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周 洲, 王 俊, 李 怀, 杨 瑷, 唐 康, 周 游, 周 兵. [Comparison of mid-term effectiveness between diabetic secondary stiff shoulder and primary frozen shoulder after arthroscopic shoulder capsular release combined with acromiohumeral distance restoration]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:867-873. [PMID: 39013826 PMCID: PMC11252682 DOI: 10.7507/1002-1892.202403078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/24/2024] [Indexed: 07/18/2024]
Abstract
Objective To compare the mid-term effectiveness of arthroscopic shoulder capsular release combined with acromiohumeral distance (AHD) restoration in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. Methods A retrospective analysis was conducted on clinical data of 22 patients with diabetic secondary stiff shoulder (group A) and 33 patients with primary frozen shoulder (group B), who underwent arthroscopic 270° capsular release combined with AHD restoration treatment. There was no significant difference between the two groups in gender, age, affected side, disease duration, and preoperative AHD, shoulder flexion range of motion, abduction range of motion, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS) score, and Constant score ( P>0.05). Only the difference in the internal rotation cone rank and external rotation range of motion between the two groups showed significant differences ( P<0.05). The improvement in shoulder pain and function was evaluated by using VAS score, ASES score, and Constant score before operation and at last follow-up. Active flexion, abduction, external rotation range of motion, and internal rotation cone rank were recorded and compared. AHD was measured on X-ray films. Results All patients were followed up 24-92 months (median, 57 months). There was no significant difference in follow-up time between group A and group B ( P>0.05). No fractures or glenoid labrum tears occurred during operation, all incisions healed by first intention, and no complication such as wound infection or nerve injury was observed during the follow-up. At last follow-up, there were significant improvements in active flexion, abduction, external rotation range of motion, internal rotation cone rank, AHD, VAS score, ASES score, and Constant score when compared with preoperative ones in both groups ( P<0.05). Except for the difference in change in external rotation range of motion, which had significant difference between the two groups ( P<0.05), there was no significant difference in other indicators between the two groups ( P>0.05). Conclusion Arthroscopic capsular release combined with AHD restoration can achieve good mid-term effectiveness in the treatment of diabetic secondary stiff shoulder and primary frozen shoulder. However, the improvement in external rotation range of motion is more significant in the patients with diabetic secondary stiff shoulder.
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Affiliation(s)
- 洲 周
- 三峡大学附属仁和医院骨科 三峡大学运动医学研究所 宜昌市运动损伤与修复临床医学研究中心(湖北宜昌 443001)Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Institute of Sports Medicine of China Three Gorges University, Yichang Sports Injury and Repair Clinical Medical Research Center, Yichang Hubei, 443001, P. R. China
- 陆军军医大学第一附属医院骨科运动医学中心(重庆 400038)Department of Sports Medicine Center, the First Affiliated Hospital of Army Medical University, Chongqing, 400038, P. R. China
| | - 俊 王
- 三峡大学附属仁和医院骨科 三峡大学运动医学研究所 宜昌市运动损伤与修复临床医学研究中心(湖北宜昌 443001)Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Institute of Sports Medicine of China Three Gorges University, Yichang Sports Injury and Repair Clinical Medical Research Center, Yichang Hubei, 443001, P. R. China
| | - 怀胜 李
- 三峡大学附属仁和医院骨科 三峡大学运动医学研究所 宜昌市运动损伤与修复临床医学研究中心(湖北宜昌 443001)Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Institute of Sports Medicine of China Three Gorges University, Yichang Sports Injury and Repair Clinical Medical Research Center, Yichang Hubei, 443001, P. R. China
| | - 瑷宁 杨
- 三峡大学附属仁和医院骨科 三峡大学运动医学研究所 宜昌市运动损伤与修复临床医学研究中心(湖北宜昌 443001)Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Institute of Sports Medicine of China Three Gorges University, Yichang Sports Injury and Repair Clinical Medical Research Center, Yichang Hubei, 443001, P. R. China
| | - 康来 唐
- 三峡大学附属仁和医院骨科 三峡大学运动医学研究所 宜昌市运动损伤与修复临床医学研究中心(湖北宜昌 443001)Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Institute of Sports Medicine of China Three Gorges University, Yichang Sports Injury and Repair Clinical Medical Research Center, Yichang Hubei, 443001, P. R. China
| | - 游 周
- 三峡大学附属仁和医院骨科 三峡大学运动医学研究所 宜昌市运动损伤与修复临床医学研究中心(湖北宜昌 443001)Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Institute of Sports Medicine of China Three Gorges University, Yichang Sports Injury and Repair Clinical Medical Research Center, Yichang Hubei, 443001, P. R. China
| | - 兵华 周
