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Mertens MG, Meeus M, Lluch Girbes E, Dueñas L, Twickler MT, Verborgt O, Struyf F. Differences in biomechanical and metabolic factors between patients with frozen shoulder and asymptomatic individuals. A cross-sectional study. Musculoskelet Sci Pract 2024; 72:102980. [PMID: 38820869 DOI: 10.1016/j.msksp.2024.102980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 05/06/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND the pathogenesis of frozen shoulder (FS) is thought to be one of inflammation and fibrosis possibly influenced by hyperglycemia. Biomechanical changes of the shoulder joint in terms of muscle strength, scapular kinematics and proprioception might occur in FS. OBJECTIVES to compare muscle strength, scapular kinematics, proprioception, and blood glucose levels within patients with FS and to asymptomatic individuals. DESIGN cross-sectional study. METHOD Thirty-five patients with FS and 35 asymptomatic age and gender-matched individuals underwent physical assessment to determine muscle strength (abduction, external and internal rotation), scapular kinematics (both visually and with a plurimeter), proprioception (joint position sense), and blood glucose level. RESULTS Patients with FS showed a decrease in muscle strength in their affected shoulder compared to both the unaffected shoulder and asymptomatic individuals. Significant differences were found between the affected and unaffected shoulder in the FS group and between groups (FS versus controls) in scapular upward rotation (plurimeter) at 30° and 60° abduction. No difference in scapular kinematics (visual observation), proprioception, and blood glucose levels was found neither between shoulders in the FS group nor between groups. CONCLUSION A clinically relevant difference in muscle strength and increase in scapular upward rotation were found in the affected shoulder of patients with FS compared to their unaffected side and controls. However, no evidence of different levels of scapular kinematics (visual observation), proprioception, and blood glucose levels in the affected shoulder compared to the unaffected shoulder or controls is lacking.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium.
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
| | - Enrique Lluch Girbes
- Pain in Motion International Research Group, Belgium; Department of Physical Therapy, University of Valencia, Valencia, Spain; Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Lirios Dueñas
- Department of Physical Therapy, University of Valencia, Valencia, Spain.
| | - Marcel Tb Twickler
- Department of Endocrinology, Diabetology and Metabolic Disease, AZ Monica, Deurne/Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium.
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium; Department of Orthopedic Surgery, University Hospital Antwerp (UZA), Edegem, Belgium.
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
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Navarro-Ledesma S, Hamed-Hamed D, Pruimboom L. A new perspective of frozen shoulder pathology; the interplay between the brain and the immune system. Front Physiol 2024; 15:1248612. [PMID: 38617059 PMCID: PMC11009429 DOI: 10.3389/fphys.2024.1248612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 03/18/2024] [Indexed: 04/16/2024] Open
Abstract
Frozen shoulder (FS), also known as adhesive capsulitis of the shoulder (FS), is a fibrotic inflammatory process of unknown etiology whose main symptoms are pain, stiffness and the loss of joint mobility. These symptoms may be associated with pathologies such as diabetes, Dupuytren's syndrome and the prevalence of today's sedentary lifestyle. This literature review provides an overview of the epidemiology and pathogenesis of this pathology, as well as the mechanisms of lowgrade chronic inflammation and infection, insulin resistance, and omics-science associated with it. We also propose a new hypothesis related to the possibility that the GABAergic system could play a decisive role in the development of frozen shoulder and that therefore diabetes type 1, endocrinological autoimmune disorders and frozen shoulder are connected by the same pathophysiological mechanisms. If that is true, the combined presence of psycho-emotional stress factors and pathogenic immune challenges could be the main causes of frozen shoulder syndrome. Finally, we propose a series of possible intervention strategies based on a multifactorial etiological and mechanistic concept.
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Affiliation(s)
- Santiago Navarro-Ledesma
- Department of Physical Therapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
- University Chair in Clinical Psychoneuroimmunology, University of Granada and PNI Europe, Melilla, Spain
| | - Dina Hamed-Hamed
- Clinical Medicine and Public Health PhD Program, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Leo Pruimboom
- University Chair in Clinical Psychoneuroimmunology, University of Granada and PNI Europe, Melilla, Spain
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3
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Dehlinger F, Bökeler U, Brandt H, Brunnader L, Eden L, Pfingsten A, Prill R. The S2e Guideline on Shoulder Stiffness. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023. [PMID: 37798915 DOI: 10.1055/a-2123-4952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
The clinical picture of "frozen shoulder" is still poorly understood. In order to present the current state of knowledge on aetiology, diagnosis, and treatment, and to provide recommendations for the professional groups involved, a working group was formed by the DGOU and the DVSE to create a German language, evidence-based guideline, which was published in 2022 by the AWMF. The following summarises the development and the most important results.
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Affiliation(s)
- Friedrich Dehlinger
- Departement for Shoulder and Elbow Surgery, Acura Fachklinik GmbH, Albstadt, Deutschland
| | - Ulf Bökeler
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Zentrum für Schwerbrandverletzte, Marien Hospital Stuttgart, Stuttgart, Deutschland
| | - Hanna Brandt
- Faculty of Applied Social and Health Sciences, Department Physiotherapy, Ostbayerische Technische Hochschule Regensburg, Regensburg, Deutschland
| | - Lars Brunnader
- Abteilung für Orthopädie und Traumatologie, Krankenhaus der Barmherzigen Brüder Eisenstadt, Eisenstadt, Deutschland
| | - Lars Eden
- Klinik für Unfall-, Schulter- und Wiederherstellungschirurgie, Sportmedizin und Sporttraumatologie, Krankenhaus Rummelsberg gGmbH, Schwarzenbruck, Deutschland
| | - Andrea Pfingsten
- Faculty of Applied Social and Health Sciences, Department Physiotherapy, Ostbayerische Technische Hochschule Regensburg, Regensburg, Deutschland
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Deutschland
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Deutschland
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4
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Leafblad N, Mizels J, Tashjian R, Chalmers P. Adhesive Capsulitis. Phys Med Rehabil Clin N Am 2023; 34:453-468. [PMID: 37003663 DOI: 10.1016/j.pmr.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Adhesive capsulitis, colloquially known as "frozen shoulder," is a relatively common disorder, affecting approximately 2% to 5% of the general population. The incidence may be higher as the condition can be relatively mild and self-limited and thus many patients who experience it may never present for treatment. It involves a pathologic process of gradual fibrosis of the glenohumeral joint that leads to limited active and passive range of motion, contracture of the joint capsule, and shoulder pain.
