Search

Frozen shoulder (FS) or adhesive capsulitis is a common shoulder condition characterized by pain, stiffness, and restricted active and passive range of motion. Evidence suggests that trigger points (TrP) may play a role in frozen shoulder, especially in restricting range of motion. To determine an association between shoulder girdle muscles TrPs and frozen shoulder. This was a cross-sectional study of 49 patients diagnosed with having a frozen shoulder. All subjects were screened for inclusion and exclusion criteria and examined for the presence of shoulder girdle muscles TrPs. There was an association between TrPs in the supraspinatus, infraspinatus, teres minor, middle deltoid, upper trapezius, and levator scapula muscles and frozen shoulder (P value -<.05), but there was no association for TrPs in the posterior deltoid, teres major, and pectoralis major muscles (P value >.05). Trigger points in the supraspinatus and levator scapula muscles had a strong association with FS. Trigger points in the anterior deltoid and middle deltoid muscles had a moderate association, and TrPs in the infraspinatus, teres minor, and upper trapezius had a weak association. [ABSTRACT FROM AUTHOR]

Adhesive capsulitis, or frozen shoulder, causes pain and reduces glenohumeral joint motion. This study aims to assesses ultrasound-guided hydrodistention with rehabilitation in hospital versus home settings. Forty patients with adhesive capsulitis were split into two groups: one received hydrodistention with hospital-assisted rehabilitation, and the other with home-based rehabilitation, following the same exercise protocol. Clinical assessments included range of motion (ROM), numeric pain rating scale (NPRS), shoulder pain and disability index (SPADI), disability of the arm, shoulder and hand (DASH), and assessment shoulder and elbow scale (ASES) The hospital-based group showed more rapid and substantial improvements in ROM and NPRS scores compared to the home-based group. The hospital-based group had a mean flexion ROM of 104.3 ± 31.6°, which increased to 149.5 ± 20.6° at the final follow-up. The home-based group started with a mean flexion ROM of 103.3 ± 29.2°, improving to 161.3 ± 23.2° by the end of the study. Both groups showed significant improvements, with the home-based group slightly outperforming in flexion ROM by the third follow-up. Initial NPRS scores were 4.7 ± 1.92 for the hospital-based group and 6.6 ± 1.63 for the home-based group. By the six-month mark, the hospital-based group's SPADI score dropped to 17.4 ± 19.5, while the home-based group's score was 10.5 ± 13.03. Both groups demonstrated significant improvements, with the hospital-based group showing slightly better outcomes at various follow-ups. Hydrodistention combined with supervised rehabilitation is optimal for treating frozen shoulder, though home-based therapy is also effective. Both methods significantly benefit from hydrodistention, highlighting its importance in treatment strategies. [ABSTRACT FROM AUTHOR]

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. 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. 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)). 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. [ABSTRACT FROM AUTHOR]

The pathophysiology of frozen shoulder (FS) involves abnormal expressions of matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases (TIMPs) that lead to capsular fibrosis. However, there has been little concern for why diabetic FS has more protracted fibrotic condition. The objective of this study was to compare the expression levels of MMPs and TIMPs in the joint capsule of patients with diabetic and nondiabetic FS. Samples of capsular tissue were collected from 20 patients with FS (10 diabetic patients; diabetic group and 10 nondiabetic patients; nondiabetic group) and 10 patients (control group) with chronic anterior shoulder instability. Quantitative real-time reverse transcriptase-polymerase chain reaction and Western blot analysis were performed to determine the expression levels of mRNA and protein for MMP-1, 3, 9, 13, 14, and TIMP-1, 2. The results of quantitative real-time reverse transcriptase-polymerase chain reaction showed significantly higher expression levels of all MMPs and TIMP-1 and significantly lower expression levels of TIMP-2 in the joint capsule of patients in the diabetic or nondiabetic groups compared with the control group. Significantly higher expression levels of MMP-1, 9, 14, and TIMP-1 were detected in the diabetic group compared with the nondiabetic group. The results of Western blot analysis showed significantly higher levels of MMP-3, 13, 14, and TIMP-1 in the joint capsule of patients in the diabetic or nondiabetic groups compared with the control group. However, no significant differences of protein levels of them were observed between diabetic and nondiabetic groups. The findings of this study demonstrate the potential involvement of MMP-1 and 9 in the pathophysiology of diabetic FS. These findings may be helpful in identification of therapeutic targets for development of novel treatments for this protracted chronic fibrosing condition. [ABSTRACT FROM AUTHOR]

Several risk factors have been identified for the development of postoperative shoulder stiffness, and there has been increasing interest in orthopedic literature regarding patient-reported allergy (PRA) as an identifiable risk factor for adverse outcomes. The purpose of this study is to determine whether PRAs are associated with subsequent rates of diagnosis of adhesive capsulitis (AC) or return to the operating room for postoperative shoulder stiffness within 2 years after arthroscopic rotator cuff repair (ARCR). Current Procedural Terminology surgical billing codes were used to retrospectively identify patients who underwent ARCR at a single urban academic institution from January 2012 to December 2020 with minimum 2-year follow-up. Lysis of adhesions (LOA), manipulation under anesthesia (MUA), and AC of the shoulder were further queried within 2 years postoperatively for the ipsilateral shoulder. Patients were excluded if they had undergone ipsilateral MUA/LOA or received a diagnosis of AC before the index procedure. Demographic characteristics and medical comorbidities (hypertension, diabetes, hyperlipidemia, and hypothyroidism) were extracted from electronic medical records. Baseline characteristics were compared between patients with and without PRAs. Multivariate logistic regression analyses were performed to determine the association of the presence of PRAs overall, as well as the presence of 1, 2, or 3 or more PRAs, with subsequent MUA/LOA or diagnosis of AC within 2 years postoperatively. Of 7057 patients identified in the study period, 6583 were eligible for the final analysis. The mean age was 56.6 ± 11.7 years, and the mean body mass index was 29.1 ± 5.6. Overall, 19.3% of patients (n = 1271) reported at least 1 allergy, and 7.1% (n = 469) had >1 PRA. A total of 44 patients (0.7%) underwent subsequent ipsilateral MUA/LOA within 2 years postoperatively, whereas 93 patients (1.4%) received a diagnosis of ipsilateral AC in the same time frame. PRAs were significantly associated with subsequent diagnosis of AC (odds ratio [OR]: 2.39; 95% confidence interval [CI]: 1.45-3.92; P <.001), but not MUA/LOA (OR: 1.97, 95% CI: 1.26-3.61; P =.133). Patients with 2 PRAs had greater odds of being diagnosed with AC than patients with 1 PRA (OR: 2.74; 95% CI: 1.14-5.99; P =.012). Although this association was nonsignificant for MUA/LOA, patients with 2 PRAs (OR: 2.67; 95% CI: 0.96-8.80; P =.059) demonstrated a similar statistical trend. PRAs are associated with increased odds of receiving a diagnosis of AC within 2 years after ARCR but were not found to be associated with return to the operating room for postoperative stiffness. [ABSTRACT FROM AUTHOR]

Arthrofibrosis following total knee arthroplasty (TKA) and adhesive capsulitis (AC) of the shoulder develop via a similar pathologic process. The purpose of this study was to examine the relationship between these two conditions. This was a retrospective cohort study using a large nationwide claims database. Patients who had a history of shoulder AC prior to TKA were compared to TKA patients who did not have AC history comparing rates of postoperative stiffness, manipulation under anesthesia (MUA), arthroscopic lysis of adhesions (LOAs), and revision arthroplasty at postoperative timepoints (3 months, 6 months, 1 year, and 2 years). Within 3 months, 6 months, 1 year, and 2 years of their TKAs, patients who had a history of AC prior to TKA were significantly more likely to experience stiffness (OR [odds ratio] = 1.29, 1.28, 1.32, and 1.36, respectively) and LOAs (OR = 6.78, 3.65, 2.99, and 2.81, respectively). They also showed increased risk of MUA within 6 months, 1 year, and 2 years (OR = 1.15, 1.15, and 1.16, respectively) of their TKAs. Patients having a preoperative diagnosis of AC did not have an increased risk of undergoing revision surgery 1 year or 2 years after their TKAs (P >.05). Patients diagnosed with AC prior to TKA experience higher rates of postoperative stiffness, resulting in additional interventions such as MUA and LOAs. These findings identify a particularly high-risk patient population that may benefit from additional interventions prior to and following TKA. This is a level III prognostic study. [ABSTRACT FROM AUTHOR]

