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De la périarthrite scapulo-huméral et des raideurs de l'epaule qui en son la conséquence.
... Frozen shoulder or adhesive capsulitis is periarthritis involving the periarticular soft tissues of the shoulder, one of the most common causes of shoulder pain and disability in the general population. 1,2 Prevalence is 2-5% in general population and 10-20% among diabetics. 2 It predominantly affects females and people between the ages of 40 and 60 years. ...
... 1,2 Prevalence is 2-5% in general population and 10-20% among diabetics. 2 It predominantly affects females and people between the ages of 40 and 60 years. The left shoulder is more likely to be affected. ...
... The left shoulder is more likely to be affected. 2,3 Both shoulders have been found to be affected in 12% of individuals. Recurrence is rare in the same shoulder. ...
Frozen shoulder or adhesive capsulitis is one of the most common causes of shoulder pain and disability in the general population. Its prevalence is 2-5% in the general population and 10-20% among diabetics. It predominantly affects females and most commonly affects people between the ages of 40 and 60 years. The left shoulder is more likely to be affected, with both shoulders affected in 12% of cases. A case study is presented to illustrate the clinical presentation, aetiology, diagnosis, radiological assessment, and management of frozen shoulder through Hijamah bila shurt (dry cupping) in a 60-year-old diabetic male patient. The present case was studied for over 8 weeks; Hijamah (dry cupping) was done on prescribed points for the affected shoulder twice a week for 8 weeks, and assessment was done at baseline and every 2 weeks. This study concluded that regimental therapy Hijamah bila shurt (dry cupping) has a significant effect in reducing pain, stiffness of joints, and increasing range of motion in frozen shoulder.
... Frozen shoulder or adhesive capsulitis is a commonly occurring condition characterized by a capsular pathology associated with pain and progressive loss of passive and active movement. The hallmarks of frozen shoulder syndrome were first described by Duplay in 1872 [18]. He felt the pain and stiffness noted in these patients was not due to arthritis, but rather, was due to soft tissue pathology of the periarticular structures. ...
... Randomized studies describing the effectiveness of mobilization techniques as a single intervention in subjects with adhesive capsulitis of the shoulder are scarce, and their results are conflicting. The comparison of present results with those of other randomized studies concerning the application of mobilization techniques in adhesive capsulitis is hampered by an insufficient description of the mobilization techniques in the majority of the available trials [17,18,19] and, except for ROM, the use of different outcome measures to evaluate treatment effects [8][9][10][11]17]. ...
Introduction: Shoulder pain is a common problem it is the third most common musculoskeletal complaint in the general population, and accounts for 5% of all general practitioner musculoskeletal consultation [1]. Frozen shoulder is a common cause of shoulder pain affecting 2–5% of the general population [2]. The term ‘‘frozen shoulder’’ was first coined by Codman and was subsequently defined as an idiopathic condition of the shoulder characterized by the spontaneous onset of pain in the shoulder with restriction of mobility at the glenohumeral joint in every direction [3,4]. Mobilization techniques can be performed as physiologic movements or accessory movements. In Maitland classification system, a concept of management in which accessory and physiologic passive movements of the joint are applied at various grades of intensity depending on a subject’s pain and joint stiffness [7]. Massage has been used for alternatives therapy on musculoskeletal system a modern systematic and clinical technique called friction massage was employed by Cyriax [10]. Need of Study: To best of our knowledge no studies have been done on comparison of high grade mobilization and cyriax manipulation in subjects with frozen shoulder. Methodology: Each subject was assigned into two groups by random sampling one Group A treated with High grade mobilization technique grade III & IV) with ultrasound and Group B receives Cyriax manipulation with ultrasound. Conclussion: The study could be concluded as” There is no significant difference produced between the High grade mobilization technique and cyriax manipulation in reducing pain & increasing shoulder abduction and external rotation in frozen shoulder”. Limitation: 1. The follow-up to see the long term effects of training is not done. 2. There is need to make an specific inclusion criteria to be developed that can identify which patients will most benefit from the HGMT. 3. This study has not taken into consideration of other than grade III & IV of Maitland mobilization grades. HGMT is not suitable for all kinds of patients. 4. Our sample size was small, and data were collected at only one hospital. 5. No control group. Future Research: 1. Future Studies should investigate whether HGMTs is effective in earlier stages of frozen shoulder in decreasing pain and improving ROM. 2. The duration of benefits from the cyriax manipulation may also be an important area for future study. 3. Sample size can be increased with inclusion of more number of subjects to generalize the effect in larger population. 4. Future study should consists of Randomized control TRAIL needed to know the long term effects of Cyriax over Maitland grade III and IV mobilization in frozen shoulder. Kyewords: High Grade Mobilization Technique; Cyriax Manipulation; Therapeutic Ultrasound Machine; Universal Goniometry; Visual Analogue Scale & Ultra-Sonic Gel.
... The periarthritis affecting the periarticular soft tissues of the shoulder, also known as adhesive capsulitis or frozen shoulder, is one of the most prevalent causes of shoulder discomfort and impairment in the general population. 1,2 Women and those between the ages of 40 and 60 are the groups most affected. It is more likely to impact the left shoulder. ...
Background:-Frozen shoulder, also known as adhesive capsulitis, is the major cause of
... The periarthritis affecting the periarticular soft tissues of the shoulder, also known as adhesive capsulitis or frozen shoulder, is one of the most prevalent causes of shoulder discomfort and impairment in the general population. 1,2 Women and those between the ages of 40 and 60 are the groups most affected. It is more likely to impact the left shoulder. ...
ABSTRACT
Background:- Frozen shoulder, also known as adhesive capsulitis, is the major cause of
shoulder pain and disability in the general population. The prevalence is 2-5% in the general
population and 10- 20% in diabetics. It typically affects females aged 40 to 60. In 12% of
cases, both shoulders are affected, although the left shoulder is more frequently afflicted.
Objectives:- In This case study our objective is to evaluate the efficacy of Fire Cupping
(Ḥijāma Nāriyya) in Alleviating Symptoms of Waja‘al-Mafāṣil-i-Katif(Frozen shoulder).
Methods:- A 61-year-old diabetic male patient presented to the OPD of the Regional
Research Institute of Unani Medicine, Srinagar. Over a 4-week period, the affected shoulder
was treated with Ḥijāma Nāriyya (fire cupping) on specific spots three times per week, with
weekly assessments. Result- This study found that regimental therapy Ḥijāma Nāriyya (fire
cupping) effectively reduces pain, stiffness, and increases mobility in the shoulder joint, as
well as enhancing range of motion in frozen shoulder. The patient's VAS scores was decreased and also indicating a decrease in symptoms. Conclusion- The treatment was safe
and bearable, and the patient's quality of life improved significantly. After treatment, there
was a statistically significant decrease in VAS and Improvement in overall shoulder mobility.
KEYWORDS: Frozen Shoulder, Case Report, ḤijāmaNāriyya, fire Cupping, Adhesive
Capsulitis, Unani Management.
... The periarthritis affecting the periarticular soft tissues of the shoulder, also known as adhesive capsulitis or frozen shoulder, is one of the most prevalent causes of shoulder discomfort and impairment in the general population. 1,2 Women and those between the ages of 40 and 60 are the groups most affected. It is more likely to impact the left shoulder. ...
