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Rhim HC, Schon JM, Xu R, Schowalter S, Ha J, Hsu C, Andrew M, Robinson DM, Tenforde AS, Daneshvar DH. Targeting the Sweet Spot: A Systematic Review With Meta-Analysis of Anterior Versus Posterior Glenohumeral Joint Injections for Adhesive Capsulitis. Clin J Sport Med 2024:00042752-990000000-00191. [PMID: 38810121 DOI: 10.1097/jsm.0000000000001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To compare clinical outcomes following steroid injections using the anterior and posterior approaches. DESIGN Systematic review with meta-analysis. SETTING Embase, Web of Science, and Cochrane Center Register of Controlled Trials were searched for randomized control trials (RCTs) and prospective comparative studies. PATIENTS Patients with adhesive capsulitis. INTERVENTIONS Glenohumeral steroid injections using either anterior or posterior approach. MAIN OUTCOME MEASURES Pain visual analog scale (VAS) and shoulder range of motion (ROM) at 12 weeks, accuracy, and adverse events. Standardized mean difference (SMD) for VAS and weighted mean difference (WMD) for ROMs. RESULTS We identified 6 RCTs and one prospective comparative study with a total of 468 patients. While there was no difference in pain VAS at 12 weeks between the 2 approaches (SMD, -0.86; 95% CI, -1.76 to 0.04), the anterior approach resulted in greater improvements in external rotation (WMD, 8.08; 95% CI, 0.79-15.38) and abduction (WMD, 6.76; 95% CI, 3.05-10.48) compared with the posterior approach. Subgroup analysis with RCTs that utilized steroid injection with hydrodilatation for both approaches demonstrated greater reduction in pain VAS at 12 weeks with the anterior approach (SMD, -0.52; 95% CI, -0.98 to -0.07). Overall, procedures were well tolerated without major complications. CONCLUSIONS While pain reduction is similar, the anterior approach may be more beneficial in restoring shoulder external rotation and abduction compared with the posterior approach at 12 weeks. Steroid injection combined with hydrodilatation may further improve pain control when performed with the anterior approach at 12 weeks.
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Affiliation(s)
- Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Jason M Schon
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Raylin Xu
- Harvard Medical School, Boston, Massachusetts; and
| | - Sean Schowalter
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Jane Ha
- Clinical and Translational Epidemiology Unit, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts
| | - Connie Hsu
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Michael Andrew
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - David M Robinson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
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Kim JH, Baek JY, Han KD, Kim BS, Kwon HS. Higher body mass index increases the risk of shoulder adhesive capsulitis in young adults: a nationwide cohort study. J Shoulder Elbow Surg 2024:S1058-2746(24)00380-X. [PMID: 38810911 DOI: 10.1016/j.jse.2024.03.063] [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: 11/03/2023] [Revised: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The impact of overweight on the incidence of shoulder adhesive capsulitis (AC) has not been clearly proven. This study aimed to investigate the association between overweight and AC by age using a large-scale nationwide population-based cohort in Korea. METHODS We analyzed clinical data from 3,517,066 individuals older than 20 years who had undergone a National Health Insurance Service health checkup in 2009. Patients who visited a hospital or private clinic to treat shoulder pain at least three times in 1 year and were assigned a diagnostic code for AC (International Classification of Diseases,10th Revision code M75.00) were identified using claims data during a median follow-up duration of 8.3 years. Hazard ratios (HRs) and 95% confidence intervals for AC were calculated using the Cox proportional hazards model. RESULTS The adjusted HR for AC in the < 40 year group started to increase in overweight status and was associated with the severity of obesity (body mass index (BMI) < 18.5; 0.654 (0.613-0.697), <23; 1, <25; 1.272 (1.231-1.315), <30; 1.322 (1.281-1.364), ≥30; 1.332 (1.253-1.416)). But in the 40-64 year group and the ≥ 65 year group, there was no significant increasing trend of HR for AC according to BMI level. We conducted a subgroup analysis based on the BMI 23 for defining overweight and presence of comorbidities including diabetes and hyperlipidemia. The adjusted HR for AC was highest with overweight and comorbidities of diabetes and hyperlipidemia (diabetes; 1.528 (1.508-1.549), hyperlipidemia; 1.212 (1.199-1.226)). CONCLUSIONS In the young age group (20-40 years), a higher BMI level increased the HR for AC. Overweight along with diabetes or hyperlipidemia significantly increased the risk of AC.