The pathogenesis of shoulder injury related to vaccine administration (SIRVA) is incompletely understood, but it is postulated to be an immune-mediated inflammatory response to a vaccine antigen, leading to shoulder pain and dysfunction. The purpose of this investigation is to systematically review the literature related to SIRVA specifically after the COVID-19 vaccination by describing the diagnostic and clinical characteristics, diagnoses associated with SIRVA, and incidence between vaccine types. A systematic review was performed to identify level I to IV studies and case descriptions of shoulder pain occurring after COVID-19 vaccination. To confirm that no studies were missing from the systematic review, references of studies from the initial search were scanned for additional relevant studies. A total of 22 studies, comprised of 81 patients, were identified meeting the inclusion/exclusion criteria. Reports were most commonly published from countries in Asia (53.1%; n = 43/81). The most commonly described vaccines were Oxford-AstraZeneca at 37.0% (n = 30/81) and Pfizer-BioNTech at 33.3% (n = 27/81). Symptoms occurred most commonly after at least 72 hours of administration (30.9%, n = 25/81). One hundred percent of patients (n = 81/81) described pain as an associated symptom and 90.1% of patients (n = 73/81) described multiple symptoms. The diagnostic modalities utilized to identify a specific pathology consisted of magnetic resonance imaging (55.6%; n = 45/81), ultrasound (28.4; n = 23/81), radiograph (25.9%; n = 21/81), and computed tomography (4.9%; 4/81). Nearly a third of patients (32.1%; n = 26/81) were diagnosed with bursitis, while 22 (27.2%) were diagnosed with adhesive capsulitis, 17 (21.0%) with either rotator cuff tear or tendinopathy, and 14 (17.3%) with polymyalgia rheumatica or polymyalgia rheumatica-like syndrome. The 2 most common treatment options were physical therapy (34.6%; n = 28/81) and nonsteroidal anti-inflammatory medications (33.3%; 27/81). The majority of SIRVA cases (52.1%; n = 38/73) completely resolved within a few weeks to months. Despite the limited quality and lack of large-scale studies, it is important for providers to recognize SIRVA as a potential risk factor as the number of patients receiving COVID-19 vaccinations and boosters continues to rise. [ABSTRACT FROM AUTHOR]

Cross-sectional analytical study. Adhesive capsulitis (AC) is a long-standing condition with varying extents of disability seen among patients. The role of postural manifestations and contractile tissue involvement in this condition is poorly understood and yet to be explored. This study aimed to analyze if individuals with adhesive capsulitis demonstrated the characteristics of an upper crossed syndrome (UCS) postural manifestation and whether or not its presence affected the extent of disability experienced by this population. Sixty-five individuals with AC were assessed for the presence of UCS. Scapular muscle strength and length alterations, forward head posture (FHP), and disability were assessed and compared between those with and without UCS. Paired T test and an independent T test were utilized to compare means within and between these groups, respectively, while non-parametric measures were utilized for their skewed counterparts. Phi coefficient (φ) was used to determine the strength of association between the descriptive patient characteristics. The correlation between symptom duration and degree of postural involvement was analyzed using Pearson's correlation coefficient. 43.1% of the study population demonstrated UCS and 80% FHP with a significant negative correlation between Cranio Vertebral Angle and chronicity of AC (r = −0.27). Individuals with AC demonstrated significantly decreased scapular muscle strength (p = <.001) and pectoralis minor length on the affected side (p =.03). No differences were seen between groups with and without UCS. The mean SPADI scores between groups demonstrated a more significant level of perceived pain and disability in individuals with UCS (p =.049). As seen in UCS, individuals with AC demonstrated alterations in movement patterns and posture. UCS was seen to contribute towards the existing disability in AC. This study suggests a careful evaluation and intervention based on these findings to document its effect on pain and dysfunction in AC. • Proportion of Upper Crossed Syndrome (43.1%) and Forward head posture (80%) was seen in individuals with adhesive capsulitis. • Craniovertebral angle was less in individuals with adhesive capsulitis and was related to its chronicity. • Scapular Muscle strength and pectoralis minor muscle length was significantly decreased in adhesive capsulitis. • Presence of Upper Crossed Syndrome caused higher levels of perceived pain and disability as seen with the SPADI scores. • Assessment and documentation of head and neck posture manifestations are warranted initially to prevent any further associated disability. [ABSTRACT FROM AUTHOR]

We are unsure if continuous passive motion (CPM) has any role in the nonoperative management of the Primary Stiff Shoulder (frozen shoulder). We hypothesized that there is no difference in pain improvement, range of motion, and function with or without CPM in patients with a primary stiff shoulder. We searched the databases for clinical trials comparing CPM versus no-CPM physiotherapy. In the final step, we reviewed five randomized clinical trials. We collected the data of Constant Shoulder Score (CSS), the visual analog scale of pain, shoulder pain and disability index (SPADI), and range of motion (flexion, abduction, external and internal rotation). We used a random-effects model to analyze the data. Five studies with a total of 224 patients were included. There were 113 patients in the CPM arm and 111 in the control arm. Both the CPM and control groups showed significant improvements in all measured parameters compared to the first visit after 8–24 weeks. Meta-analysis of pooled data showed significant differences in pain improvement, forward flexion, and CSS favoring the CPM. Still, there was no significant difference in abduction, external and internal rotation, and SPADI. The CPM seems to be slightly effective in improving pain and motion in the short term, but its long-term efficacy is still under question. The extra cost and time must be considered when offering the CPM. [ABSTRACT FROM AUTHOR]

Adhesive capsulitis (AC) is a common clinical condition of the shoulders without a clear pathophysiology or etiology. Although thyroid disease has been linked to AC, an appropriate understanding of the disease and its epidemiological evidence are lacking. This metaanalysis investigated the association of AC with thyroid disease and identified which manifestations of thyroid disease contribute to the risk of AC. The databases of PubMed, Embase, and Scopus were searched for literature retrieval up to September 20, 2022. Articles evaluating the association between AC and any type of thyroid disease were enrolled. Data from studies reporting the prevalence and its 95% confidence interval (CI) were pooled. Subgroup analysis was performed on the different manifestations of thyroid disease. We explored heterogeneity with sensitivity analyses and publication bias with funnel plots and Egger's tests. A trim and fill analysis was conducted if publication bias was found. Results: In total, 10 case-control studies comprising a total of 127,967 patients were included. The prevalence of thyroid disease was significantly higher in patients with AC (odds ratio [OR] = 1.87, 95% CI: 1.37-2.57, P <.0001) than in patients without AC. The results of subgroup analysis indicated significantly higher rates of hypothyroidism (OR = 1.92, 95% CI: 1.09-3.39, P =.02) and subclinical hypothyroidism (OR = 2.56, 95% CI: 1.81-3.63, P <.00001), but not hyperthyroidism (OR = 1.42, 95% CI: 0.63-3.22, P =.40), among patients with AC than among those without AC. Our meta-analysis demonstrated that thyroid disease, especially when presenting as hypothyroidism or subclinical hypothyroidism, is associated with an increased risk of AC. Evidence for an association between hyperthyroidism and AC was not found, although this may be due to the lack of related studies. Further research on the pathogeneses of and relationship between these two diseases is warranted. [ABSTRACT FROM AUTHOR]

Many treatment strategies have been described for the management of frozen shoulder. However, to date no randomized controlled trial has directly compared the efficacy of exercise and oral corticosteroids. The aim of this study was to determine whether pain, range of motion (ROM), and function differ between patients with frozen shoulder randomized to treatment with exercise or oral corticosteroids. This prospective, randomized, assessor-blinded trial was performed to compare the effectiveness of exercise and oral corticosteroids in patients with frozen shoulder. Overall, 33 patients with frozen shoulder were randomly assigned to receive either exercise (n = 17) or oral corticosteroids (n = 16). The exercise was applied 2 times per week for 6 weeks for 12 visits; patients in the oral corticosteroids group received prednisolone for 4 weeks. Participants were assessed at baseline, after 6 weeks and at the 12-week follow-up. The primary outcome was the Disabilities of the Arm, Shoulder and Hand and visual analog scale. Secondary outcomes were American Shoulder and Elbow Surgeons Standardized Shoulder Assessment, ROM, and Hospital Anxiety and Depression Scale. Repeated-measures analysis of covariance with baseline scores as the covariates was used to determine between-group differences. An intention-to-treat analysis was performed using the multiple imputation method to impute values for all missing data. Planned pairwise comparisons demonstrated significant improvements in pain relief and functional outcomes in both groups at the 6- and 12-week follow-ups compared to baseline. There were no significant time-by-group interactions between-group differences noted for the Disabilities of the Arm, Shoulder and Hand (F = 0.470, P =.93), visual analog scale (F = 0.006, P =.94), flexion ROM (F = 2.78, P =.1), internal rotation ROM (F = 3.440, P =.07) and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (F = 0.470, P =.49). The overall group-by-time interaction for the 2 × 3 mixed-model analysis of covariance using baseline scores as a covariate was significant for the abduction range (F = 4.460, P =.04) and external rotation ROM (F = 12.100, P =.002) in favor of the exercise group. The study demonstrated that while both groups achieved significant improvements at the 6-, and 12-week follow-ups, the exercise group was superior in terms of abduction and external rotation ROM. Additionally, even though both groups were improved, the effect sizes were larger in the exercise group. Considering the systemic side effects of oral corticosteroids, even at low doses, a well-planned exercise program that considers pain may be a good option for frozen shoulder. [ABSTRACT FROM AUTHOR]

Chronic shoulder pain is an extremely common presenting complaint. Potential pain generators include the rotator cuff tendons, biceps tendon, labrum, glenohumeral articular cartilage, acromioclavicular joint, bones, suprascapular and axillary nerves, and the joint capsule/synovium. Radiographs are typically the initial imaging study obtained in patients with chronic shoulder pain. Further imaging may often be required, with modality chosen based on patient symptoms and physical examination findings, which may lead the clinician to suspect a specific pain generator. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