ABSTRACT
Background:- Frozen shoulder, also known as adhesive capsulitis, is the major cause of shoulder pain and disability in the general population. The prevalence is 2-5% in the general population and 10- 20% in diabetics. It typically affects females aged 40 to 60. In 12% of cases, both shoulders are affected, although the left shoulder is more frequently afflicted.
Objectives:- In This case study our objective is to evaluate the efficacy of Fire Cupping (Ḥijāma Nāriyya) in Alleviating Symptoms of Waja‘al-Mafāṣil-i-Katif(Frozen shoulder).
Methods:- A 61-year-old diabetic male patient presented to the OPD of the Regional Research Institute of Unani Medicine, Srinagar. Over a 4-week period, the affected shoulder was treated with Ḥijāma Nāriyya (fire cupping) on specific spots three times per week, with weekly assessments.
Result- This study found that regimental therapy Ḥijāma Nāriyya (fire cupping) effectively reduces pain, stiffness, and increases mobility in the shoulder joint, as well as enhancing range of motion in frozen shoulder. The patient's VAS scores was decreased and also indicating a decrease in symptoms.
Conclusion- The treatment was safe and bearable, and the patient's quality of life improved significantly. After treatment, there was a statistically significant decrease in VAS and Improvement in overall shoulder mobility.
... [57][58][59] One of the newer methods of treating this very painful and in capacitating disorder uses keratinocyte growth factors and connective tissue growth factors. [60][61][62][63] Several studies have shown its potential when compared to steroid injection and other forms of conservative therapy. 5,19,64,65 PRP is more efficient and long-lasting than cortisone injection for the treatment of adhesive capsulitis, according to several research. ...
Periarthritis shoulder also called as Adhesive capsulitis or Frozen shoulder. The body creates excessive adhesion across the glenohumeral joint as a result of the idiopathic, chronic, and indolent degenerative process known as periarthritis shoulder, which causes discomfort, stiffness, and a reduction in range of motion. In the general population, the prevalence of adhesive capsulitis is 3-55%, and it is 20% in those with diabetes. Many types of treatment have been employed in the treatment of shoulder disorder such as simple analgesia, NSAIDS, intraarticular steroid, platelet rich plasma injection and surgery. PRP is more efficient and long-lasting than cortisone injection for the treatment of adhesive capsulitis, according to several research.
To evaluate the outcome of Periarthritis shoulder treated with Platelet Rich Plasma by comparing the intensity of pain, degree of increase in angle of movements of shoulder.
It is a randomized control trial with total of 30 patients between age group of 30–70 years old of both sex being diagnosed for the first time and not treated by any other modality are taken up for the study.Patients having chronic pain due to other causes like nerve damage or other neurological disorders, history of fracture around the shoulder joint, patients having local skin infection at the shoulder joint and patient not giving informed consent form to be a part of study were excluded from the study. Under sterile aseptic condition Autologous Platelet Rich Plasma of 4 ml was injected into the shoulder joint. It was a randomized single blinded controlled trial with 1 month, 3 months & 6 months follow up in which outcome was measures using visual analogue scale, ROM, SPADI.
Using the paired t test, descriptive and inferential statistical analysis were performed inthe current study. The mean VAS score at 6 months was reduced from 6.66+2.499 to 3.4±1.473; Mean SPADI Score at 6 month increased from 50.53±14.811 to 76.76±10.926; At 6 month Flexion increased from 66 to 116.33, extension increased from 18.6 to 31.33 and abduction increased from 87.33 to 126.833 with p value of 0.0001 which is statistically significant.
This study concluded that platelet rich plasma injection causes decrease in intensity of pain and increase in angle of movements of shoulder in patients of periarthritis shoulder.
... 7 Neviaser invented the term "adhesive capsulitis" in 1945 to designate a pain and stiffness in shoulder. 8 When describing a painful shoulder disease that develops slowly and causes stiffness and difficulties sleeping on the afflicted side, Codman 9 coined the phrase "frozen shoulder." However, it was Duplay who first defined the illness as 'periarthritis scapulohumerale' in 1872. ...
Background: Adhesive capsulitis is a clinical diagnosis made from a history of the gradual onset of severe shoulder pain with the progressive limitation of active and passive glenohumeral movements. The most significant loss of movement is in the external rotation of the joint. Traditionally physical therapists have used an anterior glide of the humeral head on the glenoid technique to improve external rotation range of motion a choice based on 'convex on concave' concept of joint surface motion.
... The restriction of the shoulder movement is thought to be the result of inflammation and swelling in the lining of the shoulder joint capsule and its associated ligaments with resultant contracture of the shoulder joint capsule. The lining loses its normal characteristic of the flexibility and becomes stiff and painful [5]. In frozen shoulder joint capsule get thickens, swells, and tightens due to bands of scar tissue (adhesion) that have formed inside the capsule [6]. ...
Background: Adhesive capsulitis is characterized by a painful, gradual loss of both active and passive glenohumeral motion resulting from progressive fibrosis and ultimate contracture of the glenohumeral joint capsule. Patients with Adhesive capsulitis have difficulties in everyday activities and shoulder pain also disturbs sleep at night on the affected side. Muscle energy technique helps in increasing shoulder range of motion. Maitland Mobilization is commonly used in the treatment of frozen shoulder. SPENCER Muscle Energy Technique (MET) is unique in its application as the client provides the initial effort while the practitioner facilitates the process. Objective: Objectives of the study was to compare the effect of Spencer MET Vs Maitland’s mobilization on pain, Range of Motion (ROM) and Disability in the patients with frozen shoulder. Methods: In the present experimental study, total 58 patients with frozen shoulder were included. Inclusion criteria were male and female with age of 40 to 60 year with unilateral frozen shoulder (at least 3-month duration). Patients were randomly allocated in two groups with 29 patients in each group: SPENCER MET and Conventional physiotherapy and MM and conventional physiotherapy for 5days a week with total duration of 4 weeks. Pre and post intervention assessment was carried out by using VAS, SPADI and ROM. Data was analysed by using SPSS 15 version. Results: Paired t test was applied within group comparison and result showed statistically significant difference in post intervention measurement compared to pre intervention for improving pain, reducing disability and increasing all ROM in both the groups. Independent t test was applied between group comparison and result showed statistically significant difference between groups mean pre-post differences in improving pain, reducing disability and increasing all ROM except extension and internal rotation. Conclusion: This study concludes that both the techniques used in the present study i.e., Spencer Muscle Energy Technique and Maitland Mobilization are effective for improving pain, reducing disability, and increasing ROM. However, SPENCER MET is the more effective for improving pain, reducing disability, and increasing ROM compared to Maitland Mobilization in patients with frozen shoulder. KEY WORDS: Frozen shoulder, SPENCER MET, Maitland mobilization, Shoulder Pain and Disability Index, Visual Analogue Scale.
