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Vita F, Gualtierotti R, Miceli M, Tedeschi R, Origlio F, Cavallo M, Galletti S, Stella SM, Guerra E, Donati D, Faldini C. Fibro-adhesive Bursitis: A Novel Sonographic Finding in Adhesive Capsulitis Patients and a Proposal of Management. Rheumatol Ther 2024:10.1007/s40744-024-00716-8. [PMID: 39264535 DOI: 10.1007/s40744-024-00716-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 08/16/2024] [Indexed: 09/13/2024] Open
Abstract
INTRODUCTION Adhesive capsulitis, also known as "frozen shoulder," is a debilitating shoulder condition increasingly linked to fibroadhesive bursitis, particularly after COVID-19 and related vaccinations. There is no definitive gold standard for its treatment, the primary therapeutic objectives of which are the reduction of pain and the restoration of shoulder range of motion. The aim of our study was to analyze treatment outcomes based on quantitative measures of shoulder function and symptom relief. METHOD Conducted between January 2022 and April 2023, the research involved 45 patients initially diagnosed with adhesive capsulitis and associated fibroadhesive bursitis. After excluding nine patients for other concomitant pathologies (five for calcific tendinopathy and four for rotator cuff injury), 36 patients were randomized into two groups: one group was treated with glenohumeral hydrodistension, the other with glenohumeral hydrodistension combined with bursal injection. Assessments were conducted at baseline and then 2, 4, and 6 months after treatment, focusing on changes in pain levels, functional scores, and range of motion in all planes. Each group followed a home-based rehabilitation protocol. RESULTS Significant improvements were observed in both treatment groups, with the combined hydrodistension and bursal injection group showing notably superior outcomes. Specifically, the range of motion in flexion improved from an initial median of 80° to 155° in the combined treatment group, compared to an increase from 75.5° to 129° in the group treated with hydrodistension alone. This enhancement was statistically significant (p < 0.001). Regarding pain reduction, the combined treatment group demonstrated a dramatic decrease in visual analogue scale (VAS) scores, from a baseline median of 7 to 1 at the 6-month follow-up. In contrast, the hydrodistension-only group showed a reduction from 7 to 3, with these differences also proving statistically significant (p < 0.001). CONCLUSIONS Ultrasound-guided hydrodistension of the glenohumeral joint, if combined with bursal injection and specific exercises, effectively reduces pain, decreases disability, and improves range of motion in patients with second-stage adhesive capsulitis. This study highlights the importance of a combined approach in the management of this complex condition, especially after the histological changes that occurred after COVID-19 and related vaccinations. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT06062654.
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Affiliation(s)
- Fabio Vita
- Department of Orthopedic and Traumatological Surgery, IRCCS Rizzoli Orthopedic Institute, University of Bologna, Bologna, Italy
| | - Roberta Gualtierotti
- S.C. Medicine - Hemostasis and Thrombosis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122, Milan, Italy.
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Flavio Origlio
- Physical Therapy and Rehabilitation Unit, IRCCS Rizzoli Orthopedic Institute, University of Bologna, Bologna, Italy
| | - Marco Cavallo
- Shoulder and Elbow Surgery Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Galletti
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology, Bologna, Italy
| | - Salvatore Massimo Stella
- SIUMB Advanced School for Musculoskeletal Ultrasound, Department of Clinical and Experimental Medicine, University Post-Graduate Course, Santa Chiara University Hospital, Pisa, Italy
| | - Enrico Guerra
- Shoulder and Elbow Surgery Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Danilo Donati
- Physical Therapy and Rehabilitation Unit, Policlinico di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Cesare Faldini
- Department of Orthopedic and Traumatological Surgery, IRCCS Rizzoli Orthopedic Institute, University of Bologna, Bologna, Italy
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Zhang D, Pan L, Wang G. A novel strategy for treating osteoarthritis. Asian J Surg 2024:S1015-9584(24)01809-8. [PMID: 39198056 DOI: 10.1016/j.asjsur.2024.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 08/06/2024] [Indexed: 09/01/2024] Open
Affiliation(s)
- Dan Zhang
- Traditional Chinese Medicine Department, Zigong First People's Hospital, Zigong, People's Republic of China
| | - Li Pan
- Traditional Chinese Medicine Department, Zigong First People's Hospital, Zigong, People's Republic of China
| | - Gang Wang
- Traditional Chinese Medicine Department, Zigong First People's Hospital, Zigong, People's Republic of China.