- 三峡大学附属仁和医院骨科 三峡大学运动医学研究所 宜昌市运动损伤与修复临床医学研究中心(湖北宜昌 443001)Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Institute of Sports Medicine of China Three Gorges University, Yichang Sports Injury and Repair Clinical Medical Research Center, Yichang Hubei, 443001, P. R. China
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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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Kim M, Kim KY, Huh YG, Ma SH, Jeong KY, Yoon SH. Functional improvement of bilateral frozen shoulder by unilateral intra-articular corticosteroid injection: a retrospective study. J Int Med Res 2021; 49:3000605211050535. [PMID: 34704481 PMCID: PMC8554564 DOI: 10.1177/03000605211050535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective Bilateral frozen shoulder (FS) is often treated with intra-articular corticosteroid injection (IACI). No studies have been performed to establish whether IACI must be administered in both shoulders or in only one shoulder to improve function. This study was therefore performed to determine whether unilateral IACI improves shoulder pain and passive range of motion (pROM) in bilateral FS. Methods The medical records of 165 patients with bilateral primary FS who underwent ultrasonography-guided IACI (2 mL of 10-mg/mL triamcinolone acetonide mixed with 5 mL of 1% lidocaine) in one shoulder were retrospectively reviewed. The outcome measures, namely the numeric rating scale (NRS) scores and pROM values (abduction, external rotation, flexion, hyperextension, and internal rotation), were evaluated pre- and post-injection. Results The patients’ mean age was 54.0 ± 8.0 years. The mean symptom duration was 6.5 ± 2.8 months. The mean follow-up period after injection was 6.7 ± 0.8 weeks. The NRS scores and pROM values significantly improved in both the injected and non-injected shoulders. Conclusions This study showed that unilateral IACI in patients with bilateral FS improves the clinical outcome of the non-injected shoulder. We suggest that physicians observe the non-injected shoulder after unilateral injection rather than performing bilateral injections.
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Affiliation(s)
- Minchul Kim
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Ki-Yong Kim
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Yool-Gang Huh
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Sang Hyeok Ma
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Kil-Yong Jeong
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Seung-Hyun Yoon
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
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Dyer BP, Burton C, Rathod-Mistry T, Blagojevic-Bucknall M, van der Windt DA. Diabetes as a Prognostic Factor in Frozen Shoulder: A Systematic Review. Arch Rehabil Res Clin Transl 2021; 3:100141. [PMID: 34589691 PMCID: PMC8463473 DOI: 10.1016/j.arrct.2021.100141] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
People with diabetes may experience worse outcomes from frozen shoulder than those without diabetes; however, the certainty in evidence was moderate to low. If high-quality studies can confirm the findings of this review, then clinicians should monitor patients with frozen shoulder with diabetes more closely and offer further treatment if pain or lack of function persists long-term.
Objective To summarize evidence from longitudinal observational studies to determine whether diabetes (types 1 and 2) is associated with the course of symptoms in people with frozen shoulder. Data Sources A systematic literature search of 11 bibliographic databases (published through June 2021), reference screening, and emailing professional contacts. Study Selection Studies were selected if they had a longitudinal observational design that included people diagnosed with frozen shoulder at baseline and compared outcomes at follow-up (>2wk) among those with and without diabetes at baseline. Data Extraction Data extraction was completed by 1 reviewer using a predefined extraction sheet and was checked by another reviewer. Two reviewers independently judged risk of bias using the Quality in Prognostic Factor Studies tool. Data Synthesis A narrative synthesis, including inspection of forest plots and use of the prognostic factor Grading of Recommendations, Assessment, Development and Evaluations framework. Twenty-eight studies satisfied the inclusion criteria. Seven studies were judged to be at a moderate risk of bias and 21 at a high risk of bias. Diabetes was associated with worse multidimensional clinical scores (moderate certainty in evidence), worse pain (low certainty in evidence), and worse range of motion (very low certainty in evidence). Conclusions This review provides preliminary evidence to suggest that people with diabetes may experience worse outcomes from frozen shoulder than those without diabetes. If high-quality studies can confirm the findings of this review, then clinicians should monitor patients with frozen shoulder with diabetes more closely and offer further treatment if pain or lack of function persists long-term.
