Search

Background/Objectives: To update the perspectives of the association between diabetes (DM) and adhesive capsulitis (AC). Methods: Our findings were summarized in a narrative review. We searched PubMed, Embase, and Consensus databases, using keywords such as "diabetes", "adhesive capsulitis", and "frozen shoulder", for articles published from January 2015 to June 2024, covering both type 1 and type 2 DM. Results: After compiling relevant articles on DM-related AC published since 2015, we found that most studies show an increased prevalence of AC in DM patients, ranging from 3 to 10 times. A longer duration of DM is a risk factor for AC. Whether T1DM or prolonged insulin use will increase the risk of AC is still controversial. Poor blood sugar control seems to increase the risk of AC. Recent studies also show a correlation between blood sugar levels and the prevalence of AC. Cytokines, such as IL-6, IL-8, TNF-α, VEGF, and AGEs, related to inflammation and fibrosis may contribute to the pathophysiological processes of AC. Conclusions: Recent research findings have revealed new perspectives divergent from past notions, while also presenting some topics worthy of exploration. Due the close relationship between DM and AC, clinicians need to be alert to the presence of AC, especially early stage, in DM cases, and control the blood glucose level to reduce the risk of AC. Further research is still needed to provide better prevention and management for DM patients with AC. [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]

Background: The shoulder complex with its varied pathology responds differently from patient to patient and so, the best option for progression is a choice of rehabilitation. In the present post-COVID scenario, many patients are referred to acute and sub-acute shoulder pain and dysfunction. It is very difficult to predict the outcome of therapy. Some patients recover even without any modalities. Recurrent or adverse symptoms are also possible. Gender, other demographic features, physiological response, and progressive outcome need to be considered in rehabilitation. This study is intended to evaluate the short-term effects of hydrotherapy post-intra-articular injections of shoulder dysfunctions. Aims and objectives: To evaluate the effectiveness of hydrotherapy during early rehabilitation of individuals who have undergone intra-articular injections of shoulder joint on pain and function. Materials and methods: In this prospective study, we have studied a total of 59 cases within the age group of 40–70 years with idiopathic frozen shoulder, acromio-clavicular joint dysfunction, and grade-1 untreated rotator cuff injuries. Group A patients were treated with conventional shoulder exercises and group B patients were treated in a hydrotherapy pool. The chief aim was to obtain earlier pain relief with controlled movement patterns and earlier relief from functional disability. The Constant-Murley score (CMS–100 points scale) composing pain and functional parameters was the outcome measure. Results: After confounding all the demographic factors, it was found that the experimental group B treated by hydrotherapy revealed a statistically extremely significant difference (p value < 0.0001) at the end of the first week as compared to the conventional group. The treatment protocol was continued for 5 weeks. More than 90% of patients in the hydrotherapy group felt it easier and exercise participation progression was best. Better progression and improvement of shoulder function were achieved in the hydrotherapy group compared to the conventional group. Conclusion: From this study, we conclude that hydrotherapy during early management of shoulder dysfunctions post-intra-articular injections is safer and provides excellent relief from pain as early as the first week. Functional progression is better and avoids complications related to mobilization. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions To estimate the association between newly diagnosed frozen shoulder and a subsequent diagnosis of type 2 diabetes in primary care.We conducted an age‐, gender‐ and practice‐matched cohort study in UK primary care electronic medical records containing 31 226 adults diagnosed with frozen shoulder, matched to 31 226 without frozen shoulder. Patients with pre‐existing diabetes were excluded. Variables were identified using established Read codes. A hazard ratio (HR) for the association between incident frozen shoulder and a subsequent type 2 diabetes diagnosis was estimated using shared frailty Cox regression, adjusted for age and gender. To determine whether the association could be explained by increased testing for type 2 diabetes based on other risk factors, a secondary analysis involved re‐running the Cox model adjusting for the mean number of consultations per year, hyperlipidaemia, hypertension, obesity, thyroid dysfunction, ethnicity, deprivation, age, and gender.Participants with frozen shoulder were more likely to be diagnosed with type 2 diabetes (1559 out of 31 226 patients [5%]) than participants without frozen shoulder (88 out of 31 226 patients [0.28%]). The HR for a diagnosis of type 2 diabetes in participants with frozen shoulder versus people without frozen shoulder was 19.4 (95% confidence interval [CI] 15.6–24.0). The secondary analysis, adjusting for other factors, produced similar results: HR 20.0 (95% CI 16.0–25.0).People who have been newly diagnosed with frozen shoulder are more likely to be diagnosed with type 2 diabetes in the following 15.8 years. The value of screening patients presenting with frozen shoulder for type 2 diabetes at presentation, alongside more established risk factors, should be considered in future research. [ABSTRACT FROM AUTHOR]

Objective: Physiotherapists (PTs) play a crucial role in managing individuals with Frozen Shoulder (FS), frequently being the first healthcare professionals involved in the treatment of this condition. Aim: This study aimed to compare the beliefs, expectations, and perspectives of individuals with FS with the knowledge, skills, and strategies of PTs, highlighting similarities and differences. Method: This study adhered to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). From May 1st to August 1st, 2023, a two-part survey was conducted involving PTs and individuals diagnosed with FS. The survey focused on comparing key areas such as clinical assessment, patient education, treatment expectations, and the psychological aspects of the patient-clinician relationship. Results: A total of 501 PTs and 110 subjects with FS participated in the survey. Most PTs showed proficiency in FS pathoanatomical conditions and were also attentive to psychological aspects (88.4%), describing the pathology evolution in three or two stages (68.2%). They also highlighted the importance of patient education (89.6%) and recognized the potential benefits of a multiprofessional collaboration in managing FS (82.2%). Reassurance was reported as a priority by 32.3% of PTs. Subjects with FS expressed a preference for PTs who are both expert and empathetic (73.6%). Regarding their understanding of FS, 29.09% of subjects reported receiving a three-phase explanation, while 26.36% felt inadequately informed. Nearly half of the subjects (49.09%) anticipated being managed independently by a PT, with 93.64% prioritizing the improvement of their range of motion. Conclusion: This study revealed a general agreement between subjects with FS and PTs regarding aspects of the therapeutic relationship, patient education, pathology management, compliance and motivation strategies, and pain management preferences. However, significant differences emerged concerning the perception of physiotherapy effectiveness, primary treatment goals, subjects' priorities, and the importance of psychological assessment. Impact statement: Physiotherapists and subjects suffering from frozen shoulder showed considerable differences in their perception of physiotherapy effectiveness, primary treatment goals, subjects' priorities, and the importance of psychological assessment. It is crucial for physiotherapists to delve deeper into the psychological dimension of subjects with FS in order to fully understand their needs and expectations. By incorporating individuals' priorities and psychological assessments into a multiprofessional care approach, physiotherapists can improve treatment adherence and outcomes, ultimately increasing the overall patient satisfaction. [ABSTRACT FROM AUTHOR]

