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El-Swaify ST, Refaat MA, AbdelWahab AA, Seddik MEE, Mostafa Abdelrazek AE, Doas Y, Beshay PW. Is platelet-rich plasma a new solution for shoulder adhesive capsulitis? A systematic scoping review of the literature. Shoulder Elbow 2024; 16:239-249. [PMID: 38818099 PMCID: PMC11135196 DOI: 10.1177/17585732231174184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 06/01/2024]
Abstract
Background Platelet-rich plasma (PRP) has shown promising results for adhesive shoulder capsulitis (AC) in pre-clinical models. The aim of this review is to investigate the clinical outcomes of using PRP in AC. Materials and Methods We conducted a systematic scoping review of the literature using bibliographic databases from inception until the 9th of January 2022 [PubMed, Web of Science, Scopus, and CENTRAL]. Randomized studies were included if they investigated the use of PRP in human patients with a diagnosis of AC. Authors performed individual study quality assessments using the RoB 2 tool. Results We screened a total of 470 results and 6 were included in the final synthesis. Studies included data of 578 patients with 263 patients receiving PRP (45.5%). All studies used PRP as part of non-operative treatment. PRP was compared to another intervention in all six studies. Four of these studies found PRP to be more effective. No major adverse effects were reported in any study. Conclusion PRP is a safe treatment option that can be added to the investigative treatment arsenal of AC. Despite showing some favorable results, several limitations and patient-centered questions remain to be addressed by future studies. Level of Evidence IV.
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Affiliation(s)
| | - Mazen A Refaat
- Department of Surgery, Ain Shams University Hospitals, Abbasseya, Cairo, Egypt
| | - Aly A AbdelWahab
- Department of Surgery, Ain Shams University Hospitals, Abbasseya, Cairo, Egypt
| | | | | | - Youssef Doas
- Department of Surgery, Ain Shams University Hospitals, Abbasseya, Cairo, Egypt
| | - Pavly Wagih Beshay
- Department of Surgery, Ain Shams University Hospitals, Abbasseya, Cairo, Egypt
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Feusi O, Fleischmann T, Waschkies C, Pape HC, Werner CM, Tiziani S. Vitamin C as a Potential Prophylactic Measure Against Frozen Shoulder in an In Vivo Shoulder Contracture Animal Model. Am J Sports Med 2023; 51:2041-2049. [PMID: 37249131 PMCID: PMC10315865 DOI: 10.1177/03635465231172192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/17/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Frozen shoulder is a common, painful, and movement-restricting condition. Although primary frozen shoulder is idiopathic, secondary frozen shoulder can occur after trauma or surgery. Prophylactic and therapeutic options are often unsatisfactory. Vitamin C (ascorbic acid) is a potent physiological antioxidant and likely inhibits the activation of nuclear factor κB, which plays a decisive role in inflammatory reactions. HYPOTHESIS Because of its anti-inflammatory effects, vitamin C may be valuable in the prevention of secondary frozen shoulder. STUDY DESIGN Controlled laboratory study. METHODS An in vivo shoulder contracture model was conducted by fixation of the right proximal limb of Sprague-Dawley rats. A treatment group (n = 8) receiving vitamin C orally was compared with a control group (n = 9) without vitamin C. The primary outcome was capsular thickness at the shoulder joint measured on magnetic resonance imaging (MRI) examination. Further histological examination was performed but was not statistically analyzed because of variability of the cutting plane through the glenoid. RESULTS Vitamin C treatment resulted in less thickening of the axillary fold of the operated shoulder at 2 of the 3 locations measured on MRI compared with untreated controls (insertion to the glenoid, P = .074; insertion to the humerus, P = .006; middle of the axillary recess, P = .008). The observed structural changes in histological examination corroborated the significant changes obtained from the MRI measurements. CONCLUSION Prophylactic vitamin C seemed to reduce the thickening of the axillary recess in secondary frozen shoulder in this preclinical study. CLINICAL RELEVANCE Vitamin C may be helpful as a noninvasive therapeutic measure to prevent secondary frozen shoulder (eg, within the context of surgery in the shoulder region or immobilization) or to treat primary frozen shoulder at an early stage. Further studies are required to evaluate the effect of this treatment in humans and the necessary dosage in humans.
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Affiliation(s)
- Oscar Feusi
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thea Fleischmann
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Conny Waschkies
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Clément M.L. Werner
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Simon Tiziani
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Romeo PV, Papalia AG, Alben MG, Gambhir N, Shankar D, Bi AS, Zuckerman JD, Virk MS. Prognostic factors associated with improvements in patient-reported outcomes in idiopathic adhesive capsulitis. JSES Int 2023; 7:336-341. [PMID: 36911781 PMCID: PMC9998727 DOI: 10.1016/j.jseint.2022.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The purpose of this study was to identify prognostic factors that are associated with improvements in patient-reported outcomes measures (PROMs) related to upper extremity function and pain in those suffering from idiopathic adhesive capsulitis. Methods All patients treated conservatively for primary idiopathic adhesive capsulitis were identified from our institutional database between 2019 and 2021. Exclusion criteria included any patients treated surgically, follow-up less than one year, or incomplete survey results. PROMs including Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Test Version 2.0 (P-UE), Pain Interference (P-Interference), Pain Intensity (P-Intensity), and visual analog scale (VAS) pain scores. They were obtained at initial consultation and at one year to assess patient-perceived impact of their condition. Multiple linear and multivariable logistic regressions were performed to identify factors associated with improvement in patient-perceived pain and shoulder function using final PROM scores and difference in PROM scores from initial consultation. An independent t-test was used to compare baseline and one-year minimum follow-up PROMs. Odds ratios and their 95% confidence intervals were calculated for each factor; a P value of < .05 was considered statistically significant. Results A total of 56 patients (40 females and 16 males) were enrolled in the study with an average age of 54.7 ± 7.7 years. A significant improvement (P < .001) was demonstrated at one-year minimum outcomes for P-UE, P-Interference, P-Intensity, and VAS scores. With respect to comorbid conditions, hypothyroidism [P-UE (β: 9.57, P = .006)] was associated with greater improvements in PROMs, while hyperlipidemia [P-UE (β: -4.13, P = .01) and P-Intensity (β: 2.40, P = .02)] and anxiety [P-UE (β: -4.13, P = .03)] were associated with poorer reported changes in PROMs. Female sex [P-UE (β: 4.03, P = .007) and P-Interference (β: -2.65, P = .04)] and employment in manual labor professions [P-Interference (β: -3.07, P = .01), P-Intensity (β: -2.92, P = .006), and VAS (β: -0.66, P = .03)] were associated with significantly better patient-perceived outcomes. Hispanic heritage was associated with higher reported changes of P-Intensity (β: 8.45, P = .004) and VAS (β: 2.65, P = .002). Conclusion Patient-perceived improvements in PROMIS score during the natural history of adhesive capsulitis are likely multifactorial, with anxiety, hyperlipidemia, increased body mass index, and Hispanic heritage associated with reduced improvement in PROMIS scores.
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Affiliation(s)
- Paul V Romeo
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Aidan G Papalia
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Matthew G Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Neil Gambhir
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Dhruv Shankar
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Andrew S Bi
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Joseph D Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
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Alben MG, Gambhir N, Shankar D, Gordon D, Zuckerman JD, Virk MS. Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) of upper extremity PROMIS scores in idiopathic adhesive capsulitis. Clin Rheumatol 2023; 42:579-589. [PMID: 36547817 DOI: 10.1007/s10067-022-06479-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/04/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The purpose of this study is to calculate the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) of Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Testing v2.0 (UE), Pain Interference (P-Interference), and Pain Intensity (P-Intensity) in patients treated nonoperatively for idiopathic adhesive capsulitis (IAC). METHODS The anchor-based MCID, SCB, and PASS were calculated as the change in PROMIS scores representing the optimal cutoff for a ROC curve with an area under the curve (AUC) analysis. The distribution-based MCID was calculated as a range between the average standard error of measurement multiplied by two different constants: 1 and 2.77. Effect sizes and standardized response means (SRM) were calculated to assess the responsiveness of each PROMIS instrument while regression analyses were performed to identify factors associated with achieving these thresholds. RESULTS This study enrolled 115 patients. The anchor-based MCID for PROMIS UE, P-Interference, and P-Intensity was 5.11, 4.16, and 8.16, respectively. The respective SCB was 8.44, 6.65, and 10.05. The respective PASS was 8.47, 7.01, and 10.41. The odds of achieving MCID values in adhesive capsulitis were negatively affected by gender (male), higher forward elevation at the time of presentation, higher pain scores (P-Interference), need for ≥ 2 corticosteroid injections, and a concomitant diagnosis of diabetes. CONCLUSION The MCID, SCB, and PASS parameters for PROMIS scores can be utilized to determine the clinical meaningfulness of patient-reported improvements in these instruments during the nonoperative treatment and as a research tool to compare the efficacy of new treatments for adhesive capsulitis. LEVEL OF EVIDENCE Level III, basic science study, validation of outcome instruments. Key points • This is the first study to calculate the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for the Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity and Pain instruments in patients with idiopathic adhesive capsulitis (IAC) of the shoulder.• This study determined the impact of symptom severity, demographics, and comorbidities on achieving the MCID, SCB, and PASS for PROMIS instruments in IAC patients treated nonoperatively.
