1
|
Persad-Paisley EM, Lee C, Bhatt RA. Understanding diabetic cheiroarthropathy: a focus on clinical presentation. J Surg Case Rep 2024; 2024:rjae123. [PMID: 38463740 PMCID: PMC10924721 DOI: 10.1093/jscr/rjae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/14/2024] [Indexed: 03/12/2024] Open
Abstract
Diabetic cheiroarthropathy (DCA) is a relatively uncommon and underdiagnosed complication of poorly controlled diabetes. It is caused by non-enzymatic glycation of collagen that ultimately leads to microvascular damage and polyarticular stiffness. If diagnosed early, optimal management of serum glucose levels may lessen joint stiffness and prevent microvascular and macrovascular complications associated with diabetes mellitus. We review the case of a 55-year-old male with type 2 diabetes mellitus who was diagnosed with DCA after complaints of chronic joint stiffness and immobility.
Collapse
Affiliation(s)
- Elijah M Persad-Paisley
- Division of Plastic Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| | - Chanbin Lee
- Division of Plastic Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| | - Reena A Bhatt
- Division of Plastic Surgery, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| |
Collapse
|
2
|
Saito T, Hamada J, Sasanuma H, Iijima Y, Saitsu A, Minagawa H, Kurashina W, Takeshita K. Clinical outcomes and cost-effectiveness of manipulation under brachial plexus block versus physiotherapy for refractory frozen shoulder: a prospective observational study. JSES Int 2023; 7:2410-2419. [PMID: 37969535 PMCID: PMC10638598 DOI: 10.1016/j.jseint.2023.07.017] [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] [Indexed: 11/17/2023] Open
Abstract
Background Frozen shoulder (FS) is a pathological condition that involves a painful and stiff shoulder joint, most commonly in people aged 40-60 years. Most literature supports treatment with physical therapy (PT), although some studies have demonstrated years of continuing pain and functional deficits. Manipulation under anesthesia is effective at eliminating the contracture of intra-articular lesions for refractory FS. This study aimed to compare whether manipulation under anesthesia or PT is a more effective treatment in refractory FS. Methods This study was a prospective observational study. A total of 102 patients with refractory FS were enrolled in this study in the medical records, all of whom had severe and multidirectional loss of motion and thickening of the joint capsule and coracohumeral ligament on magnetic resonance imaging. Fifty-one patients were in the manipulation under brachial plexus block (MUB) group (34 females, median age: 57 years), and 51 patients were in the PT group (34 females, median age: 59 years). The MUB procedure consisted of the conventional method with additional adduction manipulation, in which one examiner initially abducted the shoulder joint as much as possible. We recorded the visual analog scale, shoulder range of motion, and American Shoulder and Elbow Surgeons and Constant Scores at the initial baseline visit and at the 1-, 3-, 6-, and 12-month follow-ups. The total cost was calculated from the medical records, and cost-effectiveness was evaluated using quality-adjusted life year and incremental cost-effectiveness ratio. Results Visual analog scale (P < .001), range of motion (P < .001), and American Shoulder and Elbow Surgeons and Constant Scores (P < .001) in the MUB group were significantly superior to those in the PT group at 1, 3, 6, and 12 months after treatment. The median cost and total quality-adjusted life year in the MUB and PT groups were $1375 versus $2751 and 2.95 versus 2.68, respectively, and the cost-effectiveness ratio between the MUB and PT groups was calculated as -$560. Conclusions The new MUB procedure provides a shorter treatment period, better clinical outcomes, and higher cost-effectiveness in patients with refractory FS compared to PT.
Collapse
Affiliation(s)
- Tomohiro Saito
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Junichiro Hamada
- Department of Orthopaedic Surgery, Kuwano Kyoritsu Hospital, Fukushima, Japan
| | - Hideyuki Sasanuma
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Yuki Iijima
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Akihiro Saitsu
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Hiroshi Minagawa
- Department of Orthopaedic Surgery, Joto Orthpedic Clinic, Akita, Japan
| | - Wataru Kurashina
- Department of Rehabilitation, Tochigi Medical Center Shimotsuga, Tochigi, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| |
Collapse
|
3
|
Yu S, Hu R, Feng H, Huang D. Efficacy of platelet-rich plasma injection in the treatment of frozen shoulder: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2022; 36:551-564. [PMID: 36530074 DOI: 10.3233/bmr-220034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Frozen shoulder (FS) is characterized by progressive shoulder pain and a limited range of motion. Recently, platelet-rich plasma (PRP) injection is a newly developed treatment option for patients with FS and its efficacy needs to be examined. OBJECTIVE By conducting a systematic review and meta-analysis, this study attempted to evaluate the efficacy of PRP injection in the treatment of patients with FS. METHODS PubMed, EMBASE, Web of Science, Elsevier, The Cochrane Library, WanFang Data and CNKI databases were searched up to May 31, 2020. This study included randomized controlled trials as well as prospective cohort studies. Two reviewers independently screened the title, abstract and full text in order to extract data from qualified studies. The main outcome was pain visual analogue score (VAS) while the secondary outcome was range of motion (ROM) of the shoulder joint that consists of four parts: internal rotation, flexion, external rotation and abduction. RESULTES Three randomized controlled trials and one prospective cohort study met the inclusion criteria. Accordingly, a total of 359 cases were analyzed and followed up to 3 months. The control group included corticosteroids (CS), ultrasound therapy, and stellate ganglion block. Compared to other groups, VAS was statistically significant after 1 month and 3 months of treatment (SMD: -0.46, 95% CI: -0.75 to -0.18, P= 0.002; I=2 43.2%), (SMD: -0.87, 95% CI: -1.23 to -0.50, P= 0.00, I=2 61.9%). Compared to the control group, only flexion of the patients treated with PRP demonstrated no significant improvement at 1 month, whereas internal rotation, flexion, external rotation and abduction of the shoulder were found to be improved following 3 months of treatment. CONCLUSIONS The corresponding findings illustrate that compared to other non-operative treatments, local injection of PRP can effectively improve pain and shoulder motion in patients with FS. However, due to the short follow-up time and limitations regarding the quantity and quality of studies, the above conclusions require further elucidation by performing additional high-quality studies.
Collapse
Affiliation(s)
- Shanzi Yu
- Chenzhou No. 1 People's Hospital, Chenzhou, Hunan, China
| | - Rong Hu
- The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Haoming Feng
- The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Dong Huang
- The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| |
Collapse
|
4
|
Yoshikawa T, Mifune Y, Inui A, Nishimoto H, Yamaura K, Mukohara S, Shinohara I, Kuroda R. Quercetin treatment protects the Achilles tendons of rats from oxidative stress induced by hyperglycemia. BMC Musculoskelet Disord 2022; 23:563. [PMID: 35689230 PMCID: PMC9188208 DOI: 10.1186/s12891-022-05513-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Quercetin, a flavonoid abundantly in vegetables and fruits, exerts antioxidant and anti-inflammatory effects. We investigated the protective effects of quercetin against oxidative stress in the Achilles tendons of diabetic rats. Methods Cells were collected from the Achilles tendons of Sprague–Dawley rats and cultured under four conditions: regular glucose (RG) without quercetin (Quer-), RG with quercetin (Quer +), high-glucose (HG) Quer-, and HG Quer + . The expression of genes related to NADPH oxidase (NOX) and inflammation, reactive oxygen species accumulation, and apoptosis rates was analyzed. Additionally, diabetic rats were divided into two groups and subjected to quercetin (group Q) or no quercetin (group C) treatment. Histological evaluation and expression analysis of relevant genes in the Achilles tendon were performed. Results In rat tendon-derived cells, the expression of Nox1, Nox4, and Il6; reactive oxygen species accumulation; and apoptosis rates were significantly decreased by quercetin treatment in the HG group. The collagen fiber arrangement was significantly disorganized in the diabetic rat Achilles tendons in group C compared with that in group Q. The mRNA and protein expression levels of NOX1 and NOX4 were significantly decreased upon quercetin treatment. Furthermore, the expression of Il6, type III collagen, Mmp2, and Timp2 was significantly decreased, whereas that of type I collagen was significantly increased in group Q compared with that in group C. Conclusions Quercetin treatment decreases NOX expression and thus exerts antioxidant and anti-inflammatory effects in the Achilles tendons of diabetic rats. Quercetin treatment may be effective against diabetic tendinopathy.
Collapse
Affiliation(s)
- Tomoya Yoshikawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Hanako Nishimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kohei Yamaura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shintaro Mukohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Issei Shinohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| |
Collapse
|
5
|
Yoshikawa T, Mifune Y, Inui A, Nishimoto H, Yamaura K, Mukohara S, Shinohara I, Kuroda R. Influence of Diabetes-Induced Glycation and Oxidative Stress on the Human Rotator Cuff. Antioxidants (Basel) 2022; 11:antiox11040743. [PMID: 35453426 PMCID: PMC9032678 DOI: 10.3390/antiox11040743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
Most shoulder rotator cuff tears (RCTs) are caused by non-traumatic age-related rotator cuff degeneration, of which hyperglycemia is a risk factor due to its glycation reaction and oxidative stress. We aimed to identify the influence of diabetes-induced glycation and oxidative stress in patients with non-traumatic shoulder RCTs. Twenty patients, aged over 50 years, with non-traumatic shoulder RCTs participated in this study. Patients with a history of diabetes mellitus or preoperative HbA1c ≥ 6.5% were assigned to the diabetic group (n = 10), and the rest to the non-diabetic group (n = 10). Cell proliferation; expression of genes related to oxidative stress, glycation reaction, inflammation, and collagen; intracellular reactive oxygen species (ROS) levels; and apoptosis rates were analyzed. The diabetic group had significantly lower cell proliferation than the non-diabetic group. In the diabetic group, the mRNA expression levels of NOX1, NOX4, IL6, RAGE, type III collagen, MMP2, TIMP1, and TIMP2 were significantly higher; type I collagen expression was significantly lower; and the rate of ROS-positive cells and apoptotic cells, as well as the expression of advanced glycation end-products (AGEs) and the receptor for AGEs (RAGE), was significantly higher. In conclusion, hyperglycemia caused by diabetes mellitus increased AGE and RAGE expression, and led to increased NOX expression, ROS production, and apoptosis in the human rotator cuff. This provides scope to find a preventive treatment for non-traumatic RCTs by inhibiting glycation and oxidative stress.
Collapse
Affiliation(s)
| | - Yutaka Mifune
- Correspondence: ; Tel.: +81-78-382-5985; Fax: +81-78-351-6944
| | | | | | | | | | | | | |
Collapse
|
6
|
Aïm F, Chevallier R, Marion B, Klouche S, Bastard C, Bauer T. Psychological risk factors for the occurrence of frozen shoulder after rotator cuff repair. Orthop Traumatol Surg Res 2022; 108:103212. [PMID: 35077897 DOI: 10.1016/j.otsr.2022.103212] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/24/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Frozen shoulder is a dreaded complication after rotator cuff repair. HYPOTHESIS There are psychological determinants for this complication. MATERIALS AND METHODS We prospectively included 77 consecutive patients who underwent arthroscopic rotator cuff repair between May 2018 and April 2019. Along with a functional evaluation, we determined the Constant score, anxiety and depression levels based on the HADS, and kinesiophobia based on the Tampa Scale preoperatively and 6months after the surgery. RESULTS At the 6-month follow-up, 8 patients had been diagnosed with frozen shoulder (group A), 65 patients had satisfactory joint range of motion (group B) and 4 were lost to follow-up. In the frozen shoulder group, the preoperative anxiety rate was significantly higher than in group B (50% versus 17%, p=0.04). Furthermore, there were significantly more women (p=0.028) and more patients with an occupational disease in group A (75% versus 18%, p=0.027). At 6months postoperative, the Constant score was 55 in the group with a frozen shoulder versus 72 in group B (p=0.004). Neither depression nor kinesiophobia were risk factors for the development of frozen shoulder after rotator cuff repair. CONCLUSION Preoperative anxiety, the female sex and occupational disease are all risk factors for the occurrence of frozen shoulder after rotator cuff repair. Knowing these predisposing factors will help us better manage at-risk patients. LEVEL OF EVIDENCE III, prospective study.