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Affiliation(s)
- Brett P Dyer
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Claire Burton
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Trishna Rathod-Mistry
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Milisa Blagojevic-Bucknall
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Danielle A van der Windt
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, United Kingdom
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Atici T, Ermutlu C, Akesen S, Özyalçin A. High-dose short-course oral corticosteroid protocol for treatment of primary frozen shoulder: a retrospective cohort study. J Int Med Res 2021; 49:3000605211024875. [PMID: 34229518 PMCID: PMC8267043 DOI: 10.1177/03000605211024875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the effect of high-dose prednisolone on the functional outcome of patients with early-stage primary frozen shoulder. Methods Eighteen patients treated with oral prednisolone at an initial dose of 1 mg/kg/day for primary frozen shoulder were retrospectively evaluated. The patients’ range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Constant–Murley score, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale score were recorded at baseline and at 4 weeks and 6 months after treatment. Results Rapid recovery of shoulder motion was noted at 4 weeks with the exception of abduction, which was maintained at 6 months. Significant improvement in pain perception and the Constant–Murley score was evident at 4 weeks and extended to 6 months. The DASH and ASES scores did not show significant improvement in the first 4 weeks but were significantly improved at 6 months. Conclusion High-dose oral prednisolone treatment provides rapid symptom resolution that persists long after drug discontinuation. The early treatment period is characterized by marked reduction in pain and rapid recovery of shoulder motion. Improvements in functional outcomes and disability indices tend to be more subtle in the early period but significantly improve during late treatment.
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Affiliation(s)
- Teoman Atici
- Department of Orthopaedics and Traumatology, 64048Uludag University Faculty of Medicine, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Cenk Ermutlu
- Department of Orthopaedics and Traumatology, 64048Uludag University Faculty of Medicine, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Selcan Akesen
- Department of Anesthesiology and Intensive Care, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Ali Özyalçin
- Department of Orthopaedics and Traumatology, 64048Uludag University Faculty of Medicine, Uludag University Faculty of Medicine, Bursa, Turkey
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Wang C, Zhang Z, Ma Y, Liu X, Zhu Q. Platelet-rich plasma injection vs corticosteroid injection for conservative treatment of rotator cuff lesions: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24680. [PMID: 33607808 PMCID: PMC7899870 DOI: 10.1097/md.0000000000024680] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/15/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To explore the effectiveness of platelet-rich plasma (PRP) injection regarding functional recovery, pain relief, and range of motion (ROM) of shoulder compared with the corticosteroid injection in patients with rotator cuff lesions treated non-operatively. METHODS An electronic literature search was performed by 2 authors in the PubMed, Embase, Cochrane Library, and Web of Science databases to identify relevant randomized controlled trial (RCTs) that were published up to July 20, 2020. The quality of the included RCTs was evaluated using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMDs) or mean differences (MDs) with 95% confidence intervals (CIs) were applied to calculate the pooled effect sizes. RESULTS Six RCTs were included in this systematic review. Meta-analysis revealed that corticosteroid injection yielded statistically significant superior functional recovery (SMD = -0.80; 95% CI, -1.42 to -0.18; P = .01) and pain relief (MD = 1.59; 95% CI, 0.30-2.89; P = .02) compared with PRP injection for rotator cuff lesions during the short-term follow-up period. However, at the medium-term and long-term follow-up, no statistically significant difference was identified between the 2 groups. Regarding the ROM of shoulder, no statistically significant difference was found between the 2 groups during the whole follow-up period. CONCLUSIONS The current clinical evidence revealed short-term efficacy of corticosteroid injection and no significant medium- to long-term difference between corticosteroid and PRP injection in the treatment of rotator cuff lesions. Additional studies with longer follow-ups, larger sample sizes, and more rigorous designs are needed to draw more reliable and accurate conclusions.
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