... The SST canal forms a rigid and inextensible ring, if the muscle increases in size as a result of scar or an inflammatory process, it cannot glide through the canal without sticking, which causes pain 4 .Shoulder pain is the 3 rd most common cause of musculoskeletal disorder after low back pain and cervical pain. The annual incidence is estimated at 10 cases per 1000 population, peaking at 25 cases per 1000 population in a age category of 42-46 years [5][6][7] . Medical interventions like Non steroidal anti inflammatory drugs (NSAIDS), Subacromial corticosteroids and Bupivacaine suprascapular nerve block are done. ...
Aims and Objectives: To compare the effectiveness of Cryokinetics and Ultrasound therapy in treating supraspinatus tendinitis as measured by Visual analogue Scale (VAS) and 1 RM (Repetition Maximum. A sample of 60 patients with acute supraspinatus tendinitis with an experimental comparative study design. Patients who visited out patient department of Kempegowda Institute of Medical Sciences and Research Centre, Bangalore were included in the study based on inclusion and exclusion criteria. Both the groups were treated 5 times per week for three weeks. Patients were evaluated with VAS and 1RM on day 1st, 15th day and end of third week. The values are statistically analyzed to determine their effect in reducing pain and improving muscle strength. Results: The two-intervention group showed significant improvement when the pre and post values were analyzed for VAS and 1RM with significant p value (p<0.05). But inter group comparisons showed cryokinetics group to be more effective (p < 0.05) than ultrasound therapy group for all outcome parameters.
... The practice of manipulation under anesthesia (MUA) was first reported by Duplay in 1872 [20]. It has been reported that a good ROM can be obtained by using chloroform to relieve pain, releasing the joint capsule on all sides, and moving it several times in all directions. ...
Purpose of Review
This review aims to critically analyze the scientific literature on silent manipulation (SM) and offer an expert opinion on how past research translates to clinical practice. SM is a new treatment method for adhesive capsulitis, commonly known as frozen shoulder, in which a patient is treated with shoulder manipulation following an ultrasound-guided cervical nerve root block.
Recent Findings
SM showed good results in the short term, with improvements in range of motion (ROM), pain, and clinical scores. The results in patients with diabetes mellitus (DM) were also good but were slightly worse than those in patients without DM. In addition to showing good clinical results, postprocedure magnetic resonance imaging revealed that 13.3% of patients had an articular labrum injury, and 50% had humeral bone bruising. Since this treatment method is new, reports on treatment results are limited, with only short-term results being available. Results have been reported since 2017, but the improvements in the ROM are comparable to those achieved by arthroscopic capsular release.
Summary
SM is a safe and inexpensive procedure with good short-term results. However, there are still very few reports on long-term results and complications, and additional research and long-term observations are required in the future.
... He also noticed the marked reduction in forwarding elevation and external rotation that are the hallmarks of the disease [14]. In 1872, Duplay described the same condition as "peri-arthritis" [28]. In 1945, Naviesar coined the term "adhesive capsulitis" [13]. ...
Background: Frozen shoulder is a condition in which movement of the shoulder becomes restricted.It can be described as either primary (idiopathic) whereby the aetiology is unknown, or secondary,when it can be attributed to another cause. It is commonly a self-limiting condition, of approximately1 to 3 years' duration, though incomplete resolution can occur. The aetiology of shoulder pain isdiverse and includes pathology originating from the neck, glenohumeral joint, acromioclavicularjoint, rotator cuff, and other soft tissues around the shoulder girdle. The most common source ofshoulder pain is the rotator cuff, accounting for over two-thirds of cases. Material and methods:This was a prospective study with 50 patients coming to our OPD. Patients of all stages wereincluded and randomized into two groups. Group 1: Single Site Injection (SSI) group receivedsteroid injection through posterior approach and Group 2: Novel three-site ( NTS )group receivedthe same dose of steroid in diluted doses at three sites (posterior capsule, subacromial andsubcoracoid). The second sitting was repeated after 3 weeks. Both groups had received the samephysiotherapy. The patients were evaluated by the CONSTANT score at initial, 3 weeks, 6 weeks and6 months. Results: Patients of Group 2 (NTS group) had significant pain relief and earlyimprovement in activities of daily living (p < 0.005) as compared to Group 1 (SSI Group). Also,although there was an improvement in shoulder movements in both the groups but in Group 2 (NTS)patients, early near-normal scores were attained and sustained even after 6 months. About 40% inGroup 1 (SSI) could not attain near-normal levels and had relapses. Conclusion: The Novel three-site approach of steroid injections in frozen shoulder provides early recovery, better pain relief andbetter improvement in shoulder function with fewer relapses.
... The term scapulohumeral periarthritis was rst coined by French surgeon Duplay in 1872 [3]. Later, Naviaser rst validated pathological arthrogryposis and adhesion of the bone head and articular capsule in 1945 and renamed the disease "adhesive capsulitis." ...
Background: Many studies have attempted to clarify factors associated with the development of shoulder periarthritis. In its early stage, omalgia impairs normal, everyday life. Due to this pain, muscle force decreases in the affected side of the upper limb, and a change occurs in body composition distribution, especially in the upper limb. Currently, body composition distribution can be measured using dual energy X-ray absorptiometry (DEXA).
Methods: 102 patients with unilateral shoulder pain over 3 months (5 males and 97 females, mean age: 62.5 ± 10.5 years) were assigned to the shoulder pain group (painful group). The control group consisted of 237 patients without shoulder pain (20 males and 197 females, mean age: 59.8 ±14.2 years). These factors were measured using a QDR-4500 DEXA scanner (Hologic Co., Ltd.).
Results: Mean values of bone mineral density were 0.57 ±0.09 g/cm² on the affected side and 0.59 ± 0.08 g/cm² on the non-affected side in the painful group. Mean values in the control group were 0.57 ± 0.14 g/cm² on the left side and 0.58 ±0.09 g/cm² on the right side. There was no significant difference between the shoulder with and without pain, affected and non-affected side. Mean proportions of the upper limb that was fat were 40.1 ± 9.5% on the affected side and 35.7 ±9.8% on the non-affected side in the painful group. In the control group, the means were 39.2 ±11.1% on the left side and 37.5 ± 10.9% on the right side. The mean muscle masses of the upper limb were 1548.5 ±304.2 g on the affected side and 1723.5 ±321.5 g on the non-affected side in the painful group. There was a significant difference between the affected and non-affected side.
Conclusions: We measured the body composition of the upper limb. Muscle mass of upper limb was significantly different between the affected and non-affected sides.
... A sua etiologia permanece desconhecida; desde que foi descrita pela primeira vez por Duplay (2) , em 1872, diversas teorias vêm sendo propostas com relação à sua etiologia e métodos de tratamento. ...
... A sua etiologia permanece desconhecida; desde que foi descrita pela primeira vez por Duplay (2) , em 1872, diversas teorias vêm sendo propostas com relação à sua etiologia e métodos de tratamento. ...
Frozen shoulder is a condition of pain and severe and prolonged disability. This report is based in 136 patients with frozen shoulder that had been treated by the techinique of supraescapular nerve block, from 1994 June to 2000 february. Age, sex, dominance and classification was analysed. The results of the treatment was based on the UCLA rating system and AAOS criteria. The mean follow-up was 39 months. The satisfactory result was 84% (121 shoulders), an improvement of pain was obteined in 91.7% (132 shoulders). In our study there was not a significantly stastistic difference between patients presented diabetes mellitus and general population about lost of motion and response to the treatment. The supraescapular nerve block is an effective metthod to treat frozen shoulder.