Objective: To systematically review the clinical efficacy (pain, function, quality of life) and safety of platelet-rich plasma (PRP) in the treatment of frozen shoulder through meta-analysis, and provide evidence-based medical evidence for the effectiveness of PRP in the treatment of frozen shoulder. Methods: A search was conducted on international databases (Pubmed, Web of science, Embase) and Chinese databases (CNKI, Wanfang, VIP) to search the clinical studies on the efficacy of platelet-rich plasma in treating frozen shoulder (adhesive capsulitis/periarthritis/50 shoulder) and their corresponding references published from inception until January 2024. Thoroughly excluded literature not meeting the predetermined inclusion criteria, extracted relevant data from the literature, and input it into RevMan5.4 for meta-analysis. Results: This study ultimately included 14 RCTs, with a total of 1024 patients. The results showed that PRP has significant advantages compared with control groups in VAS (mean difference (MD) =-0.38, 95% confidence interval(CI)(-0.73, -0.03), P = 0.03), UCLA (MD = 3.31, 95% CI (1.02,5.60),P = 0.005), DASH (MD = -4.94,95% CI (-9.34, -0.53),P = 0.03), SPADI (SPADI Total: MD =-16.87, 95% CI (-22.84, -10.91), P < 0.00001; SPADI Pain: MD =-5.38, 95% CI (-7.80, -2.97), P < 0.0001; SPADI Disability: MD =-11.00, 95% CI (-13.61,-8.39), P < 0.00001), and the active and passive Range of Motion (active flexion: MD = 12.70, 95% CI (7.44, 17.95), P < 0.00001; passive flexion: MD = 9.47, 95% CI(3.80, 15.14), P = 0.001; active extension: MD = 3.45, 95% CI(2.39, 4.50), P < 0.00001; active abduction: MD = 13.54, 95% CI(8.42, 18.67), P < 0.00001; passive abduction: MD = 14.26, 95% CI (5.97, 22.56), P = 0.0008; active internal rotation: MD = 5.16, 95% CI (1.84, 8.48), P = 0.002; passive internal rotation: MD = 3.65, 95% CI(1.15, 6.15), P = 0.004; active external rotation: MD = 10.50, 95% CI(5.47, 15.53), P < 0.0001; passive external rotation: MD = 6.00, 95% CI (1.82, 10.19), P = 0.005) except passive extension (MD = 2.25, 95% CI (-0.77, 5.28), P = 0.14). In terms of safety, most studies reported no adverse effects, and only one study reported common complications of joint puncture such as swelling and pain after treatment in both PRP and control groups. Previous studies have shown a risk of osteonecrosis caused by corticosteroids. Therefore, the safety of PRP treatment is more reliable. Conclusion: The results showed that PRP was more durable and safer than corticosteroids and other control groups in the treatment of frozen shoulder. Study Design: Systematic review. Trial registration: PROSPERO CRD42022359444, date of registration: 22-09-2022. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of Subacromial Steroid Injection (SAI) and Hydrodilatation in treating adhesive capsulitis (frozen shoulder). Study Design: Observational study. Setting: Department of Orthopedic, Dr. Ziauddin Hospital, Located in North Nazimabad, Karachi, Pakistan. Period: March 2023 to September 2023. Methods: Included 138 participants with primary adhesive capsulitis. Participants were divided into two groups: one received hydrodilatation and the other received SAI. The Disability of Arm, Shoulder, and Hand (DASH) Score and Visual Analogue Scale (VAS) were used for pre and post-treatment assessments at intervals of 2 weeks, 6 weeks, and 6 months. SPSS version 23 was used to analyze the data. Results: Both groups show significant reductions in pain scores and DASH scores over time (p-value<0.05 for changes within each group). There are significant differences in pain scores and DASH scores between the groups at 6 weeks, 12 weeks, and 6 months (p-value<0.05), with the hydrodilatation group showing better outcomes. Moreover, the mean reduction in pain scores and DASH scores from pre-treatment to 6 months is significantly greater in the hydrodilatation group compared to the SAI group (p-value<0.05). Conclusion: While both Hydrodilatation and SAI are effective in reducing pain and improving functionality in patients with adhesive capsulitis, Hydrodilatation appears to be more effective in achieving these outcomes, particularly in terms of pain management and functional improvement. [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis (AC), more commonly known as "frozen shoulder", is a painful shoulder condition. The illness progresses through three phases: freezing, frozen and thawing. A gold standard treatment for adhesive capsulitis is not defined. The goal of any treatment is to reduce pain and restore shoulder movement. Objective: Objective of the present study is to evaluate the efficacy of gleno-humeral hydrodistension associated with physical therapy in patients with diagnosed adhesive capsulitis comparing the outcomes in term of pain and range of motion in patients with a phase 1 and a phase 2 disease. Method: Between January 2022 and April 2023, We evaluated 87 patients with adhesive capsulitis, 47 were excluded for others concomitant pathologies, finally 40 patients were enrolled for the study, of whom 23 had capsulitis in stage 1 and 17 in stage 2. Patients were evaluated at baseline and at 2, 4 and 6 months after infiltration recording range of motion in all planes, pain and functionality scores. Results: A significant improvement was recorded in shoulder range of motion in all planes with the except of extension in both groups. Phase 2 patients were able to regain shoulder range of motion in all planes except internal rotation which was recovered with more difficulty. Pain and functionality scores improved significantly between baseline and follow-up visits. Conclusion: Ultrasound-assisted hydrodistention of the glenohumeral joint combined with targeted exercise has been successful in improving pain relief, reducing disability, and increasing range of motion in subjects with stage 1 and 2 adhesive capsulitis, especially if diagnosed before phase 2 (when the range of motion is completely reduced). [ABSTRACT FROM AUTHOR]

Rheumatoid Arthritis is an autoimmune disorder that leads to persistent symmetrical polyarthritis accompanied by systemic manifestations. It may lead to an array of deformities and even complications like rheumatoid nodules, carpal tunnel syndrome, adhesive capsulitis, cardiovascular diseases, and many more. This case report intends to discuss the ayurvedic management of Rheumatoid Arthritis which was complicated by Adhesive Capsulitis. A 73-year-old male patient was diagnosed with Rheumatoid Arthritis. He had previously undergone allopathic treatment for a year. In June 2023, the patient sought ayurvedic treatment for his ailment and later acquired signs and symptoms of Adhesive Capsulitis. He was given ayurvedic oral medications along with external therapeutic procedures. There was a significant reduction in the values of the Routine Assessment of Patient Index Data 3 (RAPID3) score, Clinical Disease Activity Index (CDAI), Rheumatoid Factor (Quantitative), Visual Analogue Scale (VAS), and improvement in the range of movement of the affected joint. Ayurvedic medicines are effective in managing Rheumatoid Arthritis along with the complication of Adhesive Capsulitis. [ABSTRACT FROM AUTHOR]

Copyright of Osmangazi Journal of Medicine / Osmangazi Tip Dergisi is the property of Eskisehir Osmangazi University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Frozen shoulder (FS) is a debilitating inflammatory condition affecting the shoulder capsule that causes significant pain and stiffness. Its etiology, pathophysiology, and treatment remain poorly understood. Although regarded as self-limiting, FS can have profound implications on the activities of daily living and usually takes 1-4 years to resolve on its own accord. In recalcitrant or severe cases where active range of motion (AROM) is extensively restricted, an arthroscopic 360° release may be performed. The aim of this study is to evaluate the clinical outcomes following the FS 360° arthroscopic release. Methods: An observational prospective cohort study was conducted assessing patient-reported outcome measures (PROMs) in patients who underwent the 360° arthroscopic release between July 2013 and January 2019. Various questionnaires were used to evaluate their shoulder preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, 12 months, and 24 months postoperatively. Relevant PROMs included the Oxford Shoulder Score; Western Ontario Shoulder Instability Index; Disabilities of the Arm, Shoulder, and Hand; Constant-Murley Score; American Shoulder and Elbow Surgeons score; and general measures of pain intensity (visual analog scale) and well-being (EQ-5D-3L). AROM movements included forward flexion, abduction, external rotation, internal rotation, as well as external and internal rotation at 90° of abduction. Results: Fifty consented patients underwent the arthroscopic FS 360° release. The mean age was 52.1 ± 7.7 years (range 35-72), and mean body mass index was 27.1 ± 4.7 kg/m2 (range 19.5-37.5). All PROMs, AROM movements, patient satisfaction, and EQ-5D-3L scores improved significantly between preoperative and 24-month time points (P .05). No complications or reoperations were reported. Conclusion: The arthroscopic 360° release is an effective and safe treatment modality for severe or recalcitrant FS. Statistically and clinically significant improvements in AROM and PROMs (Oxford Shoulder Score; Western Ontario Shoulder Instability Index; Disabilities of the Arm, Shoulder, and Hand; Constant-Murley Score; and American Shoulder and Elbow Surgeons score) occurred shortly after the surgery and progressively improved from 2 weeks to 24 months postoperatively, with the operative shoulder achieving similar range of motion as the nonpathological contralateral shoulder at 24 months.