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Daher M, Fares MY, Boufadel P, Zalaquett Z, Koa J, Sakr I, Pill SG, Hasan SS, Vaccaro AR, Abboud JA. Untwining the intertwined: a comprehensive review on differentiating pathologies of the shoulder and spine. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:385-392. [PMID: 39157237 PMCID: PMC11329023 DOI: 10.1016/j.xrrt.2024.02.007] [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] [Indexed: 08/20/2024]
Abstract
Background The anatomic interplay and overlap between the cervical spine and the shoulder constitutes a challenge for shoulder and spine surgeons, as symptoms of spine and shoulder pathologies are often similar and may lead to entity misdiagnosis. Methods PubMed, Cochrane, and Google Scholar (page 1-20) searches were updated to October 2023 in search of the qualified papers. Boolean Operators were used with a combination of the keywords "spine" OR "neck" And "Shoulder". Furthermore, reference lists from papers were also searched to find literature. Results It is of pivotal importance to conduct comprehensive preoperative clinical investigation to appropriately evaluate and assess the source of the pathology and the leading causes behind it. Certain markers can help guide surgeons towards etiologies, and these include areas of pain and physical exam findings with the arm squeeze test having the highest sensitivity and specificity for diagnosing cervical radiculopathy. As for the shoulder, despite its low sensitivity, the Yergason test had the highest specificity for diagnosing subacromial impingement. Local anesthetic injection can help as well in the diagnostic approach. Moreover, the interplay between these anatomic locations is not solely related to preoperative diagnosis. Studies have shown that previous surgery for cervical spine pathology may negatively affect the outcomes of shoulder procedures like arthroplasties. Conclusion Shoulder and spine surgeons should be wary and vigilant of accurately diagnosing the etiology of the presenting symptoms to ensure proper management and optimize prognosis.
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Affiliation(s)
- Mohammad Daher
- Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Mohamad Y. Fares
- Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Peter Boufadel
- Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Ziad Zalaquett
- Orthopedic Department, Hôtel Dieu de France, Beirut, Lebanon
| | - Jonathan Koa
- Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Itala Sakr
- Orthopedic Department, Hôtel Dieu de France, Beirut, Lebanon
| | - Stephan G. Pill
- Orthopedics Department, Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA
| | - Samer S. Hasan
- Cincinnati Sports Medicine Research and Education Foundation, Cincinnati, OH, USA
| | - Alex R. Vaccaro
- Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA
| | - Joseph A. Abboud
- Rothman Institute/Thomas Jefferson Medical Center, Philadelphia, PA, USA
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Xu W, Xu J, Zhou Y, Yang W, Huang H, Xue J, Zhang J. Diagnostic Value of Superb Microvascular Imaging of the Rotator Cuff Interval for the Early Diagnosis of Frozen Shoulder. Int J Gen Med 2024; 17:3039-3046. [PMID: 39006912 PMCID: PMC11246654 DOI: 10.2147/ijgm.s465952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To explore the early diagnostic value of superb microvascular imaging (SMI) features within the rotator cuff gap for frozen shoulder. Patients and Methods This prospective study enrolled patients with acute early-stage frozen shoulder seeking treatment at Zhabei Central Hospital in Jing'an District, Shanghai, between July 2021 and December 2022 were enrolled in this study. Healthy controls were collected in a 1:1 ratio from the same hospital's physical examination center. All participants underwent SMI and power Doppler ultrasound (PDUS) of the rotator cuff gap. Results The study included 79 patients with frozen shoulder and 77 healthy controls. Compared with the healthy control group, the patient group had a higher proportion of hypoechoic rotator cuff gap (81.0% vs 48.1%, P<0.001), a thicker coracohumeral ligament (2.60±1.01 vs 2.03±0.97, P<0.001), a thicker glenohumeral joint capsule (3.10±0.99 vs 2.46±1.17, P<0.001), and elevated blood grading using SMI (P<0.001) and PDUS (P=0.014). The highest area under the curve (AUC) was observed for SMI blood flow grading (AUC=0.824, 95% CI: 0.755-0.880, P<0.001), resulting in 82% sensitivity and 77% specificity when using a cutoff of 1. SMI blood flow grading was associated with external rotation <30° (P=0.007) and abduction <30° (P=0.013) but not with internal rotation <30° (P=0.630) or flexion <30° (P=0.562). Conclusion The grading of SMI blood flow may emerge as a valuable predictive indicator for the early stages of frozen shoulder. This simple ultrasound technique holds the potential to enhance the diagnostic process, enabling early initiation of treatment and potentially improving patient outcomes.