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Affiliation(s)
- Matthew G Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Neil Gambhir
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Dhruv Shankar
- Division of Sports Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Dan Gordon
- Department of Orthopedic Surgery, Baylor University Medical Center Dallas, Dallas, TX, USA
| | - Joseph D Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, 246 East 20Th Street, New York, NY, 10003, USA.
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Almasri M, Kohrs B, Fleckenstein CM, Nolan J, Wendt A, Hasan SS. Reverse shoulder arthroplasty in patients 85 years and older is safe, effective, and durable. J Shoulder Elbow Surg 2022; 31:2287-2297. [PMID: 35550432 DOI: 10.1016/j.jse.2022.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/21/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) was originally indicated for older adults, but outcomes in the oldest patients have not been studied. The purpose of this study was to report on patients aged ≥85 years undergoing RSA. We hypothesized that RSA would be safe, effective, and durable. METHODS Sixty-one RSAs were performed in 58 patients aged ≥85 years (16 patients aged ≥90 years); 40 RSAs were performed for arthritis with cuff deficiency, 14 were performed for proximal humeral fractures, and 7 were performed as revisions. Active range of motion and patient-reported outcomes, comprising the American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, and visual analog scale pain score, were obtained preoperatively and at final follow-up. Hospital length of stay, discharge disposition, and complications were recorded. Kaplan-Meier survivorship was computed with revision surgery or death as an endpoint. RESULTS The mean age at RSA was 88.0 years. Mean forward elevation improved from 50.5° to 105.3°; abduction, from 48.7° to 96.1°; and external rotation, from 10.2° to 26.9° (P < .001 for all). Similarly, at a mean follow-up of 2.4 years, the visual analog scale pain score improved from 6.1 to 0.6; Simple Shoulder Test score, from 2.2 to 7.0; and American Shoulder and Elbow Surgeons score, from 33.6 to 78.2 (P < .001 for all). The mean length of stay was 3.6 days, and 15 patients were discharged home. Seven patients received a blood transfusion, and only 2 patients underwent a reoperation, neither of whom required explantation. DISCUSSION AND CONCLUSION Improvements in active range of motion and patient-reported outcomes in our patients were comparable to those observed in younger cohorts and exceeded published minimal clinically important differences for most patients undergoing RSA for cuff deficiency. Additionally, to date, the patients in our study who died had lived with their RSA for a mean of 3.4 years and living patients had lived with their RSA for a mean of 4.3 years. RSA in patients aged ≥85 years is safe, effective, and durable for their remaining life expectancy. This information may help counsel older patients who are considering RSA, electively or for fractures.
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Affiliation(s)
- Mahmoud Almasri
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA
| | | | - Cassie M Fleckenstein
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA
| | - Joseph Nolan
- Burkardt Consulting Center, Department of Mathematics and Statistics, Northern Kentucky University, Highland Heights, KY, USA
| | - Abby Wendt
- Burkardt Consulting Center, Department of Mathematics and Statistics, Northern Kentucky University, Highland Heights, KY, USA
| | - Samer S Hasan
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati SportsMedicine Research and Education Foundation, Cincinnati, OH, USA.
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Tawfeek W, Addosooki A, Elsayed M. Arthroscopic rotator interval release for frozen shoulder, comparative study between diabetic and non-diabetic patients. SICOT J 2022; 8:35. [PMID: 35984241 PMCID: PMC9390058 DOI: 10.1051/sicotj/2022036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/30/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The objective of this study is to evaluate the outcomes of arthroscopic rotator interval release for the treatment of frozen shoulder and compare the results in patients with and without diabetes. METHODS thirty-two patients with frozen shoulders were divided into two groups; 19 diabetics and 13 non-diabetics. All patients underwent arthroscopic rotator interval release. The VAS and UCLA score were assessed pre-operatively and post-operatively; after 1, 3, and 12 months and compared between groups. RESULTS The VAS and UCLA score was significantly improved in both groups during follow-up intervals (p < 0.01). There was no significant difference between diabetic and non-diabetic patients in VAS and UCLA scores during follow-up times (p-values > 0.05). CONCLUSION Arthroscopic rotator interval release provides significant improvement of frozen shoulder with no difference in results between diabetic and non-diabetic patients. LEVEL OF EVIDENCE Level 2; Prospective Comparative study.
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Affiliation(s)
- Wessam Tawfeek
- Orthopaedic Department, Sohag University Hospital, 82524 Sohag, Egypt
| | - Ahmad Addosooki
- Orthopaedic Department, Sohag University Hospital, 82524 Sohag, Egypt
| | - Moustafa Elsayed
- Orthopaedic Department, Sohag University Hospital, 82524 Sohag, Egypt
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Mertens MGCAM, Struyf F, Meert L, Lauwers M, Schwank A, Verborgt O, Meeus M. Factors influencing treatment outcome of physical therapy in frozen shoulder patients: a systematic review. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2022. [DOI: 10.1080/21679169.2020.1827029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Michel G. C. A. M. Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Lotte Meert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Magalie Lauwers
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Ariane Schwank
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Physiotherapy, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Evaluating whole-genome expression differences in idiopathic and diabetic adhesive capsulitis. J Shoulder Elbow Surg 2022; 31:e1-e13. [PMID: 34352401 PMCID: PMC8665043 DOI: 10.1016/j.jse.2021.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/18/2021] [Accepted: 06/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Diabetic patients have a greater incidence of adhesive capsulitis (AC) and a more protracted disease course than patients with idiopathic AC. The purpose of this study was to compare gene expression differences between AC with diabetes mellitus and AC without diabetes mellitus. METHODS Shoulder capsule samples were prospectively obtained from diabetic or nondiabetic patients who presented with shoulder dysfunction and underwent arthroscopy (N = 16). Shoulder samples of AC with and without diabetes (n = 8) were compared with normal shoulder samples with and without diabetes as the control group (n = 8). Shoulder capsule samples were subjected to whole-transcriptome RNA sequencing, and differential expression was analyzed with EdgeR. Only genes with a false discovery rate < 5% were included for further functional enrichment analysis. RESULTS The sample population had a mean age of 47 years (range, 24-62 years), and the mean hemoglobin A1c level for nondiabetic and diabetic patients was 5.18% and 8.71%, respectively. RNA-sequencing analysis revealed that 66 genes were differentially expressed between diabetic patients and nondiabetic patients with AC whereas only 3 genes were differentially expressed when control patients with and without diabetes were compared. Furthermore, 286 genes were differentially expressed in idiopathic AC patients, and 61 genes were differentially expressed in diabetic AC patients. On gene clustering analysis, idiopathic AC was enriched with multiple structural and muscle-related pathways, such as muscle filament sliding, whereas diabetic AC included a greater number of hormonal and inflammatory signaling pathways, such as cellular response to corticotropin-releasing factor. CONCLUSIONS Whole-transcriptome expression profiles demonstrate a fundamentally different underlying pathophysiology when comparing diabetic AC with idiopathic AC, suggesting that these conditions are distinct clinical entities. The new genes expressed explain the differences in the disease course and suggest new therapeutic targets that may lead to different treatment paradigms in these 2 subsets.