Abstract Background The shoulder complex with its varied pathology responds differently from patient to patient and so, the best option for progression is a choice of rehabilitation. In the present post-COVID scenario, many patients are referred to acute and sub-acute shoulder pain and dysfunction. It is very difficult to predict the outcome of therapy. Some patients recover even without any modalities. Recurrent or adverse symptoms are also possible. Gender, other demographic features, physiological response, and progressive outcome need to be considered in rehabilitation. This study is intended to evaluate the short-term effects of hydrotherapy post-intra-articular injections of shoulder dysfunctions. Aims and objectives To evaluate the effectiveness of hydrotherapy during early rehabilitation of individuals who have undergone intra-articular injections of shoulder joint on pain and function. Materials and methods In this prospective study, we have studied a total of 59 cases within the age group of 40–70 years with idiopathic frozen shoulder, acromio-clavicular joint dysfunction, and grade-1 untreated rotator cuff injuries. Group A patients were treated with conventional shoulder exercises and group B patients were treated in a hydrotherapy pool. The chief aim was to obtain earlier pain relief with controlled movement patterns and earlier relief from functional disability. The Constant-Murley score (CMS–100 points scale) composing pain and functional parameters was the outcome measure. Results After confounding all the demographic factors, it was found that the experimental group B treated by hydrotherapy revealed a statistically extremely significant difference (p value

Abstract Objective Physiotherapists (PTs) play a crucial role in managing individuals with Frozen Shoulder (FS), frequently being the first healthcare professionals involved in the treatment of this condition. Aim This study aimed to compare the beliefs, expectations, and perspectives of individuals with FS with the knowledge, skills, and strategies of PTs, highlighting similarities and differences. Method This study adhered to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). From May 1st to August 1st, 2023, a two-part survey was conducted involving PTs and individuals diagnosed with FS. The survey focused on comparing key areas such as clinical assessment, patient education, treatment expectations, and the psychological aspects of the patient-clinician relationship. Results A total of 501 PTs and 110 subjects with FS participated in the survey. Most PTs showed proficiency in FS pathoanatomical conditions and were also attentive to psychological aspects (88.4%), describing the pathology evolution in three or two stages (68.2%). They also highlighted the importance of patient education (89.6%) and recognized the potential benefits of a multiprofessional collaboration in managing FS (82.2%). Reassurance was reported as a priority by 32.3% of PTs. Subjects with FS expressed a preference for PTs who are both expert and empathetic (73.6%). Regarding their understanding of FS, 29.09% of subjects reported receiving a three-phase explanation, while 26.36% felt inadequately informed. Nearly half of the subjects (49.09%) anticipated being managed independently by a PT, with 93.64% prioritizing the improvement of their range of motion. Conclusion This study revealed a general agreement between subjects with FS and PTs regarding aspects of the therapeutic relationship, patient education, pathology management, compliance and motivation strategies, and pain management preferences. However, significant differences emerged concerning the perception of physiotherapy effectiveness, primary treatment goals, subjects’ priorities, and the importance of psychological assessment.

Abstract Objective To systematically review the clinical efficacy (pain, function, quality of life) and safety of platelet-rich plasma (PRP) in the treatment of frozen shoulder through meta-analysis, and provide evidence-based medical evidence for the effectiveness of PRP in the treatment of frozen shoulder. Methods A search was conducted on international databases (Pubmed, Web of science, Embase) and Chinese databases (CNKI, Wanfang, VIP) to search the clinical studies on the efficacy of platelet-rich plasma in treating frozen shoulder (adhesive capsulitis/periarthritis/50 shoulder) and their corresponding references published from inception until January 2024. Thoroughly excluded literature not meeting the predetermined inclusion criteria, extracted relevant data from the literature, and input it into RevMan5.4 for meta-analysis. Results This study ultimately included 14 RCTs, with a total of 1024 patients. The results showed that PRP has significant advantages compared with control groups in VAS (mean difference (MD) =-0.38, 95% confidence interval(CI)(-0.73, -0.03), P = 0.03), UCLA (MD = 3.31, 95% CI (1.02,5.60), P = 0.005), DASH (MD = -4.94,95% CI (-9.34, -0.53), P = 0.03), SPADI (SPADI Total: MD =-16.87, 95% CI (-22.84, -10.91), P

Frozen shoulder, or adhesive capsulitis, is a condition characterised by pain and stiffness in the shoulder joint. It gradually worsens over time, making it difficult to move the shoulder. The exact cause is not always clear, but it can be associated with injury, surgery, or certain medical conditions. Treatment typically involves physiotherapy and pain management. The authors present a case of a 41-year-old male who complained of acute pain in the right shoulder joint over a period of 15 days. Examination revealed a restriction in shoulder Range Of Motion (ROM). The case was treated with a single session of three therapist-administered posterolateral Mobilisation With Movement (MWM) glides. No medication was prescribed to the patient and he was asked to follow-up in the Outpatient Department (OPD) for three days. The single session of posterolateral MWM glide, along with conventional physiotherapy, led to an increase in shoulder ROM and a reduction in pain. This approach can be considered a viable treatment option for frozen shoulder.

Introduction: Adhesive capsulitis (AC), often referred to as frozen shoulder, presents a diagnostic challenge due to its insidious onset and progressive nature. The condition is characterized by pain and restricted motion in the shoulder, with a predilection for individuals between 40 and 60 years of age. A novel scoring system was developed to enhance the accuracy of diagnosing AC and distinguishing between its stages, aiming to streamline clinical decision-making and treatment planning. Methods: A cohort of patients with symptoms suggestive of AC was assessed using the new scoring system, which integrates clinical, radiological, and patient history factors. Parameters included comorbidities like diabetes mellitus, recent immobility, rotator cuff tears, and specific ultrasound findings. Patients were scored and categorized into definitive AC, uncertain diagnosis, or exclusion from AC, with scores > 7, 6–2, and < 2, respectively. Results: The scoring system effectively categorized patients, with those scoring > 7 demonstrating pronounced symptoms and ultrasound changes consistent with Phase 2 AC. Patients with scores between 6 and 2 were classified into uncertain Phase 1 or Phase 3, necessitating further observation. Scores < 2 effectively excluded AC, indicating a need to explore alternative diagnoses. Conclusion: The structured scoring system demonstrated potential as a comprehensive tool for diagnosing AC. By quantitatively assessing a range of contributory factors, it allowed for the stratification of the disease into distinct stages. This system is anticipated to improve early diagnosis and the precision of treatment interventions, although further validation in larger cohorts is warranted. Level of evidence: II-III. [ABSTRACT FROM AUTHOR]

Abstract Objective Frozen Shoulder (FS) is a musculoskeletal pathology that leads to disability, functional decline, and a worsening in quality of life. Physiotherapists are the primary professionals involved in the treatment of FS, and it is essential to determine if their practice aligns with evidence-based suggestions. Aim The aim is to assess the knowledge, skills, and operational strategies of Italian physiotherapists regarding FS and compare them with the existing literature. Methods A web-based, anonymous, and voluntary cross-sectional survey was developed and administered to Italian physiotherapists to evaluate their clinical practices. Results A total of 501 physiotherapists (38.5% female), completed the survey. More than half were under 35 years old (67.8%), declared working in private practice settings or being self-employed (57.1%), and were primarily engaged with musculoskeletal patients (81.8%). For subjects with FS at their first access, 21.4% identified X-rays as the most useful imaging technique to recognize pathologies beyond rehabilitation competence. In terms of general management, the majority reported working with an orthopaedic or physiatrist (47.5%) or in a multidisciplinary team (33.5%). Regarding manual therapy techniques, 63.3% of physiotherapists preferred intense degree mobilization, posterior direction, and moderate pain at the end of the range of motion for low irritable/high stiffness FS; however, there is a lack of consensus for managing very irritable/low stiffness FS. The majority of physiotherapists (57.7%) concurred that stretching improves the balance between metalloproteinase and its inhibitors. Additionally, 48.3% of physiotherapists selected mobile phone videos and messages to improve patients’ compliance with exercises at home and for motivational/educational purposes. Discussion and Conclusion The clinical practices of Italian physiotherapists in FS subjects sometimes deviate from evidence-based recommendations. While some discrepancies may be attributed to the existing uncertainties in the literature regarding knowledge and management strategies for FS patients, the authors recommend a stronger adherence to evidence-based practice.