... FS is a term coined by Codman in 1934 [1]. Synonyms include périarthrite scapulohumérale [2] and adhesive capsulitis [3]. In Japan, a term ''goju-kata'' (50-year-old-shoulder) has been used among the general public since the eighteenth century or before. ...
Primary frozen shoulder (FS) is a painful contracture of the glenohumeral joint that arises spontaneously without an obvious preceding event. Investigation of the intra-articular and periarticular pathology would contribute to the treatment of primary FS.
Many studies indicate that the main pathology is an inflammatory contracture of the shoulder joint capsule. This is associated with an increased amount of collagen, fibrotic growth factors such as transforming growth factor-beta, and inflammatory cytokines such as tumor necrosis factor-alpha and interleukins. Immune system cells such as B-lymphocytes, T-lymphocytes and macrophages are also noted. Active fibroblastic proliferation similar to that of Dupuytren's contracture is documented. Presence of inflammation in the FS synovium is supported by the synovial enhancement with dynamic magnetic resonance study in the clinical setting.
Primary FS shows fibrosis of the joint capsule, associated with preceding synovitis. The initiator of synovitis, however, still remains unclear. Future studies should be directed to give light to the pathogenesis of inflammation to better treat or prevent primary FS.
... Duplay was the first to recognize the condition as a pathology in its own right, referring to "periarthrite scapulohumerale" leading to the widespread but inappropriate use of the term "periarthritis" [7]. Neviasier, in 1945, described "adhesive capsulitis" using the term "adhesive" to describe the texture and integrity of the inflamed capsule, which he thought was similar to sticking plaster [8]. ...
Frozen shoulder is a common, disabling but self-limiting condition, which typically presents in three stages and ends in resolution. Frozen shoulder is classified as primary (idiopathic) or secondary cases. The aetiology for primary frozen shoulder remains unknown. It is frequently associated with other systemic conditions, most commonly diabetes mellitus, or following periods of immobilisation e.g. stroke disease. Frozen shoulder is usually diagnosed clinically requiring little investigation. Management is controversial and depends on the phase of the condition. Non-operative treatment options for frozen shoulder include analgesia, physiotherapy, oral or intra-articular corticosteroids, and intra-articular distension injections. Operative options include manipulation under anaesthesia and arthroscopic release and are generally reserved for refractory cases.
... Since first being described by Duplay in 1872 3 various attempts have been made to define and categorize frozen shoulder. I shall define frozen shoulder syndrome after Grubbs as 'a soft tissue capsular lesion accompanied by painful and restricted active and passive motion at the glenohumeral joint' 1 . ...
The purpose of this study is to compare the effectiveness between Mulligan’s mobilization and spencer technique.The study's 36 patients who met the eligibility requirements were accepted. Before beginning any examinations, each participant in this study completed a written informed consent form. Three groups of frozen shoulder patients were randomly assigned. Mulligan's mobilization was used in Group A, Spencer technique was used in Group 2, and simply conventional treatment was used in Group 3. The computer-generated list used to divide the patients into the three groups remained consistent throughout the trial. In both groups, the course of treatment lasted four weeks.Shoulder pain is very common problem now a days. Shoulder pain leads to multiple dysfunctions depending upon severity of pain. It decreases the range of motion and leads to functional dependency. Physical therapy is important in the management of shoulder pain including heat therapy, infrared radiations, and manipulation exercises and in some cases traction. This study provided an opportunity to share my personal experience with community. This study was conducted purely in clinical setting of Physiotherapy Department Mayo Hospital, Lahore. The outcome of this study is of great value in treating frozen shoulder which is a great contribution to the health care system of Pakistan. As there are numerous treatment strategies to treat shoulder pain but there is not enough evidence about the efficacy of Spencer technique. Hence this study was done to compare the efficacy of these interventions.NPRS AND SPADI post treatment scores of group A show significant improvement in reducing pain and disability.It was concluded from the results of this study that Mulligan’s mobilization are more effective than Spencer technique for treatment of frozen shoulder. It improves movements and posture of patients.
In this chapter, a summary of original descriptions, terminology, etiology, incidence, clinical presentation, and management of frozen shoulder and its idiopathic type referred to as adhesive capsulitis is provided. Role of comorbidities and association with autoimmune conditions, endocrinological, rheumatological, and autoimmune conditions that are known to increase the risk of developing a frozen shoulder are discussed. The plain radiographic findings of this condition are often unremarkable but may show subtle changes such as osteoporosis and calcified tendinitis. Considering frozen shoulder may be a secondary presentation of a number of serious conditions such as septic arthritis or metastasis of a malignant tumor, the differential diagnoses should be carefully ruled out. A brief description of nonsurgical and surgical management of primary frozen shoulder is provided at the end of the chapter.
[Purpose] The relationship between thoracic mobility and shoulder joint function in patients with frozen shoulder was examined using the precordial flexibility test and chest expansion measurement. [Participants and Methods] The participants were 22 individuals diagnosed with frozen shoulder. The correlations between their precordial flexibility test/chest expansion measurement results and the following parameters were investigated during the initial physical therapy: scores based on the Japanese Orthopaedic Association Criteria for the Evaluation of Treatment Outcomes in Diseases of the Shoulder Joint (JOA scores), at-rest and at-movement Visual Analogue Scale (VAS) scores, and the shoulder range of motion (flexion, external rotation with the arm at side, and internal rotation). [Results] Both precordial flexibility test and chest expansion measurement results were correlated with at-rest VAS scores. [Conclusion] Thoracic mobility and rest shoulder pain may be associated in patients with frozen shoulder.
Background
Nonoperative and operative treatment modalities have been used for symptom management of adhesive capsulitis, but neither has been shown to significantly alter the long-term natural history.
Purpose/Hypothesis
The purpose was to evaluate the current trends in resource and treatment strategy utilization for patients with adhesive capsulitis. It was hypothesized that (1) patients with idiopathic adhesive capsulitis will primarily undergo nonoperative treatment and (2) patients with systemic medical comorbidities will demonstrate relatively higher utilization of nonoperative therapies.
Study Design
Cross-sectional study; Level of evidence, 3.
Methods
We searched the Mariner/PearlDiver database for Current Procedural Terminology and International Classification of Diseases codes to identify patients with adhesive capsulitis from 2010 to 2020 and to track their usage of diagnostic and therapeutic modalities, including radiography, magnetic resonance imaging (MRI), physical therapy, surgery, opioids, and injection. Patients with active records 1 year before and 2 years after initial diagnosis of adhesive capsulitis were eligible. Excluded were patients with secondary causes of adhesive capsulitis, such as fracture, infection, prior surgery, or other intra-articular pathology.