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Affiliation(s)
- Jong-Ho Kim
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Yoon Baek
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
| | - Bong-Seoung Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Hyuk-Sang Kwon
- Department of Endocrinology and Metabolism, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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Di Mascio L, Hamborg T, Mihaylova B, Kassam J, Shah B, Stuart B, Griffin XL. The Adhesive Capsulitis Corticosteroid and Dilation (ACCorD) randomized controlled trial. Bone Jt Open 2024; 5:162-173. [PMID: 38432256 PMCID: PMC10909438 DOI: 10.1302/2633-1462.53.bjo-2023-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Aims Is it feasible to conduct a definitive multicentre trial in community settings of corticosteroid injections (CSI) and hydrodilation (HD) compared to CSI for patients with frozen shoulder? An adequately powered definitive randomized controlled trial (RCT) delivered in primary care will inform clinicians and the public whether hydrodilation is a clinically and cost-effective intervention. In this study, prior to a full RCT, we propose a feasibility trial to evaluate recruitment and retention by patient and clinician willingness of randomization; rates of withdrawal, crossover and attrition; and feasibility of outcome data collection from routine primary and secondary care data. Methods In the UK, the National Institute for Health and Care Excellence (NICE) advises that prompt early management of frozen shoulder is initiated in primary care settings with analgesia, physiotherapy, and joint injections; most people can be managed without an operation. Currently, there is variation in the type of joint injection: 1) CSI, thought to reduce the inflammation of the capsule reducing pain; and 2) HD, where a small volume of fluid is injected into the shoulder joint along with the steroid, aiming to stretch the capsule of the shoulder to improve pain, but also allowing greater movement. The creation of musculoskeletal hubs nationwide provides infrastructure for the early and effective management of frozen shoulder. This potentially reduces costs to individuals and the wider NHS perhaps negating the need for a secondary care referral. Results We will conduct a multicentre RCT comparing CSI and HD in combination with CSI alone. Patients aged 18 years and over with a clinical diagnosis of frozen shoulder will be randomized and blinded to receive either CSI and HD in combination, or CSI alone. Feasibility outcomes include the rate of randomization as a proportion of eligible patients and the ability to use routinely collected data for outcome evaluation. This study has involved patients and the public in the trial design, dissemination methods, and how to include groups who are underserved by research. Conclusion We will disseminate findings among musculoskeletal clinicians via the British Orthopaedic Association, the Chartered Society of Physiotherapy, the Royal College of Radiologists, and the Royal College of General Practitioners. To ensure wide reach we will communicate findings through our established network of charities and organizations, in addition to preparing dissemination findings in Bangla and Urdu (commonly spoken languages in northeast London). If a full trial is shown to be feasible, we will seek additional National Institute for Health and Care Research funding for a definitive RCT. This definitive study will inform NICE guidelines for the management of frozen shoulder.
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Affiliation(s)
- Livio Di Mascio
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Thomas Hamborg
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Borislava Mihaylova
- Health Economics and Policy Research Unit, Queen Mary University of London, London, UK
| | - Jamila Kassam
- Bone and Joint Health, Queen Mary University of London, London, UK
| | - Bina Shah
- Bone and Joint Health, Queen Mary University of London, London, UK
| | - Beth Stuart
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
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Martens G, Fontaine R, Goffin P, Raaf M, Tasset H, Lecoq JP, Benmouna K, Kaux JF, Forthomme B. Continuous suprascapular nerve blockade to potentiate intensive rehabilitation for refractory adhesive shoulder capsulitis: a cohort study. INTERNATIONAL ORTHOPAEDICS 2024; 48:495-503. [PMID: 37848767 DOI: 10.1007/s00264-023-05999-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Evaluating the short- and long-term efficacy of a continuous ten day suprascapular nerve block combined with daily multidisciplinary rehabilitation on shoulder range of motion (ROM), pain, and function in patients with refractory adhesive capsulitis (AC). METHODS In this retrospective cohort study, patients admitted to a specialized pain clinic for refractory AC for more than 6 months underwent continuous suprascapular nerve blockade for ten days and received 2 hours of physiotherapy and occupational therapy daily. Standardized assessments were performed at baseline, at days three, six, ten, 30, 90, and 180, and included active and passive ROM measurements, the visual analog scale (VAS) for pain and the disabilities of the arm, shoulder and hand (DASH) questionnaire to assess pain, disability, and quality of life. Improvements over time were assessed using ANOVAs. RESULTS Thirty-two patients were followed (age: 52 ± 8 years, 25 females, mean symptoms duration of two years). There was a significant improvement in ROM for all amplitudes at day ten (short-term; range: 20-35°, p < 0.001) and at day 180 (long-term; range: 18-47°, p < 0.001). The pain and disability scores significantly reduced by day 180 (mean VAS reduction: 2.6 units, p < 0.001; mean DASH reduction: 9.5 points, p < 0.001). CONCLUSION Continuous SSNB combined with intensive multidisciplinary rehabilitation represents an efficient therapeutic option for patients with chronic AC who did not respond to conventional treatments.
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Affiliation(s)
- Géraldine Martens
- Department of Physical Medicine and Sports Traumatology, SportS², FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium.
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium.