Nadia R Gadgaard,1 Katalin Veres,1 Victor W Henderson,1– 3 Alma B Pedersen1 1Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark; 2Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA; 3Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USACorrespondence: Nadia R Gadgaard, Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Olof Palmes Allé 43-45, Aarhus, 8200, Denmark, Tel +45 87 16 72 12, Email nrg@clin.au.dkBackground: Frozen shoulder may be an early preclinical symptom of Parkinson’s disease (PD).Objective: To examine PD risk after frozen shoulder diagnosis and to evaluate this disorder as a possible manifestation of parkinsonism preceding the clinical recognition of PD and possible target for screening.Methods: Danish population-based medical registries were used to identify patients aged ≥ 40 years with a first-time frozen shoulder diagnosis (1995– 2016). A comparison cohort was randomly selected from the general population matched on age and sex. To address detection bias and the specificity of frozen shoulder diagnosis, we performed a sensitivity analysis, using similar matching criteria to select a cohort of patients with back pain diagnosis. The outcome was incident PD. Cumulative incidences and adjusted hazard ratios (HRs) were estimated with 95% confidence intervals (CIs).Results: We identified 37,041 individuals with frozen shoulder, 370,410 general population comparators, and 111,101 back pain comparators. The cumulative incidence of PD at 0– 22 years follow-up was 1.51% in the frozen shoulder cohort, 1.03% in the general population cohort, and 1.32% in the back pain cohort. For frozen shoulder versus general population, adjusted HRs were 1.94 (CI: 1.20– 3.13) at 0– 1 years and 1.45 (CI: 1.24– 1.70) at 0– 22 years follow-up. For frozen shoulder versus back pain, adjusted HRs were 0.89 (CI: 0.54– 1.46) and 1.01 (CI: 0.84– 1.21), respectively.Conclusion: Patients with frozen shoulder had an increased PD risk compared with the general population, although the absolute risks were low. Frozen shoulder might sometimes represent early manifestations of PD. Detection bias probably cannot account for the increased PD risk during the long-term follow-up.Keywords: adhesive capsulitis, back pain, cohort studies, frozen shoulder, Parkinson disease

Copyright of Rehabilitation / Rehabilitacija is the property of University Rehabilitation Institute, Republic of Slovenia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Frozen Shoulder (FS) is a musculoskeletal pathology that leads to disability, functional decline, and a worsening in quality of life. Physiotherapists are the primary professionals involved in the treatment of FS, and it is essential to determine if their practice aligns with evidence-based suggestions. Aim: The aim is to assess the knowledge, skills, and operational strategies of Italian physiotherapists regarding FS and compare them with the existing literature. Methods: A web-based, anonymous, and voluntary cross-sectional survey was developed and administered to Italian physiotherapists to evaluate their clinical practices. Results: A total of 501 physiotherapists (38.5% female), completed the survey. More than half were under 35 years old (67.8%), declared working in private practice settings or being self-employed (57.1%), and were primarily engaged with musculoskeletal patients (81.8%). For subjects with FS at their first access, 21.4% identified X-rays as the most useful imaging technique to recognize pathologies beyond rehabilitation competence. In terms of general management, the majority reported working with an orthopaedic or physiatrist (47.5%) or in a multidisciplinary team (33.5%). Regarding manual therapy techniques, 63.3% of physiotherapists preferred intense degree mobilization, posterior direction, and moderate pain at the end of the range of motion for low irritable/high stiffness FS; however, there is a lack of consensus for managing very irritable/low stiffness FS. The majority of physiotherapists (57.7%) concurred that stretching improves the balance between metalloproteinase and its inhibitors. Additionally, 48.3% of physiotherapists selected mobile phone videos and messages to improve patients' compliance with exercises at home and for motivational/educational purposes. Discussion and Conclusion: The clinical practices of Italian physiotherapists in FS subjects sometimes deviate from evidence-based recommendations. While some discrepancies may be attributed to the existing uncertainties in the literature regarding knowledge and management strategies for FS patients, the authors recommend a stronger adherence to evidence-based practice. Implications of Physiotherapy Practice: Italian PTs' clinical practices in FS rehabilitation show partial alignment with evidence-based recommendations, particularly in the areas of diagnostic imaging suggestions and clinical assessment. Italian PTs' clinical practices exhibit partial adherence to evidence-based suggestions regarding the identification of predisposing factors, staging education, and mobilization modalities in FS cases. Italian PTs with Orthopaedic Manipulative Physical Therapists (OMPT) certification, those possessing clinical experience ranging from 6 to 10 years, and individuals working in private practice demonstrate greater appropriateness in terms of knowledge, competence, and adherence to evidence-based clinical practices for FS rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of intra-articular glenohumeral joint triamcinolone injection in treating secondary adhesive capsulitis after breast cancer surgery. Methods: This study prospectively enrolled 37 participants, including 22 in the breast cancer surgery group and 15 in the idiopathic group. All participants received intra-articular glenohumeral joint triamcinolone injection in the affected shoulder joint. The clinical outcomes included the Shoulder Pain and Disability Index (SPADI), passive range of motion (PROM), and pain intensity on the Numeric Rating Scale (NRS), which were evaluated before the intervention and 1, 3, and 6 months after. The primary outcome of this study was the mean difference in the total SPADI from baseline to 6 months after the intervention. Results: The mean differences in the total SPADI scores from baseline to 6 months after the intervention were 36.2 ± 16.4 and 47.9 ± 15.2 in the breast cancer surgery group and the idiopathic group, respectively. There was no significant difference between the two groups (p = 0.1495). However, the improvements in the SPADI pain subscale at the 3- and 6-month follow-up visits (−31.2 vs. −48.8, p = 0.042; −34.1 vs. −50.7, p = 0.0006) and the PROM of abduction at the 3-month follow-up (52.4 vs. 70.3, p = 0.0072) were inferior in the breast cancer surgery group compared to the idiopathic group. There were no adverse events in either group. Conclusion: Intra-articular triamcinolone injection is an effective and safe treatment option for adhesive capsulitis after breast cancer surgery; however, it has less effect than for idiopathic adhesive capsulitis. [ABSTRACT FROM AUTHOR]

To compare the effects of end-range manual therapy versus other conservative intervention on pain intensity, shoulder range of movement (ROM), and physical function in adhesive capsulitis (AC). Two reviewers conducted a comprehensive search from inception to December 2022. PUBMED, Cochrane Library, CINAHL, EMBASE, and PEDro databases were searched. Clinical trials investigating the effects of end-range mobilisation techniques on pain, ROM, and physical function in patients with AC were included. Methodological quality was evaluated using the PEDro scale, and bias risk was assessed using the Cochrane Collaboration tool. GRADE was used to assess the certainty of the evidence. Data were presented using forest plots, and the random effects models were applied according to the Cochrane handbook. Ten randomised controlled trials were reviewed, involving 424 AC patients aged 20–70 years. Methodological quality of studies ranged from high to low. The end-range mobilisation showed improvements in pain intensity, shoulder abduction, internal rotation, and external rotation, and physical function compared to other conservative interventions in the short-and medium-terms. Certainty of the evidence was downgraded to very low. Very low certainty evidence suggests that end-range mobilisation techniques improve pain intensity, shoulder ROM, and physical function in the short-and medium-term in AC. The Kaltenborn, Maitland, and Mulligan concepts are the most commonly used manual therapy approaches for adhesive capsulitis. The End-range mobilisation techniques seem to improve pain intensity, shoulder range of motion, and physical function at short- and medium-term of follow-up. The certainty of evidence was rated as very low for all the outcome measures. Despite the low certainty of evidence, it is recommended to continue using manual therapy for adhesive capsulitis due to the improvements demonstrated until further studies either confirm or refute its definitive efficacy. [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis also termed as frozen shoulder is a condition characterized by painful and limited active and passive range of motions of the shoulder. It can adversely affect activities of daily living and consequently impair quality of life. The aim of the study was to estimate the prevalence of adhesive capsulitis among diabetic individuals and to study its relationship with age, gender, involved shoulder, body mass index (BMI) and glycaemic control Method: A cross-sectional observational study was done in 290patients attending outpatient department of BIRDEM hospital during the period fromlst April 2023 to 30th September 2023. Convenient type of sampling technique was applied. Patients with shoulder pain and restricted active andpassive shoulder joint movements were diagnosed as having adhesive capsulitis. Data were statistically analyzed. Results: Adhesive capsulitis was present in 54 (18.62%) of patients with diabetes. It was found that adhesive capsulitis was higher in increasing age, predominant in female 34(63.0%), more involve in left shoulder 27(50%). Statistically significant association was found with poor glycaemic status. Conclusion: Adhesive capsulitis is a common problem in diabetic patients. Its occurrence was found to be prevalent with poorly controlled glycaemic status. [ABSTRACT FROM AUTHOR]