The etiology of adhesive capsulitis involves inflammation, thickening, and fibrosis of the shoulder capsule. The underlying genetic factors are poorly understood. The purpose of this study was to identify genetic variants associated with adhesive capsulitis using the UK Biobank (UKB) cohort and compare them with variants associated with Dupuytren disease investigating a common etiology between the 2 fibrotic disorders. A genome-wide association study (GWAS) was performed using data from UKB with 10,773 cases of adhesive capsulitis, and a second GWAS was performed with 8891 cases of Dupuytren disease. Next, a comparison of association statistics was performed between adhesive capsulitis and Dupuytren disease using the data from both GWAS. Finally, single-nucleotide polymorphisms (SNPs) previously reported from candidate gene studies for adhesive capsulitis and Dupuytren disease were tested for association with adhesive capsulitis and Dupuytren disease using the summary statistics from their respective GWAS. The UKB GWAS for adhesive capsulitis identified 6 loci that reached genome-wide statistical significance: a cluster of 11 closely linked SNPs on chromosome 1; a single SNP on chromosome 2; a single SNP on chromosome 14; 2 closely linked SNPs on chromosome 21; 33 closely linked SNPs on chromosome 22; and 3 closely linked SNPs on the X chromosome. These SNPs were associated with 8 different genes including TSPAN2/NGF , SATB2 , MRPL52/MMP14 , ERG , WNT7B , and FGF13. A GWAS for Dupuytren disease was performed and a comparison to the adhesive capsulitis GWAS showed 13 loci significantly associated with both phenotypes. A validation attempt of 6 previously reported SNPs associated with adhesive capsulitis using UKB summary statistics was unable to confirm any of the previously reported SNPs (all P >.19). All 23 previously reported SNPs associated with Dupuytren disease were confirmed using the UKB summary statistics (P < 2.1 × 10−3) This GWAS investigating adhesive capsulitis has identified 6 novel loci involving 8 different genes to be associated with adhesive capsulitis. A GWAS investigating Dupuytren disease was performed and compared to the adhesive capsulitis GWAS, and 13 common loci were identified between the 2 disorders with genes involved in pathologic fibrosis. We were unable to validate the SNPs in candidate genes previously reported to be associated with adhesive capsulitis although we were able to confirm all previously reported SNPs associated with Dupuytren disease. The strong genetic overlap between the adhesive capsulitis and Dupuytren disease loci suggests a similar etiology between the 2 diseases. [ABSTRACT FROM AUTHOR]

The World Health Organisation defines health as "physical, mental, and social well-being and not merely the absence of disease or infirmity". Furthermore, health promotion has been described as "the process of enabling all individuals to increase their control over, and to improve their health" (WHO, 1946 ; 1986). Our wellness starts with good nutrition, food through the digestive system and oxygen through the respiratory system. Without proper breathing mechanisms, the brain, whose priority is to survive will unconsciously limit our ability to function properly. Adhesive capsulitis also known as 'Frozen Shoulder' affects a high number of people, with the majority found in the female population between 50 and 60 years of age. The causes are still relatively unknown; however, the effects and debilitating consequences are well known, and rehabilitative procedures can include both surgical and non-surgical interventions depending on the initial structural diagnosis. Long-periods of aggressive rehabilitative physiotherapy can be part of a program including home-exercises. This paper presents partial outcomes in a female single case report with no previous medical conditions. Following a formal adhesive capsulitis diagnosis, a therapeutic program was set out by a qualified physiotherapist following an ultrasound guided hydro-dilation steroid injection. Physiotherapy was accompanied with a home program of physical and mental exercises as part of the ongoing rehabilitation and re-acquisition of normal range of movement and their functionality. Outcomes are discussed considering the transdisciplinary nature of the intervention program followed, providing some reflective clinical reasoning on the importance of a transdisciplinary approach to the management of this condition. [ABSTRACT FROM AUTHOR]

While ultrasound has become a preferred tool for musculoskeletal imaging, differing ultrasound findings that have been reported in patients with adhesive capsulitis can create confusion and misconceptions. This systematic review was aimed at summarizing all the ultrasound features currently described in the literature and providing a critical analysis of the sources to allow the readers to make a well-informed decision on the reliability of these features in the diagnosis of this condition. Databases were searched for original studies up to August 2021. Twenty-three studies were included. The QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool was used to assess the quality of each selected article. Fourteen ultrasound features were identified. A quality analysis of all ultrasound features was performed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework. All studies exhibited considerable heterogeneity in investigated ultrasound features and methodologies employed; therefore, meta-analysis was not considered to be appropriate. Hence, narrative synthesis was performed. The overall quality of each ultrasound outcome was found to be of "low" to "very low" level, and the generalisability of the results was also thought to be limited. Cautious interpretation and clinical correlation are recommended while applying these ultrasound features in clinical practice. [ABSTRACT FROM AUTHOR]

Little is known on the longitudinal relationship between adhesive capsulitis and depression. Therefore, the aim of this study was to investigate the association between adhesive capsulitis and the five-year cumulative incidence of depression in adults from Germany. The present retrospective cohort study included all adults aged ≥18 years with a first diagnosis of adhesive capsulitis in one of 1198 general practices in Germany between January 2010 and December 2018 (index date). Patients with adhesive capsulitis were matched to those without adhesive capsulitis using a propensity score based on age, sex, index year, average number of visits per year, and diagnoses documented prior to or at the index date (i.e., thyroid gland disorders, diabetes mellitus, coronary heart disease, cerebrovascular diseases, and Parkinson's disease and secondary parkinsonism). In individuals without adhesive capsulitis, the index date was a randomly selected visit date. This study included 29,258 patients with and 29,258 patients without adhesive capsulitis (mean [SD] age 55.9 [15.6] years; 53.2% men). Within five years of the index date, there were 17.5% of patients with adhesive capsulitis and 8.7% of those without adhesive capsulitis diagnosed with incident depression (log-rank p-value<0.001). This result was corroborated in the Cox regression analysis, as there was a positive and significant association between adhesive capsulitis and the cumulative incidence of depression (HR = 1.86, 95% CI: 1.78–1.95). In this study, adhesive capsulitis was associated with an increased cumulative incidence of depression. Further research is warranted to better understand the mediating factors involved in this relationship. • This study included 58,516 patients with and without adhesive capsulitis. • The incidence of depression was 17.5% in the group with adhesive capsulitis. • The incidence of depression was 8.7% in the group without adhesive capsulitis. • Adhesive capsulitis was significantly associated with incident depression (HR = 1.86). [ABSTRACT FROM AUTHOR]

Although there is evidence that the COVID-19 pandemic had profound physiological and psychological effects, there is no research aimed at understanding if the pandemic has had an impact on the incidence or severity of frozen shoulder (FS). The aim of this study was to compare the incidence and severity of idiopathic FS before and during the pandemic. A retrospective cohort study was performed to establish the incidence of FS during the pandemic, from March 2020 to January 2021 (pandemic study period), compared to the same time period 1 year earlier, before the pandemic (control group). All patients who were diagnosed with idiopathic FS were included. To assess the severity of the condition, visual analog scale (VAS) for pain score and Subjective Shoulder Value (SSV) on presentation were recorded and the patients were categorized into 5 different treatment groups (0 injections, 1 injection, 2 injections, 3 injections, or capsular release). As the pandemic and public health restrictions could have influenced the availability of appointments, the waiting time between referral and first appointment was calculated as a possible confounding factor. Statistical analysis was performed using the chi-square and Student t test for categorical and continuous variables, respectively. There were 847 new patient consultations during the pandemic study period; of these, 232 were for idiopathic FS. One year earlier, there were 898 initial consultations for a new shoulder problem; of these, 176 were for idiopathic FS. This represents a relative increase of 39.8% (P <.001) in the incidence of patients with FS. The mean SSV in the control group was 50% ± 20% vs. 45% ± 18% in the pandemic group—statistically significant (P =.013) but unlikely to be clinically significant. The VAS pain score was similar in both groups: mean 6 ± 2 and 7 ± 2, respectively (P =.06). There was no significant difference between the control and the pandemic group in the distribution of patients per treatment group (P =.94). The mean waiting time from referral to appointment was not significantly different between the control and the pandemic group: 58 ± 30 days vs. 55 ± 27 days (P =.30). During the COVID-19 pandemic, there was a significant increase in the incidence of patients with FS. No significant difference in severity was observed. Further research is needed to evaluate a causal relationship between the COVID-19 pandemic and FS. [ABSTRACT FROM AUTHOR]

Despite the fact that primary adhesive capsulitis of the glenohumeral joint is often considered a self-limiting condition, not all patients make a full recovery. Manipulation under anesthesia (MUA) is performed to forcibly rupture the contracted capsule in a controlled manner. However, the technique, timing, and use of additional injections are often debated. In this study, we report the outcomes following the addition of capsular distension and countertraction to MUA as a treatment for adhesive capsulitis. We performed a retrospective case-cohort study comparing 3 groups: Group 1 underwent MUA alone (n = 54); group 2, MUA with capsular distension (n = 114); and group 3, MUA with capsular distension and countertraction (n = 167). The re-MUA rate, Constant-Murley shoulder (CMS) score, and visual analog scale (VAS) score (for pain) were measured after 6 weeks and 6 months. The re-MUA rate fell with the addition of both capsular distension and countertraction: 63% in group 1, 39% in group 2, and 18% in group 3. Patients in group 3 recorded the greatest improvement in the CMS score after 6 weeks (+90% vs. +68% in group 2 and +58% in group 1), with all groups showing improvements compared with before treatment. The only independent risk factor identified for re-MUA was smoking. If a second MUA was performed, the CMS (+67%) and VAS (+61%) scores improved, but at 6 months, the CMS score (74.57 ± 7.6 vs. 83.30 ± 5.5) and VAS score (10.57 ± 1.8 vs. 12.96 ± 1.5) remained inferior to those of patients who only needed a single MUA. MUA combined with capsular distension and countertraction reduces the need for a second MUA and results in a faster improvement in functional outcome (CMS score) and reduction of pain (VAS score) compared with MUA alone or MUA with capsular distension. The results of this case-cohort study are of clinical relevance because they show that the efficacy of an MUA can be improved through relatively simple adaptations of the treatment protocol. [ABSTRACT FROM AUTHOR]

