuries. Following the second distension arthrogram, the symptoms resolved in 137 cases (74.5%) with no further intervention being required. An arthroscopic capsular release was ultimately required in 41 cases, comprising 1.7% of the entire cohort. CONCLUSION We found a low rate of repeat intervention following distension arthrography in patients with adhesive capsulitis of the shoulder, at long term follow-up. Greater volumes of distension are associated with lower rates of recurrence independent of capsule rupture. Cite this article: Bone Joint J 2020;102-B(5):606-610.
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Affiliation(s)
- Jamie A Nicholson
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Ben Slader
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Aleksis Martindale
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Scott Mckie
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - C Mike Robinson
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
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Yoo JC, Koh KH, Shon MS, Bae KH, Lim TK. Clinical Outcome after Arthroscopic Capsular Release for Adhesive Capsulitis of the Shoulder. Clin Shoulder Elb 2018; 21:127-133. [PMID: 33330165 PMCID: PMC7726396 DOI: 10.5397/cise.2018.21.3.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/10/2018] [Accepted: 07/13/2018] [Indexed: 11/25/2022] Open
Abstract
Background This study was undertaken to evaluate the outcome of the arthroscopic capsular release for adhesive capsulitis of the shoulder. Methods This study retrospectively investigated thirty shoulders in 29 patients who presented with recalcitrant adhesive capsulitis and underwent arthroscopic treatments. Other than typical findings of adhesive capsulitis, combined pathologies in the glenohumeral joint and subacromial space were evaluated by arthroscopy. Clinical evaluations were performed using the Constant’s score and ranges of motion (ROM) at preoperative, 6 months postoperatively and at the final follow-up. Results Our study included 17 women and 12 men with a mean age of 53.8 years (range, 34–74). Mean follow-up duration was 24 months (range, 12–40 months). Assessment of combined pathologies revealed that partial rotator cuff tear of less than 25% thickness, was most common (overall 83.3%; with bursal 57% and articular 23%). Subacromial synovitis and adhesion were also frequent (53.3%). The Constant score and ranges of motion significantly improved at the final follow-up, compared with preoperative levels. However, clinical results at 6 months postoperatively were found to be significantly inferior to those observed at the final follow-up (p≤0.001 for all factors). Functional impairment was the major complaint in 59.3% patients at the 6 months follow-up. Conclusions Although arthroscopic capsular release yielded favorable outcome at the mean 24 months follow-up, pain and motion limitations at 6-month postoperatively persisted in more than 50% of our patients. While combined pathologies were commonly encountered during arthroscopy, although their effects on surgical outcome in adhesive capsulitis remains unclear in this study.
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Affiliation(s)
- Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Soo Shon
- Department of Orthopaedic Surgery, National Medical Center, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Kyu Hwan Bae
- Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Tae Kang Lim
- Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
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Longo UG, Ciuffreda M, Locher J, Buchmann S, Maffulli N, Denaro V. The effectiveness of conservative and surgical treatment for shoulder stiffness: a systematic review of current literature. Br Med Bull 2018; 127:111-143. [PMID: 30137234 DOI: 10.1093/bmb/ldy025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/15/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Currently, no therapeutic intervention is universally accepted, and the most effective management for restoring motion and diminishing pain in patients with shoulder stiffness has yet to be defined. This systematic review analyses outcomes of conservative and surgical interventions to treat shoulder stiffness. SOURCE OF DATA A systematic review of literature according to the PRISMA guidelines was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, Ovid and Google Scholar databases using various combinations of the keywords 'shoulder', 'shoulder stiffness', 'stiff shoulder', 'conservative', since inception of databases to June 2018 was performed. AREAS OF AGREEMENT Shoulder stiffness could be treated with conservative means including nonsteroidal anti-inflammatory medications, corticosteroid injections, or transcutaneous electrical nerve stimulation, manipulation under anaesthesia, and arthroscopic capsular release. AREAS OF CONTROVERSY No therapeutic intervention is universally accepted, and the most effective management to restore motion and diminish pain in patients with shoulder stiffness has yet to be defined. GROWING POINTS The rate of failure after treatment for stiff shoulder is higher in the surgical group than in the conservative group. AREAS TIMELY FOR DEVELOPING RESEARCH There is insufficient evidence to establish whether surgical or conservative management is the best choice to manage shoulder stiffness. Prospective, randomized studies are needed to establish whether surgical or conservative management produce a clinically relevant difference in functional outcome.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria, Rome, Italy
| | - Mauro Ciuffreda
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria, Rome, Italy
| | - Joel Locher
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria, Rome, Italy
| | - Stefan Buchmann
- Department of Orthopaedic Sports Medicine, Klinikumrechts der Isar, Technical University of Munich, Ismaningerstr. 22, Munich, Germany
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria, Rome, Italy
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CELIK HALUK, SECKIN MUSTAFAFAIK, AKCAL MEHMETAKIF, KARA ADNAN, KILINC BEKIRERAY, AKMAN SENOL. MID-LONG TERM RESULTS OF MANIPULATION AND ARTHROSCOPIC RELEASE IN FROZEN SHOULDER. ACTA ORTOPEDICA BRASILEIRA 2017; 25:270-274. [PMID: 29375258 PMCID: PMC5782862 DOI: 10.1590/1413-785220172506174033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Surgical treatment options should be discussed in cases of frozen shoulder, which is usually treated in a conservative manner. In this study, we evaluated the efficacy of manipulation and arthroscopic release in cases of frozen shoulder which resisted conservative treatment. METHODS A total of 32 patients who underwent manipulation and arthroscopic capsular release in 34 shoulders were included in the study. The average follow-up period was 49.5 months (range: 24-90 months). No reason for onset could be found in 8 (25%) patients, who were classified as primary frozen shoulder; twenty-four (75%) patients were classified as secondary frozen shoulder due to underlying pathologies. The average pre-operative complaint period was 11 months (range: 3-24 months). After arthroscopic examination, manipulation was performed first, followed by arthroscopic capsular release. The range of motion in both shoulders was compared before the procedure and in the last follow-up visit. Constant and Oxford classifications were used to assess functional results, and the results were assessed statistically. RESULTS Patient values for passive elevation, abduction, adduction-external rotation, abduction-external rotation, and abduction-internal rotation increased in a statistically significant manner between the preoperative assessment and follow-up evaluation (p<0.01). The average change of 47.97±21.03 units observed in the patients' values obtained in the control measurements against the pre-op Constant scores was determined to be statistically significant (p<0.01). According to the Oxford classification, 29 shoulders were sufficient. CONCLUSION Successful results can be obtained with arthroscopic release performed after manipulation in patients with frozen shoulder resistant to conservative treatment. Level of Evidence IV, Case Series.