| | - Robert Fontaine
- Anesthesia & Intensive Care Department, University Hospital of Liège, Liège, Belgium
| | - Pierre Goffin
- Anesthesia & Intensive Care Department, MontLegia Hospital, Groupe Santé CHC, Liège, Belgium
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Mélissa Raaf
- Anesthesia & Intensive Care Department, University Hospital of Liège, Liège, Belgium
- Anesthesia & Intensive Care Department, MontLegia Hospital, Groupe Santé CHC, Liège, Belgium
| | - Hadrien Tasset
- Anesthesia & Intensive Care Department, University Hospital of Liège, Liège, Belgium
| | - Jean-Pierre Lecoq
- Anesthesia & Intensive Care Department, University Hospital of Liège, Liège, Belgium
| | - Karim Benmouna
- Department of Physical Medicine and Sports Traumatology, SportS², FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium
| | - Jean-François Kaux
- Department of Physical Medicine and Sports Traumatology, SportS², FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium
| | - Bénédicte Forthomme
- Department of Physical Medicine and Sports Traumatology, SportS², FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University and University Hospital of Liège, Liège, Belgium
- Department of Rehabilitation and Sports Sciences, University of Liège, Liège, Belgium
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Ordahan B, Yigit F, Mülkoglu C. Efficacy of Low-level Laser Versus High-intensity Laser Therapy in the Management of Adhesive Capsulitis: A Randomized Clinical Trial. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:201-207. [PMID: 37533657 PMCID: PMC10393096 DOI: 10.4103/sjmms.sjmms_626_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/20/2023] [Accepted: 06/11/2023] [Indexed: 08/04/2023]
Abstract
Background Low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) are effective in alleviating pain and improving functionality in patients with adhesive capsulitis (AC); however, no study has compared the efficacy of these two laser treatments. Objective To compare the effectiveness of LLLT and HILT in improving the shoulder joint range of motion and functional status and in reducing pain level in patients with AC. Trial Design Prospective, randomized, parallel group, patient- and assessor-blinded. Methods A total of 45 patients (aged: 18-65 years) with complaint of shoulder pain were evaluated for inclusion criteria, which included being aged 18-65 years and a diagnosis of AC based on physical examinations. Using computer-generated random numbers, eligible patients were randomized into two groups: HILT + stretching exercise and LLLT + stretching exercise groups. Both HILT and LLLT were performed three times/week for 3 weeks. Functional status and pain of the patients were evaluated with Shoulder Pain and Disability Index (SPADI) and Visual Analog Scale (VAS), while shoulder joint range of motion was measured with goniometry. All assessments were done before and 3 weeks after treatment. Results A total of 40 patients (20 in each group) completed the study. At baseline, there was no statistically significant difference in the demographic and clinical characteristics between both groups. Both the LLLT and HILT groups showed significant improvement in the VAS and SPADI scores 3 weeks after treatment; however, the improvement was significantly higher in the HILT group than the LLLT group. There was no significant improvement in goniometric scores in both groups compared with baseline. No injury or other musculoskeletal complications were recorded during or after the treatments. Conclusion HILT + stretching exercise treatment was more effective than LLLT + stretching exercise for improving functional parameters and pain in patients with AC. Trial Registration ClinicalTrials.gov Identifier: NCT05469672. Funding None.
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Affiliation(s)
- Banu Ordahan
- Department of Physical Medicine and Rehabilitation, Meram Medical School, Necmettin Erbakan University, Konya, Turkey
| | - Fatih Yigit
- Department of Physical Medicine and Rehabilitation, Meram Medical School, Necmettin Erbakan University, Konya, Turkey
| | - Cevriye Mülkoglu
- Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
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Frozen Shoulder. Tech Vasc Interv Radiol 2023; 26:100882. [PMID: 36889844 DOI: 10.1016/j.tvir.2022.100882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Adhesive capsulitis (AC) develops spontaneously without a known cause and is a common cause of painful shoulder. The natural history of AC can last until 36 months and it is classically considered a self-limiting entity, however there is a high rate of refractory cases to conventional treatment with residual deficits during years. There is no consensus on the therapeutic guidelines to be followed in patients with AC. Several authors have pointed out the relevance of hypervascularization of the capsule in the pathophysiology of AC, that is why the objective of transarterial embolization (TAE) is to decrease the abnormal vascularization responsible for the inflammatory-fibrotic state that occurs in AC. TAE has now emerged as a therapeutic option in refractory patients. We describe the most important technical aspects of TAE and review the current literature on arterial embolization as a treatment for AC.
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Goo B, Park YC, Kim E, Sung WS, Kim EJ, Kim JH, Seo BK, Baek YH. Efficacy, Safety and Cost-Effectiveness of Thread-Embedding Acupuncture for Adhesive Capsulitis (Frozen Shoulder): A Study Protocol for a Multicenter, Randomized, Patient-Assessor Blinded, Controlled Trial. J Pain Res 2023; 16:623-633. [PMID: 36880027 PMCID: PMC9984543 DOI: 10.2147/jpr.s396264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/18/2023] [Indexed: 03/03/2023] Open
Abstract
Background The aim of the present study is to confirm the efficacy, safety, and cost-effectiveness of thread-embedding acupuncture (TEA) in the treatment of adhesive capsulitis (AC). Methods This is a randomized, sham-controlled, patient-assessor blinded trial with two parallel arms in a 1:1 ratio. A total of 160 participants with AC, also known as frozen shoulder, will be recruited and screened according to the eligibility criteria. Those who meet the eligibility criteria will be randomly allocated to a TEA group or a sham TEA (STEA) group. Both groups will receive either real TEA or thread-removed STEA treatment on nine acupoints once a week for 8 weeks while being blinded to the intervention. The shoulder pain and disability index will be evaluated as a primary outcome measure. In addition, a 100-mm pain visual analogue scale, rotator cuff quality of life scale, European Quality of Life 5-dimension 5-level scale, treatment satisfaction, safety assessment, and economic evaluation will be assessed as secondary outcome measures. Outcome assessments will be conducted for a total of 24 weeks, including a treatment period of 8 weeks and follow-up of 16 weeks, according to the schedule. Discussion The results of this trial will provide a clinical basis for the efficacy, safety and cost-effectiveness of TEA in the treatment of patients with AC. Trial Registration Number KCT0005920 (Clinical Research Information Service of the Republic of Korea). Registered on 22 February 2021.