Diabetic patients have a greater incidence of adhesive capsulitis (AC) and a more protracted disease course than patients with idiopathic AC. The purpose of this study was to compare gene expression differences between AC with diabetes mellitus and AC without diabetes mellitus. Shoulder capsule samples were prospectively obtained from diabetic or nondiabetic patients who presented with shoulder dysfunction and underwent arthroscopy (N = 16). Shoulder samples of AC with and without diabetes (n = 8) were compared with normal shoulder samples with and without diabetes as the control group (n = 8). Shoulder capsule samples were subjected to whole-transcriptome RNA sequencing, and differential expression was analyzed with EdgeR. Only genes with a false discovery rate < 5% were included for further functional enrichment analysis. The sample population had a mean age of 47 years (range, 24-62 years), and the mean hemoglobin A 1c level for nondiabetic and diabetic patients was 5.18% and 8.71%, respectively. RNA-sequencing analysis revealed that 66 genes were differentially expressed between diabetic patients and nondiabetic patients with AC whereas only 3 genes were differentially expressed when control patients with and without diabetes were compared. Furthermore, 286 genes were differentially expressed in idiopathic AC patients, and 61 genes were differentially expressed in diabetic AC patients. On gene clustering analysis, idiopathic AC was enriched with multiple structural and muscle-related pathways, such as muscle filament sliding, whereas diabetic AC included a greater number of hormonal and inflammatory signaling pathways, such as cellular response to corticotropin-releasing factor. Whole-transcriptome expression profiles demonstrate a fundamentally different underlying pathophysiology when comparing diabetic AC with idiopathic AC, suggesting that these conditions are distinct clinical entities. The new genes expressed explain the differences in the disease course and suggest new therapeutic targets that may lead to different treatment paradigms in these 2 subsets. [ABSTRACT FROM AUTHOR]

Studies on the effects of manipulation under anesthesia (MUA) for primary stiff shoulder when different comorbidities are present are lacking. Our aim was to assess how comorbidities influence the recovery speed and clinical outcomes after MUA. Between April 2013 and September 2018, 281 consecutive primary stiff shoulders in the frozen phase treated with MUA were included in this study. We investigated the comorbidities of patients and divided them into the control (n = 203), diabetes mellitus (DM) (n = 32), hyperlipidemia (n = 26), and thyroid disorder (n = 20) groups. The range of motion (ROM) and clinical scores for each group before MUA and 1 week, 6 weeks, and 3 months after MUA were comparatively analyzed. We identified the ROM recovery time after MUA and the responsiveness to MUA. Then, subjects were subdivided into early and late recovery groups based on their recovery time and into successful and nonsuccessful MUA groups based on their responsiveness to MUA. Significant improvements in ROM and clinical scores at 3 months after MUA were observed in all groups. Significant differences in ROM among the 4 groups were also observed during follow-up (P <.05). The DM group had significantly lower ROM values, even at 3 months after MUA, compared with the control group. The ROM recovery speed after MUA was slowest in the DM group, followed by the thyroid disorder, hyperlipidemia, and control groups. Most (90.6%) of the DM group experienced late recovery. The proportion of nonsuccessful MUA was higher in the DM and thyroid disorder groups than that in the control and hyperlipidemia groups (P =.004). During follow-up, there were no differences among groups regarding the visual analog scale, University of California at Los Angeles shoulder, and Constant scores. The ROM recovery speed and responsiveness to MUA for primary stiff shoulder were poorer for the DM and thyroid disorder groups than for the control group. In particular, compared with any other disease, outcomes were poorer when the comorbidity was DM. If patients have comorbidities, then they should be informed before MUA that the comorbidity could affect the outcomes of treatment. [ABSTRACT FROM AUTHOR]

There is no consensus on treatment for adhesive capsulitis of the shoulder. Physiotherapy is often used to increase range of motion but individuals may experience pain during mobilisation. The objective of this study was to determine whether rehabilitation under N 2 O for shoulder AC improved pain and function more than rehabilitation alone (with placebo gas). A randomised, 1:1 parallel arm, double-blind study in 4 university hospital outpatient centres. Adults with adhesive capsulitis for at least 3 months with intact cartilage were included. Participants were randomised in blocks of 4 and stratified by centre to receive 20 sessions of intensive physiotherapy over 10 days; the 10 morning sessions were performed with either nitrous oxide (intervention) or sham gas (placebo). Primary outcome: improvement in shoulder function at day 14 (D14) (Constant-Murley score). Seventy-five participants were included, and data from 69 were analysed: 37 in the placebo group and 32 in the intervention group. Improvements occurred in both groups after the intervention. No significant difference in the Constant-Murley score was found between groups at D14 (median score increase of 12.0, IQR 5.6; 19.5 points in placebo group vs. 13.7, 5.2; 18.2 in the N20 group, p = 0.78). Pain score during sessions reduced in the intervention group from the first to final session (−11.6, p = 0.053) but not for the placebo group (−4.2, p = 0.414). Seven serious adverse events were recorded, 4 in the intervention group and 3 in the placebo group, with 11 minor adverse events only in the intervention group (mostly shortness of breath). Nitrous oxide gas associated with intensive physiotherapy for shoulder adhesive capsulitis did not improve function, pain or quality of life more than physiotherapy alone. zHowever, pain experienced during physiotherapy sessions appeared lower. Clinical Trial registration number NCT01087229. [ABSTRACT FROM AUTHOR]

To evaluate the early clinical outcomes of ultrasound (US)-guided suprascapular nerve block (SSNB) using a proximal approach compared with a distal approach for outpatient treatment of adhesive capsulitis. Randomized controlled trial. Outpatient clinic Participants (N=47) with symptomatic adhesive capsulitis. Participants were randomly assigned to either US-guided SSNB using a proximal approach (n=23, proximal group) or a distal approach (n=24, distal group). The primary outcome measure was the visual analog scale (VAS) for pain at week 12. Secondary outcomes included the American Shoulder Elbow Surgeon's (ASES) score, University California Los Angeles score, Short Form-36 mental and physical component summaries, and range of motion. All patients completed clinical follow-up at 2, 6, and 12 weeks after treatment. On US images, depth and insertion angle of needle during injection were measured. The VAS significantly improved in both groups at week 12. After treatment, no significant differences were found in early clinical outcomes (weeks 2, 6, and 12) between groups (all P >.05), except that ASES at 2 weeks showed a significantly higher score in the distal group than in the proximal group (87.1±4.8 and 83.0±6.3, respectively; P =.014). The mean depth and insertion angle of needle was significantly lower (depth: 13.4±3.9 and 30.6±4.3 mm, respectively; P <.001; insertion angle: 19.6°±6.4° and 38.7°±5.8°; P <.001) in the proximal group than in the distal group. This study demonstrated that proximal approach of US-guided SSNB provided favorable short-term outcomes of pain and functional improvement and that outcomes were comparable to those of the distal approach in adhesive capsulitis. The suprascapular nerve was located more superficially and easily identified in the proximal approach, suggesting that this method might improve the accuracy of injection. [ABSTRACT FROM AUTHOR]

To correlate the Patient Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) score with pre-existing validated outcome scores, American Shoulder and Elbow Surgeons score (ASES), and Constant score (CS) in patients with idiopathic adhesive capsulitis (AC). Patients with a clinical diagnosis of idiopathic AC ("freezing" or "frozen" phases) who agreed to complete the ASES, CS, and PROMIS UE scores during their office visit were included in this study. Trained researchers performed the objective clinical assessments on the included patients. Responses to the 3 outcome scores were statistically analyzed and compared using Pearson correlation coefficients. Floor and ceiling effects were calculated. The final cohort included 100 patients with AC, of whom there were 72% female and 87% right hand dominant, with a mean age of 55 years. The PROMIS UE required fewer question responses (5.02 ± 1.84) compared with the fixed question burden with ASES (12) and CS (9). The mean outcome scores were 34.6 ± 2.5 (PROMIS UE), 55 ± 22 (ASES), and 51 ± 16 (CS). The PROMIS UE displayed an excellent correlation with both the ASES (r = 0.80, 95% confidence interval [0.72, 0.86], P <.001) and CS (r = 0.76, 95% confidence interval [0.67, 0.83], P <.001). Neither ceiling nor floor effects were present. The PROMIS UE displayed comparable efficacy to commonly used legacy outcome scores (ASES and CS) in AC. A lower question burden with the PROMIS UE carries potential for wider acceptability with the researchers and patients with shoulder pathology. [ABSTRACT FROM AUTHOR]