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Cerny M, Omoumi P, Larbi A, Manicourt D, Perozziello A, Lecouvet FE, Berg BV, Dallaudière B. CT arthrography of adhesive capsulitis of the shoulder: Are MR signs applicable? Eur J Radiol Open 2017; 4:40-44. [PMID: 28409175 PMCID: PMC5379909 DOI: 10.1016/j.ejro.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine if diagnostic signs of adhesive capsulitis (AC) of the shoulder at Magnetic Resonance Imaging (MRI) and arthrography (MRA) are applicable to CT arthrography (CTA). METHODS 22 shoulder CTAs with AC were retrospectively reviewed for features described in MR literature. The control group was composed of 83 shoulder CTA divided into four subgroups 1) normal (N = 20), 2) omarthrosis (N = 19), 3) labral injury (N = 23), and 4) rotator cuff tear (N = 21). Two musculoskeletal radiologists assessed the rotator interval (RI) for obliteration, increased width and thickening of coracohumeral ligament (CHL). The width and capsule thickness of the axillary recess were measured. RESULTS The width of the axillary recess was significantly decreased in the AC group (4.6 ± 2.6 mm versus 9.9 ± 4.6 mm, p ≤ 0.0001; sensitivity and specificity of 84% and 80%). Thickness of the medial and lateral walls of the axillary capsule was significantly increased in the AC group (5.9 ± 1.3 mm versus 3.7 ± 1.1 mm, p ≤ 0.0001 and 5.7 ± 1 mm versus 3.5 ± 1.3 mm, p ≤ 0.0001, respectively). CHL thickness was significantly increased in the AC group (4.1 ± 1 mm (p ≤ 0.001)) in comparison to others groups. Obliteration of the RI was statistically significantly more frequent in patients with AC (72.7% (16/22) vs. 12% (10/83), p < 0.0001). Width of the RI did not differ significantly between patients and controls (p ≥ 0.428). CONCLUSION Decreased axillary width, and thickened axillary capsule are MR signs of AC applicable to CTA. Evaluation of rotator interval seems useful and reproducible only for obliteration.
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Affiliation(s)
- Milena Cerny
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium.,Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium.,Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Ahmed Larbi
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium
| | - Daniel Manicourt
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium
| | | | - Frederic E Lecouvet
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium
| | - Bruno Vande Berg
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium
| | - Benjamin Dallaudière
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussel, Belgium.,Centre d'Imagerie Ostéo-articulaire, Clinique du Sport de Bordeaux-Mérignac, 2, rue Négrevergne, 33700 Mérignac, France
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Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow 2017; 9:75-84. [PMID: 28405218 PMCID: PMC5384535 DOI: 10.1177/1758573216676786] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 10/09/2016] [Indexed: 12/12/2022]
Abstract
Adhesive shoulder capsulitis, or arthrofibrosis, describes a pathological process in which the body forms excessive scar tissue or adhesions across the glenohumeral joint, leading to pain, stiffness and dysfunction. It is a debilitating condition that can occur spontaneously (primary or idiopathic adhesive capsulitis) or following shoulder surgery or trauma (secondary adhesive capsulitis). Here, we review the pathophysiology of adhesive shoulder capsulitis, highlighting its clinical presentation, natural history, risk factors, pathoanatomy and pathogenesis. Both current non-operative and operative treatments for adhesive capsulitis are described, and evidence-based studies are presented in support for or against each corresponding treatment. Finally, the review also provides an update on the gene expression profile of adhesive capsulitis and how this new understanding can help facilitate development of novel pharmacological therapies.
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Affiliation(s)
- Hai V. Le
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA,Hai V. Le, Beth Israel Deaconess Medical Center (BIDMC), 330 Brookline Ave, Boston, MA 02215, USA.
| | - Stella J. Lee
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA
| | - Edward K. Rodriguez
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA
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Ekim AA, İnal EE, Gönüllü E, Hamarat H, Yorulmaz G, Mumcu G, Yılmazer Ş, Kaya DS, Kuzgun S, Çolak E, Orhan H. Continuous passive motion in adhesive capsulitis patients with diabetes mellitus: A randomized controlled trial. J Back Musculoskelet Rehabil 2016; 29:779-786. [PMID: 27002662 DOI: 10.3233/bmr-160689] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to clarify the effects of continuous passive motion (CPM) treatment on adhesive capsulitis (AC) in diabetes mellitus (DM) patients. METHODS Forty-one DM patients with AC were randomized to two treatment groups. The first group (n= 20) (CPM group) received CPM treatments; the second group (n= 21) had conventional physical therapy (CPT group), including active stretching, range of motion (ROM) and pendulum exercises. All patients received electrotherapy. After a four-week-long physical therapy program, the patients were instructed to continue with an eight-week home exercise program. The patients rated the pain they felt at night, both while at rest and in motion, in the past week using the visual analogue scale (VAS). Functional outcome evaluations were performed using the Constant Shoulder Score (CSS) and Shoulder Pain and Disability Index (SPADI). All patients were evaluated at baseline, and during the fourth and twelfth weeks of the study. RESULTS There were significant improvements in both groups' active and passive ROM for the shoulder, VAS measures, SPADI pain and disability scores and CSS, and excluding the active and passive internal and external rotation of shoulder increased with both treatment methods (CPM or CPT) over time (p< 0.001), however these differences were found to be prominent in patients receiving CPM therapy. CONCLUSIONS Both the CPM and CPT therapies seemed to be beneficial for the treatment of AC in DM patients, however CPM revealed more distinctive improvements in the function and pain levels of the AC patients.
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Affiliation(s)
- Ayşe Aydemir Ekim
- Department of Physical Medicine and Rehabilitation, Zübeyde Hanım Campus, Eskişehir Public Hospital, Eskişehir, Turkey
| | - Esra Erkol İnal
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Emel Gönüllü
- Department of Rheumatology, Eskişehir Public Hospital, Eskişehir, Turkey
| | - Hatice Hamarat
- Department of Internal Medicine, Eskişehir Public Hospital, Eskişehir, Turkey
| | - Göknur Yorulmaz
- Department of Endocrinology, Eskişehir Public Hospital, Eskişehir, Turkey
| | - Gamze Mumcu
- Department of Physical Medicine and Rehabilitation, Zübeyde Hanım Campus, Eskişehir Public Hospital, Eskişehir, Turkey
| | - Şebnem Yılmazer
- Department of Physical Medicine and Rehabilitation, Zübeyde Hanım Campus, Eskişehir Public Hospital, Eskişehir, Turkey
| | - Dilek Serin Kaya
- Department of Physical Medicine and Rehabilitation, Zübeyde Hanım Campus, Eskişehir Public Hospital, Eskişehir, Turkey
| | - Selen Kuzgun
- Department of Physical Medicine and Rehabilitation, Zübeyde Hanım Campus, Eskişehir Public Hospital, Eskişehir, Turkey
| | - Ertuǧrul Çolak
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
| | - Hikmet Orhan
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
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Vastamäki H, Ristolainen L, Vastamäki M. Range of motion of diabetic frozen shoulder recovers to the contralateral level. J Int Med Res 2016; 44:1191-1199. [PMID: 27856934 PMCID: PMC5536758 DOI: 10.1177/0300060516675112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective To determine whether frozen shoulder heals equally well in patients with and without diabetes and whether dependency on insulin affects the outcome. Methods We retrospectively examined 178 patients with idiopathic frozen shoulder; 27 patients had diabetes. We evaluated range of motion, pain, and functional results. The mean follow-up was 9.7 years (SD, 7.1 years). Results In the presence of frozen shoulder, range of motion did not differ between patients with and without diabetes. At follow-up, range of motion in all directions of both the affected and unaffected shoulders of patients with diabetes was inferior to that of patients without diabetes. Among patients with diabetes, range of motion of the once-frozen shoulder reached the level of the unaffected shoulder. Patients with and without diabetes experienced similar pain except during exertion. The Constant–Murley score was not significantly different between the two groups, and insulin dependency did not lead to worse outcomes. Conclusion Frozen shoulder heals well in patients with diabetes.