Collapse
Affiliation(s)
- Florence Aïm
- Service de chirurgie orthopédique, centre de référence des infections ostéoarticulaires, groupe hospitalier Diaconnesses Croix Saint-Simon, Paris, France.
| | - Romain Chevallier
- Service de chirurgie orthopédique, hôpital Henri-Mondor, Créteil, France
| | - Blandine Marion
- Service de chirurgie orthopédique, centre de référence des infections ostéoarticulaires, groupe hospitalier Diaconnesses Croix Saint-Simon, Paris, France
| | | | - Claire Bastard
- Service de chirurgie orthopédique, hôpital Henri-Mondor, Créteil, France
| | - Thomas Bauer
- Service de chirurgie orthopédique, AP-HP, hôpital Ambroise-Paré, Boulogne-Billancourt, France
| |
Collapse
|
7
|
Muluneh AG, Adem KS, Dawud JS, Kibret AK, Yitayal MM, Eriku GA. Upper-Extremity Musculoskeletal Disorders and Their Associated Factors Among Diabetes Mellitus Patients Attending at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Northwest Ethiopia: Cross-Sectional Study. Front Endocrinol (Lausanne) 2022; 13:856521. [PMID: 35557847 PMCID: PMC9086430 DOI: 10.3389/fendo.2022.856521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Globally, diabetes mellitus (DM) is a major public health, causing functional disability among those affected. Among the common diabetes mellitus-related complications, musculoskeletal disorders had a significant negative impact on the social health quality of life and productivity of individuals. Evidence in this regard, however, is scarce in Ethiopia. Therefore, this study aimed at determining the prevalence of musculoskeletal disorders and identifying factors associated in people with diabetes in Felege Hiwot Comprehensive Specialized Hospital, northwest Ethiopia. METHODS A cross-sectional study design was employed at Felege Hiwot Comprehensive Specialized Hospital from June 01 to August 30, 2020, among 413 participants. A systematic random sampling was employed to select the study participants. A structured, pretested questionnaire was used to collect data on socio-demographic, clinical, and lifestyle characteristics. Musculoskeletal disorders were assessed through clinical and physical examination. A logistic regression model was used to explore factors associated with musculoskeletal disorders. RESULT The prevalence of musculoskeletal disorders among diabetes mellitus patients was 24% (95% CI 20, 28.3). In logistic regression, factors such as being female, older age, occupation (farmer, merchant, and retired), and long duration of diabetes were significantly associated with musculoskeletal disorders. CONCLUSION Nearly one quarter of the study participants had musculoskeletal disorders. Special attention should be given for those individuals living with diabetes mellitus, particularly for those who are female, are older, and had a prolonged history of diabetes mellitus.
Collapse
Affiliation(s)
- Assefa Gebeyehu Muluneh
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kedir Sany Adem
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jemal Suleyman Dawud
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemu Kassaw Kibret
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melisew Mekie Yitayal
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Azeze Eriku
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- *Correspondence: Getachew Azeze Eriku,
| |
Collapse
|
8
|
Agarwal A, Rastogi S, Rai S, Giri M, Parashar S, Malviya D, Sharma D. Effect of Minimally Invasive Pain Intervention in Frozen Shoulder Patients: A Cross-Sectional Study. Anesth Essays Res 2021; 14:620-626. [PMID: 34349331 PMCID: PMC8294410 DOI: 10.4103/aer.aer_94_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/22/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Adhesive capsulitis or frozen shoulder (FS) is the second most common disorder accounts for 15%–30% shoulder pain and functional disability. Suprascapular nerve (SSN) interventions with corticosteroid alone have shown limited duration efficacy, adding pulsed radiofrequency (PRF) provides long-term relief. Aims and Objective: We aimed to analyze the efficacy of SSN intervention on pain relief and range of mobility in patients with FS. Settings and Design: This is a cross-sectional study of 37 patients of FS who underwent SSN interventions in a dedicated pain medicine unit of the department of anesthesiology. Materials and Methods: Thirty-seven patients, who underwent SSN interventions for FS and followed for 6 months, were included in this study. Pain (Visual Analog Scale [VAS]), range of motion (ROM) (17), and Oxford 12 point Shoulder Score (OSS) for functional outcomes were recorded. In the final analysis, two subsets of patients who underwent SSN steroid injection or SSN PRF plus steroid were found and compared using Student's t-test paired and independent with P < 0.05 considered significant at 95% confidence interval. Results: The patient population was demographically comparable. Mean VAS score and ROM improved at 1, 3, and 6 months to statistically significant. On comparing the subgroups, the VAS score and OSS in both the SI and PRF groups were significantly improved, but the PRF group showed highly significant improvement, showing better and sustained improvement in the PRF group. Conclusion: PRF with steroid injection of the SSN provides better and long-lasting relief from pain and improved mobility in FS patients in comparison to steroid alone.
Collapse
Affiliation(s)
- Anurag Agarwal
- Department of Anesthesiology, CCM and Pain Medicine, Dr RMLIMS, Lucknow, Uttar Pradesh, India
| | - Shivani Rastogi
- Department of Anesthesiology, CCM and Pain Medicine, Dr RMLIMS, Lucknow, Uttar Pradesh, India
| | - Sujeet Rai
- Department of Anesthesiology, CCM and Pain Medicine, Dr RMLIMS, Lucknow, Uttar Pradesh, India
| | - Manoj Giri
- Department of Anesthesiology, CCM and Pain Medicine, Dr RMLIMS, Lucknow, Uttar Pradesh, India
| | - Samiksha Parashar
- Department of Anesthesiology, CCM and Pain Medicine, Dr RMLIMS, Lucknow, Uttar Pradesh, India
| | - Deepak Malviya
- Department of Anesthesiology, CCM and Pain Medicine, Dr RMLIMS, Lucknow, Uttar Pradesh, India
| | - Deepti Sharma
- Department of Anesthesiology, CCM and Pain Medicine, Dr RMLIMS, Lucknow, Uttar Pradesh, India
| |
Collapse
|
9
|
Cho JH. Updates on the treatment of adhesive capsulitis with hydraulic distension. Yeungnam Univ J Med 2021; 38:19-26. [PMID: 32862630 PMCID: PMC7787893 DOI: 10.12701/yujm.2020.00535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022] Open
Abstract
Adhesive capsulitis of the shoulder joint is a common disease characterized by pain at the insertional area of the deltoid muscle and decreased range of motion. The pathophysiological process involves fibrous inflammation of the capsule and intraarticular adhesion of synovial folds leading to capsular thickening and contracture. Regarding the multidirectional limitation of motion, a limitation in external rotation is especially prominent, which is related to not only global fibrosis but also to a localized tightness of the anterior capsule. Ultrasound and magnetic resonance imaging studies can be applied to rule out other structural lesions in the diagnosis of adhesive capsulitis. Hydraulic distension of the shoulder joint capsule provides pain relief and an immediate improvement in range of motion by directly expanding the capsule along with the infusion of steroids. However, the optimal technique for hydraulic distension is still a matter of controversy, with regards to the infusion volume and rupture of the capsule. By monitoring the real-time pressure-volume profile during hydraulic distension, the largest possible fluid volume can be infused without rupturing the capsule. The improvement in clinical outcomes is shown to be greater in capsule-preserved hydraulic distension than in capsule-ruptured distension. Moreover, repeated distension is possible, which provides additional clinical improvement. Capsule-preserved hydraulic distension with maximal volume is suggested to be an efficacious treatment option for persistent adhesive capsulitis.
Collapse
Affiliation(s)
- Jang Hyuk Cho
- Department of Rehabilitation Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| |
Collapse
|
10
|
Morris FM, Bain SC. Clumsy hands in a woman with long-standing diabetes. Diabet Med 2020; 37:1770-1771. [PMID: 31127641 DOI: 10.1111/dme.14041] [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] [Accepted: 05/23/2019] [Indexed: 12/01/2022]
Affiliation(s)
- F M Morris
- Swansea Bay University Health Board, Singleton Hospital, Swansea, UK
| | - S C Bain
- Swansea Bay University Health Board, Singleton Hospital, Swansea, UK
- Diabetes Research Unit Cymru, Swansea University Medical School, Swansea, UK
| |
Collapse
|
11
|
Yang L, Zhang J, Ruan D, Zhao K, Chen X, Shen W. Clinical and Structural Outcomes After Rotator Cuff Repair in Patients With Diabetes: A Meta-analysis. Orthop J Sports Med 2020; 8:2325967120948499. [PMID: 32995347 PMCID: PMC7502797 DOI: 10.1177/2325967120948499] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/06/2020] [Indexed: 12/16/2022] Open
Abstract
Background: The impact of diabetes on clinical and structural outcomes after rotator cuff repair remains controversial. Purpose/Hypothesis: The purpose of this study was to compare clinical outcomes and retear rates after rotator cuff repair in patients with and without diabetes. Our hypotheses were that adequate control of diabetes would decrease the retear rate after rotator cuff repair and that patients with diabetes would have worse clinical outcomes. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed, Embase, and Cochrane Library databases were searched for studies comparing outcomes in patients with and without diabetes after full-thickness rotator cuff repair. Clinical outcome analysis included the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and the University of California–Los Angeles shoulder rating scale; we compared preoperative, postoperative, and change in functional scores from baseline to final follow-up among the included studies. The pooled relative risk was calculated using a random-effects model for retear rates. Clinical outcomes were also pooled using a random-effects model. Results: Overall, 10 studies were included. Compared with patients without diabetes, patients with diabetes had a worse preoperative ASES score (P = .009) as well as worse postoperative Constant score (final follow-up range, 9-103 months; P = .0003). However, there was no significant difference in the absolute mean change in clinical outcomes between patients with and without diabetes. Diabetes was associated with a higher retear rate (19.3% in patients without diabetes vs 28.2% in patients with diabetes; P < .0001). The retear rate according to the severity of sustained hyperglycemia in the subgroup analysis was 14.6% in patients without diabetes, versus 22.7% in patients with well-controlled diabetes (<7.0% of preoperative serum HbA1c level; P = .12) and 40.0% in patients with uncontrolled diabetes (HbA1c level ≥7.0%; P < .00001). Conclusion: This meta-analysis suggests that diabetes mellitus is associated with an increased risk of retears after rotator cuff repair, and improved blood glucose control may reduce the risk of retears in patients with diabetes mellitus. Although effective glycemic control was associated with a decreased risk of retears in patients with diabetes, we could not prove causation because of potential bias and confounding in the included studies.