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Affiliation(s)
- Nels Leafblad
- Department of Sports Medicine, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Josh Mizels
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Robert Tashjian
- Department of Shoulder and Elbow Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Peter Chalmers
- Department of Shoulder and Elbow Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
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5
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Dyer BP, Rathod-Mistry T, Burton C, van der Windt D, Bucknall M. Diabetes as a risk factor for the onset of frozen shoulder: a systematic review and meta-analysis. BMJ Open 2023; 13:e062377. [PMID: 36599641 PMCID: PMC9815013 DOI: 10.1136/bmjopen-2022-062377] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Summarise longitudinal observational studies to determine whether diabetes (types 1 and 2) is a risk factor for frozen shoulder. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, AMED, PsycINFO, Web of Science Core Collection, CINAHL, Epistemonikos, Trip, PEDro, OpenGrey and The Grey Literature Report were searched on January 2019 and updated in June 2021. Reference screening and emailing professional contacts were also used. ELIGIBILITY CRITERIA Longitudinal observational studies that estimated the association between diabetes and developing frozen shoulder. DATA EXTRACTION AND SYNTHESIS Data extraction was completed by one reviewer and independently checked by another using a predefined extraction sheet. Risk of bias was judged using the Quality In Prognosis Studies tool. For studies providing sufficient data, random-effects meta-analysis was used to derive summary estimates of the association between diabetes and the onset of frozen shoulder. RESULTS A meta-analysis of six case-control studies including 5388 people estimated the odds of developing frozen shoulder for people with diabetes to be 3.69 (95% CI 2.99 to 4.56) times the odds for people without diabetes. Two cohort studies were identified, both suggesting diabetes was associated with frozen shoulder, with HRs of 1.32 (95% CI 1.22 to 1.42) and 1.67 (95% CI 1.46 to 1.91). Risk of bias was judged as high in seven studies and moderate in one study. CONCLUSION People with diabetes are more likely to develop frozen shoulder. Risk of unmeasured confounding was the main limitation of this systematic review. High-quality studies are needed to confirm the strength of, and understand reasons for, the association. PROSPERO REGISTRATION NUMBER CRD42019122963.
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Affiliation(s)
- Brett Paul Dyer
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Trishna Rathod-Mistry
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Claire Burton
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Danielle van der Windt
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Milica Bucknall
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
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Causes of Shoulder Dysfunction in Diabetic Patients: A Review of Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106228. [PMID: 35627764 PMCID: PMC9140829 DOI: 10.3390/ijerph19106228] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 12/15/2022]
Abstract
Objective: Understanding the underlying mechanisms behind shoulder dysfunctions in patients with diabetes mellitus. Study Design: Systematic qualitative literature review. Participants: Patients with shoulder dysfunctions and diagnosed with impaired glucose tolerance or diabetes mellitus. Intervention: Published scientific literature containing evidence about the mechanisms of shoulder dysfunctions in the diabetic population. Articles were selected based on criteria containing diabetic population, shoulder dysfunction, methodological quality ≥ 6/9 and >20 subjects. Main Outcome measures: range of motion; questionnaires (QoL, UCLA-m, SPADI, DASH); blood glucose, blood HbA1C; calculated capsular stiffness (Kcap); calcification shoulder joint; shoulder dysfunction in patients with glucose metabolism disorders and diabetes mellitus. Results: We found 17 published articles with level 2 and 3 evidence. Multiple factors such as age, duration of diabetes mellitus (DM), glycated hemoglobin (HbA1c), advanced glycation end products (AGE), vascular endothelial growth factor (VEGF), interleukin-1ß (IL-1ß) were shown to be associated with tendon changes and increased capsular stiffness (Kcap) conceivably leading to limited range of motion (ROM) or frozen shoulder. Decreased ROM and frozen shoulder have a significantly higher prevalence in DM than in non-DM. Conclusions: Based on the current literature we confirm a high prevalence of shoulder dysfunctions in patients with diabetes mellitus. The cause of the shoulder complications is unknown, and more research is mandatory to shed more light on the complex interplay between the multifactorial causes of shoulder dysfunction in diabetes mellitus.
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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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8
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Mertens MG, Meeus M, Verborgt O, Vermeulen EHM, Schuitemaker R, Hekman KMC, van der Burg DH, Struyf F. An overview of effective and potential new conservative interventions in patients with frozen shoulder. Rheumatol Int 2021; 42:925-936. [PMID: 34487209 DOI: 10.1007/s00296-021-04979-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/18/2021] [Indexed: 12/11/2022]
Abstract
Frozen shoulder (FS) is a pathology that is difficult to understand and difficult to manage. Over the last ten years, contradictory and new evidence is provided regarding the recovery and its natural course. This narrative review provides new information about the diagnosis and conservative treatment of patients with FS and ongoing research hypotheses that might provide new insights in the pathology and treatment options. FS has a characteristic course. People with Diabetes Mellitus and thyroid disorders have a higher risk of developing a FS. The diagnosis FS is based on pattern recognition and physical examination. Additionally, 'rule-in' and 'rule-out' criteria can be used to increase the likelihood of the frozen shoulder diagnosis. Recommended and most common physical therapy interventions are mobilization techniques and exercises, in which tissue irritability can guide its intensity. In addition, physical therapy is often complementary with patient education and pharmacotherapy. The latest evidence-based practice related to FS is proprioceptive neuromuscular facilitation and mirror therapy. In addition, interventions like pain neuroscience education, high-intensity interval training and lifestyle changes are still hypothetical. Finally, better insight in the involvement of biochemical processes, function of myofibroblasts and matrix metalloproteinases can provide better understanding in the pathophysiology and will be addressed in current review.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Wilrijk, Belgium.,Pain in Motion International Research Group
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Wilrijk, Belgium.,Pain in Motion International Research Group.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Wilrijk, Belgium.,Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
| | - Eric H M Vermeulen
- Department of Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Ruud Schuitemaker
- Schuitemaker en Van Schaik Fysiotherapie en Manuele Therapie, Amsterdam, The Netherlands
| | - Karin M C Hekman
- Medisch Centrum Jan Van Goyen, Amsterdam, The Netherlands.,Schoudercentrum IBC Amstelland, Amstelveen, The Netherlands
| | - Donald H van der Burg
- Fysiotherapie Oost Nederland (FYON), Enschede, The Netherlands.,Saxion Hogeschool, Enschede, The Netherlands
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Wilrijk, Belgium.