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Affiliation(s)
- Bonhyuk Goo
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Yeon-Cheol Park
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Eunseok Kim
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea.,Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan-si, Republic of Korea
| | - Won-Suk Sung
- Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam, Republic of Korea
| | - Eun-Jung Kim
- Department of Acupuncture & Moxibustion Medicine, College of Oriental Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Jung-Hyun Kim
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Byung-Kwan Seo
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong-Hyeon Baek
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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Bonadiman JA, Esteve N, Triervelier Paiva FR, Faiad Piluski PC, Castillo Rodriguez CH, Lech O. Capsulitis adhesiva del hombro. Comparación entre métodos de tratamiento conservador. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2022. [DOI: 10.15417/issn.1852-7434.2022.87.6.1625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objetivo: Evaluar los resultados funcionales de tres protocolos distintos de tratamiento conservador en pacientes con capsulitis adhesiva del hombro.
Materiales y Métodos: Se revisaron las historias clínicas de los pacientes tratados por capsulitis adhesivaen nuestra institución, entre enero de 2016 y enero de 2019. Se compararon tres protocolos diferentes de tratamiento: grupo 1, bloqueo del nervio supraescapular con un anestésico local y corticoide, analgésicos y fisioterapia después del alivio del dolor; grupo 2, bloqueo del nervio supraescapular con anestésico local sin corticoide, analgésicos y fisioterapia; grupo 3, analgésicos y fisioterapia, sin bloqueo del nervio supraescapular. Se determinaron los resultados funcionales con la escala ASES y el resultado subjetivo con el SSV.
Resultados: Se dividió en tres grupos a 46 pacientes tratados por capsulitis adhesiva. Los pacientesdel grupo 3 tuvieron, en promedio, más sesiones de fisioterapia (30,31 ± 21,07). Los del grupo 2 recibieron la mayor cantidad promedio de bloqueos del nervio supraescapular (3,27 ± 1,22). Los resultados de los puntajes funcionales fueron: grupo 1 (15 pacientes): media 84 ASES y 84 SSV; grupo 2 (15 pacientes): media 93,40 ASES y 91,67 SSV; grupo 3 (16 pacientes): media 79,4 ASES y 80,63 SSV.
Conclusiones: Las distintas formas de tratamiento conservador para la capsulitis adhesiva logran excelentesresultados. La analgesia mediante bloqueos seriados del nervio supraescapular con un anestésico y corticoide logró mejores resultados funcionales y subjetivos, y disminuyó la necesidad de administrar analgésicos y de sesiones de fisioterapia (grupo 1).Nivel de Evidencia: IV
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Mertens MG, Meeus M, Noten S, Verborgt O, Fransen E, Lluch Girbés E, Aguilar Rodríguez M, Navarro-Ledesma S, Fernandez-Sanchez M, Luque-Suarez A, Struyf F, Dueñas L. Understanding the clinical profile of patients with frozen shoulder: a longitudinal multicentre observational study. BMJ Open 2022; 12:e056563. [PMID: 36410809 PMCID: PMC9680192 DOI: 10.1136/bmjopen-2021-056563] [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] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There is a large diversity in the clinical presentation of frozen shoulder (FS) and the clinical outcome is not always satisfactory. The aim of the current study was to examine to what extent range of motion (ROM) limitation, metabolic factors (diabetes mellitus and thyroid disorders), autonomic symptoms and pain sensitivity may contribute to the prognosis in terms of shoulder pain and disability and quality of life in patients with FS. METHODS Patients with stage 1 or 2 FS were longitudinally followed-up during 9 months after baseline assessment. They completed six questionnaires and underwent quantitative sensory testing (pressure pain thresholds, temporal summation and conditioned pain modulation) and ROM assessment. RESULTS One hundred and forty-nine patients with FS were initially recruited and 121 completed at least one follow-up measurement. Shoulder pain and disability improved over time and diabetes mellitus was found to be a prognostic factor for final outcome. Several domains of quality of life also improved over time and external rotation ROM, diabetes mellitus, thyroid disorder and autonomic symptoms were found to be prognostic factors for final outcome. These prognostic factors explained 2.5%-6.3% of the final outcome of shoulder pain and disability and quality of life. DISCUSSION AND CONCLUSION In patients with FS, prognostic variables were able to predict different outcomes, indicating that outcomes in this population can be variable-dependent. Other variables not explored in this study might contribute to the prognosis of patients with FS, which should be investigated in future research. In clinical practice, baseline assessment of prognostic factors and focusing on a more holistic approach might be useful to inform healthcare practitioners about progression of patients with FS during a 9-month period.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Pain in Motion international Research Group, www.paininmotion.be, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Pain in Motion international Research Group, www.paininmotion.be, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Suzie Noten
- Department of Rehabilitation Medicine, Erasmus MC University medical Center, Rotterdam, The Netherlands
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Belgium
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerpen, Belgium
- Department of Orthopedic Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, Antwerpen, Belgium
| | - Enrique Lluch Girbés
- Pain in Motion international Research Group, www.paininmotion.be, Belgium
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Vrije Universiteit Brussel, Brussels, Belgium
| | - Marta Aguilar Rodríguez
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | | | | | | | - Filip Struyf
- Rehabilitation Sciences, Universiteit Antwerpen Campus Drie Eiken, Wilrijk, Belgium
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