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Affiliation(s)
- Weihua Xu
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Jiayu Xu
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Yingying Zhou
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Weiwei Yang
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Hui Huang
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Jun Xue
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Jing Zhang
- Ultrasound Medicine Department, Daning Community Health Service Center in Jing'an District, Shanghai, People's Republic of China
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Lu W, Pu B, Wang S, Li M, An Y, Lian J, Wang Y. Bidirectional two-sample Mendelian randomization analysis identifies causal associations between cardiovascular diseases and frozen shoulder. J Orthop Surg Res 2024; 19:116. [PMID: 38310246 PMCID: PMC10837867 DOI: 10.1186/s13018-024-04600-7] [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: 10/31/2023] [Accepted: 01/28/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Although prior observational studies indicate an association between cardiovascular diseases (CVDs) and frozen shoulder (FS), the potential causal relationship between them remains uncertain. This study aims to explore the genetic causal relationship between CVDs and FS using Mendelian randomization (MR). METHODS Genetic variations closely associated with FS were obtained from the FinnGen Consortium. Summary data for CVD, including atrial fibrillation (AF), coronary artery disease (CAD), heart failure (HF), myocardial infarction (MI), stroke, and ischemic stroke (IS), were sourced from several large-scale genome-wide association studies (GWAS). MR analysis was performed using inverse variance weighting (IVW), MR Egger, and weighted median methods. IVW, as the primary MR analysis method, complemented by other sensitivity analyses, was utilized to validate the robustness of the results. Further reverse MR analysis was conducted to explore the presence of reverse causal relationships. RESULTS In the forward MR analysis, genetically determined risk of stroke and IS was positively associated with FS (OR [95% CI] = 1.58 (1.23-2.03), P < 0.01; OR [95% CI] = 1.46 (1.16-1.85), P < 0.01, respectively). There was no strong evidence of an effect of genetically predicted other CVDs on FS risk. Sensitivity analyses confirmed the robustness of the results. In the reverse MR analysis, no causal relationships were observed between FS and various CVDs. CONCLUSION The study suggests that stroke increases the risk of developing FS. However, further basic and clinical research is needed to substantiate our findings.
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Affiliation(s)
- WeiSong Lu
- Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan, China
| | - Bin Pu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Sen Wang
- Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan, China
| | - MengZe Li
- Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan, China
| | - Yue An
- Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan, China
| | - Jie Lian
- Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan, China
| | - YongQuan Wang
- Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan, China.
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Kuhn I, Erber B, Goller SS. [Adhesive capsulitis]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:119-124. [PMID: 37801107 DOI: 10.1007/s00117-023-01217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Adhesive capsulitis (CA; also called Frozen shoulder) is a common, usually unilateral disease of the shoulder joint primarily affecting middle-aged women. Primary, idiopathic, and secondary forms are distinguished. Painful active and passive movement restriction are the clinically leading symptoms. COURSE OF THE DISEASE The disease usually progresses in three successive stages: freezing phase, frozen phase, and thawing phase. CLINICAL DIAGNOSIS AND IMAGING CA is primarily diagnosed clinically, with imaging being used to assess or exclude differential diagnoses. Radiography as part of basic diagnostics allows exclusion of common differential diagnoses such as osteoarthritis of the shoulder or calcific tendinitis. Native magnetic resonance imaging (MRI) and MR arthrography (MRA) reveal pathomorphologies typical of CA. Intravenously administered gadolinium increases the sensitivity of MRI. Sonography may be used as a complementary diagnostic modality or as an alternative in case of contraindications to MRI. Fluoroscopy-guided arthrography has been replaced by MRI because of its invasiveness. Computed tomography (CT) has no role in diagnostics due to its radiation exposure and significantly lower sensitivity and specificity compared to MRI. TREATMENT Therapy of CA is stage-adapted and includes conservative measures such as analgesics and physiotherapy and surgical procedures such as arthroscopic arthrolysis. The therapeutic spectrum is supplemented by new, innovative procedures such as transarterial periarticular embolization. PROGNOSIS CA is self-limiting and usually persists for 2-3 years. However, the patients may even suffer from pain and limited range of motion beyond this time.