Background: Mounting evidence suggests a connection between inflammatory cytokines and adhesive capsulitis (AC). However, the specific systemic inflammatory cytokines contributing to AC have not been clearly identified. This study employed Mendelian randomization (MR) to explore the causal relationships between 41 inflammatory cytokines and AC. Methods: In this bidirectional, two-sample MR analysis, genetic variations associated with AC were derived from a comprehensive genome-wide association study (GWAS). The inflammatory cytokines data were sourced from a GWAS summary involving 8,293 healthy participants. The primary MR method employed was inverse variance weighting, supplemented by MR-Egger, weighted median, and MR-pleiotropy residual sum and outlier for sensitivity analysis. Heterogeneity was assessed using Cochran’s Q test, and the MR results were validated using the leave-one-out method. Results: Elevated levels of interferon gamma-induced protein 10 (IP-10) (odds ratio (OR) = 1.086, 95% confidence interval (CI) = 1.002–1.178) and regulated on activation, normal T cell expressed and secreted (RANTES) (OR = 1.107, 95% CI = 1.026–1.195) were linked to an increased risk of AC. Increased levels of stromal cell-derived factor-1 alpha (SDF-1α) (OR = 0.879, 95% CI = 0.793–0.974) and tumor necrosis factor-alpha (TNF-α) (OR = 0.911, 95% CI = 0.831–0.999) were associated with a reduced AC risk. Moreover, genetically predicted AC exhibited associations with elevated cutaneous T cell attracting (CTACK) levels (OR = 1.202, 95% CI = 1.007–1.435) and diminished levels of interleukin-17 (IL-17) (OR = 0.678, 95% CI = 0.518–0.888) and interleukin-5 (IL-5) (OR = 0.786, 95% CI = 0.654– 0.944), as confirmed through inverse-variance weighted (IVW) methods. Conclusion: The present study successfully establishes a causal association between genetically proxied circulating levels of IP-10, RANTES, SDF-1α, and TNF-α and the risk of AC. Additionally, AC contributes to an increase in CTACK and a decrease in IL-17 and IL-5. This significant finding not only enhances the understanding of the pathogenesis of AC but also holds promise for the development of effective clinical management strategies. [ABSTRACT FROM AUTHOR]

Background: Platelet-rich plasma (PRP) has shown promising results for adhesive shoulder capsulitis (AC) in pre-clinical models. The aim of this review is to investigate the clinical outcomes of using PRP in AC. Materials and Methods: We conducted a systematic scoping review of the literature using bibliographic databases from inception until the 9th of January 2022 [PubMed, Web of Science, Scopus, and CENTRAL]. Randomized studies were included if they investigated the use of PRP in human patients with a diagnosis of AC. Authors performed individual study quality assessments using the RoB 2 tool. Results: We screened a total of 470 results and 6 were included in the final synthesis. Studies included data of 578 patients with 263 patients receiving PRP (45.5%). All studies used PRP as part of non-operative treatment. PRP was compared to another intervention in all six studies. Four of these studies found PRP to be more effective. No major adverse effects were reported in any study. Conclusion: PRP is a safe treatment option that can be added to the investigative treatment arsenal of AC. Despite showing some favorable results, several limitations and patient-centered questions remain to be addressed by future studies. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

Background Moderate physical activity (MPA) has proven advantages for glycemic control, cardiovascular health, and functional independence. However, physical activity is not part of routine conventional physical therapy (CPT) in managing diabetic adhesive capsulitis patients. Objective To determine the effects of moderate MPA on diabetic adhesive capsulitis (AC). Methodology A randomized control trial was conducted at the Combined Military Hospital (CMH), Muzaffarabad, Pakistan from March 2022 to October 2022. A total of n = 44 patients with diabetic AC, aged 40 to 65 years, HbA1c > 6.5% were enrolled. Group A received MPA and CPT, while Group B only received CPT for six weeks. The upper extremity function, pain, and range of motion were assessed at baseline, third week, and sixth week through the disability of arm, shoulder, and hand (DASH) questionnaire, numeric pain rating scale (NPRSS), and goniometer respectively. Results The NPRS score and ROMs showed significant improvement (p < 0.05) in group A compared to group B with a large effect size. When comparing the mean difference of the DASH score (73 + 7.21 vs. 57.9 + 12.64, p < 0.001, Cohen’s d = 1.46) was significantly improved with large effect size in group A as compared to group B. Conclusion MPA along with CPT has positive effects on patient pain, range of motion, and disability in patients with diabetic adhesive capsulitis.

Background: Although several studies have reported the effectiveness of acupuncture treatment for adhesive capsulitis (AC), research on pharmacopuncture therapy for AC remains limited. We compared the effectiveness and safety of pharmacopuncture and physiotherapy for AC. Methods: This pragmatic, randomized, controlled, parallel-group pilot study enrolled patients with limitations of shoulder movement and a numeric rating scale (NRS) score for shoulder pain ≥5 randomized (1:1) to the pharmacopuncture therapy (PPT) and physiotherapy (PT) groups. Treatment sessions were administered twice weekly for 6 weeks, and the participants were followed up for 13 weeks after randomization. The primary outcome was the NRS score for shoulder pain, and the secondary outcomes were the visual analog scale (VAS), Shoulder Pain and Disability Index (SPADI), range of motion (ROM), patient global impression of change (PGIC), EuroQol 5-Dimension 5-Level (EQ-5D-5L), and Short Form 12 Health Survey (SF-12) scores. The intention-to-treat (ITT) analysis was set as the primary analysis. Results: Among 50 participants, for the primary endpoint (week 7) the PPT group showed a significantly superior improvement in NRS, VAS, SPADI, ROM for flexion, ROM for abduction, and EQ-5D-5L scores. The ROM for extension, ROM for adduction, physical component summary, and patient global impression of change were significantly better in the PPT than in the PT group, and these effects were sustained until week 13. Conclusion: In this pilot study, PPT showed better effects than PT, confirming the feasibility of a follow-up main study. Trial registration: Clinicaltrials.gov (NCT05292482) and cris.nih.go.kr (KCT0007198).

Abstract Background Historically, in-person physical therapy serves as a foundational component of nonoperative treatment of adhesive capsulitis (AC). This study compares the effectiveness of an at-home high-intensity stretch (HIS) device to traditional physical therapy (PT) and to PT in combination with the HIS device. We hypothesize that the HIS device will be as effective as PT alone or as combination therapy in the first-line treatment of AC and use of the HIS device will exhibit improvement at higher rate. Methods Thirty-four patients with idiopathic adhesive capsulitis and a minimum of 12 months follow-up were included in this study. Patients were randomized into one of the three groups: HIS device, PT alone, or HIS device + PT. Passive range of motion (ROM), American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) scores were measured. Additionally, patient satisfaction, compliance and complications were recorded. Paired t-test, ANOVA and Chi-squared tests were used in analysis. Results Final ROM in all planes improved for all groups compared to baseline (p 95% of contralateral ROM in all planes at final follow-up. Patients with PT alone were on average slowest to improve ROM from baseline, at 3 months, 6 months, and 1 year in all planes except internal rotation. ASES and SST scores improved for all groups when compared to baseline (p