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Feusi O, Karol A, Fleischmann T, von Rechenberg B, Bouaicha S, Werner CML, Jentzsch T. Platelet-rich plasma as a potential prophylactic measure against frozen shoulder in an in vivo shoulder contracture model. Arch Orthop Trauma Surg 2022; 142:363-372. [PMID: 33074367 PMCID: PMC8844181 DOI: 10.1007/s00402-020-03617-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 09/30/2020] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Frozen shoulder (adhesive capsulitis) is a common painful and functionally-limiting disease affecting around 2% of the population. So far, therapeutic options are limited and often unsatisfactory. Platelet-rich plasma (PRP) has been used as a treatment option in other orthopedic diseases since it contains growth factors that stimulate tissue repair. So far, the effect of PRP on frozen shoulder lacks evidence. We hypothesized that PRP may be valuable in the prophylaxis and treatment of secondary frozen shoulder due to capsular remodeling. MATERIALS AND METHODS An experimental study of an in vivo frozen shoulder model was conducted. Twenty Sprague-Dawley rats underwent surgery in which the body of the scapula was connected to the humerus with a high-strength suture. Two groups of 8 weeks survival time were allocated; a treatment group with one intraoperative injection of PRP into the glenohumeral joint (n = 10) and a control group without PRP (n = 10). The primary outcome was the structural change in the posterior synovial membrane of the posterior and inferior part of the glenohumeral joint using a semi-quantitative grading from 0 (lowest) to 3 (highest). RESULTS The posterior synovial membrane structural changes were significantly lower in the PRP group (median = 1 [interquartile range (IQR) = 0-1]) compared to controls (median = 2 [IQR = 1-3]) (p = 0.028). There were no differences for the remaining synovial membrane changes and fibrous capsule responses between groups. CONCLUSIONS In this in vivo shoulder contracture model, PRP injections seem to reduce the histological severity grade of some parts (i.e., posterior synovial membrane changes) of the secondary frozen shoulder without causing any side effects. It may be considered to investigate this effect further in future studies as a potential prophylaxis of secondary frozen shoulder (e.g., in operated or immobilized shoulders) or as a treatment option for patients with frozen shoulder in the early stage.
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Affiliation(s)
- Oscar Feusi
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Agnieszka Karol
- Musculoskeletal Research Unit (MSRU) Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Thea Fleischmann
- Division of Surgical Research, Centre for Clinical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit (MSRU) Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Samy Bouaicha
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Clément M. L. Werner
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thorsten Jentzsch
- Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Exercise Therapy is Effective for Improvement in Range of Motion, Function, and Pain in Patients With Frozen Shoulder: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 103:998-1012.e14. [PMID: 34425089 DOI: 10.1016/j.apmr.2021.07.806] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE(S) To determine (1) the effect of exercise therapy alone or in combination with other interventions compared with solely exercises and programs with or without exercises and (2) what kind of exercise therapy or combination with other interventions is most effective. DATA SOURCES PubMed, Web of Science and Cochrane Central Register of Controlled Trials. STUDY SELECTION Studies were screened in a 2-phase approach by 2 independent reviewers (M.M. and L.M.). Reference lists of included studies and interesting systematic reviews were hand searched. DATA EXTRACTION Two independent reviewers (M.M. and L.M.) extracted information about origin, characteristics of study participants, eligibility criteria, characteristics of interventions, outcome measures and main results in a pre-defined template. DATA SYNTHESIS Thirty-three studies were included in the qualitative and 19 in the meta-analysis. Preliminary evidence was found for supervised exercises to be more beneficial than home exercises for ROM and function. Multimodal programs comprising exercises may result in little to no difference in ROM compared to solely exercises. Programs comprising muscle energy techniques show little to no difference in ROM when compared with programs with other exercises. Adding stretches to a multimodal program with exercises may increase ROM. There is uncertain evidence that there is a difference between those programs regarding function and pain. Preliminary evidence was found for several treatment programs including exercises to be beneficial for improvement in both passive and active ROM, function, pain, and muscle strength. No studies used patient satisfaction as an outcome measure. CONCLUSIONS ROM, function, and pain improve with both solely exercises and programs with exercises, but for ROM and pain there was little to no difference between programs and for function the evidence was uncertain. Adding exercises improve active ROM compared with a program without exercises, whereas adding physical modalities has no beneficial effect. Muscle energy techniques are a beneficial type of exercise therapy for improving function compared with other types of exercise. Unfortunately, no conclusion can be drawn about the results in the long-term and most effective dose of exercise therapy.
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El Naggar TEDM, Maaty AIE, Mohamed AE. Effectiveness of radial extracorporeal shock-wave therapy versus ultrasound-guided low-dose intra-articular steroid injection in improving shoulder pain, function, and range of motion in diabetic patients with shoulder adhesive capsulitis. J Shoulder Elbow Surg 2020; 29:1300-1309. [PMID: 32553435 DOI: 10.1016/j.jse.2020.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/18/2020] [Accepted: 03/01/2020] [Indexed: 02/01/2023]
Abstract
UNLABELLED To compare the efficacy of radial extracorporeal shock-wave therapy (rESWT) vs. an ultrasound-guided low-dose intra-articular steroid injection in pain reduction and functional improvement in diabetic patients with shoulder adhesive capsulitis (AC). METHODS This was a 2-parallel-group, active-control, assessor-blinded, randomized trial. We randomized 103 diabetic patients with shoulder AC to receive either 4 sessions of rESWT, 1 week apart (rESWT group, n = 52), or a single ultrasound-guided low-dose intra-articular steroid injection of 20 mg of triamcinolone acetonide (steroid group, n = 51). The primary outcome measure was functional improvement evaluated by the Quick Disabilities of the Arm, Shoulder and Hand (qDASH) score. Secondary outcome measures were pain evaluated by the visual analog scale score and shoulder range of motion (ROM). An assessor who was blinded to treatment assignment assessed both groups at baseline and at 4, 8, and 12 weeks thereafter. RESULTS By 12 weeks, both groups demonstrated a significant reduction in the qDASH score and pain severity, as well as improvement in ROM. However, significantly improved function (qDASH score, 40.4 ± 12.9 vs. 50.5 ± 13.3; P < .001) and shoulder pain reduction (visual analog scale score, 1.6 ± 1.2 vs. 2.8 ± 1.7; P < .001) were found in the rESWT group vs. the steroid group. Similar improvement in shoulder ROM was observed in both groups. CONCLUSION At short-term follow-up, rESWT was superior to a low-dose intra-articular steroid injection in improving function and pain in diabetic patients with shoulder AC. Therefore, rESWT might be considered a safe alternative to steroid injections in diabetic patients with shoulder AC.
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Affiliation(s)
| | - Ahmed Ibrahim Elsayed Maaty
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Aly Elsayed Mohamed
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
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Comparison of Clinical Outcomes between Idiopathic Frozen Shoulder and Diabetic Frozen Shoulder After a Single Ultrasound-Guided Intra-Articular Corticosteroid Injection. Diagnostics (Basel) 2020; 10:diagnostics10060370. [PMID: 32512719 PMCID: PMC7344419 DOI: 10.3390/diagnostics10060370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/13/2022] Open
Abstract
There is no consensus on the use of intra-articular corticosteroid injections in diabetic frozen shoulder (FS). Thus, we aimed to compare clinical outcomes after intra-articular corticosteroid injections in patients with diabetic FS and idiopathic FS. Data collected from 142 FS patients who received glenohumeral joint intra-articular corticosteroid injections were retrospectively reviewed. Thirty-two patients were diagnosed with diabetic FS and 110 patients with idiopathic FS. Data including visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value (SSV), and passive range of motion (ROM) were compared before the injection and at 3, 6, and 12 weeks after the injection. There were significant improvements in all outcomes (p < 0.001 for all parameters) through 12 weeks in both groups. There were no significant differences in all outcomes, except for ASES scores, between both groups at 3 weeks. However, there were significant differences in VAS score, SSVs, ASES scores, and passive ROMs, except for angle of abduction, between the two groups at 6 weeks and 12 weeks after injection. A single intra-articular steroid injection can be used as a conservative treatment for diabetic FS, but less effective than for idiopathic FS.