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Affiliation(s)
- Isabella Kuhn
- Muskuloskelettales Universitätszentrum München (MUM), LMU Klinikum, Ziemssenstr. 5, 80336, München, Deutschland
| | - Bernd Erber
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - Sophia Samira Goller
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
- Radiologie, Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz.
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Picasso R, Pistoia F, Zaottini F, Marcenaro G, Miguel-Pérez M, Tagliafico AS, Martinoli C. Adhesive Capsulitis of the Shoulder: Current Concepts on the Diagnostic Work-Up and Evidence-Based Protocol for Radiological Evaluation. Diagnostics (Basel) 2023; 13:3410. [PMID: 37998547 PMCID: PMC10670865 DOI: 10.3390/diagnostics13223410] [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: 09/29/2023] [Revised: 10/28/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
Adhesive capsulitis is an idiopathic and disabling disorder characterized by intense shoulder pain and progressive limitation of active and passive glenohumeral joint range of motion. Although adhesive capsulitis has been traditionally considered a diagnosis of exclusion that can be established based on a suggestive medical history and the detection of supporting findings at the physical exam, imaging studies are commonly requested to confirm the diagnostic suspicion and to exclude other causes of shoulder pain. Indeed, clinical findings may be rather unspecific, and may overlap with diseases like calcific tendinitis, rotator cuff pathology, acromioclavicular or glenohumeral arthropathy, autoimmune disorders, and subacromial/subdeltoid bursitis. Magnetic resonance imaging, magnetic resonance arthrography, and high-resolution ultrasound have shown high sensitivity and accuracy in diagnosing adhesive capsulitis through the demonstration of specific pathological findings, including thickening of the joint capsule and of the coracohumeral ligament, fibrosis of the subcoracoid fat triangle, and extravasation of gadolinium outside the joint recesses. This narrative review provides an updated analysis of the current concepts on the role of imaging modalities in patients with adhesive capsulitis, with the final aim of proposing an evidence-based imaging protocol for the radiological evaluation of this condition.
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Affiliation(s)
- Riccardo Picasso
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genova, Liguria, Italy; (R.P.); (F.Z.); (A.S.T.); (C.M.)
| | - Federico Pistoia
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genova, Liguria, Italy; (R.P.); (F.Z.); (A.S.T.); (C.M.)
| | - Federico Zaottini
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genova, Liguria, Italy; (R.P.); (F.Z.); (A.S.T.); (C.M.)
| | - Giovanni Marcenaro
- Department of Health Sciences (DISSAL), Università di Genova, Via Antonio Pastore 1, 16132 Genova, Liguria, Italy;
| | - Maribel Miguel-Pérez
- Unidad de Anatomía y Embriología Humana, Departamento de Patología y Terapéutica Experimental, Facultad de Medicina y Ciencias de la Salud (Campus de Bellvitge), Universitat de Barcelona, 08904 Barcelona, Spain;
| | - Alberto Stefano Tagliafico
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genova, Liguria, Italy; (R.P.); (F.Z.); (A.S.T.); (C.M.)
- Department of Health Sciences (DISSAL), Università di Genova, Via Antonio Pastore 1, 16132 Genova, Liguria, Italy;
| | - Carlo Martinoli
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genova, Liguria, Italy; (R.P.); (F.Z.); (A.S.T.); (C.M.)