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Kulm S, Langhans MT, Shen TS, Kolin DA, Elemento O, Rodeo SA. Genome-Wide Association Study of Adhesive Capsulitis Suggests Significant Genetic Risk Factors. J Bone Joint Surg Am 2022; 104:1869-1876. [PMID: 36223477 DOI: 10.2106/jbjs.21.01407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adhesive capsulitis of the shoulder involves loss of passive range of motion with associated pain and can develop spontaneously, with no obvious injury or inciting event. The pathomechanism of this disorder remains to be elucidated, but known risk factors for adhesive capsulitis include diabetes, female sex, and thyroid dysfunction. Additionally, transcriptional profiling and pedigree analyses have suggested a role for genetics. Identification of elements of genetic risk for adhesive capsulitis using population-based techniques can provide the basis for guiding both the personalized treatment of patients based on their genetic profiles and the development of new treatments by identification of the pathomechanism. METHODS A genome-wide association study (GWAS) was conducted using the U.K. Biobank (a collection of approximately 500,000 patients with genetic data and associated ICD-10 [International Classification of Diseases, 10th Revision] codes), comparing 2,142 patients with the ICD-10 code for adhesive capsulitis (M750) to those without. Separate GWASs were conducted controlling for 2 of the known risk factors of adhesive capsulitis-hypothyroidism and diabetes. Logistic regression analysis was conducted controlling for factors including sex, thyroid dysfunction, diabetes, shoulder dislocation, smoking, and genetics. RESULTS Three loci of significance were identified: rs34315830 (in WNT7B; odds ratio [OR] = 1.28; 95% confidence interval [CI], 1.22 to 1.39), rs2965196 (in MAU2; OR = 1.67; 95% CI, 1.39 to 2.00), and rs1912256 (in POU1F1; OR = 1.22; 95% CI, 1.14 to 1.31). These loci retained significance when controlling for thyroid dysfunction and diabetes. The OR for total genetic risk was 5.81 (95% CI, 4.08 to 8.31), compared with 1.70 (95% CI, 1.18 to 2.36) for hypothyroidism and 4.23 (95% CI, 2.32 to 7.05) for diabetes. CONCLUSIONS The total genetic risk associated with adhesive capsulitis was significant and similar to the risks associated with hypothyroidism and diabetes. Identification of WNT7B, POU1F1, and MAU2 implicates the Wnt pathway and cell proliferation response in the pathomechanism of adhesive capsulitis. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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11
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Abstract
Frozen shoulder is a common debilitating disorder characterized by shoulder pain and progressive loss of shoulder movement. Frozen shoulder is frequently associated with other systemic conditions or occurs following periods of immobilization, and has a protracted clinical course, which can be frustrating for patients as well as health-care professionals. Frozen shoulder is characterized by fibroproliferative tissue fibrosis, whereby fibroblasts, producing predominantly type I and type III collagen, transform into myofibroblasts (a smooth muscle phenotype), which is accompanied by inflammation, neoangiogenesis and neoinnervation, resulting in shoulder capsular fibrotic contractures and the associated clinical stiffness. Diagnosis is heavily based on physical examination and can be difficult depending on the stage of disease or if concomitant shoulder pathology is present. Management consists of physiotherapy, therapeutic modalities such as steroid injections, anti-inflammatory medications, hydrodilation and surgical interventions; however, their effectiveness remains unclear. Facilitating translational science should aid in development of novel therapies to improve outcomes among individuals with this debilitating condition.
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12
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Floyd SB, Sarasua SM, Pill SG, Shanley E, Brooks JM. Factors related to initial treatment for adhesive capsulitis in the medicare population. BMC Geriatr 2022; 22:548. [PMID: 35773660 PMCID: PMC9248121 DOI: 10.1186/s12877-022-03230-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary adhesive capsulitis (AC) is not well understood, and controversy remains about the most effective treatment approaches. Even less is known about the treatment of AC in the Medicare population. We aimed to fully characterize initial treatment for AC in terms of initial treatment utilization, timing of initial treatments and treatment combinations. METHODS Using United States Medicare claims from 2010-2012, we explored treatment utilization and patient characteristics associated with initial treatment for primary AC among 7,181 Medicare beneficiaries. Patients with primary AC were identified as patients seeking care for a new shoulder complaint in 2011, with the first visit related to shoulder referred to as the index date, an x-ray or MRI of the shoulder region, and two separate diagnoses of AC (ICD-9-CM codes: 726.00). The treatment period was defined as the 90 days immediately following the index shoulder visit. A multivariable logistic model was used to assess baseline patient factors associated with receiving surgery within the treatment period. RESULTS Ninety percent of beneficiaries with primary AC received treatment within 90 days of their index shoulder visit. Physical therapy (PT) alone (41%) and injection combined with PT (34%) were the most common treatment approaches. Similar patient profiles emerged across treatment groups, with higher proportions of racial minorities, socioeconomically disadvantaged and more frail patients favoring injections or watchful waiting. Black beneficiaries (OR = 0.37, [0.16, 0.86]) and those residing in the northeast (OR = 0.36, [0.18, 0.69]) had significantly lower odds of receiving surgery in the treatment period. Conversely, younger beneficiaries aged 66-69 years (OR = 6.75, [2.12, 21.52]) and 70-75 years (OR = 5.37, [1.67, 17.17]) and beneficiaries with type 2 diabetes had significantly higher odds of receiving surgery (OR = 1.41, [1.03, 1.92]). CONCLUSIONS Factors such as patient baseline health and socioeconomic characteristics appear to be important for physicians and Medicare beneficiaries making treatment decisions for primary AC.