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13
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Is frozen shoulder completely resolved at 2 years after the onset of disease? J Orthop Sci 2020; 25:224-228. [PMID: 30952550 DOI: 10.1016/j.jos.2019.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/02/2019] [Accepted: 03/17/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although numerous studies have suggested that frozen shoulder (FS) is a self-limiting disease with most patients recovering within 2 years, its long-term outcome is still controversial. The aims of this study were to evaluate the clinical outcomes after conservative treatment for FS and to determine the predictors of its clinical outcome. METHODS This study included 234 shoulders of 215 patients who received conservative treatment for FS. The mean follow-up period was 41.8 months (range 27-117 months). Initial evaluation included demographics, detailed medical history, and clinical assessments of shoulder status. Questionnaires, which included the Visual Analogue Scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV) and satisfaction grading for the current shoulder status were assessed at the final follow-up. RESULTS The mean VAS pain score, ASES score, and SSV significantly improved from 6.7, 37.0, and 40.1% at the time of initial evaluation to 1.5, 87.6, and 85.0% at the final follow-up evaluation (all p < 0.001). According to satisfaction grading, the shoulder status at the final follow-up was very satisfied in 101 shoulders (43.2%), satisfied in 68 (29.1%), fair in 37 (15.8%), unsatisfied in 20 (8.5%), and very unsatisfied in 8 (3.4%). Univariate analysis revealed that gender, diabetes, simultaneous bilateral involvement, overall bilateral involvement and duration of symptoms were associated with clinical outcomes at the final follow-up. Multivariate analysis revealed that duration of symptoms (p = 0.002) was an independent risk factor for unsuccessful outcome. CONCLUSIONS At the mean follow-up period of 41.8 months, 72.3% of patients revealed subjective satisfaction for the current shoulder status. Duration of symptoms was an independent risk factor for poor prognosis.
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Comparison of outcomes following arthroscopic capsular release for idiopathic, diabetic and secondary shoulder adhesive capsulitis: A Systematic Review. Orthop Traumatol Surg Res 2019; 105:839-846. [PMID: 31202716 DOI: 10.1016/j.otsr.2019.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/24/2018] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Arthroscopic capsular release for adhesive capsulitis of the shoulder is a treatment option. The present study aimed to investigate the clinical outcomes following arthroscopic capsular release among idiopathic, diabetic and secondary adhesive capsulitis. HYPOTHESIS Different aetiological groups yield variable outcomes following arthroscopic capsular release. MATERIALS AND METHODS A literature search was performed using MEDLINE, EMBASE, CINAHL and the Cochrane Database in April 2017. Comparative studies that reported range of motion or functional outcomes following arthroscopic capsular release in patients with adhesive capsulitis were included. A systematic review of the studies was conducted following the PRISMA guidelines. RESULTS Six studies met the eligibility criteria. The overall population included 463 patients; 203 idiopathic, 61 diabetic and 199 secondary cases. Of four studies comparing idiopathic and diabetic patients, three reported significantly worse range of movement and function in the diabetic group at various follow up points. No significant difference in function and motion was reported between the idiopathic and secondary groups. Recurrent pain was highest in diabetic patients (26%) compared to idiopathic groups (0%) and the secondary group had a higher rate of revision surgery when compared to the idiopathic group (8.1% vs. 2.4%) DISCUSSION: Arthroscopic capsular release has a high success rate regardless of the underlying aetiology. However, diabetic patients are reported to have more residual pain, reduced motion and inferior function compared to idiopathic cases. The rate of revision capsular release is higher among patients with post-surgical adhesive capsulitis when compared to idiopathic cases. LEVEL OF EVIDENCE IV, systematic review.
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Barbosa F, Swamy G, Salem H, Creswell T, Espag M, Tambe A, Clark D. Chronic adhesive capsulitis (Frozen shoulder): Comparative outcomes of treatment in patients with diabetes and obesity. J Clin Orthop Trauma 2019; 10:265-268. [PMID: 30828190 PMCID: PMC6383066 DOI: 10.1016/j.jcot.2018.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/16/2018] [Accepted: 02/24/2018] [Indexed: 11/22/2022] Open
Abstract
Despite an abundance of information about frozen shoulders, larger prospective studies on the outcomes of intervention are limited. The purpose of our study was to assess the functional and clinical outcomes with a further aim to analyse the independent effects of diabetes and BMI. A prospective cohort study of all 210 primary frozen shoulders over a 12 - month period was analysed. The Oxford Shoulder score was used to assess functional outcomes before and after interventions. Further demographic data was collected. The effect of interventions including steroid injections, arthroscopic release and manipulation was analysed. 54% patients responded to intra-articular steroid injections. Patients with recalcitrant symptoms (46%) had an arthroscopic release. Failure of initial injection therapy was higher in diabetes [70%] than non-diabetes [44%] patients. After surgery, the Oxford shoulder score improved from a mean of 41.6 to 27.2 at 3 months [p < 0.05]. 85% of patients had satisfactory resolution of symptoms with external rotation improving from a mean of 10.5 ° to 61.3 ° [p < 0.05]. There was no statistical significance in outcomes of patients with BMI of >_30 and <30. Understanding the outcomes of surgical intervention is important in counselling patients with frozen shoulder. We found that patients with diabetes had higher failure rates of conservative management and increasing needs for multiple surgery but complete resolution of symptoms can still be achieved and that BMI status in isolation was not a predictor of poorer outcome.
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16
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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.
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Affiliation(s)
- Johanne M. Lyhne
- Corresponding author at: Department of Orthopaedic Surgery, Regional Hospital Randers, Skovlyvej 1, 8930, Randers, Danmark.
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Alsubheen SA, Nazari G, Bobos P, MacDermid JC, Overend TJ, Faber K. Effectiveness of Nonsurgical Interventions for Managing Adhesive Capsulitis in Patients With Diabetes: A Systematic Review. Arch Phys Med Rehabil 2018; 100:350-365. [PMID: 30268804 DOI: 10.1016/j.apmr.2018.08.181] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/21/2018] [Accepted: 08/13/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This systematic review evaluated the effectiveness of nonsurgical interventions for managing adhesive capsulitis (AC) in patients with diabetes on pain, function, and range of motion. DATA SOURCES MEDLINE and other databases were searched for studies published in the last 20 years. STUDY SELECTION Randomized controlled trials (RCTs) that assessed AC in people with diabetes and implemented 1 or a combination of physiotherapeutic interventions, corticosteroids, and manipulation under anesthesia (MUA) were eligible for inclusion. DATA EXTRACTION The Cochrane Risk of Bias was used by 2 independent raters who met to achieve consensus. The quality of trials was assessed using Grading of Recommendations, Assessment, Development and Evaluations. Data extracted from the eligible studies included study design, participant characteristics and duration of symptoms, type of intervention, outcome measures, follow-up intervals, and research findings. DATA SYNTHESIS Because of the lack of similar interventions, a narrative synthesis was conducted, and meta-analyses were not performed. The effect sizes or between-group differences of the interventions were reported. A total of 8 RCTs met the inclusion criteria: 4 addressed physiotherapeutic interventions, 3 corticosteroid injections, and 1 MUA. The effect sizes for physiotherapeutic interventions were 0.8-2.0, 0.9-2.0, and 1.0 for ROM, function, and pain, respectively, with the largest effect size (2.0) being reported for joint mobilization plus exercises. The effect sizes for corticosteroids were 0.2-0.5 and 0.1 for ROM and pain. The between-group improvement for MUA was 5.6 points on Constant Shoulder Score. CONCLUSION Low-quality evidence suggests large effects of joint mobilization plus exercises on AC in people with diabetes, although confidence in this conclusion is limited due to the high risk of bias. Even weaker support was available for corticosteroid and MUA. Future high-quality RCTs are needed to determine the best intervention for managing AC in patients with diabetes.