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9
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Eckert AJ, Plaumann M, Pehlke S, Beck C, Mühldorfer S, Weickert U, Laimer M, Pfeifer M, Stechemesser L, Holl R. Idiopathic Frozen Shoulder in Individuals with Diabetes: Association with Metabolic Control, Obesity, Antidiabetic Treatment and Demographic Characteristics in Adults with Type 1 or 2 Diabetes from the DPV Registry. Exp Clin Endocrinol Diabetes 2021; 130:468-474. [PMID: 34425597 DOI: 10.1055/a-1543-8559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS To examine the association of frozen shoulder (FS) with demographic and diabetes-related outcomes in individuals with type 1 (T1D) or type 2 (T2D) diabetes aged ≥30 years. MATERIALS AND METHODS Multivariable logistic regression models, adjusted for demographics were used to calculate the proportion of FS in association with age, gender, diabetes duration, body mass index (BMI), haemoglobin A1C (HbA1c) and diabetes treatment. RESULTS The unadjusted percentage of FS was higher in T1D compared to T2D (0.22% vs. 0.06%). In T1D, adjusted regression models revealed higher prevalence of FS in women than men (0.26 [0.20-0.34] % vs. 0.15 [0.11-0.21] %, p=0.010). No significant relationship of age and BMI with FS was found in both diabetes types. Longer diabetes duration was associated with a higher proportion of FS in T1D (p<0.001) and T2D (p=0.004). In T1D, HbA1c >7% was related to a higher proportion of FS compared to HbA1c ≤7% (0.25 [0.19-0.32] vs. 0.12 [0.08-0.20] %, p=0.007), while an inverse relationship was found in T2D (HbA1c ≤7%: 0.08 [0.07-0.10] vs. HbA1c >7%: 0.05 [0.04-0.06] %, p=0.001). CONCLUSIONS Different associations of FS with gender and HbA1c were observed for T1D and T2D; however, longer diabetes duration increases the risk for FS independent of diabetes type. Musculoskeletal diseases are still underreported in individuals with diabetes and awareness should be raised for FS as a specific diabetes complication.
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Affiliation(s)
- Alexander J Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Maike Plaumann
- Diabetologische Schwerpunktpraxis Hannover, Hannover, Germany
| | | | - Christof Beck
- Klinik für Innere Medizin 4, Klinikum Nürnberg Süd, Nürnberg, Germany
| | | | - Uwe Weickert
- Department of Medicine II, SLK Kliniken Heilbronn, University of Heidelberg, Germany
| | - Markus Laimer
- Universitätsklinik für Diabetologie, Endokrinologie, Ernährungsmedizin und Metabolismus, Universität Bern, Inselspital, Bern, Switzerland
| | | | - Lars Stechemesser
- Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - ReinhardW Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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10
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Aljethaily A, Alshuwayrikh A, Alkhonezan S, Alasmari A, Almakdob M, Albogami A, Aloriney A, Ahmed I, Alzahrani B. The Prevalence of Shoulder Pain and Its Functional Limitations Among Patients With Uncontrolled Diabetes. Cureus 2020; 12:e11487. [PMID: 33335816 PMCID: PMC7735990 DOI: 10.7759/cureus.11487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objectives To investigate the prevalence of shoulder pain and its functional limitations among patients with uncontrolled diabetes mellitus (DM). Methods This is a cross-sectional study that was conducted over a period of four months from October 2019 to January 2020 and included all patients with uncontrolled DM (HbA1c > 9) who are visiting the diabetes clinic at Security Forces Hospital during the study period. Telephone interviews were held by a physician from the Family Medicine Department using a previously validated questionnaire, that is, the American Shoulder and Elbow Surgeons Evaluation Form. Results A total of 285 patients were included in the study; 156 (54.7%) were females and 129 (45.3%) were males. Most (51.1%) of the patients aged 45-64 years. The majority of the patients 58.9% had type II DM and 41.1% of them had type I DM. The mean HbA1c level was 10.56. Of the patients are having shoulder pain (109; 38.2%), 42.5% were between 45 and 64 years of age and 44.1% were between 65 and 96 of years. While 176 (61.8%) of the participants had no pain at all, 70.5% males and 54.5% females did not have shoulder pain (p<0.001). The mean shoulder pain intensity for all patients was 5.81(SD=3.21), ranging from 4.71 (SD=3.15) to 6.13 (SD=3.29), according to different age groups, and showed a significant correlation (p<0.05). Conclusions Increasing prevalence of shoulder dysfunction is making physicians alert regarding early diagnosis and management of the disease. Thus, it should be mandatory to include screening, prevention, and rehabilitation strategies for shoulder dysfunction in diabetic care programs to improve the daily lifestyle of the patients.
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11
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Hagiwara Y, Kanazawa K, Ando A, Sekiguchi T, Yabe Y, Takahashi M, Koide M, Takahashi N, Sugaya H. Clinical outcomes of arthroscopic pan-capsular release with or without entire coracohumeral ligament release for patients with frozen shoulder. JSES Int 2020; 4:826-832. [PMID: 33345222 PMCID: PMC7738570 DOI: 10.1016/j.jseint.2020.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background We aimed to retrospectively determine the effects of arthroscopic pan-capsular release with or without entire coracohumeral ligament (CHL) release and diabetes mellitus (DM) in patients with frozen shoulder (FS). Methods The study included 34 patients (20 male and 14 female patients) who underwent arthroscopic pan-capsular release without entire CHL release (group 1) and 26 patients (6 male and 20 female patients) who underwent entire CHL release for FS (group 2). Patients with a minimum of 12 months of follow-up were included, and range of motion (ROM) and the shoulder rating scale of the University of California at Los Angeles (UCLA) scoring system were evaluated. Results In group 2, external rotation and hand-behind-the-back (HBB) ROMs were significantly increased compared with group 1 at the final follow-up (external rotation, 53.1° ± 15.2° vs. 41.3° ± 20.5° [P = .044]; HBB level, T6 [interquartile range, T5-T9] vs. T11 [interquartile range, T8-L4] [P < .001]). Total UCLA scores and UCLA scores for pain (9.2 ± 1.5 vs. 10.0, P = .003), function (8.5 ± 1.4 vs. 10.0, P < .001), and active forward flexion (4.6 ± 0.6 vs. 4.9 ± 0.2, P < .011) were significantly greater in group 2 at the final follow-up. Patients without DM tended to have greater recovery of forward flexion and HBB ROMs and better total, pain, and function UCLA scores compared with those with DM. In group 2, there were no significant differences in ROMs and UCLA scores between the patients with DM and those without DM. Conclusion Arthroscopic entire CHL release is an essential treatment option for FS patients to regain ROMs and function and to reduce pain.