Collapse
Affiliation(s)
- Lingdi Yang
- Department of Orthopedic Surgery of The Second Affiliated Hospital and Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China.,Lishui People's Hospital, Lishui, China
| | - Jun Zhang
- Department of Orthopedic Surgery of The Second Affiliated Hospital and Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China.,Longquan People's Hospital, Longquan, China
| | - Dengfeng Ruan
- Department of Orthopedic Surgery of The Second Affiliated Hospital and Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Kun Zhao
- Department of Orthopedic Surgery of The Second Affiliated Hospital and Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China.,Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China.,China Orthopaedic Regenerative Medicine Group, Hangzhou, China
| | - Xiao Chen
- Department of Orthopedic Surgery of The Second Affiliated Hospital and Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China.,Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China.,China Orthopaedic Regenerative Medicine Group, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Weiliang Shen
- Department of Orthopedic Surgery of The Second Affiliated Hospital and Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China.,Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China.,China Orthopaedic Regenerative Medicine Group, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
12
|
Schoch B, Huttman D, Syed UA, Patel MS, Lazarus MD, Abboud JA. Surgical Treatment of Adhesive Capsulitis: A Retrospective Comparative Study of Manipulation Under Anesthesia and/or Capsular Release. Cureus 2020; 12:e9032. [PMID: 32775111 PMCID: PMC7406188 DOI: 10.7759/cureus.9032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background No consensus exists among orthopedic surgeons regarding the optimal intervention for adhesive capsulitis. The purpose of this study was to determine which treatment provides the best objective outcome following manipulation under anesthesia (MUA), MUA + arthroscopic capsular release (CR), or CR alone. Methods Between 2011 and 2015, 97 shoulders were treated for adhesive capsulitis (MUA, MUA+CR, CR) and followed for three months or until achieving full range of motion (ROM). Patients' charts were reviewed for demographic information, diabetes, pre/post-operative ROM, and complications. Results The average age at surgery was 57 years (range: 31-80 years) with a mean follow-up of 6.2 months (range: 2-43 months). ROM improved significantly regardless of treatment modality (p < 0.001). MUA had significantly more external rotation at follow-up than MUA+CR and CR alone (62 vs 49 vs 48, p = 0.02). Groups were similar in regards to post-operative elevation and internal rotation. Loss of external rotation following surgery was significantly more common in the MUA+CR group (p = 0.03). In diabetics, no treatment option was superior to another in regards to final ROM. Conclusion Operative treatment of idiopathic adhesive capsulitis is efficacious and safe for improving shoulder ROM across treatment modalities. Surgeon preference may effectively guide treatment independent of diabetic status.
Collapse
Affiliation(s)
| | - Daniel Huttman
- Shoulder and Elbow Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, USA
| | - Usman Ali Syed
- Shoulder and Elbow Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, USA
| | - Manan S Patel
- Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Mark D Lazarus
- Shoulder and Elbow Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, USA
| | - Joseph A Abboud
- Shoulder and Elbow Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, USA
| |
Collapse
|
13
|
Kurosawa T, Mifune Y, Inui A, Nishimoto H, Ueda Y, Kataoka T, Yamaura K, Mukohara S, Kuroda R. Evaluation of apocynin in vitro on high glucose-induced oxidative stress on tenocytes. Bone Joint Res 2020; 9:23-28. [PMID: 32435452 PMCID: PMC7229300 DOI: 10.1302/2046-3758.991.bjr-2019-0074.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aims The purpose of this study was to evaluate the in vitro effects of apocynin, an inhibitor of nicotinamide adenine dinucleotide phosphate oxidase (NOX) and a downregulator of intracellular reactive oxygen species (ROS), on high glucose-induced oxidative stress on tenocytes. Methods Tenocytes from normal Sprague-Dawley rats were cultured in both control and high-glucose conditions. Apocynin was added at cell seeding, dividing the tenocytes into four groups: the control group; regular glucose with apocynin (RG apo+); high glucose with apocynin (HG apo+); and high glucose without apocynin (HG apo–). Reactive oxygen species production, cell proliferation, apoptosis and messenger RNA (mRNA) expression of NOX1 and 4, and interleukin-6 (IL-6) were determined in vitro. Results Expression of NOX1, NOX4, and IL-6 mRNA in the HG groups was significantly higher compared with that in the RG groups, and NOX1, NOX4, and IL-6 mRNA expression in the HG apo+ group was significantly lower compared with that in the HG apo– group. Cell proliferation in the RG apo+ group was significantly higher than in the control group and was also significantly higher in the HG apo+ group than in the HG apo– group. Both the ROS accumulation and the amounts of apoptotic cells in the HG groups were greater than those in the RG groups and were significantly less in the HG apo+ group than in the HG apo– group. Conclusion Apocynin reduced ROS production and cell death via NOX inhibition in high-glucose conditions. Apocynin is therefore a potential prodrug in the treatment of diabetic tendinopathy. Cite this article:Bone Joint Res 2020;9(1):23–28.
Collapse
Affiliation(s)
- T Kurosawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Y Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - A Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - H Nishimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Y Ueda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - T Kataoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - K Yamaura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - S Mukohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - R Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
14
|
Cox ER, Coombes JS, Keating SE, Burton NW, Coombes BK. Not a Painless Condition: Rheumatological and Musculoskeletal Symptoms in Type 2 Diabetes, and the Implications for Exercise Participation. Curr Diabetes Rev 2020; 16:211-219. [PMID: 31146662 DOI: 10.2174/1573399815666190531083504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/15/2019] [Accepted: 05/03/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES People with type 2 diabetes (T2D) are more likely to develop a range of rheumatological and musculoskeletal symptoms (RMS), and experience both chronic and widespread pain, compared with the general population. However, these symptoms are not commonly acknowledged by researchers, which hampers our understanding of the impact on this population. Since exercise is a key lifestyle management strategy for T2D and participation levels are typically low, understanding the potential impact of RMS on exercise participation is critical. The aim of this review is to summarise the literature regarding the prevalence and pathophysiology of RMS in T2D, the evidence for the benefits and risks associated with exercise on RMS, and the currently available tools for the reporting of RMS in both research studies and community settings. METHODS A narrative review. RESULTS There are numerous exercise trials in T2D, but few have sufficiently reported pain-related adverse events and even fewer have investigated the effects of exercise on RMS and chronic pain. DISCUSSION Recommendations for future research are provided.
Collapse
Affiliation(s)
- Emily R Cox
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Nicola W Burton
- School of Applied Psychology, Griffith University, Mt. Gravatt, Queensland, Australia
| | - Brooke K Coombes
- School of Allied Health Sciences, Griffith University, Nathan, Queensland, Australia
| |
Collapse
|
15
|
Kaka B, Maharaj SS, Fatoye F. Prevalence of musculoskeletal disorders in patients with diabetes mellitus: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2019; 32:223-235. [PMID: 30248032 DOI: 10.3233/bmr-171086] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with musculoskeletal disorders (MSDs) and is often not clinically diagnosed and managed. There are also no systematic reviews of literature relating to the prevalence of MSDs among people with diabetes. OBJECTIVE To determine the prevalence and areas of the body affected by MSDs in diabetic patients. METHODS A literature search of the electronic databases of CINAH, PubMed, Web of Science and Google Scholar using the keywords of "MSDs and DM" as the search term was conducted. Pooled estimates were calculated using a meta-analysis of proportion. RESULTS Five thousand and eighty-eight studies were identified from the databases; 21 studies fulfilled the inclusion criteria and were included in the review. Five studies were of high quality, 13 were of moderate quality and three were of low quality. The prevalence of all types of MSDs among patients with diabetes was 58.15% (95% CI 41.4%-73.9%). The hand was the most common area of the body affected being 33.05% (95% CI 21.1-46.13) followed by the shoulder. CONCLUSIONS A high prevalence of MSDs was found among diabetic patients with the hand and shoulder being the most frequently reported areas affected. However, future studies with a larger sample and the relevant type of diabetes are required.
Collapse
Affiliation(s)
- Bashir Kaka
- Divisions of Physiotherapy, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Sonill Sooknunan Maharaj
- Divisions of Physiotherapy, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Francis Fatoye
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
16
|
Yanlei GL, Keong MW, Tijauw Tjoen DL. Do diabetic patients have different outcomes after arthroscopic capsular release for frozen shoulder? J Orthop 2019; 16:211-215. [PMID: 30906125 PMCID: PMC6411596 DOI: 10.1016/j.jor.2019.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/01/2018] [Accepted: 02/17/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION While the exact mechanism of primary adhesive capsulitis is unknown, we know that it has strong associations with diabetes mellitus (DM). Although self-limiting, a significant percentage of patients still have persistent pain and stiffness beyond 3 years. Arthroscopic capsular release (ACR) has been described as a successful intervention for recalcitrant adhesive capsulitis that provides early and long-term recovery. The aim of this study is to investigate the relationship between DM and ACR. METHODS We reviewed prospectively collected data of 56 consecutive patients with idiopathic frozen shoulder who underwent ACR (360° arthroscopic capsulotomy) under a single surgeon. Range of motion, pain score and shoulder function (Constant Shoulder Score, Oxford Shoulder Score, University of California Los Angeles Shoulder Score) were documented preoperatively and one year postoperatively. Patients were dichotomized into diabetic (n = 32) and non-diabetic patients (n = 24) and compared using a mixed ANOVA design to investigate for differences in outcomes. RESULTS Both group of patients had significant improvement in range of motion, reduced pain scores and improved shoulder scores one year postoperatively (p = 0.000). Diabetic patients had poorer internal rotation (p = 0.000), forward flexion (p = 0.035) and poorer postoperative Constant Shoulder score (p < 0.05). Otherwise both groups improved equally in all other aspects. CONCLUSION ACR offered good outcomes in both diabetic and non-diabetic patients in terms of range of motion, pain relief and shoulder function. However diabetic patients had poorer improvement in internal rotation and forward flexion postoperatively. Preoperative counselling and postoperative rehabilitation can be better tailored to treat diabetic patients with idiopathic adhesive capsulitis.
Collapse
Affiliation(s)
- Geraldine Lei Yanlei
- Singapore General Hospital, 20 College Road, 20 College Road Academia Level 4, 1698655, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mak Wai Keong
- Singapore General Hospital, 20 College Road, 20 College Road Academia Level 4, 1698655, Singapore
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Denny Lie Tijauw Tjoen
- Singapore General Hospital, 20 College Road, 20 College Road Academia Level 4, 1698655, Singapore
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| |
Collapse
|
17
|
Lyhne JM, Jacobsen JR, Hansen SJ, Jensen CM, Deutch SR. Diabetic and non-diabetic patients report equal symptom relief after arthroscopic capsular release of frozen shoulder. J Clin Orthop Trauma 2019; 10:261-264. [PMID: 30828189 PMCID: PMC6383122 DOI: 10.1016/j.jcot.2018.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 04/24/2018] [Accepted: 05/10/2018] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND Frozen shoulder is a painful joint disease. Patients with diabetes seem to have worse clinical symptoms and surgery in this patient population is believed to be more common.The objective postoperative evaluation indicates inferior results when surgically treating diabetics, but no previous studies have investigated exclusively the subjective patient satisfaction with arthroscopic capsular release. MATERIALS AND METHODS A total of 93 patients were included. All had persistent symptoms despite conservative treatment for at least six months. The patients were retrospectively divided into two groups based on diabetes status: Group 1 consisted of patients with type 1 or type 2 diabetes (18) and group 2 consisted of the remaining patients (75). Evaluation was performed prior to arthroscopic capsular release and at six months follow-up. The web-based questionnaire consisted of two different evaluation forms: The Oxford Shoulder Score (OSS) and a visual quality scale (VQS). RESULTS Both groups reported a statistically significant improvement in both evaluations. OSS in group 1 improved by 11.5 [95% CI: 6.2 ; 16.4] and by 15.8 [95% CI: 13.6 ; 17.9] in group 2. The improvement was more pronounced in group 2, though not statistically significant (p = 0.09). The VQS improved 39.6 in group 1 and 44.5 in group 2, (p = 0.50). CONCLUSION Diabetic and non-diabetic patients reported equal symptom relief after arthroscopic capsular release of frozen shoulder when selected for operation without considering diabetic status. We will continue to select patients for arthroscopic release without differences in preoperative counseling between diabetics and non-diabetics.