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Affiliation(s)
- Sana'a A Alsubheen
- School of Physical Therapy, Western University, London, Ontario, Canada.
| | - Goris Nazari
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Pavlos Bobos
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Western University, London, Ontario, Canada; Hand and Upper Limb Center, St. Joseph's Health Care London, London, Ontario, Canada
| | - Tom J Overend
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Kenneth Faber
- Hand and Upper Limb Center, St. Joseph's Health Care London, London, Ontario, Canada
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18
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Schröder S, Meyer-Hamme G, Friedemann T, Kirch S, Hauck M, Plaetke R, Friedrichs S, Gulati A, Briem D. Immediate Pain Relief in Adhesive Capsulitis by Acupuncture-A Randomized Controlled Double-Blinded Study. PAIN MEDICINE 2018; 18:2235-2247. [PMID: 28371868 DOI: 10.1093/pm/pnx052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Primary adhesive capsulitis (AC), or frozen shoulder, is an insidious and idiopathic disease. Severe pain is predominant in the first two of the three stages of the condition, which can last up to 21 months. Design, Setting, and Subjects Sixty volunteers with primary AC were randomly assigned to acupuncture with press tack needles compared with press tack placebos in a patient- and observer-blinded placebo-controlled study. The participants were subsequently offered classical needle acupuncture in an open follow-up clinical application. Thirty-four volunteers received conservative therapy, including 10 classical needle acupuncture treatments over 10 weeks, 13 volunteers received conservative therapy without classical needle acupuncture. All subjects agreed to follow-up after one year. Methods Acupuncture treatment was performed using a specific distal needling concept, using reflex areas on distant extremities avoiding local treatment. Results An immediate improvement of 3.3 ± 3.2 points in Constant-Murley Shoulder Score (CMS) pain subscore was seen in the press tack needles group and of 1.6 ± 2.8 points in the press tack placebos group (P <0.02). Conservative therapy including classical needle acupuncture significantly improved the pain subscore within 14.9 ± 15.9 weeks compared with 30.9 ± 15.8 weeks with only conservative therapy (P < 0.001). Conclusion The efficiency of distal needling acupuncture on immediate pain reduction was demonstrated in patients with AC and confirmed the applicability of press tack needles and press tack placebos for double-blind studies in acupuncture. Subsequent clinical application observation proved that results obtained with press tack needles/press tack placebos can be transferred to classical needle acupuncture. Integrating acupuncture with conservative therapy showed superior effectiveness with respect to the time course of the recovery process in AC compared with conservative therapy alone.
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Affiliation(s)
- Sven Schröder
- HanseMerkur Center for Traditional Chinese Medicine at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gesa Meyer-Hamme
- HanseMerkur Center for Traditional Chinese Medicine at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Friedemann
- HanseMerkur Center for Traditional Chinese Medicine at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Kirch
- HanseMerkur Center for Traditional Chinese Medicine at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Hauck
- Departments of Neurology.,Neurophysiology and Pathophysiology
| | | | - Sunja Friedrichs
- HanseMerkur Center for Traditional Chinese Medicine at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Daniel Briem
- Trauma, Hand, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lamplot JD, Lillegraven O, Brophy RH. Outcomes From Conservative Treatment of Shoulder Idiopathic Adhesive Capsulitis and Factors Associated With Developing Contralateral Disease. Orthop J Sports Med 2018; 6:2325967118785169. [PMID: 30023406 PMCID: PMC6047247 DOI: 10.1177/2325967118785169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background: Idiopathic adhesive capsulitis is a common condition resulting in painful multidirectional restriction of motion without other identifiable shoulder abnormality. First-line therapies for this condition are nonoperative, but limited data are available regarding which treatments are most effective. Factors associated with contralateral disease are not well established. Hypothesis: Younger patients will have a better response to treatments, and older patients and patients with diabetes will be more likely to develop contralateral disease. Study Design: Cohort study; Level of evidence, 3. Methods: Patients diagnosed with idiopathic adhesive capsulitis were treated with a single intra-articular glenohumeral injection of local anesthetic and corticosteroid as well as 4 weeks of supervised physical therapy (PT). Patients were re-evaluated monthly and received additional conservative treatment based on failure to restore normal motion. Patient-reported outcome scores and range of motion were used to assess treatment efficacy. Results: Minimum 2-year follow-up data (mean, 3.4 years) were available for 60 of 75 eligible patients (80%). Patients who did not attend supervised PT as prescribed were more likely to undergo repeat injection due to a lack of adequate range of motion at follow-up (P = .003). Conservative therapy failed in 2 patients (3.3%), and they underwent arthroscopic release and manipulation under anesthesia. Twenty-two patients (36.7%) were subsequently diagnosed with contralateral idiopathic adhesive capsulitis, with a higher incidence in patients with diabetes (P = .009) and patients younger than 50 years (P = .005). American Shoulder and Elbow Surgeons score improved from 41.2 (95% CI, 33.0-49.4) at baseline to 92.0 (95% CI, 88.4-95.6) at final follow-up (P < .0001). Patients with diabetes had a decrease in Shoulder Activity Scale score at final follow-up (P = .049). Conclusion: Conservative treatment for idiopathic adhesive capsulitis resulted in good clinical outcomes with a low incidence of surgical intervention. Physical therapy reduced the use of a second injection as part of treatment in this treatment algorithm. Young patients and patients with diabetes may be more likely to develop contralateral disease.
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Affiliation(s)
- Joseph D Lamplot
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Olivia Lillegraven
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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20
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Lamplot JD, Lillegraven O, Brophy RH. Shoulder activity level in patients with idiopathic adhesive capsulitis. J Shoulder Elbow Surg 2017; 26:1514-1519. [PMID: 28372965 DOI: 10.1016/j.jse.2017.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Idiopathic adhesive capsulitis is a common condition resulting in painful multidirectional restriction of motion. Adhesive capsulitis may inhibit shoulder activity level, but this relationship has not been previously studied. This study tested the hypothesis that patients with idiopathic adhesive capsulitis have lower shoulder activity than sex- and age-matched controls. METHODS Seventy-two eligible patients (37 men and 35 women) with idiopathic adhesive capsulitis completed a validated shoulder activity scale that was compared with sex- and age-matched norms from a healthy population with no history of shoulder disorders. The association of shoulder activity level with patient age, sex, and American Shoulder and Elbow Surgeons and Simple Shoulder Test (SST) scores was evaluated. RESULTS Overall, 58% of patients actually had higher shoulder activity scores than sex- and age-matched controls. Among patients aged 51 to 70 years, 68% of patients (73% of men and 63% of women) demonstrated higher Shoulder Activity Scale scores compared with controls. The activity level was higher among all patients aged 51 to 70 years compared with controls (10.3 ± 1.48 vs. 8 ± 0.52, P = .0067). The difference was significant for men in this age group (12.2 ± 1.7 vs. 9 ± 0.75, P = .0042). There was a statistically significant positive correlation of the Shoulder Activity Scale score with the SST score (r = 0.31, P = .009). CONCLUSION Patients with idiopathic adhesive capsulitis do not have a lower shoulder activity level than sex- and age-matched controls, and older men may actually have a higher level of shoulder activity than controls. Shoulder activity level is correlated with the SST score in patients with idiopathic adhesive capsulitis.
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Affiliation(s)
- Joseph D Lamplot
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Olivia Lillegraven
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.
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Ranalletta M, Rossi LA, Zaidenberg EE, Campos C, Ignacio T, Maignon GD, Bongiovanni SL. Midterm Outcomes After Arthroscopic Anteroinferior Capsular Release for the Treatment of Idiophatic Adhesive Capsulitis. Arthroscopy 2017; 33:503-508. [PMID: 27866795 DOI: 10.1016/j.arthro.2016.08.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/01/2016] [Accepted: 08/19/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to report the early and midterm functional outcomes and complications of a consecutive series of patients with primary adhesive capsulitis who were treated with isolated anteroinferior arthroscopic capsular release after they did not respond to conservative treatment. METHODS Thirty-two consecutive patients with idiopathic adhesive capsulitis who did not respond to conservative physiotherapy were included in the study. Arthroscopic anteroinferior capsular release was performed in all cases. The primary outcome was improvement in range of motion in the short- and midterm follow-up. We also evaluated pain relief with the visual analog scale, functional outcomes with the Constant-Murley score, and we registered postoperative complications. RESULTS The mean age was 49.6 years (range, 33-68 years) and the mean follow-up was 63 months (range, 18-84). Overall, there was significant improvement in the Constant-Murley score from 42.4 to 86 points (P < .001). The visual analog scale decreased by approximately 6.3 points compared with the preoperative value (P < .001). All parameters improved significantly the first 6 months and then remained stable until the end of follow-up (P < .001). There was an additional minor improvement in both parameters between the sixth month and the final follow-up; however, this improvement was less than in the first 6 months and it was not statistically significant. CONCLUSIONS In patients who don't respond to conservative treatment for primary adhesive capsulitis, isolated anteroinferior capsular release provides a reliable improvement in pain and range of motion that is maintained in the mid-term follow-up. LEVEL OF EVIDENCE Level IV, therapeutic, case series study.