Abstract Background Frozen Shoulder (FS) is a painful condition characterized by severe pain and progressive restriction of shoulder movement, leading to functional impairment and reduced quality of life. While different Patient Reported Outcome Measurements (PROMs) tools exist for assessing shoulder diseases, few specific PROMs are validated for FS patients. Purpose This study aims to assess the psychometric properties of the Disability of Arm, Shoulder, and Hand (DASH) questionnaire in FS patients. Methods One hundred and twenty-four subjects (mean ± SD age = 55.4 ± 7.9 years; 55.6% female) diagnosed with FS were included and completed the DASH questionnaire, the Numerical Pain Rating Scale (NPRS), the Shoulder Pain and Disability Index (SPADI), and the Short-Form Health Survey 36 (SF-36). Floor or ceiling effects were investigated. Structural validity was analysed through a unidimensional Confirmatory Factor Analysis (CFA), internal consistency through Cronbach’s alpha, test-retest reliability through the Intraclass Correlation coefficient (ICC), measurement error through the Standard Error of Measurement (SEM), and the Minimum Detectable Change (MDC), and construct validity through the hypothesis testing with the correlation with the other outcome measures used. Results No floor or ceiling effects were observed. CFA confirmed a one-factor structure after addressing local item dependency (Root Mean Square Error of Approximation = 0.055; Standardized Root Mean Square Residual = 0.077; Comparative Fit Index = 0.970; Tucker-Lewis Index = 0.968). Cronbach’s alpha was high (= 0.951), and test-retest reliability was excellent (ICC = 0.999; 95% CI: 0.998-1.000). SEM was equal to 0.5 points, and MDC to 1.5 points. Construct validity was considered satisfactory as 80% of the a-priori hypotheses were met. Conclusion The DASH questionnaire demonstrated good psychometric properties in FS patients, supporting its use as a valuable tool for assessing the impact of FS in clinical and research settings.

Background: Adhesive capsulitis (AC) of the glenohumeral joint is a recognized cause of pain associated with both active and passive restricted ranges of movement. AC can be subdivided into primary and secondary forms. Trauma, surgery, immobilization, and diabetes mellitus are the leading well-recognized causes of secondary AC. Calcific tendinitis/tendinitis (CT) of the rotator cuff is considered a possible trigger for AC, as reported in a few previous articles. However, there are no original investigations that assess the frequency and characteristics of this association. The aim of our research was to evaluate the presence of AC in a cohort of patients with a known CT condition of the rotator cuff by an ultrasound (US) examination. Materials and methods: We prospectively enrolled all the patients admitted at our single institution (October 2022–June 2023) for the preoperative US evaluation of a known CT condition. In these patients, we searched for parameters related to secondary AC. An axillary pouch (AP) thickness equal to or greater than 4 mm (or greater than 60% of the contralateral AP) was considered diagnostic of AC. Moreover, rotator interval (RI) thickness and the presence of effusion within the long-head biceps tendon (LHBT) sheath was also assessed in all patients. Results: A total of 78 patients (54F, 24M—mean age = 50.0 and range = 31–71 y.o.) were enrolled in the study. In 26 of those patients (26/78—33.3%), US signs of AC were detected. Notably, the mean AP thickness in patients with AC and CT was 3.96 ± 1.37 mm (Group 1) and 2.08 ± 0.40 mm in patients with CT only (Group 2). RI thickness was significantly greater in patients with superimposed AC: 2.54 ± 0.38 mm in Group 1 and 1.81 ± 0.41 mm in Group 2 (p < 0.00001). Moreover, effusion within the LHBT was significantly more frequently detected in patients with AC: 84.61% in Group 1 versus 15.79% in Group 2—p < 0.00001. Conclusion: US signs of AC are found in one-third of patients with CT of the rotator cuff, demonstrating that AC represents a frequent complication that should be routinely evaluated during US investigation to provide more personalized treatment strategies.

Introduction Neck dissection (ND) operations are performed to treat known metastatic neck illness. These operations have been associated with chronic neck and shoulder problems. In patients who have had a ND, adhesive capsulitis (AC) is one of the causes of shoulder dysfunction. Methods Forty patients with AC following modified radical neck dissection (MRND) surgeries were chosen at random and divided into two groups of equal size. The low-level laser therapy (LLLT) group (group A) received LLLT with: wavelength – 830 nm, output – 50 mw, maximum frequency – 5000 Hz, pulse duration – 50 ns, and average dose – 9 J/cm 2 for 20 min, plus traditional physical therapy (mobilisation technique, myofascial release, range of motion (ROM), and strengthening exercises) for 30 min. The proprioceptive neuromuscular facilitation (PNF) group (group B) received PNF for 25–30 min in addition to traditional physical therapy. The treatment period was 3 times each week and lasted for eight weeks. The discomfort in the shoulder was measured using the visual analogue scale (VAS). Shoulder impairment and pain were assessed by the SPADI scale and the shoulder ranges of motion were assessed using the universal goniometer technique. All measures were taken before and after the intervention. Results The findings reveal that there was a significant enhancement in all variables in both groups A and B after therapy compared to before the treatment ( p < 0.001). After therapy, there were no obvious changes in the VAS and SPADI values among the groups ( p > 0.05). However, statistical analysis showed significant improvement in the PNF group (group B) in shoulder flexion, abduction and external rotation in comparison to that of the LLLT group (group A) after treatment ( p < 0.001). Conclusions PNF proved to be more effective than LLLT in increasing ROM but was as effective as LLLT in decreasing shoulder pain and dysfunction in AC post ND surgery.

Aims: Is it feasible to conduct a definitive multicentre trial in community settings of corticosteroid injections (CSI) and hydrodilation (HD) compared to CSI for patients with frozen shoulder? An adequately powered definitive randomized controlled trial (RCT) delivered in primary care will inform clinicians and the public whether hydrodilation is a clinically and cost-effective intervention. In this study, prior to a full RCT, we propose a feasibility trial to evaluate recruitment and retention by patient and clinician willingness of randomization; rates of withdrawal, crossover and attrition; and feasibility of outcome data collection from routine primary and secondary care data. Methods: In the UK, the National Institute for Health and Care Excellence (NICE) advises that prompt early management of frozen shoulder is initiated in primary care settings with analgesia, physiotherapy, and joint injections; most people can be managed without an operation. Currently, there is variation in the type of joint injection: 1) CSI, thought to reduce the inflammation of the capsule reducing pain; and 2) HD, where a small volume of fluid is injected into the shoulder joint along with the steroid, aiming to stretch the capsule of the shoulder to improve pain, but also allowing greater movement. The creation of musculoskeletal hubs nationwide provides infrastructure for the early and effective management of frozen shoulder. This potentially reduces costs to individuals and the wider NHS perhaps negating the need for a secondary care referral. Results: We will conduct a multicentre RCT comparing CSI and HD in combination with CSI alone. Patients aged 18 years and over with a clinical diagnosis of frozen shoulder will be randomized and blinded to receive either CSI and HD in combination, or CSI alone. Feasibility outcomes include the rate of randomization as a proportion of eligible patients and the ability to use routinely collected data for outcome evaluation. This study has involved patients and the public in the trial design, dissemination methods, and how to include groups who are underserved by research. Conclusion: We will disseminate findings among musculoskeletal clinicians via the British Orthopaedic Association, the Chartered Society of Physiotherapy, the Royal College of Radiologists, and the Royal College of General Practitioners. To ensure wide reach we will communicate findings through our established network of charities and organizations, in addition to preparing dissemination findings in Bangla and Urdu (commonly spoken languages in northeast London). If a full trial is shown to be feasible, we will seek additional National Institute for Health and Care Research funding for a definitive RCT. This definitive study will inform NICE guidelines for the management of frozen shoulder. Cite this article: Bone Jt Open 2024;5(3):162–173.