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Affiliation(s)
- Heidi Vastamäki
- ORTON Foundation and ORTON Orthopaedic Hospital, Helsinki, Finland
| | | | - Martti Vastamäki
- ORTON Foundation and ORTON Orthopaedic Hospital, Helsinki, Finland
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Ueda Y, Sugaya H, Takahashi N, Matsuki K, Kawai N, Tokai M, Onishi K, Hoshika S. Rotator Cuff Lesions in Patients with Stiff Shoulders: A Prospective Analysis of 379 Shoulders. J Bone Joint Surg Am 2015; 97:1233-7. [PMID: 26246257 DOI: 10.2106/jbjs.n.00910] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Idiopathic adhesive capsulitis is defined as a frozen shoulder with severe and global range-of-motion loss of unknown etiology. The purpose of our study was to clarify the prevalence of rotator cuff lesions according to patterns and severity of range-of-motion loss in a large cohort of patients with stiff shoulders. METHODS Rotator cuff pathology was prospectively investigated with use of magnetic resonance imaging (MRI) or ultrasonography in a series of 379 stiff shoulders; patients with traumatic etiology, diabetes, or radiographic abnormalities were excluded. Eighty-nine shoulders demonstrated severe and global loss of passive motion (≤100° of forward flexion, ≤10° of external rotation with the arm at the side, and internal rotation not more cephalad than the L5 level) and were classified as having severe and global loss of motion (Group 1). The remaining 290 shoulders were divided into two groups: those with severe but not global loss (Group 2; 111 shoulders) and mild to moderate limitation (Group 3; 179 shoulders). RESULTS Among all shoulders, imaging demonstrated an intact rotator cuff in 51%, a full-thickness tear in 35%, and a partial-thickness tear in 15%. In Group 1, 91% had an intact rotator cuff and 9% had a partial-thickness rotator cuff tear. No patient in this group demonstrated a full-thickness tear. In Group 2 and Group 3, respectively, 44% and 35% of the shoulders were intact, 17% and 16% had a partial-thickness tear, and 39% and 50% had a full-thickness tear. CONCLUSIONS Shoulder stiffness with severe and global loss of passive range of motion is not associated with full-thickness rotator cuff tears, although some patients may have a partial-thickness tear. Shoulders with severe and global loss of range of motion at a first visit are likely to be cases of idiopathic adhesive capsulitis and may not require further imaging studies.
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Affiliation(s)
- Yusuke Ueda
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
| | - Hiroyuki Sugaya
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
| | - Norimasa Takahashi
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
| | - Keisuke Matsuki
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
| | - Nobuaki Kawai
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
| | - Morihito Tokai
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
| | - Kazutomo Onishi
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
| | - Shota Hoshika
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
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Moon NH, Lee SJ, Shin WC, Lee SM, Suh KT. Is Pancapsular Release More Effective than Selective Capsular Release for the Treatment of Adhesive Capsulitis? Clin Shoulder Elb 2015. [DOI: 10.5397/cise.2015.18.1.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Nagata H, Thomas WJC, Woods DA. The management of secondary frozen shoulder after anterior shoulder dislocation - The results of manipulation under anaesthesia and injection. J Orthop 2015; 13:100-5. [PMID: 27053831 DOI: 10.1016/j.jor.2015.01.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/27/2015] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Patients with secondary frozen shoulder following anterior dislocation were treated with manipulation under anaesthesia (MUA) and injection. METHODS Ten patients included in study. Oxford Shoulder Scores (OSS), range of motion (ROM) and need for any further treatment measured. RESULTS Mean follow-up of 93 weeks. OSS and ROM improved in all patients. Three patients required repeat MUA. Two patients developed recurrent instability. DISCUSSION Secondary frozen shoulder may be more recalcitrant. Recurrent instability is a risk following anterior shoulder dislocation. It is feasible that by performing an MUA to maximise mobility, stability may be sacrificed. It should be performed with caution.
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Affiliation(s)
- Hideki Nagata
- Department of Trauma & Orthopaedics, Great Western Hospitals NHS Foundation Trust, Swindon, SN3 6BB, United Kingdom
| | - William J C Thomas
- Department of Trauma & Orthopaedics, Great Western Hospitals NHS Foundation Trust, Swindon, SN3 6BB, United Kingdom
| | - David A Woods
- Department of Trauma & Orthopaedics, Great Western Hospitals NHS Foundation Trust, Swindon, SN3 6BB, United Kingdom
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Kim YS, Lee HJ, Park IJ. Clinical outcomes do not support arthroscopic posterior capsular release in addition to anterior release for shoulder stiffness: a randomized controlled study. Am J Sports Med 2014; 42:1143-9. [PMID: 24585363 DOI: 10.1177/0363546514523720] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic capsular release is an effective treatment for shoulder stiffness, yet its extent is controversial. PURPOSE To compare the clinical outcomes of arthroscopic capsular release in patients with and without posterior extended capsular release for shoulder stiffness. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Between January 2008 and March 2011, 75 patients who underwent arthroscopic capsular release for shoulder stiffness were enrolled and randomized into 2 groups. In group I (n = 37), capsular release was performed, including release of the rotator interval and anterior and inferior capsule. In group II (n = 38), capsular release was extended to the posterior capsule. The American Shoulder and Elbow Surgeons score, Simple Shoulder Test, visual analog scale for pain, and range of motion (ROM) were used for the evaluation before surgery and at 3, 6, and 12 months after surgery and at the last follow-up. RESULTS Preoperative demographic data of age, sex, symptom duration, and clinical outcomes showed no significant differences (P > .05). The average follow-up was 18.4 months. Both groups showed significantly increased ROM at the last follow-up compared with preoperative ROM (P < .05). At the last follow-up, no statistical differences were found (P > .05) between groups I and II in American Shoulder and Elbow Surgeons score (91.3 vs. 79.5), Simple Shoulder Test (83.3 vs. 83.3), and visual analog scale (1.5 vs. 2.2). There were also no statistical differences between the 2 groups at the last follow-up (P > .05) in ROM: forward flexion, 145.2° vs. 143.3°; external rotation with 90° of abduction, 88.1° vs. 86.2°; external rotation at side, 88.9° vs. 82.9°; and internal rotation, 9.1° vs. 8.3°. CONCLUSION Posterior extended capsular release might not be necessary in arthroscopic surgery for shoulder stiffness.
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Affiliation(s)
- Yang-Soo Kim
- Hyo-Jin Lee, 505 Banpo-dong, Seocho-gu, Seoul, Korea, 137-701, Department of Orthopedic Surgery, Seoul St Mary's Hospital, The Catholic University of Korea.