Collapse
Affiliation(s)
- Johanne M. Lyhne
- Corresponding author at: Department of Orthopaedic Surgery, Regional Hospital Randers, Skovlyvej 1, 8930, Randers, Danmark.
| | | | | | | | | |
Collapse
|
18
|
Alhashimi RAH. Analytical Observational Study of Frozen Shoulder among Patients with Diabetes Mellitus. JOINTS 2018; 6:141-144. [PMID: 30582100 PMCID: PMC6301845 DOI: 10.1055/s-0038-1676105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 10/21/2018] [Indexed: 12/01/2022]
Abstract
Purpose
This study aims to identify the prevalence of frozen shoulder (FS) among diabetic patients and its relation to demographic features.
Methods
This observational study of 216 patients randomly included those with diabetes mellitus (DM) attending the Misan Rheumatology and Medical Rehabilitation Department at Al-Sadder Teaching Hospital in Misan Province of Iraq and was conducted during the period from April 2014 to March 2015. Detailed medical histories were taken from patients and scratch test and hemoglobin A
1C
were used in diagnostic procedure to confirm diagnosis of FS and DM, respectively.
Results
The occurrence rate of FS was 11.5% among patients, with a higher prevalence in females versus males. The most commonly afflicted age group was 60 to 70 years old at 33.3%. Dominant shoulder was more commonly affected than nondominant one. DM presented in large number of patients with FS with a prevalence of 90.3% of cases. The onset of FS in patients with DM was most common within the chronic phase of the disease at 32.3 and 33.8% for durations of 1 to 5 and 5 to 10 years, respectively.
Conclusion
There is a strong association between DM and FS. Females were more commonly affected than males. Aging increased shoulder disorder distribution with dominant side being mostly affected. Chronic and noncontrolling diabetic patients were more commonly affected.
Level of Evidence
This is a Level III, analytical, observational study.
Collapse
|
19
|
Abstract
Frozen shoulder, also known as adhesive capsulitis, is a common presentation in the primary care setting and can be significantly painful and disabling. The condition progresses in three stages: freezing (painful), frozen (adhesive) and thawing, and is often self-limiting. Common conservative treatments include nonsteroidal anti-inflammatory drugs, oral glucocorticoids, intra-articular glucocorticoid injections and/or physical therapy. However, many physicians may find themselves limited to prescribing medications for treatment. This article elaborates on physical therapy exercises targeted at adhesive capsulitis, which can be used in combination with common analgesics.
Collapse
Affiliation(s)
| | - Pek Ying Pua
- Rehabilitative Services, Changi General Hospital, Singapore
| | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore
| |
Collapse
|
20
|
Mueller MJ, Sorensen CJ, McGill JB, Clark BR, Lang CE, Chen L, Bohnert KL, Hastings MK. Effect of a Shoulder Movement Intervention on Joint Mobility, Pain, and Disability in People With Diabetes: A Randomized Controlled Trial. Phys Ther 2018; 98:745-753. [PMID: 29893977 PMCID: PMC6692706 DOI: 10.1093/ptj/pzy070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 06/06/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND People with diabetes are at high risk for shoulder pain, limited joint mobility, and adhesive capsulitis. OBJECTIVE The objective of this study was to evaluate the effects of a shoulder movement intervention (ShoMo) compared to a wellness intervention on the primary outcomes of active shoulder flexion and reported Shoulder Pain and Disability Index (SPADI) measured after intervention and 9 months later. DESIGN The design was a prospective, randomized, controlled clinical trial. SETTING The setting was a research center at an academic medical center. PARTICIPANTS Fifty-two participants with type 2 diabetes and shoulder pain or limited motion were randomized to a group receiving ShoMo (N = 27; mean age = 59.3; SD = 7.0) or a group receiving wellness activities (N = 25; mean age = 57.9; SD = 7.7). INTERVENTION The ShoMo group received instruction in a progressive, active shoulder movement program. The wellness group received instruction in diabetes management. MEASUREMENTS Measurements were made at baseline, after 3 months of intervention, and at 6, 9, and 12 months after baseline. RESULTS After intervention, the ShoMo group had a 7.2-degree increase in active shoulder flexion compared with the wellness group (95% CI = 0.9-13.5°), but there was no difference at subsequent follow-ups. The ShoMo group showed a 12.7-point improvement in the SPADI score compared to the wellness group after intervention (95% CI = 1.1-24.3), which remained better than the wellness group 9 months later. LIMITATIONS The number of participants and duration of follow-up were inadequate to determine if intervention can help to prevent future severe shoulder problems. CONCLUSIONS A progressive shoulder movement program can have meaningful effects on active motion and symptoms in people with type 2 diabetes and mild-to-moderate shoulder symptoms, with symptom improvement lasting at least 9 months.
Collapse
Affiliation(s)
- Michael J Mueller
- Program in Physical Therapy and Department of Radiology, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Blvd, St Louis, MO 63108 (USA),Address all correspondence to Dr Mueller at:
| | | | - Janet B McGill
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine
| | - B Ruth Clark
- Program in Physical Therapy and Department of Neurology, Washington University School of Medicine
| | - Catherine E Lang
- Program in Physical Therapy, Program in Occupational Therapy, and Department of Neurology, Washington University School of Medicine
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine
| | - Kathryn L Bohnert
- Program in Physical Therapy, Washington University School of Medicine
| | - Mary K Hastings
- Program in Physical Therapy and Department of Orthopaedic Surgery, Washington University School of Medicine
| |
Collapse
|
21
|
Rendeiro DG, Deyle GD, Gill NW, Majkowski GR, Lee IE, Jensen DA, Wainner RS. Effectiveness of translational manipulation under interscalene block for the treatment of adhesive capsulitis of the shoulder: A nonrandomized clinical trial. Physiother Theory Pract 2018; 35:703-723. [PMID: 29658838 DOI: 10.1080/09593985.2018.1457118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Study Design: Nonrandomized controlled trial. Objective: To determine whether translational manipulation under anesthesia/local block (TMUA) adds to the benefit of mobilization and range of motion exercise for improving pain and functional status among patients with adhesive capsulitis of the shoulder (AC). Background: TMUA has been shown to improve pain and dysfunction in patients with AC. This intervention has not been directly compared to physical therapy treatment without TMUA in a prospective trial. Methods: Sixteen consecutive patients with a primary diagnosis of AC were divided into two groups. Patients in the first (TMUA) group received a session of translational manipulation under interscalene block, followed by six sessions of manipulation and exercise. Patients in the comparison group received seven sessions of manipulation and exercise. Outcome measures taken at baseline and 3, 6, 12 months and 4 years included Shoulder Pain and Disability Index (SPADI) scores. Four-year outcomes included percent of normal ratings, medication use, and activity limitations. Results: Both groups showed improved SPADI scores across all follow-up times compared to baseline. The TMUA group showed a greater improvement in SPADI scores than the comparison group at 3 weeks, with no significant differences in SPADI scores at other time points. However, at 4 years, significantly more subjects in the comparison group (5 of 8) had activity limitations versus subjects in the TMUA group (1 of 8). No subject experienced a complication from either intervention protocol. Conclusion: Physical therapy consisting of manual therapy and exercise provides benefit for patients with AC. Translational manipulation under local block may be a useful adjunct to manual therapy and exercise for patients with AC.
Collapse
Affiliation(s)
| | - Gail D Deyle
- b Army-Baylor University Doctoral Fellowship Program in Orthopaedic Manual Physical Therapy , Brooke Army Medical Center, Fort Sam Houston , San Antonio, TX , USA
| | - Norman W Gill
- c Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston , San Antonio, TX , USA
| | - Guy R Majkowski
- d US Air Force Health Clinic, United States Air Force, RAF Lakenheath , England
| | - Ian E Lee
- e U.S. Army Office of the Surgeon General , Falls Church , VA , USA
| | - Dale A Jensen
- f Department of Physical Medicine and Rehabilitation , Naval Medical Center Portsmouth , Portsmouth , VA
| | - Robert S Wainner
- g DPT Program, School of Physical Therapy , South College , Knoxville , TN , USA
| |
Collapse
|
22
|
Kermani ZH, Bazzaz SMM, Farahmand SK, Raoof AA. The comparison of frequency of the upper limb musculoskeletal disorders among patients with diabetes type II with normal cases. Electron Physician 2018; 9:5848-5853. [PMID: 29403629 PMCID: PMC5783138 DOI: 10.19082/5848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/14/2017] [Indexed: 12/25/2022] Open
Abstract
Background and aim Musculoskeletal disease, that is recognized in diabetes and diabetes mellitus (DM) has shown a higher prevalence of chronic musculoskeletal complications. This study aimed at assessing the frequency of upper limb musculoskeletal disorders among patients with diabetes type II with normal cases in Mashhad, Iran. Methods A cross-section of 100 patients with upper limb musculoskeletal disorders were enrolled in this study. The patients were examined by a unique physician considering carpal tunnel syndrome disorder, trigger finger, adhesive capsulitis, and Dupuytren's contracture at Ghaem hospital, Mashhad, Iran in 2015. All collected data were recorded by using SPSS version 21 and were analyzed through independent-samples t-test for comparing changes, and Chi-square. Results In this study, the mean age was 51.7±8.7 years old. Gender frequency was 114 (57%) male, and 86 (43%) female. There was no significant difference between groups in cases of gender frequency and mean of age (p>0.05). In evaluation of association between the two groups, there was significant difference for adhesive capsulitis, (p=0.04). Chi-square test showed significant association for age and adhesive capsulitis between the two groups, (p=0.040); but no other diabetes-related disorders, (p<0.05). Conclusion The results of this study showed that in patients with diabetes mellitus and musculoskeletal complications such as upper limb musculoskeletal abnormalities, it will lead to an increase in skeletal muscle effects in DM patients. It is recommended that musculoskeletal examination is done periodically in DM patients for identification of these disorders and necessary actions are carried out for prevention of the disorders as soon as possible.