Objectives: Frozen shoulder (FS) is one of the most challenging shoulder disorders for patients and clinicians. Its symptoms mainly include any combination of stiffness, nocturnal pain, and limitation of active and passive glenohumeral joint movement. Conventional treatment options for FS are physical therapy, nonsteroidal anti-inflammatory drugs, injection therapy, and arthroscopic capsular release, but adverse and limited effects continue to present problems. As a result, pharmacoacupuncture (PA) is getting attention as an alternative therapy for patients with FS. PA is a new form of acupuncture treatment in traditional Korean medicine (TKM) that is mainly used for musculoskeletal diseases. It has similarity and specificity compared to corticosteroid injection and hydrodilatation, making it a potential alternative injection therapy for FS. However, no systematic reviews investigating the utilization of PA for FS have been published. Therefore, this review aims to standardize the clinical use of PA for FS and validate its therapeutic effect.Methods: The protocol was registered in Prospero (CRD42023445708) on 18 July 2023. Until Aug. 31, 2023, seven electronic databases will be searched for randomized controlled trials of PA for FS. Authors will be contacted, and manual searches will also be performed. Two reviewers will independently screen and collect data from retrieved articles according to predefined criteria. The primary outcome will be pain intensity, and secondary outcomes will be effective rate, Constant-Murley Score, Shoulder Pain and Disability Index, range of motion, quality of life, and adverse events. Bias and quality of the included trials will be assessed using the Cochrane handbook’s risk-of-bias tool for randomized trials. Meta analyses will be conducted using Review Manager V.5.3 software. GRADE will be used to evaluate the level of evidence for each outcome.Results: This systematic review and meta-analysis will be conducted following PRISMA statement. The results will be published in a peer-reviewed journal.Conclusion: This review will provide scientific evidence to support health insurance policy as well as the standardization of PA in clinical practice.

Aim: This study aims to compare the efficacy of ultrasonography-guided corticosteroid injection to the glenohumeral joint and oral steroid therapy on clinical response and inferior axillary pouch (AR) thickness measured by ultrasonography (USG) in patients with adhesive capsulitis (AC). Materials and Methods: Our prospective randomized study included 48 patients (18-65 years) with a diagnosis of AC. The first group (n=24) underwent USG-guided corticosteroid injection to glenohumeral joint. In the second group (n=24), oral prednisone was started at 0.5 mg/kg dose with the dosing schedule determined by decreasing and continued for 6 weeks. Both groups were also included in a standard physical therapy program (electrotherapy+exercises). The questionnaire, active and passive shoulder joint range of motion (ROM) measurements, Shoulder Pain and Disability Index (SPADI), evaluation of the joint with USG, and AR thickness measurements were performed. Results: There was a statistically significant increase in passive-active ROM values in all directions before and after the treatment (p<0.05) and decrease in AR values after the treatment (p<0.001) in both groups. However, there was no significant difference between the two groups. In addition, the decrease in inferior pouch thickness and the decrease in SPADI scores were positively correlated. Conclusion: Steroid injection into the glenohumeral joint and oral steroid use significantly reduced shoulder pain and disability and increased range of motion in AC patients. Moreover, both oral steroid and steroid injection treatments improved radiologic findings (by reducing AR), consistent with clinical response. Although both treatments were effective, they were not superior to each other. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of injecting various amounts of fluid into the shoulder joints for capsule distension in patients with adhesive capsulitis. Design: A randomized controlled trial. Setting: Outpatient clinic of a tertiary care centre. Participants: Eighty-four patients with adhesive capsulitis underwent a baseline (time0), 6 weeks (time1), and 12 weeks (time2) follow-up after hydrodilitation. Intervention: Group 1 (n = 42) received 20 ml of lidocaine, steroid, and saline hydrodilatation via posterior glenohumeral recess, while Group 2 (n = 42) received 10 ml of lidocaine, steroid, and saline hydrodilitation. Main measures: The primary outcome was the visual analogue scale for pain. The secondary outcomes were shoulder pain and disability index (SPADI) and ROM of the shoulder. Results: There was a significant reduce in VAS scores for pain, SPADI scores, and increased shoulder ROM in both groups over time; however, the group-by-time interactions for any of the outcomes between groups were not significant except VAS pain in motion. Post-hoc pairwise analysis of the marginal effect of time and group showed that the significant difference of VAS in motion is due to time effect: time1 vs time0 (95% CI −4.09 to −2.68), time2 vs time0 (−4.21 to −2.77), and time2 vs time1 (−0.83 to 0.63), without between-group difference: group 1 vs group 2 (−0.38 to 0.59). Conclusion: Our study suggests hydrodilatation achieved an optimal effect at time1 for patients with adhesive capsulitis in both groups, and adding more saline offers additional benefits in flexion and external roatation until time2. [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]

Background: Treatment for idiopathic adhesive capsulitis of the shoulder remains controversial. Stages 1 to 2 reflect an inflammatory process supporting a rationale for intra-articular glenohumeral joint corticosteroid injection to treat synovial inflammation and prevent progression to capsular fibrosis. Hypothesis: We hypothesize that an intra-articular ultrasound-guided glenohumeral injection (USGI) of corticosteroid in patients diagnosed with Stage 1 or 2 idiopathic adhesive capsulitis will result in timely functional recovery and resolution of pain and stiffness. Study Design: Case series. Level of Evidence: Level 4. Methods: Patients with Stage 1 or 2 idiopathic adhesive capsulitis treated with an intra-articular corticosteroid injection were included. Patients were seen by a single physician and diagnosed using history and physical examination with careful attention to measurement of glenohumeral range of motion (ROM). A total of 61 patients met inclusion criteria. ROM measurements documented in the patient charts were recorded in forward flexion, abduction, internal rotation, and external rotation in neutral abduction. All ROM measurements were performed pre- and postinjection. All patients were treated with an USGI of local anesthetic and depomedrol. Recovery criteria were defined as forward flexion, abduction, and external rotation within 15° of the contralateral side and internal rotation within 3 spinous process levels of the contralateral side. Results: A total of 11 patients with Stage 1 and 50 patients with Stage 2 adhesive capsulitis comprised the final study cohort. Within the Stage 1 cohort, all 11 patients met recovery criteria for forward flexion and internal rotation (100%), 10 met recovery criteria for abduction (91%), and 8 met recovery criteria for external rotation (73%). Within the Stage 2 cohort, 31 patients met recovery criteria for forward flexion (62%), 30 met recovery criteria for abduction (60%), 36 met recovery criteria for internal rotation (72%), and 25 met recovery criteria for external rotation (50%). The difference in time to recovery in days was statistically significant in all ROM planes and was within 2 to 6 weeks for patients in Stage 1 and 7 to 10 weeks for Stage 2. Conclusion: USGI for early adhesive capsulitis allows patients to recover ROM more rapidly if performed early after onset of pain and stiffness. Clinical Relevance: These results stress the importance of recognition of idiopathic adhesive capsulitis in its early stages and subsequent intervention with an intra-articular glenohumeral corticosteroid injection. [ABSTRACT FROM AUTHOR]

This document provides a summary of a study that examined the relationship between balance and various factors in patients with adhesive capsulitis (AC), also known as frozen shoulder. The study used questionnaires and tests to assess pain levels, functional capacity, depression levels, and upper extremity function in the participants. The results showed that balance was negatively affected by increases in pain and depression levels. Additionally, resting pain intensity and functional capacity were found to be predictors of balance. The study suggests that these factors should be considered when developing evaluation and rehabilitation programs for individuals with AC. [Extracted from the article]

Background and Objective: The aim of this study was to analyze trends in surgical and non-surgical service utilization for common shoulder disorders in Korea from 2010 to 2019. Methods and Materials: This retrospective, cross-sectional, descriptive study utilized National Patient Sample data from the Health Insurance and Review Assessment Service (HIRA) of Korea. These data constitute a 2% sample out of the entire Korean population and include data for a variety of parameters instrumental for health care research. Patients with at least one medical service use for rotator cuff syndrome or tear, impingement syndrome, or adhesive capsulitis between January 2010 and December 2019 were included. Trends in healthcare utilization by disorder type, patient demographics, seasonal service use, and treatment details were examined. Results: There was an upward trend in the total number of patients and costs for shoulder disorders, from 35,798 patients and USD 5,485,196 in 2010 to 42,558 and USD 11,522,543 in 2019, respectively. The number of patients aged ≥60 and hospital visits increased. March had the highest number of claims. Physical therapy was the most common non-surgical procedure, while nerve block claims more than doubled. Opioid prescription rates also tripled. Surgical treatments were dominated by shoulder rotator cuff repair and acromioplasty. Conclusions: There was a significant increase in healthcare utilization for shoulder disorders, marked by rising costs and patient numbers. The use of nerve blocks and opioids notably increased. These data are valuable for clinicians, researchers, and policymakers. [ABSTRACT FROM AUTHOR]