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Functional results and patient satisfaction after arthroscopic capsular release of idiopathic and post-traumatic stiff shoulder. INTERNATIONAL ORTHOPAEDICS 2014; 38:1205-11. [PMID: 24469306 DOI: 10.1007/s00264-014-2283-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this prospective study was to compare the functional results and patient satisfaction after arthroscopic shoulder capsular release in patients with idiopathic and posttraumatic stiff shoulder. METHODS The study included 50 patients who underwent arthroscopic capsular release after failure of conservative treatment. The etiology of stiffness was either idiopathic (25 patients) or post-traumatic (25 patients). There were 28 women and 22 men with an average age of 49 years (range, 32-70 years). All patients were treated with physical therapy for a mean of six months (range, 3-12 months) before surgery. Range of motion was measured three times: 48 hours after surgery, then one month and six months after surgery. RESULTS Constant score showed improvement for both groups of patients in the period of six months after surgery. In the group with idiopathic stiffness the score increased from 36 to 86, while in the group with post-traumatic stiff shoulder the score advanced from 32 to 91. The idiopathic stiff shoulder group had an improved active forward flexion from 90 to 161°, external rotation from 10 to 40°, and internal rotation from L5 to L1. In the post-traumatic stiff shoulder groupthe forward flexion was improved from 95 to 170°, external rotation from 13 to 40° and internal rotation from L4 to L1. CONCLUSION There was an improvement of range of motions and patients' satisfaction after arthroscopic shoulder capsular release and manipulation under anesthesia, equally in idiopathic and post-traumatic stiff shoulder, compared to the situation before surgery. Post-traumatic contracture patients expressed higher level of satisfaction with their shoulder function than the idiopathic stiff shoulder patients.
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Sokk J, Gapeyeva H, Ereline J, Merila M, Pääsuke M. Shoulder muscle function in frozen shoulder syndrome patients following manipulation under anesthesia: a 6-month follow-up study. Orthop Traumatol Surg Res 2013; 99:699-705. [PMID: 23993770 DOI: 10.1016/j.otsr.2013.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 07/20/2012] [Accepted: 04/12/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The present study evaluates changes in shoulder muscle function in patients with frozen shoulder syndrome (FSS) following manipulation under general anesthesia (MUA). PATIENTS AND METHODS Fifteen FSS patients with mean (±SD) age of 53.6±9.7 years were included in this study. Isometric endurance of the shoulder muscles was characterized by time and net impulse (NI), which were assessed with the patient holding a weight in the hand until exhaustion. Fatigability of the deltoid and trapezius muscles during isometric endurance test was assessed by electromyogram power spectrum median frequency (MF) slope per minute. Patients were also screened for daytime pain. Data were collected before MUA, and at 1 and 6 months postoperatively. RESULTS Six months postoperatively, the MF slope for the trapezius and deltoid muscles of the involved and uninvolved shoulders did not differ (P>0.05), whereas NI remained lower and endurance time was longer (P<0.05). Shoulder pain was reduced as compared to preoperative levels (on visual analog scale) 1 and 6 months postoperatively (P<0.05). DISCUSSION In patients with FSS, the fastest improvements in shoulder muscle NI, fatigability and pain take place in the first month after MUA; 6 months after MUA, however, NI and endurance time remained impaired for the involved shoulder. Physiotherapy should pay more attention to muscle function recovery. LEVEL OF EVIDENCE Level III, prospective follow-up study.
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Affiliation(s)
- J Sokk
- Institute of Exercise Biology and Physiotherapy, University of Tartu, Tartu, Estonia; Centre of Behavioral and Health Sciences, University of Tartu, Tartu, Estonia.
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Harris G, Bou-Haidar P, Harris C. Adhesive capsulitis: review of imaging and treatment. J Med Imaging Radiat Oncol 2013; 57:633-43. [PMID: 24283550 DOI: 10.1111/1754-9485.12111] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 08/10/2013] [Indexed: 12/23/2022]
Abstract
Adhesive capsulitis is one of the most common conditions affecting the shoulder; however, early clinical diagnosis can be challenging. Treatment is most effective when commenced prior to the onset of capsular thickening and contracture; consequently, the role of imaging is increasing. The aim of this review is to demonstrate the typical imaging appearances of adhesive capsulitis and to examine some of the evidence regarding each of these imaging modalities. An evaluation of the various management options available to the clinician is also presented.
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Affiliation(s)
- Guy Harris
- Central Coast Local Health District, Gorsford, New South Wales, Australia
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21
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22
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Effects of whole-body cryotherapy in the management of adhesive capsulitis of the shoulder. Arch Phys Med Rehabil 2012; 94:9-16. [PMID: 22850489 DOI: 10.1016/j.apmr.2012.07.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 07/09/2012] [Accepted: 07/11/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare 2 different treatment approaches, physical therapy modalities, and joint mobilization versus whole-body cryotherapy (WBC) combined with physical therapy modalities and joint mobilization, for symptoms of adhesive capsulitis (AC) of the shoulder. DESIGN A randomized trial. SETTING Hospital. PARTICIPANTS Patients with AC of the shoulder (N=30). INTERVENTION Patients were randomly assigned to 2 groups. The WBC group received physical therapy modalities, passive joint mobilization of the shoulder, and WBC, whereas the non-WBC group received only physical therapy modalities and passive joint mobilization of the shoulder. MAIN OUTCOME MEASURES Visual analog scale (VAS), active range of motion (ROM) of flexion, abduction, internal and external rotation of the shoulder, and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) were measured before and after the intervention. RESULTS A statistically significant difference between groups was found for the VAS, active ROM of flexion, abduction, internal rotation, and external rotation, and the ASES with greater improvements in the WBC group (Ps<.01). Overall, both groups showed a significant improvement in all outcome measures and ROM measures from pre to post at a level of P<.01. CONCLUSIONS There is significant improvement with the addition of WBC to treatment interventions in this sample of patients.
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23
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Anakwenze OA, Hsu JE, Kim JS, Abboud JA. Acromioclavicular joint pain in patients with adhesive capsulitis: a prospective outcome study. Orthopedics 2011; 34:e556-60. [PMID: 21902157 DOI: 10.3928/01477447-20110714-05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Diagnosis of adhesive capsulitis is a clinical diagnosis based on history and physical examination. Afflicted patients exhibit active and passive loss of motion in all planes and a positive capsular stretch sign. The effect of adhesive capsulitis on acromioclavicular biomechanics leading to tenderness has not been documented in the literature. This study reports on the incidence of acromioclavicular tenderness in the presence of adhesive capsulitis. Furthermore, we note the natural history of such acromioclavicular joint pain in relation to that of adhesive capsulitis. Over a 2-year period (2005-2007), 84 patients undergoing initial evaluation for adhesive capsulitis were prospectively examined with the use of validated outcome measures and physical examination. Acromioclavicular joint tenderness results were compared and analyzed on initial evaluation and final follow-up of at least 1 year. Forty-eight patients (57%) with adhesive capsulitis had acromioclavicular joint pain on examination. At final follow-up, as range of motion improved, a significant increase in American Shoulder and Elbow Surgeons/Penn shoulder score and decrease in number of patients with acromioclavicular pain was noted with only 6 patients with residual pain (P<.05). In the presence of adhesive capsulitis, there is not only compensatory scapulothoracic motion but also acromioclavicular motion. This often results in transient symptoms at the acromioclavicular joint, which abate as the frozen shoulder resolves and glenohumeral motion improves. This is important to recognize to avoid unnecessary invasive treatment of the acromioclavicular joint when the patient presents with adhesive capsulitis.