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Affiliation(s)
- Maximiliano Ranalletta
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Luciano Andrés Rossi
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
| | - Ezequiel Ernesto Zaidenberg
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Carlos Campos
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Tanoira Ignacio
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Gastón Daniel Maignon
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Santiago Luis Bongiovanni
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Vastamäki H, Ristolainen L, Vastamäki M. Range of motion of diabetic frozen shoulder recovers to the contralateral level. J Int Med Res 2016; 44:1191-1199. [PMID: 27856934 PMCID: PMC5536758 DOI: 10.1177/0300060516675112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective To determine whether frozen shoulder heals equally well in patients with and without diabetes and whether dependency on insulin affects the outcome. Methods We retrospectively examined 178 patients with idiopathic frozen shoulder; 27 patients had diabetes. We evaluated range of motion, pain, and functional results. The mean follow-up was 9.7 years (SD, 7.1 years). Results In the presence of frozen shoulder, range of motion did not differ between patients with and without diabetes. At follow-up, range of motion in all directions of both the affected and unaffected shoulders of patients with diabetes was inferior to that of patients without diabetes. Among patients with diabetes, range of motion of the once-frozen shoulder reached the level of the unaffected shoulder. Patients with and without diabetes experienced similar pain except during exertion. The Constant–Murley score was not significantly different between the two groups, and insulin dependency did not lead to worse outcomes. Conclusion Frozen shoulder heals well in patients with diabetes.
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Affiliation(s)
- Heidi Vastamäki
- ORTON Foundation and ORTON Orthopaedic Hospital, Helsinki, Finland
| | | | - Martti Vastamäki
- ORTON Foundation and ORTON Orthopaedic Hospital, Helsinki, Finland
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Cho CH, Kim DH, Lee YK. Serial Comparison of Clinical Outcomes After Arthroscopic Capsular Release for Refractory Frozen Shoulder With and Without Diabetes. Arthroscopy 2016; 32:1515-20. [PMID: 27062011 DOI: 10.1016/j.arthro.2016.01.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 12/05/2015] [Accepted: 01/15/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare serial clinical outcomes after arthroscopic treatment of refractory frozen shoulder with and without diabetes. METHODS Seventeen patients with diabetic frozen shoulder (diabetes group) and 20 patients with idiopathic frozen shoulder (idiopathic group) were included. The mean follow-up period was 48.4 ± 15.8 months. Visual analog scale pain score; University of California, Los Angeles score; American Shoulder and Elbow Surgeons score; and range of motion were evaluated preoperatively; at 3, 6, and 12 months after surgery; and at the final follow-up examination. RESULTS Both groups showed significant improvement in all clinical scores and range of motion during the serial follow-up periods (P < .001). There were no significant differences between the 2 groups in any of the assessed clinical scores, except the mean American Shoulder and Elbow Surgeons score in the diabetes group was significantly lower than that in the idiopathic group at 12 months after surgery (77.7 v 88.8, P = .025). In the diabetes group, mean forward flexion was significantly lower than that in the idiopathic group at 3 months (140.0° v 151.5°, P = .011) and 6 months (152.2° v 161.8°, P = .045) after surgery. Mean external rotation was significantly lower than that in the idiopathic group at 6 months after surgery (43.3° v 55.0°, P = .021). Mean internal rotation was significantly lower than that in the idiopathic group at 6 months (13.7 v 11.7, P = .006) and 12 months (12.2 v 9.9, P = .041) after surgery. There were no significant differences between the 2 groups in any assessed outcomes at the final follow-up examination. CONCLUSIONS These results provide supportive evidence suggesting that the diabetes group had slower postoperative functional recovery until 12 months postoperatively, although arthroscopic capsular release for refractory frozen shoulder with and without diabetes yielded satisfactory clinical outcomes at the final follow-up examination. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Chul-Hyun Cho
- Pain Research Center, Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Republic of Korea.
| | - Dong-Hu Kim
- Department of Orthopedic Surgery, The Open Hospital, Daegu, Republic of Korea
| | - Young-Kuk Lee
- Department of Orthopedic Surgery, Hanmi Hospital, Daegu, Republic of Korea
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Pons-Villanueva J, Escalada San Martín J. The stiff shoulder in diabetic patients. Int J Rheum Dis 2016; 19:1226-1236. [DOI: 10.1111/1756-185x.12890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Juan Pons-Villanueva
- Department of Orthopedic Surgery and Traumatology; Clínica Universidad de Navarra; Pamplona Spain
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Does chondrolysis occur after corticosteroid-analgesic injections? An analysis of patients treated for adhesive capsulitis of the shoulder. J Shoulder Elbow Surg 2016; 25:890-7. [PMID: 26803933 DOI: 10.1016/j.jse.2015.10.004] [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: 04/28/2015] [Revised: 10/17/2015] [Accepted: 10/18/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinical studies using continuous infusions of local anesthetics and basic science studies that model injections of local anesthetics have shown chondrotoxicity. However, clinical studies do not exist that have assessed for the risk of chondrolysis in nonarthritic joints exposed to single or intermittent corticosteroid or analgesic injections. Currently, there are no data available to guide the clinician on the safety of using these injections in clinical practice. MATERIALS AND METHODS A retrospective review of patients treated for adhesive capsulitis of the shoulder with at least 1 intra-articular injection of a corticosteroid and anesthetic was performed. The inclusion criteria were a diagnosis of adhesive capsulitis and a minimum 2-year follow-up. Prospective follow-up was performed to obtain patient-determined outcome scores, range of motion, and radiographs to determine the presence of chondrolysis. RESULTS Fifty-six patients with a mean age of 52.5 ± 7.2 years were enrolled at a mean follow-up of 54 months. The mean number of injections performed was 1.5 ± 0.7 (range, 1-4). At final follow-up, the mean Western Ontario Osteoarthritis of the Shoulder score was 91.4% ± 14.2%; Disabilities of the Arm, Shoulder and Hand score, 6.7 ± 9.6; Shoulder Pain and Disability Index score, 7.4 ± 11.4; and Single Assessment Numeric Evaluation score, 92.7% ± 10.1%. The Shoulder Activity Score was 8.3 ± 4.7. Passive and active forward elevation, external rotation, internal rotation, and cross-body adduction showed no significant differences compared with the unaffected contralateral shoulder. There was no radiographic evidence of chondrolysis in any patient. CONCLUSIONS This study did not show chondrolysis in patients treated with an intra-articular corticosteroid and local anesthetic for adhesive capsulitis. The findings of this study do not support the cessation of using intra-articular analgesic-corticosteroid injections for the treatment of adhesive capsulitis. LEVEL OF EVIDENCE Level IV; Case Series; Treatment Study.
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Ranalletta M, Rossi LA, Bongiovanni SL, Tanoira I, Elizondo CM, Maignon GD. Corticosteroid Injections Accelerate Pain Relief and Recovery of Function Compared With Oral NSAIDs in Patients With Adhesive Capsulitis: A Randomized Controlled Trial. Am J Sports Med 2016; 44:474-81. [PMID: 26657263 DOI: 10.1177/0363546515616238] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Intra-articular corticosteroid injection is a common therapy for adhesive capsulitis, but there is a lack of prospective randomized controlled studies analyzing the efficacy of single injections applied blindly to accelerate improvement in pain and function. HYPOTHESIS In patients with adhesive capsulitis, a single intra-articular corticosteroid injection without image control applied before the beginning of a physical therapy program will accelerate pain relief and recovery of function compared with oral nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 74 patients with primary adhesive capsulitis in the freezing stage were randomized to receive either intra-articular injections with betamethasone or oral NSAIDs. Clinical outcome was documented at baseline and after 2, 4, 8, and 12 weeks and comprised a visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) Shoulder Score, the abbreviated Constant-Murley score, and the abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score for function. Passive range of motion was measured with a goniometer. RESULTS Patients treated with corticosteroid injections achieved faster pain relief compared with control patients during the first 8 weeks after treatment (P < .001). However, no significant difference in pain was observed among the groups at final follow-up. Likewise, shoulder function and motion improved significantly in both groups at all follow-up points. Shoulder function scores and most motion parameters improved faster in the injection group up to week 8 (P < .001). Again, no significant differences in function or motion were seen at final follow-up. CONCLUSION In patients with adhesive capsulitis, a single corticosteroid injection applied without image control provides faster pain relief and earlier improvement of shoulder function and motion compared with oral NSAIDs.