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Affiliation(s)
- Sarah B Floyd
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA. .,Center for Effectiveness Research in Orthopaedics, Greenville, USA.
| | | | - Stephan G Pill
- Steadman Hawkins Clinic of the Carolinas, Prisma Health, Greenville, SC, USA
| | | | - John M Brooks
- Center for Effectiveness Research in Orthopaedics, Greenville, USA.,Department of Health Services Policy and Management, University of South Carolina, Columbia, USA
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13
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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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14
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Xue H, Bird S, Jiang L, Jiang J, Cui L. Anchoring Apparatus of Long Head of the Biceps Tendon: Ultrasonographic Anatomy and Pathologic Conditions. Diagnostics (Basel) 2022; 12:diagnostics12030659. [PMID: 35328211 PMCID: PMC8947553 DOI: 10.3390/diagnostics12030659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 02/01/2023] Open
Abstract
The long head of the biceps tendon (LHBT) has been recognized as an important generator of anterior shoulder pain, causing a significant reduction in the shoulder flexion range. Various tendinous and ligamentous structures form the anchoring apparatus of the LHBT along its course to maintain its appropriate location during shoulder movements, including the coracohumeral ligament (CHL), superior glenohumeral ligament (SGHL), subscapularis (SSC) tendon and supraspinatus (SSP) tendon as well as the less recognized tendons of pectoralis major (PM), latissimus dorsi (LD) and teres major (TM). Lesions of this stabilizing apparatus may lead to an instability of the LHBT, resulting in pain at the anterior shoulder. Ultrasonography (US) has been increasingly used in the assessment of shoulder injuries, including the anchoring apparatus of the LHBT. An accurate diagnosis of these injuries is often challenging, given the complex anatomy and wide spectrum of pathologies. In this review article, US anatomy and common pathologic conditions that affect the anchoring apparatus of the LHBT are discussed, including biceps pulley lesions, adhesive capsulitis, chronic pathology of SSC and SSP tendons, tears in the PM tendon and injuries to the LD and TM. Knowledge of a normal anatomy, an appropriate scanning technique and US findings of common pathologic conditions are the keys to accurate diagnoses.
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Affiliation(s)
- Heng Xue
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China; (H.X.); (L.J.); (J.J.)
| | | | - Ling Jiang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China; (H.X.); (L.J.); (J.J.)
| | - Jie Jiang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China; (H.X.); (L.J.); (J.J.)
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China; (H.X.); (L.J.); (J.J.)
- Correspondence: ; Tel.: +86-15611908349
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15
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Kraler B, Bissig P, Nyffeler RW. Devastating Pneumococcal Arthritis of the Shoulder After Two Corticosteroid Injections. Cureus 2022; 14:e21006. [PMID: 35018274 PMCID: PMC8740204 DOI: 10.7759/cureus.21006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/05/2022] Open
Abstract
A 36-year-old man was treated with two intraarticular corticoid injections for intense pain and severely decreased range of motion of his left shoulder. After the second injection, he came back with fulminant arthritis. Microbiological examination revealed streptococcus pneumoniae. Open debridement, long-term antibiotics, and total shoulder replacement were necessary to restore acceptable shoulder function.
The fulminant course with rapid destruction of the joint illustrates the risks of intraarticular corticoid injections. This case also shows that the diagnosis should be accurately made and risk factors excluded before considering injection as a treatment.
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16
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Chou LW, Chang CY, Wu YT, Lin CY, Liu TJ, Ho TY, Shen YP, Liu KC, Lu TY. Inertial measurement unit-based functional evaluation for adhesive capsulitis assessment. JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/jmedsci.jmedsci_89_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Zikria BA. CORR Insights®: Is the Anterior Injection Approach Without Ultrasound Guidance Superior to the Posterior Approach for Adhesive Capsulitis of the Shoulder? A Sequential, Prospective Trial. Clin Orthop Relat Res 2021; 479:2490-2492. [PMID: 34166274 PMCID: PMC8509942 DOI: 10.1097/corr.0000000000001876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/07/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Bashir Ahmed Zikria
- Associate Professor, Department of Orthopaedics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Chief of Surgery, Aspetar Sports Medicine Hospital, Doha, Qatar
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18
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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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19
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Forsythe B, Lavoie-Gagne O, Patel BH, Lu Y, Ritz E, Chahla J, Okoroha KR, Allen AA, Nwachukwu BU. Efficacy of Arthroscopic Surgery in the Management of Adhesive Capsulitis: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Arthroscopy 2021; 37:2281-2297. [PMID: 33221429 DOI: 10.1016/j.arthro.2020.09.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine which interventions optimize clinical outcomes in adhesive capsulitis by performing a network meta-analysis of randomized controlled trials. METHODS A systematic review was conducted of all clinical trials on adhesive capsulitis published since 2008. Patient cohorts were grouped into treatment categories; data collected included range of motion (ROM) and patient-reported outcome measures (PROMs). Interventions were compared across groups by means of arm-based Bayesian network meta-analysis in a random-effects model. RESULTS Sixty-six studies comprising 4042 shoulders (57.6% female patients, age 54.8 ± 3.2 years [mean ± standard deviation]) were included. The most commonly studied interventions were physical therapy (PT) or shoulder injections. Network meta-analysis demonstrated that arthroscopic surgical capsular release was the most effective treatment in increasing ROM. This effect was apparent in forward flexion (effect difference [ED] versus placebo, 44°, 95% confidence interval [CI] 31° to 58°), abduction (ED 58°, 45° to 71°), internal rotation (ED 34°, 24° to 44°), and external rotation (ED 59°, 37° to 80°). Interventions most effective for pain relief included PT supplemented with either medical therapy (ED -4.50, -9.80 to 2.80) or ultrasound therapy (ED -5.10, -5.10 to -1.40). Interventions most effective for improvement of functional status included PT, manipulation under anesthesia (MUA), intra-articular or subacromial steroid injection, surgical capsular release, and supplementation of PT with alternative therapy. CONCLUSIONS No one treatment emerged superior in regard to ROM, pain symptoms, and functional status. Surgery (after failure of conservative treatment) ranked highest across all ROM domains. Treatments that ranked highest for treatment of pain included PT supplemented with either medical therapy or ultrasound. Finally, treatments that ranked highest for improvements in functional status included MUA, PT with medical therapy, surgical intervention, PT with ultrasound, PT with injection, and injection alone. LEVEL OF EVIDENCE II, systematic review and network meta-analysis of level I and II studies.