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Affiliation(s)
- Oke A Anakwenze
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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24
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Sabat D, Kumar V. Early arthroscopic release in stiff shoulder. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2011; 2:36-40. [PMID: 20300309 PMCID: PMC2840819 DOI: 10.4103/0973-6042.40455] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: To evaluate the results of early arthroscopic release in the patients of stiff shoulder Methods: Twenty patients of stiff shoulder, who had symptoms for at least three months and failed to improve with steroid injections and physical therapy of 6 weeks duration, underwent arthroscopic release. The average time between onset of symptoms and the time of surgery was 4 months and 2 weeks. The functional outcome was evaluated using ASES and Constant and Murley scoring systems. Results: All the patients showed significant improvement in the range of motion and relief of pain by end of three months following the procedure. At 12 months, mean improvement in ASES score is 38 points and Constant and Murley score is 4O.5 points. All patients returned to work by 3-5 months (average -4.5 months). Conclusion: Early arthroscopic release showed promising results with reliable increase in range of motion, early relief of symptoms and consequent early return to work. So it is highly recommended in properly selected patients. Level of evidence: Level IV
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Affiliation(s)
- Dhananjaya Sabat
- Department of Orthopedic Surgery, Maulana Azad Medical College and Associated LN Hospital, New Delhi, India
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Gokalp G, Algin O, Yildirim N, Yazici Z. Adhesive capsulitis: Contrast-enhanced shoulder MRI findings. J Med Imaging Radiat Oncol 2011; 55:119-25. [DOI: 10.1111/j.1754-9485.2010.02215.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Shoulder Elbow Surg 2011; 20:502-14. [PMID: 21167743 DOI: 10.1016/j.jse.2010.08.023] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 08/10/2010] [Accepted: 08/24/2010] [Indexed: 02/01/2023]
Affiliation(s)
- Jason E Hsu
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Rill BK, Fleckenstein CM, Levy MS, Nagesh V, Hasan SS. Predictors of outcome after nonoperative and operative treatment of adhesive capsulitis. Am J Sports Med 2011; 39:567-74. [PMID: 21160014 DOI: 10.1177/0363546510385403] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies regarding adhesive capsulitis have concurrently evaluated nonoperative and operative treatment. PURPOSE The objectives were to evaluate the efficacy of operative and nonoperative treatment of adhesive capsulitis and to determine predictors of clinical outcome. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS At minimum 24 months' follow-up, 85 patients underwent self-assessment using the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) score, including 24 patients treated operatively. RESULTS Mean number of yes responses on the SST improved from 4.0 ± 2.7 at initial presentation to 9.9 ± 2.8 at final follow-up (P < .0001). Patients who received nonoperative treatment and patients who underwent surgery demonstrated similar improvements on the SST. For the entire cohort, forward elevation and external rotation at the side improved from 119° ± 20° to 152° ± 15° and from 29° ± 18° to 46° ± 11° (P < .0001), respectively, between initial presentation and discharge from treatment. Internal rotation to the back improved from the gluteal area to the thoracolumbar junction (P < .0001). Improvements in forward elevation and external rotation were greater for patients undergoing surgery. After nonoperative treatment, patients with diabetes had a lower final SST than patients without diabetes (P < .05). For the entire cohort, initial SST predicted final SST (P < .05), and a shorter duration of symptoms predicted a higher final ASES score (P < .05). Younger patients (P < .001) and those with a lower initial SST (P < .05) were more likely to undergo surgery. CONCLUSIONS A multimodal nonoperative treatment program is effective for most patients with adhesive capsulitis. Patients who do not improve, including those with diabetes, respond well to manipulation and arthroscopic release. Residual motion deficits at discharge from treatment do not appear to affect longer-term clinical outcome.
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Affiliation(s)
- Brian K Rill
- Cincinnati Sports Medicine Research and Education Foundation, 10663 Montgomery Road, Cincinnati, OH 45242, USA
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Use of continuous interscalene brachial plexus block and rehabilitation to treat complex regional pain syndrome of the shoulder. Ann Phys Rehabil Med 2010; 53:406-16. [DOI: 10.1016/j.rehab.2010.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 05/31/2010] [Indexed: 11/23/2022]
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Elhassan B, Ozbaydar M, Massimini D, Higgins L, Warner JJP. Arthroscopic capsular release for refractory shoulder stiffness: a critical analysis of effectiveness in specific etiologies. J Shoulder Elbow Surg 2010; 19:580-7. [PMID: 20004595 DOI: 10.1016/j.jse.2009.08.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 08/11/2009] [Accepted: 08/17/2009] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose of this study is to report and compare the outcome of arthroscopic capsular release in patients with shoulder stiffness with post-traumatic, postsurgical, and idiopathic etiologies. We hypothesize that patients with idiopathic or post-traumatic stiffness have better outcomes after arthroscopic capsular release than those with shoulder stiffness with a postsurgical etiology. MATERIALS AND METHODS A retrospective review of 115 patients who underwent arthroscopic capsular release for refractory shoulder stiffness was performed. There were 60 men and 55 women with a mean age of 49 years (range, 27 to 81 years). The patients were divided into 3 groups according to the etiology of stiffness: post-traumatic (26 patients), postsurgical (48 patients), and idiopathic (41 patients). Arthroscopic capsular release was performed in all patients after a mean of 9 months of physical therapy (range, 6 to 13 months). RESULTS At a mean follow-up of 46 months (range, 25 to 89 months), the overall subjective shoulder value in all groups improved from 29% to 73% and the age- and gender-adjusted Constant score improved from 35% to 86%. The mean pain score decreased from 7.5 to 1, and mean active forward flexion, external rotation, and internal rotation increased from 97 degrees , 14 degrees , and the L5 vertebral level, respectively, to 135 degrees , 38 degrees , and the T11 vertebral level, respectively (P < .0001). There was no significant difference between the outcomes of idiopathic and post-traumatic stiffness (P = .7). However, the Constant score and subjective shoulder value were significantly lower in the postsurgical group compared with the idiopathic and post-traumatic groups (P = .0001 and P = .006, respectively). CONCLUSIONS Arthroscopic capsular release is an effective treatment for refractory shoulder stiffness. Patients with idiopathic and post-traumatic shoulder stiffness have better outcomes than patients with postsurgical stiffness.
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Affiliation(s)
- Bassem Elhassan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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30
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Cinar M, Akpinar S, Derincek A, Circi E, Uysal M. Comparison of arthroscopic capsular release in diabetic and idiopathic frozen shoulder patients. Arch Orthop Trauma Surg 2010; 130:401-6. [PMID: 19471947 DOI: 10.1007/s00402-009-0900-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The clinical results of arthroscopic capsular release for frozen shoulder in diabetic (group 1) and idiopathic (group 2) patients were compared. Surgery was performed on 28 shoulders of 26 patients (24 women, 2 men) with frozen shoulder unresponsive to conservative treatment. The mean age was 50 (range 40-65). A total of 14 patients were included in group 1, and 12 were in group 2. The average duration of complaints was 10 and 7 months in groups 1 and 2, respectively. The evaluation of shoulder functions was made according to the University of California, Los Angeles (UCLA) and Constant Scoring Systems. Duration of complete pain relief and for regaining range of motion (ROM) after surgery were also noted in their final follow-up examination. RESULTS The mean follow-up period was 48.5 and 60.2 months in group 1 and group 2, respectively. There was no significant difference between the two groups in terms of the postoperative duration of complete pain relief and that for regaining ROM (P > 0.05). The duration of complete pain relief was 2.6 and 2.5 months, and regaining of ROM was 1.6 and 1.5 months for groups 1 and 2, respectively. The postoperative UCLA and Constant scores had significant increases in both groups compared to the preoperative ones (P < 0.05). There was a significant difference between the groups in terms of Constant scores (P < 0.05) while there was no difference in terms of UCLA scores (P > 0.05). There was a statistically significant difference in shoulder abduction and internal rotation degrees between the groups (P < 0.05). CONCLUSION The results of arthroscopic capsular release for frozen shoulder in diabetic patients had less good results in terms of range of motion and Constant-Score. There was no significant difference between the two groups in terms of the duration of pain relief and that of regaining the ROM.