Adhesive Capsulitis (AC) is a common disabling musculoskeletal pain condition of unknown etiology related to the shoulder joint. Literature reported the restricted range of motion (ROM) and pain could be the result of myofascial trigger points (MTrPs) in the muscles of the shoulder girdle. Hence, the objective of this study was to assess the short-term effectiveness of MTrP dry needling (DN) in improving ROM, pain, pressure pain threshold (PPT), and physical disability among patients having AC. In a single group pre-post experimental study design, a total of 70 clinically diagnosed patients (both male & female, age group between 40 and 65 years) with AC were recruited from three multi-specialty hospitals. The informed consent forms were received from each patient before participating in the study. Each patient received DN for the MTrPs of shoulder girdle muscles for alternative six days. In addition to DN, each patient had received conventional physiotherapy for continuous twelve days which includes electrotherapy modalities and exercises. The pain intensity (visual analog scale), shoulder ROM (Goniometer), disability (shoulder pain and disability index) and PPT (Algometer) were the outcome measures assessed at the baseline and twelfth day of the intervention. There was a statistically significant (p < 0.05) improvement in shoulder ROM, pain intensity, shoulder disability, and PPT at the end of the twelve days of intervention as compared to baseline assessment. MTrPs-DN techniques may improve the pain, ROM, disability and PPT along with conventional physiotherapy management among patients with AC. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare the outcomes of arthroscopic rotator cuff repair (ARCR) in patients with preoperative stiffness to those without.Methods: A total of 135 patients were prospectively evaluated for 2 years after ARCR for small to medium sized rotator cuff tears at our institution. Patients were divided into stiff (<100° of passive forward flexion) and non-stiff cohorts. The stiff group underwent manipulation under anesthesia (MUA) before ARCR was performed. Outcomes were measured using visual analog scale (VAS), Constant Shoulder Score (CSS), and Oxford Shoulder Score (OSS) recorded at the preoperative, 6- , 12-, and 24-month time points. The results of ARCR between the cohorts were then compared.Results: A total of 123 out of 135 patients (91.1%) completed the follow-up (stiff n = 46, non-stiff n = 77). There were significant improvements in the mean CSS scores at 6 (mean, 59.87; P < .001) and 12 months (mean, 65.88; P = .021) in the stiff group. There were no significant differences detectable in the CSS and OSS scores between the stiff and non-stiff groups at 6, 12, and 24 months. However, the percentage of patients achieving minimal clinically important difference was significantly higher in the stiff group (97.8%) compared with the non-stiff group (75.3%; P = .001). The VAS scores, forward flexion, and strength in both groups were found to be comparable.Conclusions: The results of our study showed no significant differences in outcomes scores in patients with stiff shoulders who underwent MUA combined with ARCR compared with patients with non-stiff shoulders who underwent ARCR alone. Therefore, early surgical repair should be considered in patients with rotator cuff tears and concomitant shoulder stiffness.Level Of Evidence: Level II, prospective cohort study. [ABSTRACT FROM AUTHOR]

Hyperglycemia is the most commonly cited risk factor for adhesive capsulitis. However, no study has established whether fasting glucose levels within the normoglycemic range are associated with idiopathic adhesive capsulitis (IAC). This study hypothesized that increments of fasting glucose levels within the normoglycemic range would be linked to IAC. This study investigated any association between normoglycemic fasting glucose levels and IAC. This case-control study comprised a group of 151 patients with IAC without intrinsic shoulder lesions, extrinsic causes, or known metabolic risk factors such as diabetes, dyslipidemia, and thyroid dysfunction. The control group comprised 453 age- and sex-matched persons seeking general check-ups at the authors' health promotion center during the same period as the case group. Control subjects had normal shoulder function, no previous diagnosis of adhesive capsulitis or of metabolic disease, and no history of trauma or of shoulder surgery. The studied variables were body mass index, serum lipid profiles, thyroid hormone levels, fasting glucose levels, glycosylated hemoglobin A1c, and high-sensitivity C-reactive protein. Fasting glucose levels were studied as scale data and categorical data (<85, 85-89, 90-94, and 95-99 mg/dL). Multivariable conditional logistic regression analysis evaluated the matched sets of subjects. Odds ratios and 95% confidence intervals were determined for various potentially associated factors. Fasting glucose level, hypercholesterolemia, and high-sensitivity C-reactive protein were significantly associated with IAC (P ≤.030). Fasting glucose levels in the <85 mg/dL quartile were significantly negatively associated with IAC (P ≤.001). In contrast, fasting glucose levels in the 90-94 mg/dL quartile or higher were significantly positively associated with IAC (P ≤.034). IAC is positively associated with fasting glucose levels of 90-99 mg/dL, which are currently considered normoglycemic. [ABSTRACT FROM AUTHOR]

• Adhesive capsulitis of hip joint is uncommon disease usually affecting young adults. • Pain relief might be associated with arthrogram study. • Hormonal changes during pregnancy might have some effect on adhesive capsulitis. Adhesive capsulitis of the hip is a rare presenting pathology. History and physical examination are essential for diagnosis. Conservative management is the main line of treatment with surgical intervention preserved for resistant cases. The authors report a case of young female diagnosed with adhesive capsulitis of the hip with two pain free periods during pregnancy and after arthrogram. The relation between the pregnancy hormones and generalized laxity is well established. Animals studies proved the role of female hormones in treatment of adhesive capsulitis of the shoulder. Hip pain relief during pregnancy can raise the suspicion of adhesive capsulitis of the hip. Further investigations are needed to prove this relation. [ABSTRACT FROM AUTHOR]

To compare the efficacy of radial extracorporeal shock-wave therapy (rESWT) vs. an ultrasound-guided low-dose intra-articular steroid injection in pain reduction and functional improvement in diabetic patients with shoulder adhesive capsulitis (AC). This was a 2-parallel-group, active-control, assessor-blinded, randomized trial. We randomized 103 diabetic patients with shoulder AC to receive either 4 sessions of rESWT, 1 week apart (rESWT group, n = 52), or a single ultrasound-guided low-dose intra-articular steroid injection of 20 mg of triamcinolone acetonide (steroid group, n = 51). The primary outcome measure was functional improvement evaluated by the Quick Disabilities of the Arm, Shoulder and Hand (qDASH) score. Secondary outcome measures were pain evaluated by the visual analog scale score and shoulder range of motion (ROM). An assessor who was blinded to treatment assignment assessed both groups at baseline and at 4, 8, and 12 weeks thereafter. By 12 weeks, both groups demonstrated a significant reduction in the qDASH score and pain severity, as well as improvement in ROM. However, significantly improved function (qDASH score, 40.4 ± 12.9 vs. 50.5 ± 13.3; P <.001) and shoulder pain reduction (visual analog scale score, 1.6 ± 1.2 vs. 2.8 ± 1.7; P <.001) were found in the rESWT group vs. the steroid group. Similar improvement in shoulder ROM was observed in both groups. At short-term follow-up, rESWT was superior to a low-dose intra-articular steroid injection in improving function and pain in diabetic patients with shoulder AC. Therefore, rESWT might be considered a safe alternative to steroid injections in diabetic patients with shoulder AC. [ABSTRACT FROM AUTHOR]

To observe the clinical efficacy of different acupuncture modalities in the treatment of adhesive capsulitis a tthrough different clinical stages. Ninety patients of adhesive capsulitis weregraded in three different stages based on clinical presentations. Patients in painful stage were treated with silver needles once every 5to 7 days for two courses; patients in adhesive stage were given acupotomy treatment every 7 to 10 days for two courses; while patients in recovery stage were treated with acupuncture with warm needles by moxibustion on tendon knots, once a day 10 times in a course, for two courses of treatment. The disease scores were compared between all groups before and after the treatment, and clinical efficacy was evaluated after the treatment. The disease scores in patients of all three stages were higher after treatment, and the differences were statistically significant (all P < 0.05). Among 90 patients with adhesive capsulitis, 32 cases were clinically under controlled, 37 cases claimed remarkably effective, 18 were effective, and 3 ineffective cases, thus the total effective rate for this stage-based treatment is 96.7%. For adhesive capsulitis,different acupuncture modalities targeting patients in different clinical stages were feasible and effective, the disease scores of patients were significantly improved. [ABSTRACT FROM AUTHOR]

We report a case of a 48-year-old female who presented four months following a low-energy trauma with symptoms most consistent with adhesive capsulitis. An MRI demonstrated extensive patchy areas of intramuscular edema-like signal involving the lateral head of the deltoid with associated muscle atrophy, in keeping with a subacute denervation injury. She was diagnosed with quadrilateral space syndrome (QSS) and successfully treated with an fluoroscopic-guided corticosteroid injection. At her two-year follow-up, the patient had regained full function and had no lasting symptoms. Non-specific symptoms like ill-defined shoulder pain, decreased motor function, and weakness can delay the diagnosis and management of QSS. As there is a lack of a good diagnostic study, fluoroscopic-guided quadrilateral space block should be considered should the diagnosis fit a patient's clinical profile, as this has the potential to be both diagnostic and therapeutic. [ABSTRACT FROM AUTHOR]