Collapse
Affiliation(s)
- Zahra Haeri Kermani
- MD, MPH, General Practitioner, Mashhad University of Medical Sciences, Health Centre 3, 24th Akhud Khorasani Street, Mashhad, Iran
| | - Seyed Mojtaba Mousavi Bazzaz
- Associate Professor of Community Medicine and Public Health, Department of Community Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Kazem Farahmand
- MD, PhD, Assistant Professor of Chinese Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Akbar Raoof
- General Practitioner, Director of Parsian Diabetes Centre, Chamran Street, Mashhad, Iran
| |
Collapse
|
23
|
Correlations of magnetic resonance imaging findings with clinical symptom severity and prognosis of frozen shoulder. Knee Surg Sports Traumatol Arthrosc 2017; 25:3242-3250. [PMID: 26611904 DOI: 10.1007/s00167-015-3887-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the correlation between indirect magnetic resonance (MR) arthrographic imaging findings and the clinical symptoms and prognosis of patients with frozen shoulder. METHODS Indirect MR arthrography was performed for 52 patients with primary frozen shoulder (mean age 55.1 ± 9.0 years) and 52 individuals without frozen shoulder (mean age 53.1 ± 10.7 years); capsular thickening and enhancement of the axillary recess as well as soft tissue thickening of the rotator interval were evaluated. Clinical symptom severity was assessed using the Visual Analogue Scale for Pain (VAS Pain), simple shoulder test (SST), Constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM). At 6-month follow-up, we evaluated whether MR arthrography findings correlated with the clinical symptoms and prognosis. RESULTS Capsular thickening and enhancement of the axillary recess as well as soft tissue thickening of the rotator interval were significantly greater in the patient group than in the controls (p < 0.001). Capsular thickening of the axillary recess did not correlate with clinical symptoms or ROM (n.s.); however, capsular enhancement correlated with clinical symptom severity according to VAS Pain (p = 0.005), SST (p = 0.046), and ASES scores (p = 0.009). Soft tissue thickening of the rotator interval did not correlate with clinical symptom severity, but was associated with external rotation limitation (p = 0.002). However, none of the parameters correlated with clinical symptoms at 6-month follow-up. CONCLUSIONS Indirect MR arthrography provided ancillary findings, especially with capsular enhancement, for evaluating clinical symptom severity of frozen shoulder, but did not reflect the prognosis. MR findings in frozen shoulder should not replace clinical judgments regarding further prognosis and treatment decisions. LEVEL OF EVIDENCE IV.
Collapse
|
24
|
Doria C, Mosele GR, Badessi F, Puddu L, Caggiari G. Shoulder Adhesive Capsulitis in Type 1 Diabetes Mellitus: A Cross-Sectional Study on 943 Cases in Sardinian People. JOINTS 2017; 5:143-146. [PMID: 29270543 PMCID: PMC5738482 DOI: 10.1055/s-0037-1605555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Purpose
To evaluate the prevalence of adhesive capsulitis (AC) of the shoulder in patients with type 1 diabetes mellitus (T1DM) in Sardinia.
Methods
In this cross-sectional study, we evaluated 943 patients with T1DM attending the division of Endocrinology and Metabolism at the University Hospital in Sassari, Italy. The criteria for diagnosing AC were: pain for at least 1 month, inability to lie on the affected shoulder, and restricted active and passive shoulder joint movements in at least three planes. Age, gender, duration of DM, blood pressure, and presence of neuropathy and retinopathy were noted. Metabolic control of DM was evaluated with glycosylated hemoglobin A1c (GHbA1c) blood concentrations.
Results
AC was diagnosed in 331 patients (prevalence: 35.1%). Age, duration of DM, high blood pressure levels, and the presence of neuropathy and retinopathy were significantly associated with AC. No significant association was observed between gender and AC. There was no significant difference in mean levels of GHbA1c in T1DM patients with or without AC.
Conclusion
This study shows that AC of the shoulder is a common disorder in patients with T1DM in Sardinia. It is significantly associated with age, duration of DM, and related complications.
Level of Evidence
Level IV, observational cross-sectional study.
Collapse
Affiliation(s)
- Carlo Doria
- Department of Orthopaedic, Medical School of Sassari, Sassari, Italy
| | - Giulia R Mosele
- Department of Orthopaedic, Medical School of Sassari, Sassari, Italy
| | - Francesca Badessi
- Division of Endocrinology and Metabolism, Medical School of Sassari, Sassari, Italy
| | - Leonardo Puddu
- Department of Orthopaedic, Medical School of Sassari, Sassari, Italy
| | | |
Collapse
|
25
|
Inayat F, Ali NS, Shahid H, Younus F. Prevalence and Determinants of Frozen Shoulder in Patients with Diabetes: A Single Center Experience from Pakistan. Cureus 2017; 9:e1544. [PMID: 29018641 PMCID: PMC5630460 DOI: 10.7759/cureus.1544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction Frozen shoulder (FS) or adhesive capsulitis is a constellation of symptoms like pain, stiffness, and/or functional deficit at the glenohumeral joint. It is one of the musculoskeletal complications in patients with diabetes that can be particularly debilitating. The aim of this study is to estimate the prevalence of FS and to compare the determinants of this disease in a population with diabetes from Lahore, Pakistan. Materials and Methods We carried out this cross-sectional study on a systematically randomized sample of 80 patients with diabetes. It included 38 males and 42 females from 2,964 patients registered at the Diabetes Management Center, Services Hospital Lahore, Pakistan. The study was conducted in the months of April, May, and June 2017. A structured questionnaire was designed and the responses of patients were recorded at the clinic after informed verbal and written consent. The questionnaire outlined the key factors that can lead to a higher frequency of FS in patients with diabetes. Results Thirty-three of the total 80 respondents included in the study were diagnosed with FS. The estimated prevalence of FS in diabetics from this data was 41.3% in Lahore, which is an urban area of Pakistan with a population of more than seven million. Female sex, insulin dependence, uncontrolled blood glucose levels, and a positive family history were associated with a significantly higher prevalence of FS. In our study, most patients with FS were in Stage 1 of the disease and had unilateral involvement. Conclusion The present study shows that the prevalence of FS is higher in patients with diabetes residing in Lahore than in comparable foreign populations with diabetes. It can be attributed to socioeconomic status, lack of awareness, a higher threshold for diagnosis, and/or poor glycemic control. Mass awareness campaigns, especially for female patients with diabetes, are required to be initiated to create awareness about the disease and to facilitate early diagnosis and appropriate management. In-depth and multicenter studies are needed to further explore the association between FS and diabetes.
Collapse
Affiliation(s)
- Faisal Inayat
- Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York City, NY, USA
| | - Nouman Safdar Ali
- Department of Medicine, Jinnah Hospital, Allama Iqbal Medical College, Lahore, Pakistan
| | - Haroon Shahid
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Fariha Younus
- Department of Medicine Unit 4, Services Hospital, Services Institute of Medical Sciences, Lahore, Pakistan
| |
Collapse
|
26
|
The diagnostic value of a modified Neer test in identifying subacromial impingement syndrome. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:1063-1067. [PMID: 28534226 DOI: 10.1007/s00590-017-1979-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Subacromial impingement syndrome (SAIS) is characterized by pain experienced through an arc of elevation as the shoulder abducts and diagnosed commonly by Neer test (NT). However, the diagnostic accuracy of NT for SAIS is still limited. Here, a modified Neer test (MNT) was introduced to improve the accuracy of the clinical examination in diagnosing SAIS and differentiating it from frozen shoulder. The aim of this study was to investigate the diagnostic values of MNT in diagnosing SAIS and differentiating it from frozen shoulder. METHODS Between January 2015 and June 2015, a prospective study assessed 85 shoulders among 82 patients with shoulder joint disease; 42 patients underwent arthroscopic surgery, and all 82 patients received X-rays, magnetic resonance imaging (MRI) or MRI contrast examinations. The diagnostic criteria are based on arthroscopy and MRI scanning. RESULTS Using clinical epidemiology and diagnostic tests, we calculated the sensitivity, specificity, positive predictive value, negative predictive value and degree of accuracy of MNT in diagnosing SAIS. The diagnostic accuracy rate of MNT in identifying shoulder SAIS was 90.59%, and the specificity was 95.56%. CONCLUSIONS In the diagnosis of SAIS, MNT is a reliable and highly accurate maneuver and seems useful to distinguish this syndrome from frozen shoulder.
Collapse
|
27
|
Kothari SY, Srikumar V, Singh N. Comparative Efficacy of Platelet Rich Plasma Injection, Corticosteroid Injection and Ultrasonic Therapy in the Treatment of Periarthritis Shoulder. J Clin Diagn Res 2017; 11:RC15-RC18. [PMID: 28658861 DOI: 10.7860/jcdr/2017/17060.9895] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/07/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Periarthritis (PA) shoulder characterised by pain and restricted range of motion has a plethora of treatment options with inconclusive evidence. Platelet Rich Plasma (PRP) is an emerging treatment option and its efficacy needs to be examined and compared with other routine interventions. AIM To assess the efficacy of PRP injection and compare it with corticosteroid injection and ultrasonic therapy in the treatment of PA shoulder. MATERIALS AND METHODS Patients with PA shoulder (n=195) were randomised to receive single injection of PRP (2 ml) or corticosteroid (80 mg of methylprednisolone) or ultrasonic therapy (seven sittings in two weeks; 1.5 W/cm2, 1 MHz, continuous mode). All participants were also advised to perform a home based 10 minute exercise therapy. The primary outcome measure was active range of motion of the shoulder. Secondary outcome measures used were Visual Analogue Scale (VAS) for pain and a shortened version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) for function. Participants were evaluated at 0, 3, 6 and 12 weeks. Chi-square test, one way and repeated measures of ANOVA tests were used to determine significant differences. RESULTS PRP treatment resulted in statistically significant improvements over corticosteroid and ultrasonic therapy in active as well as passive range of motion of shoulder, VAS and QuickDASH at 12 weeks. At six weeks, PRP treatment resulted in statistically significant improvements over ultrasonic therapy in VAS and QuickDASH. No major adverse effects were observed. CONCLUSION This study demonstrates that single injection of PRP is effective and better than corticosteroid injection or ultrasonic therapy in treatment of PA shoulder.
Collapse
Affiliation(s)
- Shashank Yeshwant Kothari
- Ex-Professor, Department of Physical Medicine and Rehabilitation, VMMC and Safdarjang Hospital, New Delhi, India
| | - Venkataraman Srikumar
- Assistant Professor, Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Singh
- Senior Resident, Department of Physical Medicine and Rehabilitation, PGIMER and Dr. R.M.L. Hospital, New Delhi, India
| |
Collapse
|
28
|
Lui PPY. Tendinopathy in diabetes mellitus patients-Epidemiology, pathogenesis, and management. Scand J Med Sci Sports 2017; 27:776-787. [PMID: 28106286 DOI: 10.1111/sms.12824] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2016] [Indexed: 12/15/2022]
Abstract
Chronic tendinopathy is a frequent and disabling musculo-skeletal problem affecting the athletic and general populations. The affected tendon is presented with local tenderness, swelling, and pain which restrict the activity of the individual. Tendon degeneration reduces the mechanical strength and predisposes it to rupture. The pathogenic mechanisms of chronic tendinopathy are not fully understood and several major non-mutually exclusive hypotheses including activation of the hypoxia-apoptosis-pro-inflammatory cytokines cascade, neurovascular ingrowth, increased production of neuromediators, and erroneous stem cell differentiation have been proposed. Many intrinsic and extrinsic risk/causative factors can predispose to the development of tendinopathy. Among them, diabetes mellitus is an important risk/causative factor. This review aims to appraise the current literature on the epidemiology and pathology of tendinopathy in diabetic patients. Systematic reviews were done to summarize the literature on (a) the association between diabetes mellitus and tendinopathy/tendon tears, (b) the pathological changes in tendon under diabetic or hyperglycemic conditions, and (c) the effects of diabetes mellitus or hyperglycemia on the outcomes of tendon healing. The potential mechanisms of diabetes mellitus in causing and exacerbating tendinopathy with reference to the major non-mutually exclusive hypotheses of the pathogenic mechanisms of chronic tendinopathy as reported in the literature are also discussed. Potential strategies for the management of tendinopathy in diabetic patients are presented.