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Affiliation(s)
- Murat Cinar
- Department of Orthopaedic and Trauma Surgery, Adana Research and Education Center, Baskent University School of Medicine, Dadaloglu Mah. 39 Sk. No: 6, Yuregir, Adana, Turkey.
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Jacobs LG, Smith MG, Khan SA, Smith K, Joshi M. Manipulation or intra-articular steroids in the management of adhesive capsulitis of the shoulder? A prospective randomized trial. J Shoulder Elbow Surg 2009; 18:348-53. [PMID: 19393928 DOI: 10.1016/j.jse.2009.02.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 12/18/2008] [Accepted: 02/04/2009] [Indexed: 02/01/2023]
Abstract
BACKGROUND The management of adhesive capsulitis (frozen shoulder) is controversial. The authors present a prospective randomized study comparing the outcome, at a two-year follow-up period, of two groups of patients treated either by manipulation of the shoulder under anaesthetic or by intra-articular shoulder injections using steroid with distension. METHODS Fifty-three patients suffering from Idiopathic "Primary" Frozen Shoulder were prospectively randomized into two treatment groups and followed up for two years from the start of treatment. Patients were assessed using the Constant score, a Visual Analogue Score, and the SF36 questionnaire. RESULTS No statistical differences were found between the two groups of patients with regards to the outcome measures. CONCLUSION Treatment using steroid injections with distension as an out-patient is therefore recommended for the treatment of Idiopathic "Primary" Frozen Shoulder. This has the same clinical outcome as a manipulation under anaesthetic with less attendant risks.
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Affiliation(s)
- Leo G Jacobs
- Department of Orthopaedics, Royal Oldham Hospital, Oldham, Lancashire, United Kingdom
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Abstract
UNLABELLED Frozen shoulder or adhesive capsulitis describes the common shoulder condition characterized by painful and limited active and passive range of motion. The etiology of frozen shoulder remains unclear; however, patients typically demonstrate a characteristic history, clinical presentation, and recovery. A classification schema is described, in which primary frozen shoulder and idiopathic adhesive capsulitis are considered identical and not associated with a systemic condition or history of injury. Secondary frozen shoulder is defined by 3 subcategories: systemic, extrinsic, and intrinsic. We also propose another classification system based on the patient's irritability level (low, moderate, and high), that we believe is helpful when making clinical decisions regarding rehabilitation intervention. Nonoperative interventions include patient education, modalities, stretching exercises, joint mobilization, and corticosteroid injections. Glenohumeral intra-articular corticosteroid injections, exercise, and joint mobilization all result in improved short- and long-term outcomes. However, there is strong evidence that glenohumeral intra-articular corticosteroid injections have a significantly greater 4- to 6-week beneficial effect compared to other forms of treatment. A rehabilitation model based on evidence and intervention strategies matched with irritability levels is proposed. Exercise and manual techniques are progressed as the patient's irritability reduces. Response to treatment is based on significant pain relief, improved satisfaction, and return of functional motion. Patients who do not respond or worsen should be referred for an intra-articular corticosteroid injection. Patients who have recalcitrant symptoms and disabling pain may respond to either standard or translational manipulation under anesthesia or arthroscopic release. LEVEL OF EVIDENCE Level 5.
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Yoo JC, Ahn JH, Lee YS, Koh KH. Magnetic resonance arthrographic findings of presumed stage-2 adhesive capsulitis: focus on combined rotator cuff pathology. Orthopedics 2009; 32:22. [PMID: 19226041 DOI: 10.3928/01477447-20090101-29] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to report the magnetic resonance arthrography (MRA) findings of patients considered to have stage-2 idiopathic adhesive capsulitis and to identify differences in rotator cuff pathologies between 2 age groups (ie, =or< and >60 years). Eighty-one patients, considered to have stage-2 idiopathic adhesive capsulitis based on medical history and a physical examination underwent MRA. Magnetic resonance evaluations focused on combined pathologies other than adhesive capsulitis, especially on the supraspinatus tendon. The pathologies of supraspinatus tendon were divided into 4 categories: normal, tendinosis, partial-tears, and full-thickness tears. Mean patient age was 66 years and mean symptom duration was 8.9 months. There were 38 men and 43 women. Overall, 50 patients (61.7%) showed some form of supraspinatus tendon pathology [small full-thickness tears 6 (7.4%), partial-thickness tears 25 (30.9%), and supraspinatus tendon tendinosis 19 (23.5%)]. The most common MRA finding, other than rotator cuff pathology, was the impression of adhesive capsulitis in 58 patients (71.6%). Group 2 (>60 years) showed a higher prevalence of full and partial-thickness tears (P<.05), however the overall prevalence of supraspinatus tendon pathologies were similar in those younger than and older than 60 years (P=.1795). Approximately 1/3 of stage-2 adhesive capsulitis patients showed some form of supraspinatus tendon tear by MRA, and <10% of patients who were considered to have idiopathic adhesive capsulitis had a full-thickness tear. Adhesive capsulitis patients older than 60 years appeared to be more likely to have a supraspinatus tendon tear.
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Affiliation(s)
- Jae Chul Yoo
- Department of Orthopedic Surgery, Korea University Ansan Hospital, 516 Gozan-dong, Danwon-gu, Ansan 425-707, Korea
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Kanbe K, Inoue K, Inoue Y. Dynamic movement of the long head of the biceps tendon in frozen shoulders. J Orthop Surg (Hong Kong) 2008; 16:295-9. [PMID: 19126893 DOI: 10.1177/230949900801600305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To assess the importance of the dynamic movement of the long head of the biceps (LHB) tendon for treatment of frozen shoulder. METHODS 87 consecutive patients (with 88 frozen shoulders) aged 36 to 77 (mean, 54) years underwent arthroscopic capsular release by a single surgeon. Preoperative treatments included rehabilitation, steroid and/or hyaluronic acid injections. The inclusion criteria were severe night pain, no improvement of flexion and external rotation, and poor response to rehabilitation for at least 6 months. Shoulders were divided into 3 types; types A/B/C indicate slight/moderate/severe degree of synovitis and adhesion of the LHB tendon to the rotator interval. 23 shoulders were type A, 26 type B, and 39 type C. 18 of the 39 type-C shoulders were controls with release of the capsule alone but not the LHB tendon. Patients were followed up for a mean of 21 (range, 12-35) months. Changes in the American Shoulder and Elbow Surgeons (ASES) score, range of movement, and muscle strength (flexion and external rotation) among types A, B, C, and controls were compared. RESULTS The severity of the adhesion of the LHB tendon to the rotator interval was associated with the ASES score. In all adhesion types, muscle strength and the range of movement in flexion, external rotation, and internal rotation improved postoperatively. CONCLUSIONS Arthroscopic capsular release for adhesion of the LHB tendon to the rotator interval improves the sliding movement and thereby shoulder function.