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Affiliation(s)
- Maximiliano Ranalletta
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Luciano A Rossi
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Santiago L Bongiovanni
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Tanoira
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Cristina M Elizondo
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Gastón D Maignon
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Prognostic factors and therapeutic options for treatment of frozen shoulder: a systematic review. Arch Orthop Trauma Surg 2016; 136:1-7. [PMID: 26476720 DOI: 10.1007/s00402-015-2341-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Indexed: 02/09/2023]
Abstract
PURPOSE To evaluate the current status of scientific research on the natural history of frozen shoulder as published in the literature. MATERIALS AND METHODS This systematic review was carried out on PubMed data and was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Articles had to meet inclusion criteria. The quality of the papers was assessed using a newly developed tool, AMQPP (Assessing the Methodological Quality of Published Papers). The AMQPP score was correlated with the level of evidence rating according to the Oxford Centre for Evidence-Based Medicine. Suitable papers were divided into groups according to the shoulder condition on which they reported. This article focuses on the frozen shoulder. RESULTS Seven articles on frozen shoulder met the inclusion criteria. One article was considered to have level 1 of evidence. Three articles had level 3 and the remaining 3 had level 4. Three papers assessed the natural history and the natural course of different forms of stiff shoulder. The others indirectly assessed the natural history by evaluating therapy trends. None of the articles clearly referred to the role of regression to the mean of frozen shoulder specifically. CONCLUSION Spontaneous recovery to normal levels of function is possible and standardised non-operative treatment programmes are an effective alternative to surgery in most cases. However, patients with high risk factors such as diabetes mellitus, and those who suffer chronic symptoms or bilaterally affected, would benefit from early surgery. We also concluded that AMQPP score is simple and straight forward. It works as a quick quality-checking tool which helps researchers to identify the key points in each paper and reach a decision regarding the eligibility of the paper more easily. The AMQPP score is still open for further development.
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Mehta SS, Singh HP, Pandey R. Comparative outcome of arthroscopic release for frozen shoulder in patients with and without diabetes. Bone Joint J 2014; 96-B:1355-8. [PMID: 25274921 DOI: 10.1302/0301-620x.96b10.34476] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Our aim was to compare the outcome of arthroscopic release for frozen shoulder in patients with and without diabetes. We prospectively compared the outcome in 21 patients with and 21 patients without diabetes, two years post-operatively. The modified Constant score was used as the outcome measure. The mean age of the patients was 54.5 years (48 to 65; male:female ratio: 18:24), the mean pre-operative duration of symptoms was 8.3 months (6 to 13) and the mean pre-operative modified Constant scores were 36.6 (standard deviation (sd) 4.6) and 38.4 (sd 5.7) in the diabetic and non-diabetic groups, respectively. The mean modified Constant scores at six weeks, six months and two years post-operatively in the diabetics were 55. 6 (sd 4.7), 67. 4 (sd 5.6) and 84. 4 (sd 6.8), respectively; and in the non-diabetics 66.8 (sd 4.5), 79.6 (sd 3.8) and 88.6 (sd 4.2), respectively. A total of 15 (71%) of diabetic patients recovered a full range of movement as opposed to 19 (90%) in the non-diabetics. There was significant improvement (p < 0.01) in the modified Constant scores following arthroscopic release for frozen shoulder in both groups. The results in diabetics were significantly worse than those in non-diabetics six months post-operatively (p < 0.01) with a tendency towards persistent limitation of movement two years after operation. These results may be used when counselling diabetic patients for the outcome after arthroscopic treatment of frozen shoulder.
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Affiliation(s)
- S S Mehta
- Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, Lancashire WN6 9EP, UK
| | - H P Singh
- Birmingham City Hospital, Dudley Road, Birmingham, West Midlands, B18 7QH, UK
| | - R Pandey
- University Hospitals of Leicester NHS Trust, Department of Orthopaedics, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK
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Abstract
CONTEXT The mature athlete's shoulder remains a challenging clinical condition to manage. A normal natural history of the shoulder includes stiffness, rotator cuff tears, and osteoarthritis, all of which can become increasingly more symptomatic as an athlete ages. EVIDENCE ACQUISITION PubMed (1978-2013). STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 3-4. RESULTS Rotator cuff pathology increases with age and activity level. Partial tears rarely heal, and debridement of significant partial tears results in poorer outcomes than those of repair. Repair of partial-thickness tears can be accomplished with completion and subsequent repair or in situ repair. The most successful result for treatment of osteoarthritis in the shoulder remains total shoulder arthroplasty, with more than 80% survival at 20 years and high rates of return to sport. Caution should be taken in patients younger than 60 years, as they show much worse results with this treatment. Adhesive capsulitis of the shoulder can be successfully treated with nonoperative management in 90% of cases. CONCLUSION Mature athletes tend to have rotator cuff pathology, osteoarthritis, and stiffness, which may limit their participation in athletic events. Age is a significant consideration, even within the "mature athlete" population, as patients younger than 50 years should be approached differently than those older than 65 years with regard to treatment regimens and postoperative restriction.
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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.
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Affiliation(s)
- Theodore S Wolfson
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY
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Jenkins EF, Thomas WJC, Corcoran JP, Kirubanandan R, Beynon CR, Sayers AE, Woods DA. The outcome of manipulation under general anesthesia for the management of frozen shoulder in patients with diabetes mellitus. J Shoulder Elbow Surg 2012; 21:1492-8. [PMID: 22265768 DOI: 10.1016/j.jse.2011.11.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 10/31/2011] [Accepted: 11/06/2011] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Frozen shoulder has a greater incidence, more severe course, and resistance to treatment in patients with diabetes mellitus compared with the general population. We hypothesized that diabetic patients with frozen shoulder undergoing treatment with manipulation under general anaesthesia (MUA) would have the same outcome as patients without diabetes. MATERIALS AND METHODS We retrospectively analyzed data collected during a 10-year period of referrals for frozen shoulder. In all cases, a standardized MUA protocol was followed once the diagnosis of frozen shoulder in the frozen phase was made; this included an early repeat MUA in individuals with recurrence. We compared outcomes for patients documented as having diabetes with a nondiabetic control group and assessed the effect of insulin dependence and frozen shoulder etiology within the diabetic group. RESULTS Of a consecutive series of 315 frozen shoulders, 36 patients (39 shoulders) were included in the diabetic group, with 256 patients (274 shoulders) as controls. There was a significant improvement in range of movement and Oxford Shoulder Score (P all <.001), with no difference between diabetic and control groups at early or late follow-up (mean, 41 months). A repeat procedure was required in 36% of diabetic patients compared with 15% of control patients. Recurrence in the diabetic group was influenced by etiology (47% of primary vs 0% of secondary frozen shoulders) and insulin requirement (39% insulin-dependent vs. 31% non-insulin-dependent). CONCLUSION We provide a strategy for the management of diabetic frozen shoulders using MUA and estimates of success and recurrence rates that may be useful when informing consent.