- Department of Health Sciences (DISSAL), Università di Genova, Via Antonio Pastore 1, 16132 Genova, Liguria, Italy;
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Mertens MG, Meeus M, Verborgt O, Girbes EL, Horno SMD, Aguilar-Rodriguez M, Dueñas L, Navarro-Ledesma S, Fernandez-Sanchez M, Luque-Suarez A, Struyf F. Exploration of the clinical course of frozen shoulder: A longitudinal multicenter prospective study of functional impairments. Braz J Phys Ther 2023; 27:100539. [PMID: 37639942 PMCID: PMC10474583 DOI: 10.1016/j.bjpt.2023.100539] [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: 01/11/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Contradictory evidence exists regarding the clinical course of frozen shoulder (FS). OBJECTIVES To explore the clinical course of FS regarding disabilities, pain, range of motion (ROM), muscle strength, scapular upward rotation, and proprioception and to establish longitudinal correlations between these variables. METHODS Patients with FS were prospectively followed for 9 months at 3-month intervals. Assessment included the Disabilities of the Arm, Shoulder and Hand questionnaire; visual analogue scale for pain; an inclinometer for shoulder external rotation (ER), internal rotation (IR), flexion, and abduction ROM, and scapular upward rotation and proprioception, as well as handheld dynamometry for muscle strength in shoulder abduction, ER, and IR. RESULTS Initially, 149 patients (98 females; mean (SD) age 53 (9) years) were included, with 88 completing all follow-up assessments. Most variables showed early improvement in the clinical course of FS, particularly ER and IR at 90° abduction, which continued to improve from 6 to 9 months of follow-up. Associations were observed between disabilities and pain (r = 0.61), disabilities/pain and ROM (r=-0.62 to -0.59 and r=-0.47 to -0.39, respectively), disabilities/pain and muscle strength (r=-0.24 to -0.35 and r=-0.36 to -0.17, respectively), and between disabilities/pain and scapular upward rotation below shoulder level (r = 0.23 to 0.38 and r = 0.24 to 0.30, respectively). ROM correlated with muscle strength (r = 0.14 to 0.44), while both ROM and ER muscle strength correlated with scapular upward rotation below shoulder level (r=-0.37 to -0.23 and r=-0.17 to -0.12, respectively). Muscle strength correlated with scapular upward rotation above shoulder level (r = 0.28 to 0.38) and lift-off muscle strength correlated with joint repositioning (r=-0.17 to -0.15). CONCLUSION Almost all factors improved in the early phase (3-6 months) after baseline assessment, while ER and IR ROM at shoulder level continued to improve long term.
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Affiliation(s)
- Michel Gcam Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion International Research Group, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Olivier Verborgt
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium; Department of Orthopaedic Surgery, University Hospital (UZA), Edegem, Belgium
| | - Enrique Lluch Girbes
- Pain in Motion International Research Group, Belgium; Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain; Department of Physical Therapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Marta Aguilar-Rodriguez
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Santiago Navarro-Ledesma
- Department of Physical Therapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
| | | | | | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physical Therapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
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Qin X, Sun K, Ao Y, Liu J, Wang M, Deng Q, Zhong W, Liu J, Sun S, Liu X, Shi B, Guan X, Du S, Zou J, Wu C, Chen F, Fang Y, Nie X, Mo W, Guo J, Zhang Y, Dong Y, Wei X, Zhu L. Traditional Chinese medicine for frozen shoulder: An evidence-based guideline. J Evid Based Med 2023. [PMID: 37020403 DOI: 10.1111/jebm.12530] [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: 02/03/2023] [Accepted: 03/22/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Frozen shoulder is a common disorder that can lead to long-lasting impairment in shoulder-related daily activities. Traditional Chinese medicine (TCM) has played an important role in the effort to manage frozen shoulder. PURPOSE We aimed to develop an evidence-based guideline for treating frozen shoulder with traditional Chinese medicine. STUDY DESIGN Evidence-based guideline. METHODS We developed this guideline based on internationally recognized and accepted guideline standards. The guideline development group used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to rate the certainty of evidence and the strength of recommendations. The benefits and harms, resources, accessibility, and other factors were fully taken into account, and the GRADE grid method was used to reach consensus on all recommendations. RESULTS We established a multidisciplinary guideline development panel. Based on a systematic literature search and a face-to-face meeting, nine clinical questions were identified. Finally, twelve recommendations were reached by consensus, comprehensively considering the balance of benefits and harms, certainty of evidence, costs, clinical feasibility, accessibility, and clinical acceptability. CONCLUSION This guideline panel made twelve recommendations, which covered the use of manual therapy, acupuncture, needle knife, Cheezheng Xiaotong plaster, Gutong plaster, exercise therapy and integrated TCM and Western medicine, such as combined modalities and corticosteroid injections. Most of them were weakly recommended or consensus based. The users of this guideline are most likely to be clinicians and health administrators.