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Affiliation(s)
- K Kanbe
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Medical Center East, Arakawa, Tokyo, Japan.
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Rundquist PJ. Alterations in scapular kinematics in subjects with idiopathic loss of shoulder range of motion. J Orthop Sports Phys Ther 2007; 37:19-25. [PMID: 17286095 DOI: 10.2519/jospt.2007.2121] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To determine the effect of idiopathic loss of shoulder range of motion on scapular kinematics. BACKGROUND Subjects with idiopathic loss of shoulder range of motion have difficulty performing activities of daily living. Previous investigations have focused on the glenohumeral component of shoulder complex motion. MATERIALS AND METHODS Seventeen unilaterally impaired and 17 nonimpaired subjects. The 3-dimensional motion of the humerus, scapula, and trunk were measured withthe Fastrak electromagnetic motion-tracking system during humerus-to-trunk scapular plane elevation. An analysis of variance compared the impaired subjects noninvolved to the nonimpaired subjects' scapulae at 4 scapularplane elevation positions. A repeated-measures analysis of variance compared the impaired subjects' involved and noninvolved scapulae at 3 scapular plane elevation positions, and matched-pairs t test compared peak elevation values. RESULTS The between-group ANOVAs demonstrated no difference in anterior tipping, internal rotation, or upward rotation. The repeated-measures ANOVAs demonstrated no difference in anterior tipping or internal rotation and a position-by-side interaction in upward rotation. The involved-side scapulae were more upwardly rotated (7.7 degrees) at peak humerus-to-trunk scapular plane elevation. DISCUSSION AND CONCLUSION The impaired subjects' noninvolved scapular kinematics were not significantly different than the nonimpaired subjects, but were significantly different than their involved scapulae. The upward rotation differences may be a substitution pattern used to accomplish functional elevation.
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Affiliation(s)
- Peter J Rundquist
- University of Indianapolis, Krannert School of Physical Therapy, 1400 East Hanna Avenue, Indianapolis, IN 46227, USA.
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Sirveaux F, Roche O, Aubrion JH, Gosselin O, Mole D. [Arthroscopic treatment of capsular shoulder stiffness.]. CHIRURGIE DE LA MAIN 2006; 25S1:S43-S49. [PMID: 17349410 DOI: 10.1016/j.main.2006.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The shoulder capsular sitffness must be managed first by a physiotherapist and the arthroscopic release is indicated after failure. The clinical assessment is essential and reveals the loss of passive motion in specified direction. The x-rays and imaging are necessary for excluding the other etiologies of shoulder stiffness. The arthroscopic treatment is part of he treatment strategy which has to be explained to the patient. The arthroscopic treatment starts by measuring under anesthesia the loss of passive motion. The next step consists of the release of the rotator interval followed by resection of the anterior capsule. Finally, the posterior capsule is cut according to the location of the capsular retraction. The interest of the subacromial debridement is still of debate. The postoperative pain control and the rehabilitation are part of the treatment. The literature analysis demonstrates the efficiency of the arthroscopic treatment, even if the post-op care are often long. A delay of 6 months is currently necessary to obtain the final results. The main advantages of the arthroscopic treatment is to address specifically the retracted capsule and to perform a selective release which allow to start rehabilitation program early.
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Affiliation(s)
- F Sirveaux
- Clinique de traumatologie et d'orthopédie, SINCAL, 49, rue Hermite, 54000 Nancy, France
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Abstract
Adhesive capsulitis, or frozen shoulder syndrome, is a condition characterized by gradual loss of active and passive glenohumeral motion. The etiology of adhesive capsulitis is unknown. Treatment methods include supervised benign neglect, physical therapy, intra-articular corticosteroid injections, closed manipulation under anesthesia, arthroscopic capsular release, and open surgical release. Approximately 70% of patients presenting with adhesive capsulitis are women; however, the role of sex in the etiology, development, and outcome of treatment for adhesive capsulitis remains unclear. Individualized treatment is necessary following thorough evaluation of patient symptoms and stage of the disease.
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Affiliation(s)
- Monique A Sheridan
- Women's Sports Medicine Center, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Diwan DB, Murrell GAC. An evaluation of the effects of the extent of capsular release and of postoperative therapy on the temporal outcomes of adhesive capsulitis. Arthroscopy 2005; 21:1105-13. [PMID: 16171636 DOI: 10.1016/j.arthro.2005.05.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate effects of the extent of surgical release and of postoperative physiotherapy on the outcomes of this procedure. TYPE OF STUDY Case-controlled cohort study. METHODS Pain and range of motion scores were compared preoperatively, operatively, and at 1, 6, 12, 24, 52, and 104 weeks postoperatively, in 2 temporal cohorts of patients with adhesive capsulitis. The first cohort (n = 18) underwent a 155 degrees +/- 40 degrees (mean +/- SEM) standard anteroinferior arthroscopic capsule release of the shoulder (ACR-S) and rehabilitation. The second cohort (n = 22) underwent capsular release that was extended an additional 65 degrees +/- 65 degrees posteriorly, a portion of the intra-articular part of the subscapularis tendon was divided, and the patients had a modified earlier, supervised postoperative physical therapy program (ACR-M). RESULTS In both cohorts, there was a significant reduction in pain 1 week after surgery, which was maintained at all time-points (P < .05). More gains in intraoperative range of forward flexion (121 degrees v 150 degrees), abduction (114 degrees v 146 degrees) and external rotation (55 degrees v 68 degrees) were obtained in the ACR-M cohort (P < .001). Six weeks after surgery, external and internal rotation regressed to preoperative levels in the ACR-S cohort; 2 of them required a re-release. This regression was not observed in the ACR-M cohort. There was no instability or weakness in lift-off power in either cohort. CONCLUSIONS This is a level IV study of 2 nonrandomized cohorts where simultaneous changes in surgical technique and rehabilitation were introduced to the ACR-M cohort. Arthroscopic capsular release for adhesive capsulitis resulted in significant reductions in pain by 1 week in both cohorts. A more extensive capsular release with division of the intra-articular portion of subscapularis improved intraoperative motion. Gains in internal and external rotation were lost postoperatively in the ACR-S cohort, but were preserved when an extended surgical release and an early, supervised postoperative physical therapy program was initiated in the ACR-M cohort. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Divya Bhargav Diwan
- Sports Medicine and Shoulder Service, Orthopedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, Australia
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Lee JC, Sykes C, Saifuddin A, Connell D. Adhesive capsulitis: sonographic changes in the rotator cuff interval with arthroscopic correlation. Skeletal Radiol 2005; 34:522-7. [PMID: 15999280 DOI: 10.1007/s00256-005-0957-0] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Revised: 04/19/2005] [Accepted: 06/01/2005] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the sonographic findings of the rotator interval in patients with clinical evidence of adhesive capsulitis immediately prior to arthroscopy. DESIGN AND PATIENTS We prospectively compared 30 patients with clinically diagnosed adhesive capsulitis (20 females, 10 males, mean age 50 years) with a control population of 10 normal volunteers and 100 patients with a clinical suspicion of rotator cuff tears. Grey-scale and colour Doppler sonography of the rotator interval were used. RESULTS Twenty-six patients (87%) demonstrated hypoechoic echotexture and increased vascularity within the rotator interval, all of whom had had symptoms for less than 1 year. Three patients had hypoechoic echotexture but no increase in vascularity, and one patient had a normal sonographic appearance. All patients were shown to have fibrovascular inflammatory soft-tissue changes in the rotator interval at arthroscopy commensurate with adhesive capsulitis. None of the volunteers or the patients with a clinical diagnosis of rotator cuff tear showed such changes. CONCLUSIONS Sonography can provide an early accurate diagnosis of adhesive capsulitis by assessing the rotator interval for hypoechoic vascular soft tissue.