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Affiliation(s)
- Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Ophelie Lavoie-Gagne
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bhavik H Patel
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, U.S.A
| | - Yining Lu
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ethan Ritz
- Bioinformatics and Biostatistics Core, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Kelechi R Okoroha
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Answorth A Allen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
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20
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A Multisite Injection Is More Effective Than a Single Glenohumeral Injection of Corticosteroid in the Treatment of Primary Frozen Shoulder: A Randomized Controlled Trial. Arthroscopy 2021; 37:2031-2040. [PMID: 33581295 DOI: 10.1016/j.arthro.2021.01.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the possible effects of multisite injection therapy around the shoulder and prospectively compare the pain relief, range of motion (ROM), and functional scores of randomly selected patients with primary frozen shoulder using the American Shoulder and Elbow Surgeons score and the University of California-Los Angeles score after the completion of a standard physiotherapy program. METHODS Seventy-six patients with primary frozen shoulder were randomly divided into 2 groups based on the treatment: multisite injection and single injection. In the multisite-injection group, the glenohumeral joint and posteroinferior capsule, subacromial space, posterosuperior capsule, biceps long head, and coracohumeral ligament were injected with a combination of 2 mL of triamcinolone acetonide (40 mg/mL), 4 mL of bupivacaine (0.5%), and 34 mL of saline solution. The glenohumeral joint in the single-injection group was injected with 1 mL of triamcinolone acetonide (40 mg/mL) and 2 mL of bupivacaine (0.5%). Patients in both groups underwent physical therapy using the same protocol. Patients were evaluated for pain (visual analog scale score), functional status, and active and passive joint ROM at 1, 3, and 6 months and 1 year after the injection. RESULTS The follow-up rate was 82.6%, and significantly lower VAS scores were recorded in all periods in the multisite-injection group compared with the single-injection group (P = .01). In terms of active and passive ROM, the follow-up results were significantly better in the multisite-injection group (P < .05). Significantly higher functional scores were recorded in the multisite-injection group (P < .05). CONCLUSIONS Both treatments were effective in patients with primary frozen shoulder. However, the multisite-injection technique provided better pain palliation, better ROM restoration, and better functional results than the single glenohumeral injection in patients with primary frozen shoulder who were treated with the same physiotherapy regimen. LEVEL OF EVIDENCE Level I, prognostic comparative study.
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21
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Arthroscopic release combined with single-row fixation or double-row suture bridge fixation in patients with traumatic supraspinatus tear and adhesive capsulitis non-responsive to conservative management: A prospective randomized trial. Orthop Traumatol Surg Res 2021; 107:102828. [PMID: 33524627 DOI: 10.1016/j.otsr.2021.102828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/27/2020] [Accepted: 11/26/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are few previous studies on traumatic supraspinatus tear with adhesive capsulitis. This study used arthroscopic release with single-row fixation or double-row suture bridge fixation to treat adhesive capsulitis of the shoulder with rotator cuff tears. Further, the clinical efficacy of arthroscopic release with single-row fixation and double-row suture bridge fixation was compared. HYPOTHESES Arthroscopic release combined with single-row fixation or double-row suture bridge fixation showed good clinical outcomes in patients with traumatic supraspinatus tear with adhesive capsulitis. METHODS A single-center prospective randomized trial was performed from June 2013 to June 2017. Of the 68 patients with traumatic supraspinatus tear and adhesive capsulitis who underwent arthroscopic release, 34 (22 with tear measuring≤3cm and 12 with tear measuring>3cm) were included in the single-row fixation group and 34 (20 with tear measuring≤3cm and 14 with tear measuring>3cm) were included in the double-row suture bridge fixation group. The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) and American Shoulder and Elbow Surgeons (ASES) shoulder scores, range of motion, time to achieve satisfactory scores, and rotator cuff re-tear rate were compared between the groups. RESULTS The range of motion, VAS score, UCLA and ASES shoulder scores significantly improved after surgery in both groups. There was a significant difference in the UCLA and ASES shoulder scores, time to achieve satisfactory scores, and rotator cuff re-tear rates in patients with tears measuring>3cm between the groups. CONCLUSIONS Arthroscopic release combined with single-row fixation or double-row suture bridge fixation showed good clinical outcomes in patients with traumatic supraspinatus tear with adhesive capsulitis. Therefore, the capsule of the shoulder should be thoroughly released to achieve such outcomes. For patients with rotator cuff tears measuring>3cm, double-row suture bridge fixation was superior to single-row fixation and the rotator cuff re-tear rate was low. LEVEL OF EVIDENCE I; prospective, randomized trial, treatment study.