Results
The median age of this 165,937-patient cohort was 58 years, with 67% being women. There was a high prevalence of comorbid diabetes (44.2%), thyroid disorder (29.6%), and Dupuytren contracture (1.3%). Within 2 years of diagnosis of adhesive capsulitis, diagnostic and therapeutic modality utilization included radiography (47.2%), opioids (46.7%), physical therapy (43.1%), injection (39.0%), MRI (15.8%), arthroscopic surgery (2.7%), and manipulation under anesthesia (2.5%). Over 68% of the diagnostic and therapeutic modalities were rendered from 3 months before to 3 months after diagnosis. Patients with diabetes, thyroid disorders, tobacco use, and obesity had greater odds for treatment with physical therapy, opioids, radiography, and injection when compared with patients without these comorbidities (odds ratio [OR] range, 1.05-2.21; P < .0001). Patients with diabetes and thyroid disorders had decreased odds for surgery (OR range, 0.88-0.91; P ≤ .003). Patients with Dupuytren contracture had increased odds for all therapeutic modalities (OR range, 1.20-1.68; P < .0001).
Conclusion
Patients with adhesive capsulitis underwent primarily nonoperative treatment, with a high percentage utilizing opioids. The most active periods for treatment were from 3 months before diagnosis to 3 months after, and patients with medical comorbidities were more likely to undergo nonoperative treatment.
Idiopathic adhesive capsulitis is a primary shoulder condition that presents with varying degrees of pain and restricted range of motion. Shoulder stiffness as a result of trauma or surgery is distinct from this condition. Arthroscopy enables early diagnosis in patients with pain. Some patients benefit from arthroscopic excision of contracted strictures.
In dit artikel worden de epidemiologie en de klinische kenmerken van de frozen shoulder beschreven. Tevens wordt een overzicht gegeven van de evidentie die er is voor effectiviteit van de fysiotherapeutische behandeling van de frozen shoulder. Vervolgens wordt deze evidentie afgezet tegen de mening om juist geen behandeling te adviseren.
Background:
Idiopathic adhesive capsulitis is defined as a frozen shoulder with severe and global range-of-motion loss of unknown etiology. The purpose of our study was to clarify the prevalence of rotator cuff lesions according to patterns and severity of range-of-motion loss in a large cohort of patients with stiff shoulders.
Methods:
Rotator cuff pathology was prospectively investigated with use of magnetic resonance imaging (MRI) or ultrasonography in a series of 379 stiff shoulders; patients with traumatic etiology, diabetes, or radiographic abnormalities were excluded. Eighty-nine shoulders demonstrated severe and global loss of passive motion (≤100° of forward flexion, ≤10° of external rotation with the arm at the side, and internal rotation not more cephalad than the L5 level) and were classified as having severe and global loss of motion (Group 1). The remaining 290 shoulders were divided into two groups: those with severe but not global loss (Group 2; 111 shoulders) and mild to moderate limitation (Group 3; 179 shoulders).
Results:
Among all shoulders, imaging demonstrated an intact rotator cuff in 51%, a full-thickness tear in 35%, and a partial-thickness tear in 15%. In Group 1, 91% had an intact rotator cuff and 9% had a partial-thickness rotator cuff tear. No patient in this group demonstrated a full-thickness tear. In Group 2 and Group 3, respectively, 44% and 35% of the shoulders were intact, 17% and 16% had a partial-thickness tear, and 39% and 50% had a full-thickness tear.
Conclusions:
Shoulder stiffness with severe and global loss of passive range of motion is not associated with full-thickness rotator cuff tears, although some patients may have a partial-thickness tear. Shoulders with severe and global loss of range of motion at a first visit are likely to be cases of idiopathic adhesive capsulitis and may not require further imaging studies.
Frozen shoulder is a common disease which causes significant morbidity. Despite over a hundred years of treating this condition the definition, diagnosis, pathology and most efficacious treatments are still largely unclear. This systematic review of current treatments for frozen shoulder reviews the evidence base behind physiotherapy, both oral and intra articular steroid, hydrodilatation, manipulation under anaesthesia and arthroscopic capsular release. Key areas in which future research could be directed are identified, in particular with regard to the increasing role of arthroscopic capsular release as a treatment.
Adhesive capsulitis is a subset of frozen shoulder. Primary adhesive capsulitis is a distinct pathologic entity whose etiology is yet to be determined. Understanding of this condition has evolved over the centuries. Four stages of adhesive capsulitis have been established by Neviaser and Neviaser. A correlation between these findings, clinical examination, and histologic appearance was later described by Hannafin. Diagnosis is made by physical examination and subjective history. The stages of adhesive capsulitis represent a continuum. Clinical decision making can be optimized by recognizing the stage of presentation, as well as the irritability of the shoulder. The goals of treatment are to address the symptoms and impairments that the patient presents with, and to optimize function in the presenting stage.
Purpose:
Rotator cuff surgery is a rapidly evolving branch in orthopaedics, which has raised from a minor niche to a fully recognized subspecialty. This article summarizes its history, examining the development of its key principles and the technical advancements.
Methods:
Literature was thoroughly searched, and few senior surgeons were interviewed in order to identify the significant steps in the evolution of rotator cuff surgery.
Results:
A wide variety of surgical options is available to reduce pain and restore function after rotator cuff tears. Rotator cuff repair surgical techniques evolved from open to arthroscopic and are still in development, with new fixation techniques and biological solutions to enhance tendon healing being proposed, tested in laboratory and in clinical trials. Although good or excellent results are often obtained, there is little evidence that the results of rotator cuff repair are improving with the decades. An overall high re-tear rate remains, but patients with failed rotator cuff repairs can experience outcomes comparable with those after successful repairs.
Conclusions:
Rotator cuff repair techniques evolve at a fast pace, with new solutions often being used without solid clinical evidence of superiority. It is necessary to conduct high-level clinical studies, in which data relating to anatomical integrity, patient self-assessed comfort and function, together with precise description of patient's condition and surgical technique, are collected.
Level of evidence:
IV.
This review summarizes recent research relevant to assessing the effectiveness of treatment for frozen shoulder, including the natural history, the prevalence of frozen shoulder, and other conditions sometimes associated with it. We searched Medline, the Cochrane Database of Systematic Reviews and Embase databases for systematic reviews and randomized controlled trials published in English from 1999 to 2009. Frozen shoulder is of unknown aetiology and has three distinct phases: (1) the painful phase; (2) the stiff (‘frozen’) phase; and (3) recovery (‘thawing’). Frozen shoulder is more common in women and within the age-range 40 years to 60 years. The prevalence of frozen shoulder is between 2% and 5%, but between 10% and 31% in people with diabetes. Diagnosis can prove difficult, particularly within primary care. The many treatment options involve little consensus on usage and in relation to different phases of frozen shoulder. There is limited evidence of the effectiveness of different forms of treatment used for frozen shoulder. Many studies evaluating treatment effects carry a moderate to high risk of bias and omit details of the duration of symptoms or the phase of the condition. The outcome measures used may all lack sufficient specificity. Data on economic outcomes concerning patterns of care, treatment and treatment effects for frozen shoulder are limited.
The aim of this study was to evaluate the impact of arthroscopic capsular release in patients with primary frozen shoulder on muscular strength of nonaffected and treated shoulder after at least two-year follow-up after the surgery. The assessment included twenty-seven patients, who underwent arthroscopic capsular release due to persistent limitation of range of passive and active motion, shoulder pain, and limited function of upper limb despite 6-month conservative treatment. All the patients underwent arthroscopic superior, anteroinferior, and posterior capsular release. After at least two-year follow-up, measurement of muscular strength of abductors, flexors, and external and internal rotators of the operated and nonaffected shoulder, as well as determination of range of motion (ROM) and function (ASES) in the operated and nonaffected shoulder, was performed. Measurement of muscular strength in the patient group did not reveal statistically significant differences between operated and nonaffected shoulder. The arthroscopic capsular release does not have significant impact on the decrease in the muscular strength of the operated shoulder.