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Affiliation(s)
- Yoshihiro Hagiwara
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kenji Kanazawa
- Department of Orthopaedic Surgery, South Miyagi Medical Center, Ōgawara, Japan
| | - Akira Ando
- Department of Orthopaedic Surgery, Matsuda Hospital, Sendai, Japan
| | - Takuya Sekiguchi
- Department of Orthopaedic Surgery, Japan Railway Company Sendai Hospital, Sendai, Japan
| | - Yutaka Yabe
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Masaki Takahashi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Masashi Koide
- Department of Orthopaedic Surgery, Matsuda Hospital, Sendai, Japan
| | - Norimasa Takahashi
- Department of Orthopaedic Surgery, Funabashi Orthopaedic Hospital, Funabashi, Japan
| | - Hiroyuki Sugaya
- Department of Orthopaedic Surgery, Funabashi Orthopaedic Hospital, Funabashi, Japan
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12
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Yang L, Zhang J, Ruan D, Zhao K, Chen X, Shen W. Clinical and Structural Outcomes After Rotator Cuff Repair in Patients With Diabetes: A Meta-analysis. Orthop J Sports Med 2020; 8:2325967120948499. [PMID: 32995347 PMCID: PMC7502797 DOI: 10.1177/2325967120948499] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/06/2020] [Indexed: 12/16/2022] Open
Abstract
Background: The impact of diabetes on clinical and structural outcomes after rotator cuff repair remains controversial. Purpose/Hypothesis: The purpose of this study was to compare clinical outcomes and retear rates after rotator cuff repair in patients with and without diabetes. Our hypotheses were that adequate control of diabetes would decrease the retear rate after rotator cuff repair and that patients with diabetes would have worse clinical outcomes. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed, Embase, and Cochrane Library databases were searched for studies comparing outcomes in patients with and without diabetes after full-thickness rotator cuff repair. Clinical outcome analysis included the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and the University of California–Los Angeles shoulder rating scale; we compared preoperative, postoperative, and change in functional scores from baseline to final follow-up among the included studies. The pooled relative risk was calculated using a random-effects model for retear rates. Clinical outcomes were also pooled using a random-effects model. Results: Overall, 10 studies were included. Compared with patients without diabetes, patients with diabetes had a worse preoperative ASES score (P = .009) as well as worse postoperative Constant score (final follow-up range, 9-103 months; P = .0003). However, there was no significant difference in the absolute mean change in clinical outcomes between patients with and without diabetes. Diabetes was associated with a higher retear rate (19.3% in patients without diabetes vs 28.2% in patients with diabetes; P < .0001). The retear rate according to the severity of sustained hyperglycemia in the subgroup analysis was 14.6% in patients without diabetes, versus 22.7% in patients with well-controlled diabetes (<7.0% of preoperative serum HbA1c level; P = .12) and 40.0% in patients with uncontrolled diabetes (HbA1c level ≥7.0%; P < .00001). Conclusion: This meta-analysis suggests that diabetes mellitus is associated with an increased risk of retears after rotator cuff repair, and improved blood glucose control may reduce the risk of retears in patients with diabetes mellitus. Although effective glycemic control was associated with a decreased risk of retears in patients with diabetes, we could not prove causation because of potential bias and confounding in the included studies.
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Affiliation(s)
- Lingdi Yang
- Department of Orthopedic Surgery of The Second Affiliated Hospital and Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China.,Lishui People's Hospital, Lishui, China
| | - Jun Zhang
- Department of Orthopedic Surgery of The Second Affiliated Hospital and Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China.,Longquan People's Hospital, Longquan, China
| | - Dengfeng Ruan
- Department of Orthopedic Surgery of The Second Affiliated Hospital and Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Kun Zhao
- Department of Orthopedic Surgery of The Second Affiliated Hospital and Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China.,Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China.,China Orthopaedic Regenerative Medicine Group, Hangzhou, China
| | - Xiao Chen
- Department of Orthopedic Surgery of The Second Affiliated Hospital and Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China.,Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China.,China Orthopaedic Regenerative Medicine Group, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Weiliang Shen
- Department of Orthopedic Surgery of The Second Affiliated Hospital and Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China.,Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China.,China Orthopaedic Regenerative Medicine Group, Hangzhou, China.,Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
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13
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Cohen C, Tortato S, Silva OBS, Leal MF, Ejnisman B, Faloppa F. Association between Frozen Shoulder and Thyroid Diseases: Strengthening the Evidences. Rev Bras Ortop 2020; 55:483-489. [PMID: 32904783 PMCID: PMC7458737 DOI: 10.1055/s-0039-3402476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 02/26/2019] [Indexed: 12/03/2022] Open
Abstract
Objective
To clarify the association of thyroid disorders and primary frozen shoulder by comparing this group with controls without shoulder disease and with patients with rotator cuff tears.
Methods
We evaluated 166 patients who presented frozen shoulder with treatment in progress or already treated, which were compared with 129 patients with diagnosis of rotator cuff tears and 251 control subjects. All of the participants answered the questionnaire on the following variables: age, gender, body mass index (BMI), occupation, physical activity, presence of thyroid disorders and other comorbidities, smoking and use of alcohol.
Results
When comparing the frozen shoulder group with the control and rotator cuff groups, there is a specific association between the presence of thyroid disorders and frozen shoulder. By calculating relative risk, it is possible to state that an individual with thyropathy has 2.69 more chance of developing frozen shoulder. Also, there was an association with gender, since women with frozen shoulder exceeded significantly the risk.
Conclusions
Thyroid disorders, especially hypothyroidism and the presence of benign thyroid nodules, are risk factors significantly associated with frozen shoulder, rising the chances to 2.69 times of developing frozen shoulder.
This is the first study that uses, in addition to the control group, a second group with rotator cuff tears, so it was shown that there is a specific association of thyroid disorders and frozen shoulder, but not with shoulder disorders in general.