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22
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Tzeng CY, Chiang HY, Huang CC, Lin WS, Hsiao TH, Lin CH. The impact of pre-existing shoulder diseases and traumatic injuries of the shoulder on adhesive capsulitis in adult population: A population-based nested case-control study. Medicine (Baltimore) 2019; 98:e17204. [PMID: 31574829 PMCID: PMC6775364 DOI: 10.1097/md.0000000000017204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Adhesive capsulitis (AC) is a common chronic disorder for adult patients; however, whether a history of pre-existing shoulder diseases may affect the development of AC is still not fully understood. We aimed to investigate the incidence and prevalence of AC and to assess the association of pre-existing shoulder diseases and traumatic injuries of the shoulder with the development of AC in adults.This retrospective population-based cohort and nested case-control study used data from the National Health Institute Research Database of Taiwan. A total of 24,414 patients aged 20 years or older and with a diagnosis of AC were identified between 2000 and 2013. We calculated the incidence of AC for each year during the study period. In addition, these AC patients were matched with controls (n = 97,656) in a ratio of 1:4 based on age, gender, and index date. Univariate and multivariate logistic regression models were performed to identify variables associated with AC.Females and patients aged 50 to 69 years had higher age-gender standardized incidence and prevalence of AC than their counterparts. Multivariate analyses showed that after adjusting for relevant covariates, pre-existing shoulder diseases of calcific tendinitis (odds ratio [OR] = 8.74, 95% confidence interval [CI] = 5.66-13.5), biceps tendinitis (OR = 7.93, 95% CI = 5.33-11.79), rotator cuff syndrome (OR = 6, 95% CI = 5.26-6.85), osteoarthritis (OR = 4.27, 95% CI = 3.44-5.3), and impingement syndrome (OR = 3.13, 95% CI = 2.64-3.71), as well as fracture (OR = 4.51, 95% CI = 3.82-5.34) and dislocation (OR = 3.57, 95% CI = 2.35-5.45) of the shoulder were significantly associated with AC risk.Higher odds of AC were observed among patients with pre-existing shoulder conditions. This study highlights the need to consider differences in AC risk among patients with various types of shoulder diseases and traumatic injuries of the shoulder.
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Affiliation(s)
- Chung-Yuh Tzeng
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung
- Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung
| | - Chun-Che Huang
- Department of Healthcare Administration, I-Shou University, Kaohsiung
- Department of Medical Research, Taichung Veterans General Hospital, Taichung
| | - Wei-Szu Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung
| | - Tzu-Hung Hsiao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung
- Department of Public Health, Fu-Jen Catholic University, New Taipei
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung
- Department of Public Health, Fu-Jen Catholic University, New Taipei
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
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23
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Kraal T, Beimers L, The B, Sierevelt I, van den Bekerom M, Eygendaal D. Manipulation under anaesthesia for frozen shoulders: outdated technique or well-established quick fix? EFORT Open Rev 2019; 4:98-109. [PMID: 30993011 PMCID: PMC6440298 DOI: 10.1302/2058-5241.4.180044] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Manipulation under anaesthesia (MUA) for frozen shoulder (FS) leads to a considerable increase in range of motion and Oxford shoulder score, a significant reduction in pain and around 85% satisfaction.A clearly defined indication for MUA in FS patients cannot be extracted from this review or the available literature. The associating criteria before proceeding to MUA vary widely.All but one study in this review lacked a control group without intervention. Therefore, firm conclusions about the role of MUA in the treatment of FS cannot be drawn from the current literature.An overall complication rate of 0.4% was found and a re-intervention rate of 14%, although most of the included papers were not designed to monitor complications.The following criteria before proceeding to MUA are proposed: a patient unable to cope with a stiff and painful shoulder; clinical signs of a stage 2 idiopathic FS; lessening pain in relation to stage 1; external rotation < 50% compared to contralateral shoulder joint; a minimal duration of symptoms of three months; and failure to respond to an intra-articular corticosteroid infiltration. Cite this article: EFORT Open Rev 2019;4:98-109. DOI: 10.1302/2058-5241.4.180044.
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Affiliation(s)
- Tim Kraal
- Department of Orthopaedic Surgery, Amphia Hospital, The Netherlands
| | - Lijkele Beimers
- Department of Orthopaedic Surgery, Slotervaart Center of Orthopedic Research & Education (SCORE), The Netherlands
| | - Bertram The
- Department of Orthopaedic Surgery, OLVG Hospital, The Netherlands
| | - Inger Sierevelt
- Department of Orthopaedic Surgery, Slotervaart Center of Orthopedic Research & Education (SCORE), The Netherlands
| | | | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amphia Hospital, The Netherlands
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