Background: Anterior pericapsular muscles potentially contribute to active hip joint stability in walking by controlling anterior femoral translation in peak extension. Alternatively, these muscles could flex the hip and tension the anterior capsule to aid initiation of swing. Although never investigated, the location of Iliocapsularis and its extensive anterior hip capsule attachment imply a potential role in these functions. We hypothesised if these muscles contribute to control of femoral head translation (rather than hip flexion), their activation would decrease when peak hip extension is reduced during shorter stride walking.Research Questions: To provide the first description of iliocapsularis activity during walking and challenge the hypothesised roles of the anterior pericapsular hip muscles in gait by walking with shortened strides.Methods: Fifteen healthy volunteers walked with self-selected and shortened stride lengths. Electromyographic recordings were made from iliocapsularis, iliacus and anterior gluteus minimus with intramuscular electrodes, and rectus femoris with surface electrodes. Stride characteristics were measured using force sensors and 3D motion capture. Ensembles of burst activity profiles for each stride length were compared.Results: Iliocapsularis displayed a consistent EMG burst around toe-off (terminal hip extension) that peaked during early swing phase with self-selected strides. In shortened strides, iliocapsularis EMG increased during mid to late stance (p = 0.03), with no difference in other muscles. Iliocapsularis, iliacus and rectus femoris activity decreased during early stance (p < 0.01) in short strides, whereas gluteus minimus EMG increased (p = 0.03).Significance: Iliocapsularis displayed an EMG burst around toe-off during walking, and greater EMG during mid-late stance in short stride walking, which was not seen in other pericapsular muscles. Shortened strides increase the demand for active tensioning of the hip joint capsule in initial swing, and suggests a role for iliocapsularis during active hip flexion in pain free young individuals. [ABSTRACT FROM AUTHOR]

Hypothesis We hypothesized that a new method considering the humeral head would distinguish rotator cuff tears (RCTs) and osteoarthritis (OA) better than the critical shoulder angle (CSA). Methods A total of 1011 patients were tested in this study and divided into 4 groups: those with RCTs (n = 493), those with OA (n = 73), those with anterior instability (n = 361), and those with adhesive capsulitis (n = 84). The CSA and new radiologic parameters including the humeral head were measured in the true anterior-to-posterior view: the Y angle connecting the lower end of the glenoid (LG), the center of the humeral head (CH), and the upper end of the glenoid (UG); the G angle connecting UG, CH, and the lateral tip of the acromion; the YG angle connecting LG, CH, and the lateral tip of the acromion; and the R angle connecting UG, LG, and CH. Results The CSA and G angle were the largest in the RCT group (34.2° and 70.4°, respectively; P <.001) and the smallest in the OA group (29.8° and 61.7°, respectively; P <.001). The Y angle was the largest in the OA group (82.8°, P <.001). The R angle in the RCT group (52.9°) was significantly larger than that in the OA group, which was the smallest among the groups (48.0°; P <.001). The CSA was correlated with the G and YG angles in the RCT group, whereas the CSA was correlated with the Y, G, and R angles in the OA group (P <.05). The CSA showed the highest correlation with the size of RCTs (correlation coefficient = 0.138). Conclusion The Y, G, and R angles reflected the lesions of RCTs or OA. The CSA showed good correlations with the new radiologic parameters, and it had the highest correlation coefficient with the size of RCTs. [ABSTRACT FROM AUTHOR]

Abstract Objective This systematic review evaluated the effectiveness of nonsurgical interventions for managing adhesive capsulitis (AC) in patients with diabetes on pain, function, and range of motion. Data Sources MEDLINE and other databases were searched for studies published in the last 20 years. Study Selection Randomized controlled trials (RCTs) that assessed AC in people with diabetes and implemented 1 or a combination of physiotherapeutic interventions, corticosteroids, and manipulation under anesthesia (MUA) were eligible for inclusion. Data Extraction The Cochrane Risk of Bias was used by 2 independent raters who met to achieve consensus. The quality of trials was assessed using Grading of Recommendations, Assessment, Development and Evaluations. Data extracted from the eligible studies included study design, participant characteristics and duration of symptoms, type of intervention, outcome measures, follow-up intervals, and research findings. Data Synthesis Because of the lack of similar interventions, a narrative synthesis was conducted, and meta-analyses were not performed. The effect sizes or between-group differences of the interventions were reported. A total of 8 RCTs met the inclusion criteria: 4 addressed physiotherapeutic interventions, 3 corticosteroid injections, and 1 MUA. The effect sizes for physiotherapeutic interventions were 0.8-2.0, 0.9-2.0, and 1.0 for ROM, function, and pain, respectively, with the largest effect size (2.0) being reported for joint mobilization plus exercises. The effect sizes for corticosteroids were 0.2-0.5 and 0.1 for ROM and pain. The between-group improvement for MUA was 5.6 points on Constant Shoulder Score. Conclusion Low-quality evidence suggests large effects of joint mobilization plus exercises on AC in people with diabetes, although confidence in this conclusion is limited due to the high risk of bias. Even weaker support was available for corticosteroid and MUA. Future high-quality RCTs are needed to determine the best intervention for managing AC in patients with diabetes. [ABSTRACT FROM AUTHOR]

Highlights • The best way to treat adhesive capsulitis is not known. • Intensive physical therapy may improve range of motion but may increase pain. • The use of analgesic gas during rehabilitation may help with the treatment. • A multicentre randomized clinical trial is designed to test the effectiveness of gas associated with rehabilitation for adhesive capsulitis. Abstract Background There is little evidence regarding the best way to treat adhesive capsulitis. Physical therapy can reduce pain and improve function and range of motion. However, we lack clear indications on the regimen, techniques or intensity of physical therapy to achieve better results. Intensive physical therapy seems to be confined to the later stages of adhesive capsulitis (chronic stage) given that rehabilitation-induced pain could worsen the outcomes. Here we describe a protocol for a study comparing the efficacy of a standardized program of intensive mobilization under analgesic gas to a similar program under placebo gas and questioning the impact of pain. Method/Design A randomized, double-blind, multicenter study — the MEOPA Trial — was designed to include adults with strictly defined clinical adhesive capsulitis for a 14-day intensive physical rehabilitation program under an equimolar mixture of oxygen and nitrous oxide or sham gas administration. Efficacy will be assessed by the Constant-Murley score. Data for secondary criteria including pain, disability, quality of life and perceived efficacy by the patient or physiotherapist will be collected over 6 months. Discussion This randomized controlled trial has been designed to test the effectiveness of intensive physical therapy under a simple and safe analgesic method. This study will also address the effect of pain during rehabilitation in adhesive capsulitis. Furthermore, results from the 6-month multidimensional follow-up of painful mobilization for this condition could be extrapolated to other musculoskeletal conditions. Trial registration ClinicalTrials.gov No. NCT01087229. [ABSTRACT FROM AUTHOR]

L'arthro-distension est actuellement indiquée dans le traitement de la capsulite rétractile en phase raide et douloureuse, en cas d'insuffisance d'une à deux infiltrations intra articulaires gléno-humérales. Elle consiste en une injection intra articulaire gléno-humérale sous pression associée à un corticoïde, sous repérage clinique, échographique ou radioscopique. Elle doit être couplée à une mobilisation immédiate alors que l'épaule est encore sous l'effet de l'anesthésique. Une kinésithérapie régulière complète la séquence artho-distension-mobilisation. Cette modalité thérapeutique est utilisée en pratique pour accélérer la récupération algofonctionnelle. Joint distension is currently indicated in the treatment of adhesive capsulitis of the shoulder in the stiff and painful phase, in the event of insufficiency of one or two intra articular glenohumeral infiltrations. It consists of an intra articular glenohumeral injection under pressure associated with corticosteroid, under clinical, ultrasound or radioscopic guidance. It must be coupled with immediate mobilization while the shoulder is still under the effect of the anesthetic. Regular physiotherapy should follox the joint distension-mobilization sequence. This therapeutic modality is used in practice to accelerate algofunctional recovery. [ABSTRACT FROM AUTHOR]

Background The etiology of frozen shoulder (FS) is unclear. Accordingly, this study used a label-free quantitative shotgun proteomic approach to elucidate the pathogenesis of FS based on protein expression levels. Methods Tissue samples from the rotator interval (RI), middle glenohumeral ligament (MGHL), and anterior-inferior glenohumeral ligament (IGHL) were collected from 12 FSs with severe stiffness and 7 shoulders with a rotator cuff tear (RCT) as controls. Protein mixtures were digested and analyzed by nano-liquid chromatography/electrospray ionization–tandem mass spectrometry. Relative protein expression levels were calculated by the signal intensity of identified peptide ions on mass spectra. Differentially expressed proteins between FS and RCT samples were evaluated by a gene enrichment analysis using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes. Results We identified 1594 proteins, 1358 of which were expressed in all 6 tissue groups. We detected more upregulated proteins in the upper (RI and MGHL) FS groups and the lower (IGHL) RCT group than in the comparative groups, respectively. Various proteins with functions in tissue repair, collagen metabolism and fibrillation, cell–cell and cell–matrix adhesion, blood coagulation, and the immune response were expressed more highly in the RI and MGHL FS groups than in the RCT group. Proteins with functions in phagocytosis, glutathione metabolism, retinoid metabolism, and cholesterol metabolism were expressed more highly in the IGHL RCT group than in the FS group. Conclusions The pathophysiology of FS differs between the upper and lower parts of the joint capsule. Different treatment strategies for FS may be appropriate, depending on the location. [ABSTRACT FROM AUTHOR]