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Affiliation(s)
- Xiaokuan Qin
- Department of Spine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Kai Sun
- Department of Spine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yingfang Ao
- Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Jianping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Mei Wang
- Department of Scientific Research, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiang Deng
- Department of Spine, Gansu Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Weihong Zhong
- Physical Therapy Department, Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jun Liu
- Department of Orthopedics, Guangdong Second Traditional Chinese Medicine, Guangzhou, China
| | - Shaoqiu Sun
- Department of Orthopedics, Hunan Provincial Hospital of Traditional Chinese Medicine, Changsha, China
| | - Xiangdi Liu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Bin Shi
- Department of Traditional Chinese Medicine Orthopedics, Neck-Shoulder and Lumbocrural Pain Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xuefeng Guan
- Party and Government Office, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Shuangqing Du
- Department of Bone Injury, Hebei Hospital of Traditional Chinese Medicine, Hebei University of Traditional Chinese Medicine, Shijiazhuang, China
| | - Jun Zou
- Development and Planning Office, Shanghai University of Sport, Shanghai, China
| | - Chengliang Wu
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Feng Chen
- Guangxi Scientific Experimental Center of Traditional Chinese Medicine, Guangxi University of Chinese Medicine, Nanning, China
| | - Yigong Fang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaoyan Nie
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Wen Mo
- Department of Orthopedics and Traumatology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiayi Guo
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Yili Zhang
- School of Traditional Chinese Medicine and School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yan Dong
- Institute of Information on Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xu Wei
- Department of Scientific Research, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liguo Zhu
- Department of Spine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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10
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Romeo PV, Papalia AG, Alben MG, Gambhir N, Shankar D, Bi AS, Zuckerman JD, Virk MS. Prognostic factors associated with improvements in patient-reported outcomes in idiopathic adhesive capsulitis. JSES Int 2023; 7:336-341. [PMID: 36911781 PMCID: PMC9998727 DOI: 10.1016/j.jseint.2022.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The purpose of this study was to identify prognostic factors that are associated with improvements in patient-reported outcomes measures (PROMs) related to upper extremity function and pain in those suffering from idiopathic adhesive capsulitis. Methods All patients treated conservatively for primary idiopathic adhesive capsulitis were identified from our institutional database between 2019 and 2021. Exclusion criteria included any patients treated surgically, follow-up less than one year, or incomplete survey results. PROMs including Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Test Version 2.0 (P-UE), Pain Interference (P-Interference), Pain Intensity (P-Intensity), and visual analog scale (VAS) pain scores. They were obtained at initial consultation and at one year to assess patient-perceived impact of their condition. Multiple linear and multivariable logistic regressions were performed to identify factors associated with improvement in patient-perceived pain and shoulder function using final PROM scores and difference in PROM scores from initial consultation. An independent t-test was used to compare baseline and one-year minimum follow-up PROMs. Odds ratios and their 95% confidence intervals were calculated for each factor; a P value of < .05 was considered statistically significant. Results A total of 56 patients (40 females and 16 males) were enrolled in the study with an average age of 54.7 ± 7.7 years. A significant improvement (P < .001) was demonstrated at one-year minimum outcomes for P-UE, P-Interference, P-Intensity, and VAS scores. With respect to comorbid conditions, hypothyroidism [P-UE (β: 9.57, P = .006)] was associated with greater improvements in PROMs, while hyperlipidemia [P-UE (β: -4.13, P = .01) and P-Intensity (β: 2.40, P = .02)] and anxiety [P-UE (β: -4.13, P = .03)] were associated with poorer reported changes in PROMs. Female sex [P-UE (β: 4.03, P = .007) and P-Interference (β: -2.65, P = .04)] and employment in manual labor professions [P-Interference (β: -3.07, P = .01), P-Intensity (β: -2.92, P = .006), and VAS (β: -0.66, P = .03)] were associated with significantly better patient-perceived outcomes. Hispanic heritage was associated with higher reported changes of P-Intensity (β: 8.45, P = .004) and VAS (β: 2.65, P = .002). Conclusion Patient-perceived improvements in PROMIS score during the natural history of adhesive capsulitis are likely multifactorial, with anxiety, hyperlipidemia, increased body mass index, and Hispanic heritage associated with reduced improvement in PROMIS scores.