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Affiliation(s)
- Carina Cohen
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Simone Tortato
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Otavio Bento Souza Silva
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Mariana Ferreira Leal
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Benno Ejnisman
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Flavio Faloppa
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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14
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Yanlei GL, Keong MW, Tijauw Tjoen DL. Do diabetic patients have different outcomes after arthroscopic capsular release for frozen shoulder? J Orthop 2019; 16:211-215. [PMID: 30906125 PMCID: PMC6411596 DOI: 10.1016/j.jor.2019.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/01/2018] [Accepted: 02/17/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION While the exact mechanism of primary adhesive capsulitis is unknown, we know that it has strong associations with diabetes mellitus (DM). Although self-limiting, a significant percentage of patients still have persistent pain and stiffness beyond 3 years. Arthroscopic capsular release (ACR) has been described as a successful intervention for recalcitrant adhesive capsulitis that provides early and long-term recovery. The aim of this study is to investigate the relationship between DM and ACR. METHODS We reviewed prospectively collected data of 56 consecutive patients with idiopathic frozen shoulder who underwent ACR (360° arthroscopic capsulotomy) under a single surgeon. Range of motion, pain score and shoulder function (Constant Shoulder Score, Oxford Shoulder Score, University of California Los Angeles Shoulder Score) were documented preoperatively and one year postoperatively. Patients were dichotomized into diabetic (n = 32) and non-diabetic patients (n = 24) and compared using a mixed ANOVA design to investigate for differences in outcomes. RESULTS Both group of patients had significant improvement in range of motion, reduced pain scores and improved shoulder scores one year postoperatively (p = 0.000). Diabetic patients had poorer internal rotation (p = 0.000), forward flexion (p = 0.035) and poorer postoperative Constant Shoulder score (p < 0.05). Otherwise both groups improved equally in all other aspects. CONCLUSION ACR offered good outcomes in both diabetic and non-diabetic patients in terms of range of motion, pain relief and shoulder function. However diabetic patients had poorer improvement in internal rotation and forward flexion postoperatively. Preoperative counselling and postoperative rehabilitation can be better tailored to treat diabetic patients with idiopathic adhesive capsulitis.
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Affiliation(s)
- Geraldine Lei Yanlei
- Singapore General Hospital, 20 College Road, 20 College Road Academia Level 4, 1698655, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mak Wai Keong
- Singapore General Hospital, 20 College Road, 20 College Road Academia Level 4, 1698655, Singapore
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Denny Lie Tijauw Tjoen
- Singapore General Hospital, 20 College Road, 20 College Road Academia Level 4, 1698655, Singapore
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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15
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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: 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: 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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Abstract
Frozen shoulder causes significant functional disability and pain in a population group constituted by patients who are often middle-aged and working. Frozen shoulder remains poorly understood. The available literature is limited and often prone to bias. A rapid, non-surgical and cost-effective treatment that reduces pain and restores function is an attractive option. Hydrodilatation is a potential first-line treatment of frozen shoulder in secondary care.
Cite this article: EFORT Open Rev 2017;2:462–468. DOI: 10.1302/2058-5241.2.160061
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Affiliation(s)
- S Rymaruk
- University Hospital of South Manchester NHS Foundation Trust, UK
| | - C Peach
- University Hospital of South Manchester NHS Foundation Trust, UK
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17
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Gutefeldt K, Hedman CA, Thyberg ISM, Bachrach-Lindström M, Arnqvist HJ, Spångeus A. Upper extremity impairments in type 1 diabetes with long duration; common problems with great impact on daily life. Disabil Rehabil 2017; 41:633-640. [DOI: 10.1080/09638288.2017.1397202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kerstin Gutefeldt
- Department of Endocrinology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Christina A. Hedman
- Department of Endocrinology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ingrid S. M. Thyberg
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Margareta Bachrach-Lindström
- Division of Nursing Sciences, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Hans J. Arnqvist
- Department of Endocrinology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Anna Spångeus
- Department of Endocrinology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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18
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Chan JH, Ho BS, Alvi HM, Saltzman MD, Marra G. The relationship between the incidence of adhesive capsulitis and hemoglobin A 1c. J Shoulder Elbow Surg 2017; 26:1834-1837. [PMID: 28495575 DOI: 10.1016/j.jse.2017.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/09/2017] [Accepted: 03/13/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies have shown no correlation between adhesive capsulitis and hemoglobin A1c (HbA1c). However, HbA1c is only a measure of short-term blood sugar control. We created a previously nonvalidated variable, cumulative HbA1c, that uses HbA1c values over time to estimate the total disease burden a single individual experiences over a period. In this study, we aimed to evaluate whether a correlation exists between cumulative HbA1c levels in diabetic patients and the prevalence of frozen shoulder. We hypothesized that poor long-term glucose control would be correlated with increased incidence of adhesive capsulitis. METHODS A retrospective analysis at a single institution was performed. Data from all patients from a single institution with any HbA1c values were collected. A total of 24,417 patients met the inclusion criteria. A variable was created establishing the cumulative magnitude of abnormal HbA1c values over time, termed "cumulative HbA1c." Logistic regression analysis was performed to determine whether long-term glucose control was predictive of the development of adhesive capsulitis. RESULTS Cumulative HbA1c was positively associated with adhesive capsulitis (7.6 × 10-5) (ie, odds ratio of 1.000076). The effect size of cumulative HbA1c on adhesive capsulitis was significant; for each unit of time that the HbA1c level was greater than 7, there was a 2.77% increase in the risk of adhesive capsulitis. DISCUSSION Cumulative HbA1c was associated with an increased incidence of adhesive capsulitis. This finding suggests that the effects of diabetes that predispose patients to the development of adhesive capsulitis are dose dependent. Patients with worse blood sugar control over a longer period are at an increased risk of the development of adhesive capsulitis.
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Affiliation(s)
- Justin H Chan
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | | | - Hasham M Alvi
- Barrington Orthopedic Specialists, Schaumburg, IL, USA.
| | - Matthew D Saltzman
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | - Guido Marra
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
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19
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Inayat F, Ali NS, Shahid H, Younus F. Prevalence and Determinants of Frozen Shoulder in Patients with Diabetes: A Single Center Experience from Pakistan. Cureus 2017; 9:e1544. [PMID: 29018641 PMCID: PMC5630460 DOI: 10.7759/cureus.1544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction Frozen shoulder (FS) or adhesive capsulitis is a constellation of symptoms like pain, stiffness, and/or functional deficit at the glenohumeral joint. It is one of the musculoskeletal complications in patients with diabetes that can be particularly debilitating. The aim of this study is to estimate the prevalence of FS and to compare the determinants of this disease in a population with diabetes from Lahore, Pakistan. Materials and Methods We carried out this cross-sectional study on a systematically randomized sample of 80 patients with diabetes. It included 38 males and 42 females from 2,964 patients registered at the Diabetes Management Center, Services Hospital Lahore, Pakistan. The study was conducted in the months of April, May, and June 2017. A structured questionnaire was designed and the responses of patients were recorded at the clinic after informed verbal and written consent. The questionnaire outlined the key factors that can lead to a higher frequency of FS in patients with diabetes. Results Thirty-three of the total 80 respondents included in the study were diagnosed with FS. The estimated prevalence of FS in diabetics from this data was 41.3% in Lahore, which is an urban area of Pakistan with a population of more than seven million. Female sex, insulin dependence, uncontrolled blood glucose levels, and a positive family history were associated with a significantly higher prevalence of FS. In our study, most patients with FS were in Stage 1 of the disease and had unilateral involvement. Conclusion The present study shows that the prevalence of FS is higher in patients with diabetes residing in Lahore than in comparable foreign populations with diabetes. It can be attributed to socioeconomic status, lack of awareness, a higher threshold for diagnosis, and/or poor glycemic control. Mass awareness campaigns, especially for female patients with diabetes, are required to be initiated to create awareness about the disease and to facilitate early diagnosis and appropriate management. In-depth and multicenter studies are needed to further explore the association between FS and diabetes.