Collapse
Affiliation(s)
- P P Y Lui
- Headquarter, Hospital Authority, Hong Kong SAR, China
| |
Collapse
|
29
|
Agarwal S, Raza S, Moiz JA, Anwer S, Alghadir AH. Effects of two different mobilization techniques on pain, range of motion and functional disability in patients with adhesive capsulitis: a comparative study. J Phys Ther Sci 2016; 28:3342-3349. [PMID: 28174448 PMCID: PMC5276757 DOI: 10.1589/jpts.28.3342] [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] [Received: 06/19/2016] [Accepted: 08/09/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to compare the effects of two different mobilization
techniques in the management of patients with adhesive capsulitis. [Subjects and Methods]
Thirty non-diabetic men and women with adhesive capsulitis were randomly allocated to the
reverse distraction group (n=15) or Kaltenborn group (n=15). The reverse distraction
technique and Kaltenborn’s caudal and posterior glides (grades III and IV) were applied
10–15 times along with conventional physical therapy for 18 treatment sessions in 6 weeks.
Pain was measured with a visual analog scale, abduction and external rotation range of
motion with goniometry, hand behind back reach with inch tape, and functional disability
with the Flexilevel scale of shoulder function before and after the treatment. [Results]
Although all the variables improved significantly in both groups after 18 intervention
sessions, reverse distraction was significantly better than Kaltenborn’s caudal and
posterior glides in decreasing pain and improving abduction range of motion and functional
scores. [Conclusion] This study supports the clinical use of reverse distraction as an
alternative to conventional mobilization techniques to decrease pain and improve range of
motion and functional scores in patients with adhesive capsulitis.
Collapse
Affiliation(s)
| | - Shahid Raza
- Centre for Physiotherapy and Rehabilitation Sciences, India
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, India
| | - Shahnawaz Anwer
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Saudi Arabia; Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, India
| | - Ahmad H Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| |
Collapse
|
30
|
Park GY, Lee JH, Kwon DG. Ultrasonographic measurement of the axillary recess thickness in an asymptomatic shoulder. Ultrasonography 2016; 36:139-143. [PMID: 27764911 PMCID: PMC5381854 DOI: 10.14366/usg.16032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/15/2016] [Accepted: 09/19/2016] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this study was to measure the axillary recess (AR) thickness in an asymptomatic shoulder by using ultrasonography (US) and to analyze the factors affecting it. Methods We recruited 141 patients (52 males; 89 females; age, 57.7±9.9 years) with unilateral shoulder pain and performed US on the unaffected shoulder. Two physiatrists measured the AR thickness of the unaffected shoulder independently. All patients were examined in an upright sitting position with 90° shoulder abduction. The ultrasonographic transducer was placed longitudinally on the mid-axillary line and along the long axis of the humeral shaft. The factors affecting the AR thickness values were analyzed, and intra-class correlation coefficients were used for assessing the reproducibility of each measurement. Results The intrarater reliability values for the two physiatrists were 0.98 and 0.96, respectively. The inter-rater reliability of the mean AR thickness measurements was 0.91. The mean AR thickness in all subjects, males, and females was 2.8±0.6 mm, 3.1±0.6 mm, and 2.6±0.5 mm (P<0.01), respectively. No difference between the left and the right sides (males, P=0.086; females, P=0.535) or between the dominant and the non-dominant sides (males, P=0.173; female, P=0.244) was found. The AR thickness correlated positively with the height (r=0.313, P<0.01) and the weight (r=0.319, P<0.01). However, it did not correlate with the body mass index (r=0.152, P=0.077) or the age (r=-0.056, P=0.515). Conclusion US measurements of the AR thickness in asymptomatic shoulders demonstrated excellent intrarater and inter-rater reliabilities. The AR thickness showed anatomical variation with sex, height, and weight.
Collapse
Affiliation(s)
- Gi-Young Park
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jin Hoon Lee
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Dae Gil Kwon
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| |
Collapse
|
31
|
Yoon JP, Chung SW, Kim JE, Kim HS, Lee HJ, Jeong WJ, Oh KS, Lee DO, Seo A, Kim Y. Intra-articular injection, subacromial injection, and hydrodilatation for primary frozen shoulder: a randomized clinical trial. J Shoulder Elbow Surg 2016; 25:376-83. [PMID: 26927433 DOI: 10.1016/j.jse.2015.11.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/28/2015] [Accepted: 11/10/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this prospective randomized study was to compare the efficacy of 3 injection methods, intra-articular injection, subacromial injection, and hydrodilatation (HD), in the treatment of primary frozen shoulder. METHODS Patients with primary frozen shoulder were randomized to undergo intra-articular injection (n = 29), subacromial injection (n = 29), or HD (n = 28). Evaluations using a visual analog scale for pain, Simple Shoulder Test, Constant score, and passive range of shoulder motion were completed before treatment and 1 month, 3 months, and 6 months after treatment. RESULTS Among the 3 injection methods for primary frozen shoulder, HD resulted in a greater range of motion in forward flexion and external rotation, a lower visual analog scale score for pain after 1 month, and better outcomes for all functional scores after 1 month and 3 months of follow-up. However, there were no significant differences in any clinical outcomes among the 3 groups in the final follow-up at 6 months. CONCLUSIONS Although HD yielded more rapid improvement, the 3 injection methods for primary frozen shoulder resulted in similar clinical improvement in the final follow-up at 6 months.
Collapse
Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, South Korea.
| | - Ju-Eun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hyung Sup Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hyun-Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Won-Ju Jeong
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, South Korea
| | - Dong-Oh Lee
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, South Korea
| | - Anna Seo
- Center for Bionics, Korea Institute of Science and Technology, Seoul, South Korea
| | - Youngjun Kim
- Center for Bionics, Korea Institute of Science and Technology, Seoul, South Korea
| |
Collapse
|
32
|
Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles Ligaments Tendons J 2016; 6:26-34. [PMID: 27331029 PMCID: PMC4915459 DOI: 10.11138/mltj/2016.6.1.026] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND adhesive capsulitis (AC) results in progressive painful restriction in range of movement and can reduce function and quality of life. Whilst it has been associated with diabetes mellitus (DM), there is considerable variation in the reported prevalence of AC in the diabetic population. The aim of this study is to determine through meta-analysis the prevalence of AC in DM and examine whether it is influenced by type of DM or insulin therapy. We also aim to further establish the prevalence of DM in patients presenting with AC. METHODS we conducted a literature search for terms regarding AC and DM on Embase and Pubmed NCBI. RESULTS of 5411 articles identified, 18 were selected. Meta-analysis showed that patients with DM were 5 (95% CI 3.2-7.7) times more likely than controls to have AC. The overall prevalence of AC in DM was estimated at 13.4% (95% CI 10.2-17.2%). Comparison of prevalence in patients on insulin vs other treatments showed no significant difference between the two. Meta-analysis estimated the prevalence of DM in AC at 30% (95% CI 24-37%). CONCLUSION to our knowledge this is the first meta-analysis to estimate the overall prevalence of diabetes in a population with AC. A high prevalence of AC exists in DM and equally a high prevalence of DM is present in AC. Screening for DM should be considered in patients presenting with AC.
Collapse
Affiliation(s)
- Nasri Hani Zreik
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, UK
| | - Rayaz A. Malik
- Weill Cornell Medical College, Doha, Qatar
- Centre for Endocrinology & Diabetes, Institute of Human Development, University of Manchester, Manchester, UK
| | - Charalambos P. Charalambous
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, UK
- School of Medicine, University of Central Lancashire, Preston, UK
- Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
33
|
Bidwai AS, Mayne AIW, Nielsen M, Brownson P. Limited capsular release and controlled manipulation under anaesthesia for the treatment of frozen shoulder. Shoulder Elbow 2016; 8:9-13. [PMID: 27582995 PMCID: PMC4935169 DOI: 10.1177/1758573215578590] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/26/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND In light of recent interest in the cost-effectiveness of the treatment options available for frozen shoulder, we aimed to determine the results of limited anterior capsular release and controlled manipulation under anaesthesia (MUA) in the treatment of primary frozen shoulder in terms of patient-related outcomes measure, range of motion and re-intervention rates. METHODS This single-surgeon series included prospectively collected data on all patients undergoing capsular release with MUA from March 2011 until June 2013, with a minimum follow-up of 6 months from the index procedure. Outcome measures included pre- and postoperative Oxford Shoulder Score (OSS), range of motion and need for re-intervention. RESULTS Fifty-four procedures were performed in 52 patients. Mean age 50 years (range 42 years to 59 years); male: female ratio = 11: 41. There was a highly statistically significant improvement in both pain and function modules of the OSS (p < 0.005) and range of motion (p < 0.005) at 6 months. The median postoperative score was 41 from a maximum of 48 points, with an average mean improvement of 24 points. Seventeen patients were diabetics. There was no significant difference in pre-operative and postoperative OSS or range of motion between the diabetic group and the non-diabetic groups. No patients required surgical re-intervention. CONCLUSIONS A combination of limited capsular release and MUA for the treatment of primary frozen shoulder is a safe and effective procedure resulting in marked improvement in pain, function and range of motion.
Collapse
Affiliation(s)
| | - Alistair IW Mayne
- Alistair Mayne, Royal Liverpool & Broadgreen University Hospitals, Prescot Street, Liverpool L7 8XP, UK. Tel: 07940062214.
| | | | | |
Collapse
|
34
|
Ahn KS, Kang CH, Kim Y, Jeong WK. Diagnosis of adhesive capsulitis: comparison of contrast-enhanced MRI with noncontrast-enhanced MRI. Clin Imaging 2015; 39:1061-7. [PMID: 26362354 DOI: 10.1016/j.clinimag.2015.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/31/2015] [Accepted: 08/12/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the diagnostic performance of contrast-enhanced (CE) magnetic resonance imaging (MRI) and non-CE MRI for adhesive capsulitis (AC). METHODS CE MRI of 50 AC and 53 non-AC patients were reviewed by two radiologists independently. RESULTS Axillary capsular thickening and T2 hyperintensity (sensitivity=92-94%; specificity=53-64%) and enhancement of the axillary capsule and rotator interval (sensitivity=92-98%; specificity=38-64%) were helpful in diagnosing AC. Interobserver reliability was highest with axillary joint capsule enhancement (κ=0.92). CONCLUSION Non-CE and CE MRI are helpful in confirming the clinical diagnosis of AC. CE-MRI may improve assessment of the rotator interval and diagnostic confidence in patients with AC.