Objective
To evaluate “The Niel-Asher Technique (NAT)” for adhesive capsulitis
Method
Prospective observational multi-center study
Subjects
154 patients (113 from Israel, 25 from the UK and 16 from the US) with pain, stiffness and globally restricted gleno-humeral mobility shoulder for more than three months.
Outcome measures
Change in active range of motion (AROM) Flexion and Abduction of the gleno-humeral joint measured by a goniometer; changes in pain as evaluated by the patients on a linear Visual Analogue Scale (VAS). Analysis was based on the intention-to-treat principle.
Results
Multivariate repeated measures analysis of covariance indicated that there was a significant improvement in AROM abduction and flexion across time, with no interaction between time and phase of illness (acute / stiff / resolving). The improvement in range of motion was significantly more pronounced in patients from Israel compared to the UK and US. Similarly, among patients from Israel, large and statistically significant reduction in the VAS pain score between baseline and post-treatment assessments was observed.
Conclusions
All patients demonstrated a significant improvement in AROM for both flexion and abduction. The data supports the notion that NAT is autonomously reproducible. NAT demonstrated significant improvement in AROM for both flexion and abduction with a consistent average of twelve degrees improvement per treatment session. The mean number of treatments was 7. NAT expedites both pain reduction and increased mobility for adhesive capsulitis over and above the natural history.
OBJECTIVE:
Describe the outcomes of patients with adhesive capsulitis treated with arthroscopic surgical procedure.
METHODS:
Between January and September of 2009, 9 patients (10 cases) underwent arthroscopic surgical release. There were 4 male (one bilateral) and 5 female patients. Their mean age was 51 years (27-63). The time from onset of symptoms to the surgical procedure averaged 23.4 months (6-38). Preoperative assessment was based on the UCLA and Constant score. ROM was evaluated with one week and six months of surgery.
RESULTS:
According to UCLA shoulder score (p < 0.01) it increased from 9.8 preoperatively (6-14) to 31.6 postoperatively (26-35) and the Constant (p < 0.01) from 20 (13-27) to 79.2 (66-91). ROM improved significantly, with mean passive elevation changing from 89° (80-100°) preoperatively to 150° postoperatively with one week and 153° with six months, mean passive external rotation changing from 12.5° (0-30°) preoperatively to 46° (one week) and 56° (six months) postoperatively, and passive internal rotation from L5 (T12-gluteus) to T11 (one week) and T9 (six months). There was not statistical significance of the duration of the disease and the postoperative result.
CONCLUSION:
This study shows that the surgical treatment of adhesive capsulitis with arthroscopic capsular release and manipulation appears to be a safe procedure that results in pain relief and functional gain.
The aim of this review is to illustrate the spectrum of ultrasound-guided procedures around the shoulder. The shoulder is affected by a wide range of both, traumatic and degenerative diseases. Ultrasound guidance is a low-cost and safe tool to perform minimally invasive interventional procedures around the shoulder. The clinical outcome is shown by the use of clinical scores: visual analogue scale (VAS), Constant's score and Shoulder Pain Disability Index (SPADI). Rotator cuff calcification is a common painful condition that occurs in up to 7.5 % of otherwise healthy adults. Ultrasound-guided procedures include single-needle and double-needle approach with different needles. These techniques are described and the results are critically compared. Ultrasound-guided viscosupplementation is a new therapeutic approach for treatment of several shoulder pain disorders: osteoarthritis, rotator cuff tear and tendinosis. In adhesive capsulitis, different therapeutic ultrasound-guided techniques such as corticosteroid injection, capsular distension (sodium chlorate solution; sodium chlorate and corticosteroids; air) and viscosupplementation are evaluated. Acromion-clavear injection of steroid and lidocaine solution under ultrasound guidance is easy to perform and is indicated in conservative treatment of painful osteoarthrosis. The treatment of rotator cuff tendinosis and partial tears with ultrasound-guided injection of concentrated autologous platelets is also described.
La rigidez del hombro, caracterizada desde el punto de vista clínico por la disminución de los movimientos pasivos, sobre todo en rotación lateral E1 y en flexión, aún conserva una parte de su misterio fisiopatológico. En la mayoría de los casos, forma parte del síndrome de dolor regional complejo (SDRC) de tipo I, denominación que sustituye a las de capsulitis adhesiva o retracción capsular o síndrome algodistrófico. Los pocos estudios anatomopatológicos e inmunológicos realizados ponen de manifiesto una proliferación de células fibroblásticas, en algunos casos con asociación de signos inflamatorios de la sinovial. El tratamiento es ante todo conservador: rehabilitación, control del dolor y distensiones artrográficas que permiten, en la mayoría de los casos y al precio de una evolución de varios meses, la recuperación funcional. Las liberaciones artroscópicas, menos perjudiciales que las artrólisis a cielo abierto, pueden indicarse cuando fracasan los tratamientos conservadores. Las medidas preventivas de la rigidez tras cirugía del hombro son producto de un consenso profesional: rehabilitación precoz y control del dolor postoperatorio. En la cirugía del hombro, cualquiera que sea la técnica empleada, debe informarse al paciente acerca de la posibilidad de que se produzca un SDRC de tipo I.
Zusammenfassung Die Frakturen im Schultergürtelbereich sind eine Domäne konservativer Behandlungsmethoden. Wir konnten zeigen, daß das Ziel der modernen Frakturbehandlung mit seiner möglichst schnellen aktiven Bewegungstherapie durch funktionelle Behandlungsmethoden am Schultergürtel befriedigend erreicht wird. Die Voraussetzungen für unsere aufgezeigte Methodik ergeben sich aus den hierfür günstigen biomechanischen Verhältnissen des Schulterarmbereichs, die es auch zulassen, daß bisweilen ein achsengerechter Frakturstand vernachlässigt werden kann.
Within the past 100 years, shoulder and elbow surgery has developed into a highly sophisticated specialty. Technical advancements now allow operative treatment of most shoulder and elbow disorders.
Shoulder arthroplasty is able to accurately reproduce normal anatomy and function. It is used in degenerative omarthrosis, humeral head fractures, rheumatoid arthritis, and rotator cuff arthropathy. After 10 years, survival of 93% can be expected and in omarthrosis an outcome score of 85 of 100 points.
In recurrent shoulder instability, open surgery is still the gold standard. It allows to accurately adjust capsular tension. Modern arthroscopic techniques shorten the capsule with sutures or by capsular shrinkage, but sufficient follow-up is not yet available.
Arthroscopic subacromial decompression is the standard procedure for subacromial disorders. The indication for operative rotator cuff closure must be adjusted to the age and functional expectations of the patient. Smaller defects can be closed arthroscopically. The operative technique in proximal humerus fractures is particularly demanding, due to osteoporosis and the risk of avascular necrosis.