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Affiliation(s)
- Faisal Inayat
- Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York City, NY, USA
| | - Nouman Safdar Ali
- Department of Medicine, Jinnah Hospital, Allama Iqbal Medical College, Lahore, Pakistan
| | - Haroon Shahid
- Department of Radiology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Fariha Younus
- Department of Medicine Unit 4, Services Hospital, Services Institute of Medical Sciences, Lahore, Pakistan
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20
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Bloomgarden Z. Upper extremity arthropathy in diabetes. J Diabetes 2017; 9:542-543. [PMID: 28374546 DOI: 10.1111/1753-0407.12557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Zachary Bloomgarden
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
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21
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Cui J, Lu W, He Y, Jiang L, Li K, Zhu W, Wang D. Molecular biology of frozen shoulder-induced limitation of shoulder joint movements. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:61. [PMID: 28616048 PMCID: PMC5461583 DOI: 10.4103/jrms.jrms_1005_16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/18/2017] [Accepted: 02/22/2017] [Indexed: 12/22/2022]
Abstract
Frozen shoulder is a chronic condition characterized by pain in the shoulder and restriction of movements in all directions. Some patients are left with long-term limitation of shoulder joint activity with various severities, which results in reduced quality of life. Currently, there is a paucity of literature on the molecular biology of frozen shoulder, and the molecular biological mechanism for periarthritis-induced limitation of shoulder joint movements remains unclear. Research in this field is focused on inflammation and cytokines associated with fibrosis. Repeated investigations confirmed alterations of specified inflammatory mediators and fibrosis-associated cytokines, which might be involved in the pathogenesis of frozen shoulder by causing structural changes of the shoulder joint and eventually the limitation of shoulder movements. The aim of this article is to review studies on molecular biology of frozen shoulder and provide a reference for subsequent research, treatment, and development of new drugs.
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Affiliation(s)
- Jiaming Cui
- Guangzhou Medical University, Guangzhou 510182, P. R. China.,Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, P. R. China.,Shenzhen Research and Development Engineering Center for Sports Medicine, Shenzhen 518000, P. R. China.,Chinese Orthopaedic Regenerative Medicine Group, Hangzhou 310000, P. R. China
| | - Wei Lu
- Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, P. R. China.,Shenzhen Research and Development Engineering Center for Sports Medicine, Shenzhen 518000, P. R. China.,Chinese Orthopaedic Regenerative Medicine Group, Hangzhou 310000, P. R. China
| | - Yong He
- Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, P. R. China
| | - Luoyong Jiang
- Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, P. R. China
| | - Kuokuo Li
- Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, P. R. China
| | - Weimin Zhu
- Guangzhou Medical University, Guangzhou 510182, P. R. China.,Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, P. R. China.,Shenzhen Research and Development Engineering Center for Sports Medicine, Shenzhen 518000, P. R. China.,Chinese Orthopaedic Regenerative Medicine Group, Hangzhou 310000, P. R. China
| | - Daping Wang
- Guangzhou Medical University, Guangzhou 510182, P. R. China.,Department of Sports Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, P. R. China.,Shenzhen Research and Development Engineering Center for Sports Medicine, Shenzhen 518000, P. R. China.,Chinese Orthopaedic Regenerative Medicine Group, Hangzhou 310000, P. R. China
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22
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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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23
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Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles Ligaments Tendons J 2016; 6:26-34. [PMID: 27331029 PMCID: PMC4915459 DOI: 10.11138/mltj/2016.6.1.026] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND adhesive capsulitis (AC) results in progressive painful restriction in range of movement and can reduce function and quality of life. Whilst it has been associated with diabetes mellitus (DM), there is considerable variation in the reported prevalence of AC in the diabetic population. The aim of this study is to determine through meta-analysis the prevalence of AC in DM and examine whether it is influenced by type of DM or insulin therapy. We also aim to further establish the prevalence of DM in patients presenting with AC. METHODS we conducted a literature search for terms regarding AC and DM on Embase and Pubmed NCBI. RESULTS of 5411 articles identified, 18 were selected. Meta-analysis showed that patients with DM were 5 (95% CI 3.2-7.7) times more likely than controls to have AC. The overall prevalence of AC in DM was estimated at 13.4% (95% CI 10.2-17.2%). Comparison of prevalence in patients on insulin vs other treatments showed no significant difference between the two. Meta-analysis estimated the prevalence of DM in AC at 30% (95% CI 24-37%). CONCLUSION to our knowledge this is the first meta-analysis to estimate the overall prevalence of diabetes in a population with AC. A high prevalence of AC exists in DM and equally a high prevalence of DM is present in AC. Screening for DM should be considered in patients presenting with AC.
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Affiliation(s)
- Nasri Hani Zreik
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, UK
| | - Rayaz A. Malik
- Weill Cornell Medical College, Doha, Qatar
- Centre for Endocrinology & Diabetes, Institute of Human Development, University of Manchester, Manchester, UK
| | - Charalambos P. Charalambous
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, UK
- School of Medicine, University of Central Lancashire, Preston, UK
- Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
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24
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Hagiwara Y, Sugaya H, Takahashi N, Kawai N, Ando A, Hamada J, Itoi E. Effects of intra-articular steroid injection before pan-capsular release in patients with refractory frozen shoulder. Knee Surg Sports Traumatol Arthrosc 2015; 23:1536-1541. [PMID: 24643358 DOI: 10.1007/s00167-014-2936-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of the study was to retrospectively determine the effects of intra-articular steroid injection on the clinical outcome of patients who underwent arthroscopic pan-capsular release for refractory frozen shoulder. METHODS Between 2000 and 2010, 34 patients (20 males, 14 females) who underwent an arthroscopic pan-capsular release for frozen shoulder were included. Intra-articular steroid injections were administered from April 2006, and just before surgery and at the final follow-up, ranges of motion (ROM) and scores of the Shoulder Rating Scale of the University of California, Los Angeles (UCLA) scoring system were evaluated. RESULTS Intra-articular steroid injection significantly improved the UCLA scores of pain just before surgery and at the final follow-up (1.7 ± 0.5 vs. 6 ± 2, p < 0.0001). We subdivided the patients into those with and without diabetes mellitus. Steroid injection had a significant effect on the ROM in forward flexion (166.6 ± 8.6 vs. 140 ± 36.1, p = 0.026) and the scores of pain (10 vs. 9.3 ± 1.2, p = 0.046) at the final follow-up in the group without diabetes mellitus compared with those with it. CONCLUSION Intra-articular steroid injection improves pain just before an arthroscopic pan-capsular release and at the final follow-up in all the patients with refractory frozen shoulder. However, it improves the ROM in forward flexion and the UCLA scores of pain at the final follow-up only in those without diabetes mellitus. LEVEL OF EVIDENCE Therapeutic studies, Level IV.