Background: Historically, in-person physical therapy serves as a foundational component of nonoperative treatment of adhesive capsulitis (AC). This study compares the effectiveness of an at-home high-intensity stretch (HIS) device to traditional physical therapy (PT) and to PT in combination with the HIS device. We hypothesize that the HIS device will be as effective as PT alone or as combination therapy in the first-line treatment of AC and use of the HIS device will exhibit improvement at higher rate. Methods: Thirty-four patients with idiopathic adhesive capsulitis and a minimum of 12 months follow-up were included in this study. Patients were randomized into one of the three groups: HIS device, PT alone, or HIS device + PT. Passive range of motion (ROM), American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) scores were measured. Additionally, patient satisfaction, compliance and complications were recorded. Paired t-test, ANOVA and Chi-squared tests were used in analysis. Results: Final ROM in all planes improved for all groups compared to baseline (p < 0.001), with only HIS device group able to restore > 95% of contralateral ROM in all planes at final follow-up. Patients with PT alone were on average slowest to improve ROM from baseline, at 3 months, 6 months, and 1 year in all planes except internal rotation. ASES and SST scores improved for all groups when compared to baseline (p < 0.001). Use of HIS-device resulted in greater improvement in SST and ASES Total scores compared to PT alone (p = 0.045, and p = 0.048, respectively). Conclusions: Use of an at-home high-intensity stretching device for conservative treatment of idiopathic adhesive capsulitis improves outcomes in ROM and in ASES and SST scores both when used as an adjunct to physical therapy and when used alone. Trial registration: The study protocol was registered at www.clinicaltrials.gov (20/05/2022, NCT05384093). [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis (AC) of the glenohumeral joint is a recognized cause of pain associated with both active and passive restricted ranges of movement. AC can be subdivided into primary and secondary forms. Trauma, surgery, immobilization, and diabetes mellitus are the leading well-recognized causes of secondary AC. Calcific tendinitis/tendinitis (CT) of the rotator cuff is considered a possible trigger for AC, as reported in a few previous articles. However, there are no original investigations that assess the frequency and characteristics of this association. The aim of our research was to evaluate the presence of AC in a cohort of patients with a known CT condition of the rotator cuff by an ultrasound (US) examination. Materials and methods: We prospectively enrolled all the patients admitted at our single institution (October 2022–June 2023) for the preoperative US evaluation of a known CT condition. In these patients, we searched for parameters related to secondary AC. An axillary pouch (AP) thickness equal to or greater than 4 mm (or greater than 60% of the contralateral AP) was considered diagnostic of AC. Moreover, rotator interval (RI) thickness and the presence of effusion within the long-head biceps tendon (LHBT) sheath was also assessed in all patients. Results: A total of 78 patients (54F, 24M—mean age = 50.0 and range = 31–71 y.o.) were enrolled in the study. In 26 of those patients (26/78—33.3%), US signs of AC were detected. Notably, the mean AP thickness in patients with AC and CT was 3.96 ± 1.37 mm (Group 1) and 2.08 ± 0.40 mm in patients with CT only (Group 2). RI thickness was significantly greater in patients with superimposed AC: 2.54 ± 0.38 mm in Group 1 and 1.81 ± 0.41 mm in Group 2 (p < 0.00001). Moreover, effusion within the LHBT was significantly more frequently detected in patients with AC: 84.61% in Group 1 versus 15.79% in Group 2—p < 0.00001. Conclusion: US signs of AC are found in one-third of patients with CT of the rotator cuff, demonstrating that AC represents a frequent complication that should be routinely evaluated during US investigation to provide more personalized treatment strategies. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to compare the differences in clinical impairments between patients with primary and intrinsic secondary adhesive capsulitis and confirm rotator cuff tendon pathology in intrinsic secondary adhesive capsulitis. Design: This study included 130 patients with unilateral adhesive capsulitis in freezing or frozen stages. Clinical impairment was evaluated using visual analog scale score, shoulder passive range of motion, Cyriax stage, and Constant-Murley score. Plain radiography, ultrasonography, single-contrast arthrography, and intravenous gadolinium-enhanced magnetic resonance imaging were performed in all patients. Results: Among 130 patients, 77 patients were diagnosed as primary adhesive capsulitis and 53 patients as intrinsic secondary adhesive capsulitis. Among intrinsic secondary adhesive capsulitis patients, 44 rotator cuff tendon tears, 6 calcific tendinitis, and 3 rotator cuff tendon tears with calcific tendinitis were observed. No significant intergroup difference was observed in all clinical parameters, including shoulder passive range of motion, visual analog scale, Cyriax stage, and Constant-Murley score. The prevalence of subacromial subdeltoid bursitis was significantly higher in intrinsic secondary adhesive capsulitis compared with primary adhesive capsulitis. Conclusions: There was no significant difference in all clinical parameters investigated between patients with primary and intrinsic secondary adhesive capsulitis caused by rotator cuff tendon pathology. [ABSTRACT FROM AUTHOR]

Objective: To compare rotator cuff (RC) muscle cross-sectional areas (CSA) in subjects with adhesive capsulitis (AC) to age- and sex-matched controls. Materials and methods: We retrospectively analyzed 97 shoulder MRIs or MR arthrography studies, of which 42 were clinically diagnosed with AC (27 female, 15 male) and 55 were age- and sex-matched controls (38 female, 17 male). All AC subjects underwent imaging ≥ 6 months after symptom onset. All imaging was examined to exclude RC full-thickness tears and prior surgery. A standardized T1 sagittal MR image was segmented in each subject to obtain the CSA of subscapularis (SSC), supraspinatus (SSP), and infraspinatus (ISP) muscles. Differences in CSAs between AC and control subjects were analyzed by sex (females and males separately) and all subjects combined. Results: AC females had significantly decreased SSC (P = 0.002) and total (P = 0.006) CSAs compared to controls. Male AC subjects showed decreased SSC (P = 0.044), SSP (P = 0.001), and total (P = 0.005) CSAs. Across all subjects, male and female, the AC cohort had significantly decreased SSC (P = 0.019) and total (P = 0.029) CSAs compared to controls. Conclusion: Decreased RC muscle CSAs were present in AC subjects with ≥ 6 months of symptom duration, with decreased SSC and total CSAs in male and female subjects, and decreased SSP CSA in males. [ABSTRACT FROM AUTHOR]

Background: Frozen Shoulder (FS) is a painful condition characterized by severe pain and progressive restriction of shoulder movement, leading to functional impairment and reduced quality of life. While different Patient Reported Outcome Measurements (PROMs) tools exist for assessing shoulder diseases, few specific PROMs are validated for FS patients. Purpose: This study aims to assess the psychometric properties of the Disability of Arm, Shoulder, and Hand (DASH) questionnaire in FS patients. Methods: One hundred and twenty-four subjects (mean ± SD age = 55.4 ± 7.9 years; 55.6% female) diagnosed with FS were included and completed the DASH questionnaire, the Numerical Pain Rating Scale (NPRS), the Shoulder Pain and Disability Index (SPADI), and the Short-Form Health Survey 36 (SF-36). Floor or ceiling effects were investigated. Structural validity was analysed through a unidimensional Confirmatory Factor Analysis (CFA), internal consistency through Cronbach's alpha, test-retest reliability through the Intraclass Correlation coefficient (ICC), measurement error through the Standard Error of Measurement (SEM), and the Minimum Detectable Change (MDC), and construct validity through the hypothesis testing with the correlation with the other outcome measures used. Results: No floor or ceiling effects were observed. CFA confirmed a one-factor structure after addressing local item dependency (Root Mean Square Error of Approximation = 0.055; Standardized Root Mean Square Residual = 0.077; Comparative Fit Index = 0.970; Tucker-Lewis Index = 0.968). Cronbach's alpha was high (= 0.951), and test-retest reliability was excellent (ICC = 0.999; 95% CI: 0.998-1.000). SEM was equal to 0.5 points, and MDC to 1.5 points. Construct validity was considered satisfactory as 80% of the a-priori hypotheses were met. Conclusion: The DASH questionnaire demonstrated good psychometric properties in FS patients, supporting its use as a valuable tool for assessing the impact of FS in clinical and research settings. [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]