Magnetic resonance imaging is the preferred imaging technique at the shoulder, often combined with intravenous or intra-articular contrast injection. Elbow joint replacement is mostly used in rheumatoid arthritis and has achieved a high technical standard.
Introduction
Le but de ce travail est d’étudier l’impact sur le recouvrement clinique du respect ou non du seuil douloureux dans la prise en charge des épaules enraidies.
Patients et méthodes
Les auteurs ont réalisé une étude prospective comparative multicentrique de 193 cas d’épaules enraidies suivies pendant 12 mois (huit à 31) et traitées selon quatre protocoles différents : premier : rééducation conventionnelle infra-douloureuse (58 cas) ; deuxième : rééducation exclusive avec incitation supra-douloureuse (59 cas) ; troisième : rééducation supra-douloureuse encadrée (31 cas) et quatrième : capsulotomie et rééducation infra-douloureuse (45 cas). Le suivi a été journalier les six premières semaines puis hebdomadaire les six suivantes avec évaluation pour chaque séance de la douleur, de la faisabilité et du temps de travail de chaque exercice de rééducation par le praticien et d’auto-rééducation par le patient, associé à l’évaluation de sa douleur, son handicap et son état psychique. Le chirurgien a revu les patients à six semaines, trois mois, six mois, un an et à la révision finale.
Résultats
La rééducation infra-douloureuse donne des résultats progressifs et limités dans le temps (p < 0,05). L’auto-rééducation avec incitation supra-douloureuse est moins algique (p < 0,05) dés les premiers jours avec une douleur nocturne qui disparaît dans 43 % des cas après sept jours d’exercices. L’encadrement des exercices d’auto-rééducation optimise le résultat clinique (p < 0,05). La capsulotomie ne modifie pas l’évolution antalgique les huit premières semaines mais améliore l’évolution antalgique ensuite. Les échecs (un an : 14 à 17 %, révision finale : 3,5 %) sont directement corrélés au nombre d’exercices réalisés par le patient (p < 0,05).
Discussion
Le dogme du respect du seuil douloureux n’a plus lieu d’être, une douleur infligée à un patient passif altère l’évolution clinique, une douleur gérée par un patient éduqué, actif et encadré par un praticien averti permettra un recouvrement fonctionnel et antalgique rapide.
Niveau de preuve
Niveau III, cas témoins, prospectif comparatif.
Zusammenfassung Impingementsyndrom, Rotatorenmanschettendefekt und Omarthrose können gut konservativ behandelt werden. Voraussetzungen sind
eine differenzierte Diagnostik und eine klare Therapiezielvorgabe. Beim Impingementsyndrom sind meistens durch eine gezielte
klinische Untersuchung eine exakte Differenzierung und Ursachenklärung möglich. Auf dem Boden einer exakten Diagnose kann
mit einer spezifischen funktionellen Behandlung in vielen Fällen Schmerzfreiheit erzielt werden. Die medikamentöse Behandlung
spielt dabei eine untergeordnete Rolle. Bei der manuellen Therapie ist je nach Befund der Schwerpunkt auf freie Beweglichkeit
(Dehnen der dorsalen oder kaudalen Kapsel) oder die Wiederherstellung des muskulären Gleichgewichts zu legen. Das kann durch
Kräftigung der Schulterblattstabilisatoren einerseits und Dehnen der destabilisierenden Muskeln andererseits erreicht werden.
Eine arthroskopische Schulterdacherweiterung lässt sich damit in der Regel vermeiden. Beim Rotatorenmanschettendefekt können
kleine bis mittelgroße schmerzhafte Defekte mit oder ohne Bewegungseinschränkung beim älteren, nicht mehr aktiven Patienten
mit Erfolg konservativ behandelt werden. Während der Schmerz meist auf eine medikamentöse Injektionsbehandlung gut anspricht,
erfordert die Bewegungseinschränkung und Kraftlosigkeit eine gezielte Krankengymnastik. Dabei steht Schmerzfreiheit immer
vor Beweglichkeit. Bei der Omarthrose erfordert die schmerzhafte Bewegungseinschränkung eine gezielte medikamentöse und physikalische
Therapie. Knorpelschutzpräparate spielen für die Schmerztherapie eine untergeordnete Rolle. Die manuelle Therapie sollte unter
Traktion die Mobilität und auch den Schmerz verbessern.
BACKGROUND For well over a century, adhesive capsulitis of the shoul- der has remained a complex disorder with variable clinical outcomes. In 1872, Duplay1 described a condition he called peri-arthritis scapulo-humerale, and later Codman2 described this disorder as a frozen shoulder and stated adhesive capsulitis of the shoulder remains "a class of cases which are difficult to define, difficult to treat, and difficult to explain from the point of pathology." This remains true even today. It has been suggested that the frozen shoulder is precipitated by degeneration of the supraspinatus tendon and is associated with chronic inflammation of the subacromial bursa and gle- nohumeral capsule. Furthermore, immunological pathogenesis and chromosomal abnormalities of this condition have also been postulated. Despite several theories and hypotheses, the pathogenesis and pathophysiology of this disorder continues to be poorly understood. Adhesive capsulitis of the shoulder is clinically described as having three phases: the freezing or painful stage, the frozen or progressive stiffness phase, and the thawing or resolution phase. Codman2 stated that even the most protracted cases recover with or without treatment in approximately two years. However, other authors3 have noted that this disorder may not be self-limited with long-term follow up revealing persistent loss of motion in many patients. In 1995, we set out upon a comprehensive study to determine the prevalence of this disorder as well as the natural history of adhesive capsulitis of the shoulder. Furthermore, we evaluated the surgical outcome of those patients undergoing arthroscopic capsular release for refractory adhesive capsulitis of the shoulder. We are now in the early stages of evaluating
Adhesive capsulitis is a condition "difficult to define, difficult to treat and difficult to explain from the point of view of pathology". This Codman's assertion is still actual because of a variable nomenclature, an inconsistent reporting of disease staging and many types of treatment. There is no consensus on how the best way best to manage patients with this condition, so we want to provide an evidence-based overview regarding the effectiveness of conservative and surgical interventions to treat adhesive capsulitis.
Diabetes is a disease characterized by chronic hyperglycemia. This can cause microvascular and macrovascular complications. There are several musculoskeletal disorders that occur in people with diabetes. Some are likely directly because of the disease process, others have a higher incidence in those with diabetes, and yet others are likely associated with common etiologies. Rehabilitation professionals should be aware of common musculoskeletal disorders present in those with diabetes and be familiar with the implications of therapy interventions.
Frozen shoulder is characterized by active and passive stiffness of the shoulder with pain. A distinction between primary and secondary frozen shoulder is required because of the different course and therapy.
The cause of primary frozen shoulder is unknown. The course is typically divided in three phases with characteristic complaints. Secondary frozen shoulder is caused by systemic, intrinsic, or extrinsic factors with different courses. The distinction between primary and secondary frozen shoulder is not easy because, apart from clinical signs, there is no diagnostic certainty.