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Affiliation(s)
- Yoshihiro Hagiwara
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Hiroyuki Sugaya
- Funabashi Orthopaedic Sports Medicine Center, 1-833 Hazama-cho, Funabashi, Japan
| | - Norimasa Takahashi
- Funabashi Orthopaedic Sports Medicine Center, 1-833 Hazama-cho, Funabashi, Japan
| | - Nobuaki Kawai
- Funabashi Orthopaedic Sports Medicine Center, 1-833 Hazama-cho, Funabashi, Japan
| | - Akira Ando
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Junichiro Hamada
- Department of Orthopaedic Surgery, Kuwano Kyoritsu Hospital, 2-9-18 Shima, Koriyama, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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25
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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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26
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Austin DC, Gans I, Park MJ, Carey JL, Kelly JD. The association of metabolic syndrome markers with adhesive capsulitis. J Shoulder Elbow Surg 2014; 23:1043-51. [PMID: 24560465 DOI: 10.1016/j.jse.2013.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/31/2013] [Accepted: 11/06/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Research has associated adhesive capsulitis with diabetes mellitus but suggests that glucose-mediated injury may begin before diabetes is diagnosed. The period preceding diabetes is often marked by metabolic syndrome. METHODS We investigated the relationship between metabolic syndrome components (insulin resistance, hypertension, dyslipidemia, and obesity) and the development of adhesive capsulitis using a case-control study. We retrospectively reviewed 150 consecutive adhesive capsulitis patient charts to determine the prevalence of obesity and of medications used for treating metabolic syndrome elements and compared these with previously reported nationwide values. RESULTS The prevalence of anti-hyperglycemia medications in the adhesive capsulitis cohort was 18.4% (95% confidence interval [CI], 12.9%-25.7%), twice the national rate of diagnosed diabetes of 7.6% (95% CI, 6.7%-8.5%). In the 20- to 39-year-old group, the prevalence of anti-hyperglycemic medications, 26.3% (95% CI, 11.8%-48.8%), was over 10 times the nationwide rate. The overall prevalence of hypertensive medication use in the adhesive capsulitis group, 33.1% (95% CI, 25.9%-41.2%), was notably higher than the nationwide rate, 21.6% (95% CI, 19.8%-23.4%). In the 40- to 64-year-old group, the prevalence of hypertensive medication use, 36.8% (95% CI, 28.6%-46.0%), was notably higher than the nationwide rate of 24.5% (95% CI, 22.2%-27.0%). The prevalence of anti-lipid medications and obesity was similar between the groups. CONCLUSIONS The relationship between adhesive capsulitis and metabolic syndrome remains unclear. Our results confirm previous work associating hyperglycemia with adhesive capsulitis. We have also shown a possible association of hypertension, part of metabolic syndrome and a proinflammatory condition, with adhesive capsulitis, which has not been previously described.
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Affiliation(s)
- Daniel C Austin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Itai Gans
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Min Jung Park
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - James L Carey
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - John D Kelly
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
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Diabetes mellitus: musculoskeletal manifestations and perioperative considerations for the orthopaedic surgeon. J Am Acad Orthop Surg 2014; 22:183-92. [PMID: 24603828 DOI: 10.5435/jaaos-22-03-183] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Diabetes mellitus is a disease of uncontrolled hyperglycemia. Despite a more sophisticated understanding of the pathophysiology of diabetes mellitus and despite pharmacologic advancements that enable better glycemic control, the prevalence of this disease and its devastating sequelae continue to rise. The adverse effects of diabetes on the nervous, vascular, and immune systems render the musculoskeletal system vulnerable to considerable damage. Foot involvement has traditionally been thought of as the most severe and frequently encountered orthopaedic consequence. However, the upper extremity, spine, and muscles are also commonly affected. Orthopaedic surgeons are more involved than ever in the care of patients with diabetes mellitus, and they play a vital role in the multidisciplinary approach used to treat these patients. As a result, surgeons must have a comprehensive understanding of the musculoskeletal manifestations and perioperative considerations of diabetes in order to most effectively care for patients with diabetes mellitus.
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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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29
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Siu KK, Zheng LB, Ko JY, Wang FS, Wang CJ, Wong T, Chou WY. Increased interleukin 1β levels in the subacromial fluid in diabetic patients with rotator cuff lesions compared with nondiabetic patients. J Shoulder Elbow Surg 2013; 22:1547-51. [PMID: 23523071 DOI: 10.1016/j.jse.2013.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 01/06/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Diabetic patients have a high prevalence of shoulder pain and stiffness. Interleukin (IL) 1β was reportedly correlated with shoulder stiffness and decreased shoulder function. We retrospectively compared the expression of IL-1β in the subacromial synovial fluid between diabetic and nondiabetic patients with rotator cuff tearing. MATERIALS AND METHODS We enrolled 68 patients with rotator cuff tearing (23 diabetic patients and 45 nondiabetic patients). The preoperative sum of range-of-motion deficit (SROMD), Constant score, and visual analog scale (VAS) score were obtained. Intraoperatively, subacromial synovial fluid was collected for the IL-1β level measurement. Comparisons of IL-1β levels, Constant scores, SROMD, and VAS scores between diabetic and nondiabetic patients were analyzed with the Mann-Whitney U test. RESULT Diabetic patients with rotator cuff tearing had significantly increased subacromial IL-1β levels (P = .048), SROMD (P < .001) and VAS scores (P = .022) and lower Constant scores (P < .001) than nondiabetic patients. The IL-1β levels in the subacromial fluid were significantly correlated with the Constant score (r = -0.477, P < .001), VAS score (r = 0.698, P < .001), and SROMD (r = 0.293, P = .015) in all patients. CONCLUSION The elevated IL-1β levels in the subacromial fluid of patients with diabetes may explain the likelihood of pain and shoulder stiffness developing in these patients. We suggest more aggressive treatment for rotator cuff lesions in diabetic patients.