Collapse
Affiliation(s)
- Kyung-Sik Ahn
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Yura Kim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woong-Kyo Jeong
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
35
|
Relationship Between Skin Intrinsic Fluorescence--an Indicator of Advanced Glycation End Products-and Upper Extremity Impairments in Individuals With Diabetes Mellitus. Phys Ther 2015; 95:1111-9. [PMID: 25858973 PMCID: PMC4528014 DOI: 10.2522/ptj.20140340] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 04/02/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Accumulation of advanced glycation end products (AGEs) is thought to contribute to limited joint mobility in people with diabetes mellitus (DM), but the relationships among AGEs, shoulder structural changes, movement, and disability are not understood. OBJECTIVE The purpose of this study was to determine the differences and relationships among skin intrinsic fluorescence (SIF), a proxy measure of AGEs, biceps and supraspinatus tendon thickness, upper extremity movement, and disability in groups with and without DM. DESIGN This was a cross-sectional, case-control study. METHODS Fifty-two individuals participated: 26 with type 2 DM and 26 controls matched for sex, age, and body mass index. The main outcome measures were: SIF; biceps and supraspinatus tendon thickness; 3-dimensional peak shoulder motion; and Disability of the Arm, Shoulder and Hand (DASH) questionnaire scores. RESULTS Mean SIF measurements were 19% higher in the DM group compared with the control group (P<.05). Biceps tendons (mean and 95% confidence interval [CI]) (4.7 mm [4.4, 5.0] versus 3.2 mm [2.9, 3.5]) and supraspinatus tendons (6.4 mm [5.9, 6.8] versus 4.9 mm [4.4, 5.3]) were thicker and peak humerothoracic elevation (139° [135°, 146°] versus 150° [146°, 155°]) and glenohumeral external rotation (35° [26°, 46°] versus 51° [41°, 58°]) were reduced in the DM group compared with the control group (P<.05). In the DM group, SIF was correlated to biceps tendon thickness, DASH score, and shoulder motion (r=.44-.51, P<.05). The SIF score and shoulder strength explained 64% of the DASH scores (P<.01). LIMITATIONS Because this was a cross-sectional study design, a cause-effect relationship could not be established. CONCLUSIONS Accumulation of AGEs in the connective tissues of individuals with DM appears to be associated with increased tendon thickness and decreased shoulder joint mobility and upper extremity function. Physical therapists should be aware of these possible metabolic effects on structure, movement, and disability when treating people with diabetes.
Collapse
|
36
|
Raje YR, Cracknell G, Davoren PM. Frequency of hand and shoulder symptoms in patients with type 1 diabetes. Diabet Med 2015; 32:968-71. [PMID: 25644754 DOI: 10.1111/dme.12704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
AIMS To characterize the frequency of joint symptoms in patients with Type 1 diabetes mellitus and to determine the subset of patients at risk of developing these symptoms. METHODS We invited patients with Type 1 diabetes to complete a survey in which upper limb joint symptoms were scored using a composite of the Shoulder Pain and Disability Index and a visual analogue scale. Family or friends of the participants, without diabetes, completed control surveys. RESULTS A total of 131 patients and 79 age- and sex-matched control subjects completed the surveys. Patients with Type 1 diabetes had higher composite symptom scores than did the control subjects [median (range) score 25 (0-208) vs. 12 (0-145); P < 0.001]. Patients with long-standing diabetes had significantly higher median (range) scores than those with diabetes of shorter duration [diabetes >30 years: 63(0-208), 15-30 years: 46(0-168), diabetes <15 years: 17(0-143)]. Patients with diabetic nephropathy had higher scores than those without [median (range) score 103 (0-173) vs. 22 (0-208); P = 0.007 between groups]. Neither blood glucose control nor age at diagnosis predicted higher scores. CONCLUSION Upper limb joint symptoms occur with greater frequency in patients with Type 1 diabetes. Longer duration of disease is the best predictor of symptoms. Blood glucose control does not appear to be associated with development of symptoms.
Collapse
Affiliation(s)
- Y R Raje
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - G Cracknell
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - P M Davoren
- Gold Coast University Hospital, Southport, Queensland, Australia
| |
Collapse
|
37
|
Lee SY, Lee KJ, Kim W, Chung SG. Relationships Between Capsular Stiffness and Clinical Features in Adhesive Capsulitis of the Shoulder. PM R 2015; 7:1226-1234. [DOI: 10.1016/j.pmrj.2015.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 04/14/2015] [Accepted: 05/12/2015] [Indexed: 11/16/2022]
|
38
|
Addition of lidocaine injection immediately before physiotherapy for frozen shoulder: a randomized controlled trial. PLoS One 2015; 10:e0118217. [PMID: 25714415 PMCID: PMC4340950 DOI: 10.1371/journal.pone.0118217] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/06/2015] [Indexed: 11/19/2022] Open
Abstract
The intraarticular injection of lidocaine immediately before a physiotherapy session may relieve pain during the stretching and mobilization of the affected joint in patients with a frozen shoulder, thus enhancing the treatment effect. To compare the effects of intraarticular injection of lidocaine plus physiotherapy to that of physiotherapy alone in the treatment of a frozen shoulder, a prospective randomized controlled trial was conducted in the rehabilitation department of a private teaching hospital. Patients with a frozen shoulder were randomized into the physiotherapy group or the lidocaine injection plus physiotherapy (INJPT) group. The subjects in the INJPT group underwent injection of 3 ml of 1% lidocaine into the affected shoulder 10 to 20 minutes before each physiotherapy session. In each group, the treatment lasted 3 months. The primary outcome measures were the active and passive range of motion of the affected shoulder. The secondary outcome measures were the results of the Shoulder Disability Questionnaire, the Shoulder Pain and Disability Index, and the 36-item Short-Form Health Survey (SF-36). The outcome measures were evaluated before treatment and 1, 2, 3, 4, and 6 months after the start of treatment. The group comparisons showed significantly greater improvement in the INJPT group, mainly in active and passive shoulder range of motion in flexion and external rotation and improvements in pain and disability (P < 0.05); however, no significant group difference was seen in the SF-36 results. The intraarticular injection of lidocaine immediately before a physiotherapy session might be superior to physiotherapy alone in the treatment of a frozen shoulder. Trial registration: ClinicalTrials.gov NCT01817348.
Collapse
|
39
|
Sharma SP, Bærheim A, Kvåle A. Passive range of motion in patients with adhesive shoulder capsulitis, an intertester reliability study over eight weeks. BMC Musculoskelet Disord 2015; 16:37. [PMID: 25888419 PMCID: PMC4340115 DOI: 10.1186/s12891-015-0495-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measuring range of motion (ROM) in the shoulder joint is important for the diagnosis and monitoring of change over time. To what degree passive ROM can be trusted as a reliable outcome measure was examined as part of an on-going randomized controlled trial for patients with shoulder capsulitis. The aim of this study was to examine intertester reliability of passive ROM in the shoulder joint over a period of eight weeks in patients with adhesive capsulitis stage II. METHODS Fifty patients with a clinical diagnosis of adhesive shoulder capsulitis were examined by two independent testers. A predefined protocol was used for measuring passive range of motion with an inclinometer, a plurimeter, in both affected and non-affected shoulders three times; at the start of the study and after 4 and 8 weeks. RESULTS Very good to excellent intertester agreements were found for most parameters for the affected arm at all three test points. The intraclass correlation coefficient (ICC 2.1) values ranged from 0.76 to 0.98, i.e. from very reliable to excellent. The measurement error was in general small for the affected arm (5°-7°). ICCs were slightly lower for the non-affected arm at 8 weeks, but with acceptable measurement errors. CONCLUSIONS Intertester reliability between two testers was very good at three visits over a time period of eight weeks using a plurimeter to measure passive range of motion in patients with adhesive shoulder capsulitis. This method can reliably determine passive range of motion in this patient population and be a reliable outcome measure.
Collapse
Affiliation(s)
- Satya Pal Sharma
- Department of Global Public Health and Primary Care, Research Group for General Practice, University of Bergen, Bergen, Norway.
| | - Anders Bærheim
- Department of Global Public Health and Primary Care, Research Group for General Practice, University of Bergen, Bergen, Norway.
| | - Alice Kvåle
- Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Bergen, Norway.
| |
Collapse
|
40
|
Efird W, Kellam P, Yeazell S, Weinhold P, Dahners LE. An evaluation of prophylactic treatments to prevent post traumatic joint stiffness. J Orthop Res 2014; 32:1520-4. [PMID: 25073544 DOI: 10.1002/jor.22700] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 06/27/2014] [Indexed: 02/04/2023]
Abstract
Arthrofibrosis is a major obstacle to restoring joint function after trauma. The objective of this study was to evaluate montelukast, forskolin, and triamcinolone as possible means of prophylaxis against the formation of arthrofibrosis. Forty-eight rats underwent surgical knee trauma with post-operative immobilization in full flexion. The treatment groups were: control (CTL), oral montelukast (3.75 mg/kg/day) (MLK), intra-articular forskolin injections (0.6 mg/kg) (FSK), and intra-articular triamcinolone injections (0.68 mg/kg) (STR). Rats were sacrificed after 14 days and femorotibial contracture angles were measured with the posterior capsule intact and with the posterior capsule cut. A 0.015Nm extension moment was applied to the knee. All treatment groups had significant reductions in contracture angle compared to the control. Mean contractures with the posterior capsule intact were 32°(CTL), 20° (MLK), 22° (FSK), and 7° (STR). Contractures with the posterior capsule cut were 28° (CTL), 19° (MLK), 20° (FSK), and 5° (STR). The STR group was significantly better than FSK and MLK. Triamcinolone injections provided dramatic reductions in stiffness. Both forskolin and montelukast provided significant, though lesser, reductions in stiffness. While the triamcinolone contracture angles were significantly better, the novel treatments of forskolin and montelukast provided encouraging results and should be studied further.
Collapse
Affiliation(s)
- Will Efird
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | | | | | | |
Collapse
|
41
|
Theodorides AA, Owen JM, Sayers AE, Woods DA. Factors affecting short- and long-term outcomes of manipulation under anaesthesia in patients with adhesive capsulitis of the shoulder. Shoulder Elbow 2014; 6:245-56. [PMID: 27582942 PMCID: PMC4935038 DOI: 10.1177/1758573214528155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 02/18/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND The present study aimed to evaluate and determine the factors that affect short- and long-term outcome following manipulation under anaesthesia (MUA) of patients with adhesive capsulitis. METHODS Patients recruited from January 1999 to January 2010 were retrospectively analyzed and classified as having primary or secondary adhesive capsulitis. All patients were assessed for range of movement (ROM) and Oxford Shoulder Scores (OSS) before and immediately postoperatively, as well as for OSS more than 1 year post MUA. RESULTS In total, 295 patients (315 shoulders) were sequentially recruited, and information was collected at baseline, as well as at a mean follow-up of 28 days and 3.6 years. A significant improvement in OSS and ROM was noted 1 month post MUA (p < 0.0001) with females benefiting more than males (p < 0.0025). Long-term follow-up revealed that the improvement in OSS was maintained (p < 0.0001). Secondary adhesive capsulitis significantly reduced the efficacy of MUA as assessed by ROM (p < 0.0001). Other factors (age, initial ROM and OSS, and length of symptoms prior to MUA) did not significantly affect the outcome over the short- or long-term. CONCLUSIONS The findings of the present study show that all patient groups had a significantly improved ROM and OSS in the short-term with long-term maintenance of improved OSS.