For primary frozen shoulder, conservative treatment is preferred. Because of the different pathogenetic processes in each of the known three phases, a phase-related treatment is required. For phase I, which includes the time till passing the pain peak combined with decrease of night pain, we do not recommend either conservative or operative manipulation. Only symptomatic tonus-reducing and analgetic measures are useful. Once phase II begins, mobilization exercises are indicated. If conservative treatment is not successful or spontaneous course does not reach regression of capsule contracture, operative treatment is considered. Controlled arthroscopic capsular release is preferable.
Making the indication for an operative treatment dependent on the duration of unsuccessful conservative treatment (for example, 6 weeks) is useless, because the course of a primary frozen shoulder can range from 1–3 years. Rather the treatment course should be decided depending on the phase of the illness.
In dit artikel worden de epidemiologie en klinische kenmerken van de frozen shoulder beschreven. Tevens wordt een overzicht
gegeven van de evidence die er is voor de fysiotherapeutische mogelijkheden bij de behandeling van de frozen shoulder. Vervolgens
wordt deze evidence afgezet tegen de mening om juist geen behandeling te adviseren.
There are many types of treatment used to manage the frozen shoulder, but there is no consensus on how best to manage patients with this painful and debilitating condition. We conducted a review of the evidence of the effectiveness of interventions used to manage primary frozen shoulder using the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Physiotherapy Evidence Database, MEDLINE and EMBASE without language or date restrictions up to April 2009. Two authors independently applied selection criteria and assessed the quality of systematic reviews using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Data were synthesised narratively, with emphasis placed on assessing the quality of evidence.
In total, 758 titles and abstracts were identified and screened, which resulted in the inclusion of 11 systematic reviews. Although these met most of the AMSTAR quality criteria, there was insufficient evidence to draw firm conclusions about the effectiveness of treatments commonly used to manage a frozen shoulder. This was mostly due to poor methodological quality and small sample size in primary studies included in the reviews. We found no reviews evaluating surgical interventions.
More rigorous randomised trials are needed to evaluate the treatments used for frozen shoulder.
Frozen shoulder has a greater incidence, more severe course, and resistance to treatment in patients with diabetes mellitus compared with the general population. We hypothesized that diabetic patients with frozen shoulder undergoing treatment with manipulation under general anaesthesia (MUA) would have the same outcome as patients without diabetes.
We retrospectively analyzed data collected during a 10-year period of referrals for frozen shoulder. In all cases, a standardized MUA protocol was followed once the diagnosis of frozen shoulder in the frozen phase was made; this included an early repeat MUA in individuals with recurrence. We compared outcomes for patients documented as having diabetes with a nondiabetic control group and assessed the effect of insulin dependence and frozen shoulder etiology within the diabetic group.
Of a consecutive series of 315 frozen shoulders, 36 patients (39 shoulders) were included in the diabetic group, with 256 patients (274 shoulders) as controls. There was a significant improvement in range of movement and Oxford Shoulder Score (P all <.001), with no difference between diabetic and control groups at early or late follow-up (mean, 41 months). A repeat procedure was required in 36% of diabetic patients compared with 15% of control patients. Recurrence in the diabetic group was influenced by etiology (47% of primary vs 0% of secondary frozen shoulders) and insulin requirement (39% insulin-dependent vs. 31% non-insulin-dependent).
We provide a strategy for the management of diabetic frozen shoulders using MUA and estimates of success and recurrence rates that may be useful when informing consent.
The present study investigated the impact of respecting pain threshold on clinical recovery in stiff shoulder.
A prospective multicenter comparative study followed up 193 cases of shoulder stiffness for a mean 12-month period (range, 8-31 months) after four different treatment protocols: (1) conventional sub-pain-threshold rehabilitation (58 cases); (2) self-rehabilitation exceeding the pain threshold (59 cases); (3) supervised suprathreshold rehabilitation (31 cases); and (4) capsulotomy with sub-threshold rehabilitation (45 cases). Follow-up was daily for the first 6 weeks then weekly for the next 6; each session included assessment of the painfulness, feasibility and duration of each rehabilitation and self-rehabilitation exercise and of pain status, disability and psychological status. The surgeon followed patients up at 6 weeks, 3 months, 6 months, 1 year and at last follow-up.
Sub-threshold rehabilitation provided progressive results, limited in time (P<0.05). Suprathreshold self-rehabilitation provided reduced pain (P<0.05) as of the first days, with nocturnal pain ceasing after 7 days' rehabilitation in 43% of cases. Supervision of self-rehabilitation exercises optimized the clinical result (P<0.05). Capsulotomy did not influence pain evolution over the first 8 weeks, but then improved it. Failure (at 1 year, 14-17%; last follow-up, 3.5%) correlated directly with the number of exercises performed by the patient (P<0.05).
The dogma of respecting the pain threshold is dated: pain inflicted on a passive patient impairs clinical evolution, but pain managed by an informed active patient under experienced supervision provides rapid recovery of function and pain-free status.
The aim of this study was to compare shoulder manipulation and arthroscopic arthrolysis with glenohumeral steroid injections in patients affected by idiopathic adhesive shoulder capsulitis.
In this prospective study we randomly assigned patients to enter group A (23 patients, shoulder manipulation and arthroscopic arthrolysis) and group B (21 patients, glenohumeral steroid injections). Patients were followed-up at three, six and 12 weeks, and at six and 12 months with the Constant and Murley, ASES, UCLA and SST evaluation scales. Moreover, passive forward flexion, abduction, and internal and external rotations were recorded.
Range of motion showed satisfactory results in both groups at final follow-up: in group A the mean ABD increased from 60° to 154°, ER from 20° to 40°, and FF from 75° to 174°; in group B, ABD raised from 76° to 145°, ER from 20° to 35°, and FF from 115° to 164°. All the evaluation scales performed increased significantly at final follow-up in both groups. However, while patients of group A had already reached significant improvement at the six-week follow-up (p <0.03), in group B this happened only at the 12 week follow-up (p <0.03).
Both types of treatment were effective in improving final range of motion; however, while patients of group A accomplished their goal by the six-week follow-up, in group B the same result was obtained at the 12-week follow-up.
Cryosurgery is an established adjuvant treatment of bone tumors which reduces the local recurrence rate. In this study, cryosurgical experiments were carried out in rabbits to study the temperature field, the extent of necrosis, and the revitalization process in order to optimize treatment. Intramedullary freezing of long bones with a closed liquid nitrogen cryoprobe and three consecutive sessions induces osteonecrosis down to the -10 degrees C isotherm without compromising the soft tissues. The application of a tourniquet does not influence the thermodynamics. The revitalization process is distinguished into an osteogenic and a remodelling phase. In rabbits, there is an obvious periosteal osteogenesis starting from 1 week after operation and overlapping the remodelling phase, which starts between 3 and 5 weeks after operation. Two out of eight rabbits sustained a pathologic fracture within 3 weeks of cryosurgery. No pathologic fractures were encountered during the remodelling phase, probably because of the profuse periosteal bone apposition that added mechanical strength. In clinical practice, no profound periosteal bone apposition and a high risk for pathologic fractures during the remodelling phase were noted. Future research should focus on bone strength during the remodelling phase of cryosurgically treated long bones, to decide on the role of preventive osteosynthesis or postoperative restrictions. This animal model is not advised for these biomechanical experiments because of its profuse periosteal bone apposition.
ResearchGate has not been able to resolve any references for this publication.