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Affiliation(s)
- Ka-Kit Siu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Wood AM, Brock TM, Heil K, Holmes R, Weusten A. A Review on the Management of Hip and Knee Osteoarthritis. Int J Chronic Dis 2013; 2013:845015. [PMID: 26464847 PMCID: PMC4590943 DOI: 10.1155/2013/845015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 07/25/2013] [Accepted: 09/02/2013] [Indexed: 01/12/2023] Open
Abstract
Arthritis is the most common chronic condition affecting patients over the age of 70. The prevalence of osteoarthritis increases with age, and with an aging population, the effect of this disease will represent an ever-increasing burden on health care. The knee is the most common joint affected in osteoarthritis, with up to 41% of limb arthritis being located in the knee, compared to 30% in hands and 19% in hips. We review the current concepts with regard to the disease process and risk factors for developing hip and knee osteoarthritis. We then explore the nonsurgical management of osteoarthritis as well as the operative management of hip and knee arthritis. We discuss the indications for surgical treatment of hip and knee arthritis, looking in particular at the controversies affecting young and obese patients in both hip and knee replacements. Patient and implant related outcomes along with survivorships are addressed as well as the experiences and controversies described in national joint registries.
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Affiliation(s)
| | - Timothy M. Brock
- Trauma and Orthopaedics, Wansbeck Hospital, Woodhorn Road, Ashington NE63 9JJ, UK
| | - Kieran Heil
- University of Glasgow Medical School, Glasgow, Scotland, UK
| | - Rachel Holmes
- Trauma and Orthopaedics, Wansbeck Hospital, Woodhorn Road, Ashington NE63 9JJ, UK
| | - Axel Weusten
- Trauma and Orthopaedics, Wansbeck Hospital, Woodhorn Road, Ashington NE63 9JJ, UK
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Beard D, Price A, Cook J, Fitzpatrick R, Carr A, Campbell M, Doll H, Campbell H, Arden N, Cooper C, Davies L, Murray D. Total or Partial Knee Arthroplasty Trial - TOPKAT: study protocol for a randomised controlled trial. Trials 2013; 14:292. [PMID: 24028414 PMCID: PMC3848560 DOI: 10.1186/1745-6215-14-292] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/23/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In the majority of patients with osteoarthritis of the knee the disease originates in the medial compartment. There are two fundamentally different approaches to knee replacement for patients with unicompartmental disease: some surgeons feel that it is always best to replace both the knee compartments with a total knee replacement (TKR); whereas others feel it is best to replace just the damaged component of the knee using a partial or unicompartment replacement (UKR). Both interventions are established and well-documented procedures. Little evidence exists to prove the clinical and cost-effectiveness of either management option. This provides an explanation for the high variation in treatment of choice by individual surgeons for the same knee pathology.The aim of the TOPKAT study will be to assess the clinical and cost effectiveness of TKRs compared to UKRs in patients with medial compartment osteoarthritis. METHODS/DESIGN The design of the study is a single layer multicentre superiority type randomised controlled trial of unilateral knee replacement patients. Blinding will not be possible as the surgical scars for each procedure differ.We aim to recruit 500 patients from approximately 28 secondary care orthopaedic units from across the UK including district general and teaching hospitals. Participants will be randomised to either UKR or TKR. Randomisation will occur using a web-based randomisation system. The study is pragmatic in terms of implant selection for the knee replacement operation. Participants will be followed up for 5 years. The primary outcome is the Oxford Knee Score, which will be collected via questionnaires at 2 months, 1 year and then annually to 5 years. Secondary outcomes will include cost-effectiveness, patient satisfaction and complications data. TRIAL REGISTRATION Current Controlled Trials ISRCTN03013488; ClinicalTrials.gov Identifier: NCT01352247.
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Affiliation(s)
- David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford OX3 7LD, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford OX3 7LD, UK
| | - Jonathan Cook
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Ray Fitzpatrick
- Department of Public Health, University of Oxford, Rosemary Rue Building, Old Road Campus, Headington, Oxford OX3 7LF, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford OX3 7LD, UK
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Helen Doll
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Helen Campbell
- Department of Public Health, University of Oxford, Rosemary Rue Building, Old Road Campus, Headington, Oxford OX3 7LF, UK
| | - Nigel Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford OX3 7LD, UK
| | - Cushla Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford OX3 7LD, UK
| | - Loretta Davies
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford OX3 7LD, UK
| | - David Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford OX3 7LD, UK
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Abstract
Several rheumatologic manifestations are more pronounced in subjects with diabetes, ie, frozen shoulder, rotator cuff tears, Dupuytren's contracture, trigger finger, cheiroarthropathy in the upper limb, and Achilles tendinopathy and plantar fasciitis in the lower limb. These conditions can limit the range of motion of the affected joint, thereby impairing function and ability to perform activities of daily living. This review provides a short description of diabetes-related joint diseases, the specific pathogenetic mechanisms involved, and the role of inflammation, overuse, and genetics, each of which activates a complex sequence of biochemical alterations. Diabetes is a causative factor in tendon diseases and amplifies the damage induced by other agents as well. According to an accepted hypothesis, damaged joint tissue in diabetes is caused by an excess of advanced glycation end products, which forms covalent cross-links within collagen fibers and alters their structure and function. Moreover, they interact with a variety of cell surface receptors, activating a number of effects, including pro-oxidant and proinflammatory events. Adiposity and advanced age, commonly associated with type 2 diabetes mellitus, are further pathogenetic factors. Prevention and strict control of this metabolic disorder is essential, because it has been demonstrated that limited joint motion is related to duration of the disease and hyperglycemia. Several treatments are used in clinical practice, but their mechanisms of action are not completely understood, and their efficacy is also debated.
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Affiliation(s)
- Michele Abate
- Department of Medicine and Science of Aging, University G d’Annunzio, Chieti-Pescara, Italy
- Correspondence: Michele Abate, Department of Medicine and Science of Aging, University G d’Annunzio, Chieti-Pescara, Via dei Vestini 31, 66013 Chieti Scalo, Italy, Tel +39 0871 358 576, Fax +39 0871 358 969, Email
| | - Cosima Schiavone
- Department of Medicine and Science of Aging, University G d’Annunzio, Chieti-Pescara, Italy
| | - Vincenzo Salini
- Department of Medicine and Science of Aging, University G d’Annunzio, Chieti-Pescara, Italy
| | - Isabel Andia
- BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
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Villaseñor-Ovies P, Vargas A, Chiapas-Gasca K, Canoso JJ, Hernández-Díaz C, Saavedra MÁ, Navarro-Zarza JE, Kalish RA. Clinical Anatomy of the Elbow and Shoulder. ACTA ACUST UNITED AC 2012; 8 Suppl 2:13-24. [DOI: 10.1016/j.reuma.2012.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 10/29/2012] [Indexed: 11/27/2022]
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