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Affiliation(s)
- J C Lee
- Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, London, UK
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Lin JJ, Wu YT, Wang SF, Chen SY. Trapezius muscle imbalance in individuals suffering from frozen shoulder syndrome. Clin Rheumatol 2005; 24:569-75. [PMID: 15902524 DOI: 10.1007/s10067-005-1105-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2004] [Accepted: 01/03/2005] [Indexed: 10/25/2022]
Abstract
This aim of this study was to characterize upper and lower trapezius muscle activity for patients experiencing frozen shoulder syndrome (FSS) compared to asymptomatic subjects. Fifteen patients suffering from unilateral FSS and 15 asymptomatic subjects voluntarily participated in this study. Data were gathered on electromyographic (EMG) activity obtained from the upper and lower trapezius muscles during maximal static arm elevations at six different testing positions: 60 and 120 degrees of flexion, abduction in the frontal plane, and abduction in the scapular plane. The group with FSS revealed increased upper trapezius EMG activity at the 60 degrees (mean difference = 12%, p < 0.003) and 120 degrees (mean difference = 24%, p < 0.004) testing positions, and increased lower trapezius EMG activity at the 120 degrees testing positions (mean difference = 6%, p < 0.002), compared to asymptomatic subjects. Higher ratios of the upper trapezius to lower trapezius EMG activity were also found in the patient group (p < 0.0005) compared to asymptomatic subjects. The results of this study indicate that the increased trapezius muscle activity may contribute to scapular substitution movement in compensation for impaired glenohumeral motion in patients with FSS. The insufficiency of the increased lower trapezius muscle activity should be an important consideration in the rehabilitation of patients experiencing FSS.
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Affiliation(s)
- Jiu-Jenq Lin
- School of Physical Therapy and National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, ROC
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Loew M, Heichel TO, Lehner B. Intraarticular lesions in primary frozen shoulder after manipulation under general anesthesia. J Shoulder Elbow Surg 2005; 14:16-21. [PMID: 15723009 DOI: 10.1016/j.jse.2004.04.004] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The aim of this study was to find intraarticular lesions after manipulation under general anesthesia in patients with primary frozen shoulder. In a prospective trial conducted between 2001 and 2003 in 30 patients with primary frozen shoulder, the affected shoulders were manipulated while the patients were under general anesthetia. Exclusion criteria were secondary stiffness caused by rotator cuff tears and glenohumeral arthritis. After manipulation, each patient was examined by arthroscopy, and any intraarticular lesions were documented. In all patients, during manipulation, a significant improvement in the range of motion was achieved. Under anesthesia, flexion improved on average from 70 degrees +/- 33 degrees to 180 degrees +/- 15 degrees, abduction from 50 degrees +/- 20 degrees to 170 degrees +/- 25 degrees, and external rotation from -5 degrees +/- 10 degrees to +40 degrees +/- 20 degrees. Arthroscopy revealed hemarthrosis in all patients after manipulation. In 22 patients, localized synovitis was detected in the area of the rotator interval, whereas in 8 patients, disseminated synovitis was observed as a feature of adhesive capsulitis. After manipulation, the capsule was seen to be ruptured superiorly in 11 patients, the anterior capsule was ruptured up to the infraglenoid pole in 24 patients, and 16 patients each had a capsular lesion located posteriorly. In 18 patients no additional joint damage was found after manipulation. In 4 patients, iatrogenic superior labrum anterior-posterior lesions were observed. Further injuries detected were 3 fresh partial tears of the subscapularis tendon, 4 anterior labral detachments (1 with a small osteochondral defect), and 2 tears of the middle glenohumeral ligament. Even though manipulation under anesthesia is effective in terms of joint mobilization, the method can cause iatrogenic intraarticular damage.
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Affiliation(s)
- Markus Loew
- Department of Shoulder and Elbow Surgery, University Hospital for Orthopaedic Surgery, Heidelberg, Germany.
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Abstract
We evaluated the efficacy of arthroscopic treatment in 42 patients with shoulder stiffness. Of 44 stiff shoulders, 30 were classified as primary idiopathic, 7 were classified as traumatic, 4 occurred after prolonged immobilization, and 3 occurred in diabetic patients. Similar intraarticular findings were made in all cases. Bursoscopy suggested subacromial impingement in one third of the patients; they underwent not only capsular release but also subacromial decompression. Gains in motion and the Japanese Orthopaedic Association score were statistically significant at 4 weeks after operation and at a mean follow-up of 7.5 years. The results at the latest follow-up were excellent in 37 shoulders (84%), good in 3 (7%), and poor in 4 (9%). Of the 4 poor results, 2 were in patients with traumatic injury, 1 in a diabetic patient, and 1 in a primary idiopathic patient. There were no complications related to the arthroscopic procedure. Our treatment combines fast recovery with long-term efficacy.
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Affiliation(s)
- Junji Ide
- Department of Orthopaedic Surgery, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
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Massoud SN, Pearse EO, Levy O, Copeland SA. Operative management of the frozen shoulder in patients with diabetes. J Shoulder Elbow Surg 2002; 11:609-13. [PMID: 12469088 DOI: 10.1067/mse.2002.127301] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Forty-three patients with diabetes (47 shoulders) who had a manipulation under anesthesia only (24 shoulders), a manipulation under anesthesia followed by an arthroscopy (12 shoulders), or an arthroscopic release (11 shoulders) for a frozen shoulder were followed-up for a mean period of 35 months. The mean Constant score improved from 20.3 to 63.7 points (P <.001). The mean improvement in forward flexion was 71.7 degrees, in abduction 78.5 degrees, in external rotation with the arm at the side 36.3 degrees, and in internal rotation from the buttock to the first lumbar vertebra (P <.001 for all). When gentle manipulation with the patient under anesthesia was possible, the outcome was satisfactory in 13 of 15 shoulders (86.7%) in patients with non-insulin-dependent diabetes and in 17 of 21 shoulders (81%) in patients with insulin-dependent diabetes (P >.5). Insulin-dependent patients with diabetes were more likely to require an arthroscopic release than patients with non-insulin-dependent diabetes (P <.05). Most of our patients obtained their maximum relief of pain and functional recovery within 3 months of surgery. We recommend manipulation under anesthesia for the resistant frozen shoulder in patients with diabetes. Arthroscopic release is required when mobilization under anesthesia is not possible.
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Intraarticular Analgesia in Shoulder Surgery. Anesth Analg 2002. [DOI: 10.1097/00000539-200208000-00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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