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Affiliation(s)
- Emily F Jenkins
- Department of Orthopaedic Surgery, Great Western Hospital NHS Foundation Trust, Swindon, UK
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Roh YH, Yi SR, Noh JH, Lee SY, Oh JH, Gong HS, Baek GH. Intra-articular corticosteroid injection in diabetic patients with adhesive capsulitis: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2012; 20:1947-52. [PMID: 22113218 DOI: 10.1007/s00167-011-1776-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 11/08/2011] [Indexed: 01/08/2023]
Abstract
PURPOSE An intra-articular corticosteroid injection is considered an effective treatment for idiopathic adhesive capsulitis of the shoulder. This study examined the efficacy of corticosteroid injections for the treatment for adhesive capsulitis in patients with diabetes mellitus. METHODS Forty-five diabetic patients were randomized into a corticosteroid injection group or non-injection control group and received the same instruction for a home stretching exercise. The corticosteroid group patients were administered intra-articular corticosteroid injection composed of 40 mg triamcinolone acetonide. Pain by a visual analogue scale, shoulder range of motion, and functional state by the American Shoulder and Elbow score were assessed at the baseline, 4-, 12-, and 24-week follow-up. RESULTS Diabetic patients treated with corticosteroid injections showed significant improvement in the pain score at 4 weeks and in the functional score at 12 weeks (P = 0.020 and P = 0.042, respectively). The range of motion in forward elevation and internal rotation was significantly higher in the corticosteroid group than in the non-corticosteroid group at the 12-week follow-up (P = 0.030 and 0.045, respectively), but there were no significant differences at the final follow-up between the corticosteroid and non-corticosteroid groups. CONCLUSIONS A corticosteroid injection in diabetic patients decreases the pain perception and accelerates the functional recovery in the early post-injection period. An intra-articular corticosteroid injection is considered a viable option for the treatment for adhesive capsulitis with diabetes. LEVEL OF EVIDENCE Randomized clinical trial, therapeutic study, Level II.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopedic Surgery, National Police Hospital, 58 Garakbon-dong, Songpa-gu, Seoul, 138-708, Korea
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Abstract
Frozen shoulder is commonly encountered in general orthopaedic practice. It may arise spontaneously without an obvious predisposing cause, or be associated with a variety of local or systemic disorders. Diagnosis is based upon the recognition of the characteristic features of the pain, and selective limitation of passive external rotation. The macroscopic and histological features of the capsular contracture are well-defined, but the underlying pathological processes remain poorly understood. It may cause protracted disability, and imposes a considerable burden on health service resources. Most patients are still managed by physiotherapy in primary care, and only the more refractory cases are referred for specialist intervention. Targeted therapy is not possible and treatment remains predominantly symptomatic. However, over the last ten years, more active interventions that may shorten the clinical course, such as capsular distension arthrography and arthroscopic capsular release, have become more popular. This review describes the clinical and pathological features of frozen shoulder. We also outline the current treatment options, review the published results and present our own treatment algorithm.
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Affiliation(s)
- C M Robinson
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh EH16 4SA, UK.
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Pain management in the rehabilitation of stiff shoulder: prospective multicenter comparative study of 193 cases. Orthop Traumatol Surg Res 2011; 97:S195-203. [PMID: 22036994 DOI: 10.1016/j.otsr.2011.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 09/07/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The present study investigated the impact of respecting pain threshold on clinical recovery in stiff shoulder. PATIENTS AND METHODS A prospective multicenter comparative study followed up 193 cases of shoulder stiffness for a mean 12-month period (range, 8-31 months) after four different treatment protocols: (1) conventional sub-pain-threshold rehabilitation (58 cases); (2) self-rehabilitation exceeding the pain threshold (59 cases); (3) supervised suprathreshold rehabilitation (31 cases); and (4) capsulotomy with sub-threshold rehabilitation (45 cases). Follow-up was daily for the first 6 weeks then weekly for the next 6; each session included assessment of the painfulness, feasibility and duration of each rehabilitation and self-rehabilitation exercise and of pain status, disability and psychological status. The surgeon followed patients up at 6 weeks, 3 months, 6 months, 1 year and at last follow-up. RESULTS Sub-threshold rehabilitation provided progressive results, limited in time (P<0.05). Suprathreshold self-rehabilitation provided reduced pain (P<0.05) as of the first days, with nocturnal pain ceasing after 7 days' rehabilitation in 43% of cases. Supervision of self-rehabilitation exercises optimized the clinical result (P<0.05). Capsulotomy did not influence pain evolution over the first 8 weeks, but then improved it. Failure (at 1 year, 14-17%; last follow-up, 3.5%) correlated directly with the number of exercises performed by the patient (P<0.05). DISCUSSION The dogma of respecting the pain threshold is dated: pain inflicted on a passive patient impairs clinical evolution, but pain managed by an informed active patient under experienced supervision provides rapid recovery of function and pain-free status.
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Gleyze P, Georges T, Flurin PH, Laprelle E, Katz D, Clavert P, Charousset C, Lévigne C. Comparison and critical evaluation of rehabilitation and home-based exercises for treating shoulder stiffness: prospective, multicenter study with 148 cases. Orthop Traumatol Surg Res 2011; 97:S182-94. [PMID: 22036242 DOI: 10.1016/j.otsr.2011.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 09/07/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The goal of this study was to evaluate the effectiveness of individual exercises performed as classic rehabilitation or a home program on the clinical progression of patients with shoulder stiffness. Based on this information, the secondary goal was to develop a new rehabilitation protocol. PATIENTS AND METHODS This prospective, comparative series included 148 cases of shoulder stiffness. There were three treatment groups: T1: classic rehabilitation performed below the pain threshold (58 cases); T2: home program with provocation above the pain threshold (59 cases); T3: home program supervised by a physical therapist (31 cases). The execution, pain level and time spent doing each exercise were compiled for each work session - every day for the first 6 weeks, then every week up to 3 months. Clinical (Constant score) and range of motion evaluations were performed at enrollment, week 6 and month 3.Changes were compared between groups; correlation tests were used to analyse the effectiveness of each exercise during each session. RESULTS Other than physical therapy and balneotherapy, classic rehabilitation exercises had a negative effect on clinical progression during the first 3 to 5 weeks (P<0.05), but this did not hinder the occurrence of a slow, continuous clinical improvement (P<0.05). Home programs led to rapid functional progression with improvement directly related to the number of exercises actually performed (P<0.05), however, pain during the day increased and pain at night decreased. Supervision by a physical therapist helped to optimize the home program, with the same result at week 6, but a better result at month 3 (P<0.05). CONCLUSIONS Based on the results of this study, a new treatment protocol for shoulder stiffness was proposed that combines an intensive patient home program with a well-informed physical therapist, who progressively adds classic rehabilitation techniques when they provide the best treatment value for each exercise. Patient education is the key to treatment success.
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Affiliation(s)
- P Gleyze
- Hôpital Albert-Schweitzer, 301, avenue d'Alsace, 68000 Colmar, France.
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Gleyze P, Clavert P, Flurin PH, Laprelle E, Katz D, Toussaint B, Benkalfate T, Charousset C, Joudet T, Georges T, Hubert L, Lafosse L, Hardy P, Solignac N, Lévigne C. Management of the stiff shoulder. A prospective multicenter comparative study of the six main techniques in use: 235 cases. Orthop Traumatol Surg Res 2011; 97:S167-81. [PMID: 22036993 DOI: 10.1016/j.otsr.2011.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 09/07/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Stiffness in the shoulder is a frequent symptom associated with a number of clinical entities whose management remains inadequately defined. PATIENTS AND METHODS This prospective study of 235 cases of stiffness in the shoulder compared six therapeutic techniques with a mean follow-up of 13 months (range, 3-28 months) (T1: 58 cases, conventional rehabilitation under the pain threshold, T2: 59 cases, self-rehabilitation over the pain threshold, T3: 31 cases, T2 + supervision, T4: 11 cases, T1 + capsular distension, T5: 31 cases, T1 + locoregional anesthesia, T6: 45 cases, T1 + T5 + capsulotomy). The therapeutic power of each technique and its impact on the result were assessed at each self-rehabilitation and rehabilitation session during the first 6 weeks and then at 3 months, 6 months, and at the final revision depending on subjective criteria (pain, discomfort, and morale) and objective criteria (Constant score, goniometric measurements). RESULTS Conventional rehabilitation (T1) is less effective than self-rehabilitation over the pain threshold (T2 & T3) during the first 6 weeks (P<0.05). Self-rehabilitation stagnates between the 6th and 12th week except when it is supervised by a therapist (T3). Anesthesia (T4) and capsular distension (T5) do not lead to significantly different progression beyond 6 months. Capsulotomy does not demonstrate greater therapeutic power but its failure rate (persisting stiffness at 1 year) is 0% versus 14-17% for the other techniques (P<0.05). DISCUSSION The techniques are complementary and therapeutic success stems from an algorithm adapted to the individual patient with, over the first 3 months, successive self-rehabilitation and conventional rehabilitation, possibly completed by capsular distension or anesthesia between the 3rd and 6th months. In case of failure at 6 months, endoscopic capsulotomy can be proposed. Therapeutic patient education and active participation are the key to treatment success or failure.
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Affiliation(s)
- P Gleyze
- Hôpital Albert-Schweitzer, 301, avenue d'Alsace, 68000 Colmar, France.
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