Abstract Aim of the work To evaluate the efficacy of intra-articular steroid injection of the shoulder joint with exercises in the management of patients with adhesive capsulitis and to compare glenohumeral (GH) versus subacromial subdeltoid (SASD) ultrasound-guided approaches. Patients and methods Forty patients with adhesive capsulitis were randomly divided into 2 groups according to injection approach. Patients received ultrasound-guided intra-articular injection methylprednisolone acetate (40 mg) and 1 ml 2% lidocaine followed by exercise for 12 weeks. Visual analog scale (VAS) for pain, the shoulder pain and disability index (SPADI) and active range of motion (ROM) were assessed before and 12 weeks post-injection. Results The mean age of the patients was 47.3 ± 8.7 years with 12 females and 8 males in each group. After injection, there was a significant improvement of pain (VAS) and SPADI in both groups (p < 0.001). Before injection, SASD bursitis was present in 18 (45%), GH joint effusion in 14 (35%), rotator cuff tendinopathy in 6 (15%), bursitis with effusion in 1 (2.5%) and with supraspinatus tendon calcification in another (2.5%). Both groups significantly equally improved regarding to ROM compared to before injection. Post-injection, the SPADI significantly improved in the SASD group compared to GH; with remarkable improvement in the joint extension, internal and external rotation (p < 0.001). Conclusion Intrarticular steroid injection of the shoulder joint followed by exercises in patients with adhesive capsulitis decreases pain, improves function and ROM with a more favorable response by the GH approach. Ultrasound-guided injection is an accurate, easy and cost-effective approach. [ABSTRACT FROM AUTHOR]

Background Adhesive capsulitis is characterized by a gradual, painful loss of shoulder motion. This study evaluated patient variables significantly associated with developing adhesive capsulitis compared with a sex-matched control group without adhesive capsulitis. We also sought to determine those factors associated with adhesive capsulitis patients requiring surgical intervention. Methods All patients presenting to our hospital with adhesive capsulitis between 2004 and 2014 were identified. Demographic characteristics were collected, and a sex-matched control group was randomly generated from the electronic medical record and used for comparison. Patients who underwent surgical intervention for adhesive capsulitis were also identified, and factors associated with surgical intervention were identified with logistic regression analysis. Results Included were 2190 adhesive capsulitis patients with a normal age distribution of 56.4 ± 13.1 years. Most were classified as overweight (30.7%) or obese (27.0%). Compared with controls, adhesive capsulitis patients were more likely to be younger (<50 vs. ≥50 years; odds ratio [OR], 0.69; P  < .001), obese (OR, 1.26; P  < .001), black/African American (OR, 1.71; P  < .001), Hispanic/Latino (OR, 4.85; P  < .001), or diabetic (OR, 1.12; P  < .001) and less likely to have hypertension (OR, 0.93; P  = .006). Overall, 361 subsequently underwent surgical intervention. Older patients, racial minorities, and government-sponsored/uninsured patients were significantly less likely to have surgery for adhesive capsulitis ( P  < .01), whereas workers' compensation patients were 8 times more likely to receive surgery compared with privately insured patients ( P  < .001). Conclusions Obesity and diabetes were significantly associated with adhesive capsulitis and should be considered modifiable patient factors. Additionally, younger patients and racial minorities were also significantly more likely to be diagnosed with adhesive capsulitis. Younger, white, and workers' compensation patients were more likely to receive surgery, whereas patients with government-sponsored or no insurance status were more likely to receive nonoperative treatment. [ABSTRACT FROM AUTHOR]

Background Arthroscopic capsular release (ACR) and hydrodilatation (HD) have been developed for the management of frozen shoulder refractory to conservative treatment. To date no randomized trial has directly compared the efficacy of both interventions. The aim of this trial was to determine whether the Oxford Shoulder Score (OSS) differs between patients with frozen shoulder randomized to treatment with ACR or HD. Methods Patients presenting with severe idiopathic frozen shoulder deemed suitable for surgical intervention by a consultant shoulder surgeon were randomized to ACR or HD. The primary outcome measure was OSS at 6 months, with secondary outcomes measures of the EuroQol-5D visual analog scale, external rotation, complications, and crossover rate also recorded. Results Between June 2013 and December 2016, 50 patients were randomized to HD or ACR. The average age of the HD and ACR cohorts was 55.2 and 52.6 years, respectively ( P  = .36). At 6 months after the intervention, 20 patients were available for follow-up in the HD cohort and 19 in the ACR cohort. Both groups demonstrated significant improvements in OSS from baseline, but the OSS was significantly higher in the ACR cohort than the HD cohort (43.8 vs. 38.5, P  = .023). The OSS was noted to improve rapidly after the intervention, with 75% of improvement in OSS noted at 6 weeks after surgery in both groups. Conclusions Patients randomized to ACR reported a significantly higher OSS at 6 months than those randomized to HD. Both groups, however, showed a significant improvement. [ABSTRACT FROM AUTHOR]

Résumé Le traitement de la capsulite rétractile dépend de la sévérité des symptômes, de sa phase d’évolution, de sa physiopathologie et de son type (idiopathique ou secondaire). À ce jour, le niveau de preuve d’efficacité des différentes thérapeutiques reste faible. À la phase initiale ou « phase douloureuse » ou phase « chaude », la plainte principale des patients est centrée sur la douleur. Il s’agit donc de soulager le patient et de prévenir la survenue de l’enraidissement. On prescrit en première intention des antalgiques de classe 1 et 2 associés ou non aux AINS. En cas d’échec, on propose des infiltrations intra-articulaires de corticoïdes qui ont une efficacité sur la douleur et la mobilité à court terme. En phase douloureuse et enraidie, les objectifs thérapeutiques sont centrés sur la récupération des mobilités en plus de la diminution des douleurs. Les infiltrations intra-articulaires gléno-humérales (IAGH) de corticoïdes seront proposées en 2 e intention, en l’absence de contre-indication, lorsque la douleur est invalidante et présente un caractère inflammatoire. Elles ont fait leur preuve d’efficacité à court terme sur la douleur et la mobilité et à moyen terme sur la mobilité par rapport aux traitements per os, à la rééducation et au placebo. La place des corticoïdes per os n’est pas justifiée, du fait de leur absence de supériorité et de leurs effets secondaires, excepté en cas de contre-indication aux infiltrations. Il reste à déterminer si la précocité du diagnostic, grâce notamment à l’IRM, ainsi que la précocité des infiltrations permet de limiter la durée d’évolution de la maladie. En cas d’échec des IAGH et lorsque l’enraidissement prédomine, une série d’arthrodistensions associée à une mobilisation intensive du membre supérieur peut être proposée. À tous ces stades, la place de la rééducation est primordiale pour récupérer les mobilités. Aucune étude n’a retrouvé d’effets délétères des exercices physiques adaptés dans la capsulite, quel que soit son stade. Enfin, de nouveaux traitements sont actuellement à l’étude et semblent prometteurs notamment comme alternative aux solutions chirurgicales en cas d’évolution vers une capsulite réfractaire telle que la radioembolisation artérielle et l’infiltration intra articulaire d’acide hyaluronique entre autres. Management of adhesive capsulitis of the shoulder depends on its severity, its stage, its physiopathology and its nature (idiopathic or secondary adhesive capsulitis). Today, there is no high level of evidence for its treatment's efficiency. During the first stage, called “freezing phase”, the main symptom is pain. The urgency is to relieve the pain and to prevent the shoulder from stiffness. The first treatment is painkiller with or without NSAID. If the patient is not enough relieved, we suggest intra-articular injection of corticosteroids which are efficient in reducing pain and gaining articular mobility in the short term. During stage two, called “frozen shoulder”, the objectives will be to improve articular mobility and to relieve pain. We suggest intra articular injection of corticosteroids in second line therapy, if there is no contraindication, when pain is intense and inflammatory. It showed to relieve pain and to improve mobility in the short term and to improve articular mobility in the mid term, in comparison to oral treatment, placebo and physical exercices. There is no place for oral corticosteroids, as it showed no superiority and they have many side effects, except in case of contra indication to intra-articular injections of corticosteroids. We still have to determinate if the earliness of diagnostic (thanks to the MRI) and the earliness of intra-articular injection could reduce the disease evolution. If the patient is not enough relieved and stiffness is important, we can propose capsular distension followed by intensive mobilization. At every stage, rehabilitation is very important in order to gain articular mobility. No study shows side effects of physical exercises. Several other treatments are under development and show promising results such as radio arterial embolization, intra-articular injection of hyaluronic acid, etc. These treatments could be really interesting in case of chronic stiff capsulitis as an alternative to surgery. [ABSTRACT FROM AUTHOR]

Case studies are presented of 63, 33and 54-year-old man and woman presented with the injury of shoulder rotator cuff tendinitis, and includes magnetic resonance imaging showed limited forward flexion and reduced strength; supraspinatus articular-sided tear; and treatment for the same.