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Affiliation(s)
- Paul V Romeo
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Aidan G Papalia
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Matthew G Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Neil Gambhir
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Dhruv Shankar
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Andrew S Bi
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Joseph D Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
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11
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Cao W, Chen J, Pu J, Fan Y, Cao Y. Risk Factors for the Onset of Frozen Shoulder in Middle-Aged and Elderly Subjects Within 1 Year of Discharge From a Hospitalization That Involved Intravenous Infusion: A Prospective Cohort Study. Front Med (Lausanne) 2022; 9:911532. [PMID: 35795630 PMCID: PMC9251169 DOI: 10.3389/fmed.2022.911532] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
AIM To investigate the incidence of frozen shoulder and risk factors for the onset of frozen shoulder in middle-aged and elderly subjects within 1 year of discharge from a hospitalization that involved intravenous infusion in Zhangjiagang Second People's Hospital. METHODS A total of 1,900 subjects who were discharged from a hospitalization that involved intravenous infusion in the hospital between May 2020 and September 2020 met the inclusion criteria for this study: 950 subjects had a mean daily duration of intravenous infusion ≤ 2 h (low exposure) and 950 subjects had a mean daily duration of intravenous infusion ≥3 h (high exposure). Subjects were followed up by telephone at 6 months ± 1 week and 12 months ± 1 week after discharge the incidence of frozen shoulder. RESULTS The cumulative incidence rate of frozen shoulder within 1 year of discharge was 5.2%. Multivariate logistic regression analysis revealed the risk of frozen shoulder was higher in subjects with a mean daily duration of intravenous infusion ≥3 h compared to ≤ 2 h (OR = 3.082, 95% CI 1.919-4.949, P < 0.001); subjects hospitalized for 11-30 days had a higher risk of frozen shoulder compared to those hospitalized for 10 days or less (OR = 6.836, 95%CI 4.363-10.709, P < 0.001); subjects who were overweight/ obese (BMI ≥ 25 kg/m2) had a higher risk of frozen shoulder compared to those of normal weight (BMI 18.5-24.9 kg/m2) (OR = 2.166, 95%CI 1.376-3.410, P = 0.001); subjects in the 56-70-year-old age group had a higher risk of developing frozen shoulder compared to those in the 40-55-year-old age group (OR = 1.977, 95%CI 1.154-3.387, P = 0.013); diabetes increased the risk of frozen shoulder (OR = 3.009, 95%CI 1.826-4.959, P < 0.001). The 71-85 years old age group and hypertension were statistically significant in univariate analysis but not in multivariate analysis (P > 0.05). CONCLUSION Compared with middle-aged and elderly in the general population, middle-aged and elderly subjects who received intravenous infusion during a hospitalization had a higher cumulative incidence rate of frozen shoulder within 1 year after discharge. Independent risk factors for the onset of frozen shoulder included mean daily duration of intravenous infusion ≥3 h, length of hospital stay 11-30 days, BMI ≥ 25 kg/m2, age 56-70 years, and diabetes.
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Affiliation(s)
- Wenping Cao
- Department of Acupuncture, Zhangjiagang Second People's Hospital, Zhangjiagang City, China
| | - Jiangnan Chen
- Department of Acupuncture, Zhangjiagang Second People's Hospital, Zhangjiagang City, China
| | - Jianfeng Pu
- Department of Acupuncture, Zhangjiagang Second People's Hospital, Zhangjiagang City, China
| | - Yunwu Fan
- Department of Pain Medicine, Zhangjiagang Second People's Hospital, Zhangjiagang City, China
| | - Ye Cao
- Department of Pain Medicine, Zhangjiagang Second People's Hospital, Zhangjiagang City, China
- *Correspondence: Ye Cao
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