Collapse
Affiliation(s)
- Anthony A Theodorides
- Department of Trauma and Orthopaedic Surgery,
Great Western Hospitals NHS Foundation Trust, Swindon, UK,Anthony A Theodorides, Hull Royal Infirmary, Anlaby
Road, Hull, HU3 2JZ.
| | - John M Owen
- Department of Trauma and Orthopaedic Surgery,
Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Adrian E Sayers
- School of Social and Community Based Medicine,
University of Bristol, Bristol, UK
| | - David A Woods
- Department of Trauma and Orthopaedic Surgery,
Great Western Hospitals NHS Foundation Trust, Swindon, UK,Ridgeway Hospital, Wroughton, Swindon,
UK
| |
Collapse
|
42
|
Shah KM, Clark BR, McGill JB, Mueller MJ. Upper extremity impairments, pain and disability in patients with diabetes mellitus. Physiotherapy 2014; 101:147-54. [PMID: 25442298 DOI: 10.1016/j.physio.2014.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 07/25/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To determine the severity of, and relationships between, upper extremity impairments, pain and disability in patients with diabetes mellitus, and to compare upper extremity impairments in patients with diabetes with non-diabetic controls. DESIGN Case-control, cross-sectional design. SETTING University-based, outpatient diabetes centre and physical therapy research clinic. PARTICIPANTS Two hundred and thirty-six patients with diabetes attending an outpatient diabetes clinic completed the Shoulder Pain and Disability Index (SPADI) questionnaire. A detailed shoulder and hand examination was conducted on a subgroup of 29 volunteers with type 2 diabetes, and 27 controls matched for age, sex and body mass index. INTERVENTIONS None. MAIN OUTCOME MEASURES SPADI score, passive shoulder range of motion (ROM) and strength, grip strength, hand sensation, dexterity and limited joint mobility of the hand. RESULTS Sixty-three percent (149/236) of patients with diabetes reported shoulder pain and/or disability [median SPADI score 10.0 (interquartile range 0.0 to 39.6)]. Compared with the control group, the subgroup of patients with diabetes had substantial reductions in shoulder ROM, shoulder muscle strength, grip and key pinch strength (P<0.05). Patients with diabetes had a greater prevalence of decreased sensation (26/27 vs 14/27) and limited joint mobility of the hand (17/27 vs 4/27) compared with the control group. Total SPADI score was negatively correlated (P<0.05) with shoulder ROM (r=-0.42 to -0.74) and strength measures (r=-0.44 to -0.63) in patients with diabetes. CONCLUSIONS Upper extremity impairments in this sample of patients with diabetes were common, severe and related to complaints of pain and disability. Additional research is needed to understand the unique reasons for upper extremity problems in patients with diabetes, and to identify preventative treatments.
Collapse
Affiliation(s)
- K M Shah
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, USA.
| | - B R Clark
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, USA
| | - J B McGill
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine in St. Louis, USA
| | - M J Mueller
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, USA; Department of Radiology, Washington University School of Medicine in St. Louis, USA
| |
Collapse
|
43
|
Li W, Lu N, Xu H, Wang H, Huang J. Case control study of risk factors for frozen shoulder in China. Int J Rheum Dis 2014; 18:508-13. [PMID: 24438046 DOI: 10.1111/1756-185x.12246] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Frozen shoulder is a common self-limiting regional skeletal problem of unclear pathogenesis. It usually has an insidious onset and follows a protracted course. The aim of this study was to assess the prevalence and related risk factors for frozen shoulder in Shanghai, China. METHODS We performed a hospital-based case-control study involving 182 patients with pathologically diagnosed frozen shoulder and 196 patients hospitalized during the same time period with non-shoulder related complaints who were recruited as controls. Information on potential risk factors was collected on both case and control groups through questionnaires and face-to-face interview. Univariate and multivariate logistic regression analyses were performed. RESULTS Among the frozen shoulder patients, 24.2% had diabetes and 16.5% had history of shoulder trauma. Multivariate analysis suggested that diabetes and history of slight trauma were independent risk factors for the disease. The frozen shoulder patients also had a higher prevalence of thyroid disease, increased body mass index and cervical spondylosis than the controls. The incidence of frozen shoulder was higher in female compared to male patients. No significant difference was found in occupations, physical exercise, cholecystitis, history of surgical and ischemic heart disease between the frozen shoulder group and the control group. CONCLUSIONS The findings in the present study indicate that diabetes, history of slight shoulder trauma, thyroid disease, increased body mass index and cervical spondylosis are factors significantly associated with increased frozen shoulder risk among individuals within the area of Shanghai, China.
Collapse
Affiliation(s)
- Wei Li
- Department of TCM Orthopedics & Traumatology, Jing'An District Central Hospital of Shanghai (Huashan Hospital Fudan University Jing'An Branch), Shanghai, China
| | - Nianzu Lu
- Department of TCM Orthopedics & Traumatology, Jing'An District Central Hospital of Shanghai (Huashan Hospital Fudan University Jing'An Branch), Shanghai, China
| | - Hongliang Xu
- Department of TCM Orthopedics & Traumatology, Jing'An District Central Hospital of Shanghai (Huashan Hospital Fudan University Jing'An Branch), Shanghai, China
| | - Huifang Wang
- Department of TCM Orthopedics & Traumatology, Jing'An District Central Hospital of Shanghai (Huashan Hospital Fudan University Jing'An Branch), Shanghai, China
| | - Jun Huang
- Department of TCM Orthopedics & Traumatology, Jing'An District Central Hospital of Shanghai (Huashan Hospital Fudan University Jing'An Branch), Shanghai, China
| |
Collapse
|
44
|
Wolfson TS, Hamula MJ, Jazrawi LM. Impact of diabetes mellitus on surgical outcomes in sports medicine. PHYSICIAN SPORTSMED 2013; 41:64-77. [PMID: 24231598 DOI: 10.3810/psm.2013.11.2037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Diabetes mellitus (DM) affects a significant proportion of the patients evaluated and treated by orthopedic surgeons who specialize in sports medicine. Sports-medicine-related conditions associated with DM include tendinopathy, adhesive capsulitis of the shoulder, and articular cartilage disease. This article reviews the current literature adressing the effect of DM on surgical outcomes in sports medicine. In general, patients with DM undergo operations more frequently and experience inferior surgical outcomes compared with patients without DM. Diabetes mellitus is associated with increased rates of complications from sports medicine procedures, such as infection, delayed healing, and failure of the operation. However, additional research is needed to determine the full impact of DM on patient outcomes in sports medicine. Surgeons should be cognizant of special considerations in the population of patients with DM and aim to tailor the surgical management of this growing patient population.
Collapse
Affiliation(s)
- Theodore S Wolfson
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY
| | | | | |
Collapse
|
45
|
Nagy MT, Macfarlane RJ, Khan Y, Waseem M. The frozen shoulder: myths and realities. Open Orthop J 2013; 7:352-5. [PMID: 24082974 PMCID: PMC3785028 DOI: 10.2174/1874325001307010352] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 12/01/2012] [Accepted: 12/15/2012] [Indexed: 01/30/2023] Open
Abstract
Frozen shoulder is a common, disabling but self-limiting condition, which typically presents in three stages and ends in resolution. Frozen shoulder is classified as primary (idiopathic) or secondary cases. The aetiology for primary frozen shoulder remains unknown. It is frequently associated with other systemic conditions, most commonly diabetes mellitus, or following periods of immobilisation e.g. stroke disease. Frozen shoulder is usually diagnosed clinically requiring little investigation. Management is controversial and depends on the phase of the condition. Non-operative treatment options for frozen shoulder include analgesia, physiotherapy, oral or intra-articular corticosteroids, and intra-articular distension injections. Operative options include manipulation under anaesthesia and arthroscopic release and are generally reserved for refractory cases.
Collapse
Affiliation(s)
- Mathias Thomas Nagy
- Department of Trauma and Orthopaedic Surgery, Macclesfield District General Hospital, Victoria Road, Macclesfield, SK10 3BL, UK
| | | | | | | |
Collapse
|
46
|
Tsai WC, Liang FC, Cheng JW, Lin LP, Chang SC, Chen HH, Pang JHS. High glucose concentration up-regulates the expression of matrix metalloproteinase-9 and -13 in tendon cells. BMC Musculoskelet Disord 2013; 14:255. [PMID: 23981230 PMCID: PMC3765930 DOI: 10.1186/1471-2474-14-255] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 08/23/2013] [Indexed: 01/21/2023] Open
Abstract
Background Diabetes mellitus is associated with tendinopathy or tendon injuries. However, the mechanism underlying diabetic tendinopathy is unclear. The purpose of this study was to examine the effects of high glucose concentrations on the activity and expression of matrix metalloproteinases, type I collagen, and type III collagen in tendon cells. Methods Tendon cells from rat Achilles tendons were treated with 6 mM, 12 mM, and 25 mM glucose, and then cell proliferation was evaluated by the 3-[4,5-Dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay. Messenger RNA (mRNA) expression of MMP-2, MMP-8, MMP-9, and MMP-13 and type I and type III collagen was assessed by quantitative real-time polymerase chain reaction (PCR). The enzymatic activity of MMP-2 and MMP-9 was measured by gelatin zymography. Results The MTT assay results showed that the glucose concentration did not affect tendon cell proliferation. The results of the real-time PCR assay revealed that the mRNA expression of MMP-9 and MMP-13 was up-regulated by treatment with 25 mM glucose, whereas the mRNA expression of type I and III collagen was not affected. Gelatin zymography showed that 25 mM glucose increased the enzymatic activity of MMP-9. Conclusions High glucose concentration up-regulates the expression of MMP-9 and MMP-13 in tendon cells, which may account for the molecular mechanisms underlying diabetic tendinopathy.
Collapse
Affiliation(s)
- Wen-Chung Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
| | | | | | | | | | | | | |
Collapse
|
47
|
Lo SF, Chu SW, Muo CH, Meng NH, Chou LW, Huang WC, Huang CM, Sung FC. Diabetes mellitus and accompanying hyperlipidemia are independent risk factors for adhesive capsulitis: a nationwide population-based cohort study (version 2). Rheumatol Int 2013; 34:67-74. [DOI: 10.1007/s00296-013-2847-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
|
48
|
|
49
|
Diabetic cheiroarthropathy: a case report and review of the literature. Case Rep Endocrinol 2013; 2013:257028. [PMID: 23762663 PMCID: PMC3671228 DOI: 10.1155/2013/257028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 04/27/2013] [Indexed: 11/17/2022] Open
Abstract
Diabetes mellitus is associated with a wide variety of rheumatologic manifestations which can significantly affect a patient's quality of life. One of these manifestations includes diabetic cheiroarthropathy (DCA) which affects the hands. We review a case of a 28-year-old female patient with type 1 diabetes mellitus who was diagnosed with DCA after complaining of limited movements of all joints in her hands and tightening of the skin. We examine how the diagnosis was made, the treatment administered, and the successful clinical outcome. Clinicians should be able to identify and treat this affliction. The diagnosis is mainly clinical. It is imperative to remember that the presence of DCA carries with it a significant relationship with microvascular disease.
Collapse
|
50
|
|