Introduction Frozen shoulder, also called adhesive capsulitis is an obstinate disease involving severe shoulder pain and limitation of range of motion. The aim of this study is to establish a protocol to carry out research which evaluates the effectiveness, safety, and economic efficiency of Chuna manual therapy on frozen shoulder by combining treatments with acupuncture, cupping, and self-exercise. Methods/design A multicenter, randomized, patient-assessor blind, parallel clinical trial will be carried out. Eligible subjects will be allocated to one of two groups with randomized sampling. The experimental group will receive acupuncture, cupping and real Chuna manual therapy, and control group will receive acupuncture, cupping and sham Chuna manual therapy. During the 8-weeks treatment period, effectiveness and safety evaluations will be carried out and evaluation of satisfaction and economic efficiency will be performed at the end of the trial (20-week). The primary outcome is shoulder pain and disability index. The secondary outcomes are 100 mm pain VAS, passive range of motion of the shoulder, Korean shoulder scoring system score, quality of life score, use of relief medicine, evaluation of patient satisfaction, safety, and economic efficiency. Discussion/conclusion This is the first trial evaluating the effectiveness, safety, and economic efficiency of Chuna manual therapy for frozen shoulder. The results of this trial will be used to underpin basis for the use of Chuna manual therapy for pain relief, improvement in range of motion and shoulder joint function for people with frozen shoulder. Trial registration Clinical Research Information Service Registration Number is KCT0002300. Registered on 6 April 2017. [ABSTRACT FROM AUTHOR]

Background Shoulder stiffness is a disease manifested by pain, limited range of motion, and functional disability. The inflammatory and fibrosis processes play a substantial role in the pathogenesis of shoulder stiffness. The CB1 receptor has been recognized to mediate the processes of pathologic fibrosis. This study investigated the role of the CB1 pathway in pathogenesis of rotator cuff lesions with shoulder stiffness. Methods All of the patients undergoing repair surgery for rotator cuff lesions were recruited and subcategorized into subjects with and without shoulder stiffness. Reverse transcription-polymerase chain reaction assay was used to evaluate the expression level of CB1 and interleukin 1β (IL-1β) in the subacromial bursae, and enzyme-linked immunosorbent assay was used to measure the concentration of CB1 and IL-1β in the subacromial fluid. Tenocytes treated with CB1 agonists and antagonists were also studied for the relationship of CB1 and the inflammatory cytokine IL-1β. Results The patients with shoulder stiffness had higher messenger RNA (mRNA) expression ( P  = .040) and immunohistochemistry staining ( P  < .001) of CB1 in the subacromial bursa and higher CB1 concentration in the subacromial fluid ( P  = .008). Tenocytes treated with the CB1 agonist WIN 55,212-2 and antagonist AM251 showed increased expression of IL-1β mRNA ( P  = .049) and suppressed expression of IL-1β mRNA ( P  = .001), respectively. Discussion The CB1 pathway is involved in the pathogenesis of shoulder stiffness. It may be a promising target for the treatment of rotator cuff lesions with shoulder stiffness. [ABSTRACT FROM AUTHOR]

Background The global range of motion of the arm is the result of a coordinated motion of the shoulder complex including glenohumeral (GH), scapulothoracic, sternoclavicular and acromioclavicular joints. Methods This study is a non-systematic review of kinematic patterns in degenerated shoulders. It is a based on our own research on the kinematics of the shoulder complex and clinical experience. Results For patients with subacromial impingement syndrome without rotator-cuff tears, most kinematic studies showed a small superior humeral translation relative to the glenoid and decreased scapular lateral rotation and posterior tilt. These scapular kinematic modifications could decrease the subacromial space and favor rotator-cuff tendon injury. For patients with shoulder pain and restricted mobility, the studies showed a significant increase in scapular lateral rotation generally seen as a compensation mechanism of GH decreased range of motion. For patients with multidirectional GH instability, the studies found an antero-inferior decentering of the humeral head, decreased scapular lateral rotation and increased scapular internal rotation. Conclusion The clinical or instrumented assessment of the shoulder complex with a degenerative pathology must include the analysis of scapula-clavicle and trunk movements complementing the GH assessment. Depending on the individual clinical case, scapular dyskinesis could be the cause or the consequence of the shoulder degenerative pathology. For most degenerative shoulder pathologies, the rehabilitation program should take into account the whole shoulder complex and include first a scapular and trunk postural-correcting strategy, then scapulothoracic muscle rehabilitation (especially serratus anterior and trapezius inferior and medium parts) and finally neuromotor techniques to recover appropriate upper-limb kinematic schemas for daily and/or sports activities. [ABSTRACT FROM AUTHOR]

• Most functional impairments the patients experience improve in the short-term. • Shoulder rotation at 90° abduction continues to improve in the long-term. • Proprioception does not change in the clinical course of frozen shoulder. • Direct longitudinal correlations between functional impairments were established. Contradictory evidence exists regarding the clinical course of frozen shoulder (FS). 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. 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. 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). 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. [ABSTRACT FROM AUTHOR]

Background Previous studies have shown no correlation between adhesive capsulitis and hemoglobin A 1c (HbA 1c ). However, HbA 1c is only a measure of short-term blood sugar control. We created a previously nonvalidated variable, cumulative HbA 1c , that uses HbA 1c values over time to estimate the total disease burden a single individual experiences over a period. In this study, we aimed to evaluate whether a correlation exists between cumulative HbA 1c levels in diabetic patients and the prevalence of frozen shoulder. We hypothesized that poor long-term glucose control would be correlated with increased incidence of adhesive capsulitis. Methods A retrospective analysis at a single institution was performed. Data from all patients from a single institution with any HbA 1c values were collected. A total of 24,417 patients met the inclusion criteria. A variable was created establishing the cumulative magnitude of abnormal HbA 1c values over time, termed “cumulative HbA 1c .” Logistic regression analysis was performed to determine whether long-term glucose control was predictive of the development of adhesive capsulitis. Results Cumulative HbA 1c was positively associated with adhesive capsulitis (7.6 × 10 –5 ) (ie, odds ratio of 1.000076). The effect size of cumulative HbA 1c on adhesive capsulitis was significant; for each unit of time that the HbA 1c level was greater than 7, there was a 2.77% increase in the risk of adhesive capsulitis. Discussion Cumulative HbA 1c was associated with an increased incidence of adhesive capsulitis. This finding suggests that the effects of diabetes that predispose patients to the development of adhesive capsulitis are dose dependent. Patients with worse blood sugar control over a longer period are at an increased risk of the development of adhesive capsulitis. [ABSTRACT FROM AUTHOR]

Objective This study intended to determine the extent to which Ultrasound could add to the effects of exercise and manual therapy in the rehabilitation treatment of primary adhesive capsulitis. Design A pilot double blind randomized clinical trial was carried out on 50 patients suffering from primary adhesive capsulitis. Intervention included continuous 3 MHz, 1.5 w/cm 2 Ultrasound, applied for the first group and sham Ultrasound for the second group. In addition specific stretching and strengthening exercises as well as glenohumeral joint mobilization were delivered to both groups. Pain (VAS), functional ability (using Oxford Shoulder Score) and shoulder range of motion were assessed at the baseline, after 10 sessions of treatment, and at 3 months follow-up. An intention to treat Mixed ANOVA analysis was performed to explore the interaction effects of time and group on outcome measures. Results No significant interaction effect of time and group was seen on pain, function and Range of Motion (p > 0.05), meaning that the amount of improvement in all outcome measures were alike in the two groups. Conclusion Applying continuous Ultrasound along with a regimen of semi supervised exercise and mobilization in patients with primary adhesive capsulitis did not have any additional effect to the placebo Ultrasound, on outcome measures. Larger scale studies are needed to confirm the findings. [ABSTRACT FROM AUTHOR]

Background Idiopathic adhesive capsulitis is a common condition resulting in painful multidirectional restriction of motion. Adhesive capsulitis may inhibit shoulder activity level, but this relationship has not been previously studied. This study tested the hypothesis that patients with idiopathic adhesive capsulitis have lower shoulder activity than sex- and age-matched controls. Methods Seventy-two eligible patients (37 men and 35 women) with idiopathic adhesive capsulitis completed a validated shoulder activity scale that was compared with sex- and age-matched norms from a healthy population with no history of shoulder disorders. The association of shoulder activity level with patient age, sex, and American Shoulder and Elbow Surgeons and Simple Shoulder Test (SST) scores was evaluated. Results Overall, 58% of patients actually had higher shoulder activity scores than sex- and age-matched controls. Among patients aged 51 to 70 years, 68% of patients (73% of men and 63% of women) demonstrated higher Shoulder Activity Scale scores compared with controls. The activity level was higher among all patients aged 51 to 70 years compared with controls (10.3 ± 1.48 vs. 8 ± 0.52, P  = .0067). The difference was significant for men in this age group (12.2 ± 1.7 vs. 9 ± 0.75, P  = .0042). There was a statistically significant positive correlation of the Shoulder Activity Scale score with the SST score ( r  = 0.31, P  = .009). Conclusion Patients with idiopathic adhesive capsulitis do not have a lower shoulder activity level than sex- and age-matched controls, and older men may actually have a higher level of shoulder activity than controls. Shoulder activity level is correlated with the SST score in patients with idiopathic adhesive capsulitis. [ABSTRACT FROM AUTHOR]

Purpose To investigate non-contrast MRI findings of clinical adhesive capsulitis. Methods 31 non-contrast, non-arthrographic, shoulder MRIs were evaluated for coracohumeral ligament thickness, rotator interval infiltration, and axillary recess thickening/edema. Results In detection of adhesive capsulitis, sensitivity is 76.7% and specificity is 53.3% for coracohumeral ligament thickening, sensitivity is 66.7% and specificity is 55.2% for coracohumeral ligament thickening and rotator interval infiltration, and sensitivity is 23.3% and specificity is 86.7% for coracohumeral ligament thickening, rotator interval infiltration, and axillary recess thickening/edema. Conclusions Adhesive capsulitis can be accurately diagnosed on non-contrast MRI shoulder examinations with appropriate clinical criteria without direct MR arthrography. [ABSTRACT FROM AUTHOR]