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Jhaj J, Woolner B, Rankin S, Heard G, Planner A, Thahal H, Woods D. What volume of injection should be used in hydrodilatation for frozen shoulder? A prospective cohort study. Shoulder Elbow 2024:17585732241307860. [PMID: 39713261 PMCID: PMC11660107 DOI: 10.1177/17585732241307860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 11/29/2024] [Accepted: 11/30/2024] [Indexed: 12/24/2024]
Abstract
This study evaluated the outcome and recurrence rates after hydrodilatation (HD) in patients with frozen shoulder (FS), comparing the effects of injecting 25 mL or more of fluid versus lower volumes. A total of 132 shoulders (130 patients) were treated at a shoulder clinic between August 2019 and February 2023. HD was performed under ultrasound guidance, injecting a combination of 40 mg Triamcinolone, 10 mL of local anaesthetic, and saline to a total volume of 10 to 40 mL based on patient tolerance. The results were analysed based on the volume of fluid injected and whether patients were diabetic. The overall failure or recurrence rate (FRR) was 24% after a minimum of 1 year. Non-diabetic patients injected with ≥25 mL had a significantly lower FRR (9%) compared to those injected with <25 mL (30%, p = 0.006). Diabetic patients had a much higher FRR of 52%, compared to 17% in non-diabetics (p = 0.0002). The study concluded that injecting patients with ≥25 mL of fluid had a significantly lower FRR than those injected with <25 mL at a minimum of 12 months follow-up (9% vs 30%, p = 0.006). Diabetic patients experienced a higher rate of recurrence, suggesting the need for patient counselling about the increased likelihood of failure.
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Affiliation(s)
- Jasmeet Jhaj
- Department of Orthopaedics and Radiology, Great Western Hospital, Swindon, UK
| | - Benjamin Woolner
- Department of Orthopaedics and Radiology, Great Western Hospital, Swindon, UK
| | - Sally Rankin
- Department of Orthopaedics and Radiology, Great Western Hospital, Swindon, UK
| | - Gabriel Heard
- Faculty of Medicine, Imperial College London, London, UK
| | - Andrew Planner
- Department of Orthopaedics and Radiology, Great Western Hospital, Swindon, UK
| | - Hyeladzira Thahal
- Department of Orthopaedics and Radiology, Great Western Hospital, Swindon, UK
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Martin SD, Dean MC, Eberlin CT, Kucharik MP, Abraham PF, Nazal MR, Conaway WK, Cherian NJ. AAOS 2024 best paper in the shoulder and elbow classification: watchful waiting provides higher value with similar functional outcomes to physical therapy for frozen shoulder: a prospective randomized controlled trial. J Shoulder Elbow Surg 2024:S1058-2746(24)00802-4. [PMID: 39537016 DOI: 10.1016/j.jse.2024.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 09/03/2024] [Accepted: 09/05/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Physical therapy remains a ubiquitous treatment modality for the management of frozen shoulder (adhesive capsulitis) despite limited high-level evidence supporting its use. Leveraging patient-reported outcome measures (PROMs) and healthcare costs, this study compared patient outcomes and value achieved through watchful waiting (WW) vs. physical therapy (PT) for conservative management of frozen shoulder. METHODS Patients in this prospective, parallel randomized controlled trial who were diagnosed with frozen shoulder were randomized 1:1 to WW or PT. All patients were offered therapeutic, intra-articular corticosteroid injections (CSIs). The primary outcome was the American Shoulder and Elbow Surgeons Score. Secondary outcomes included patient value (ie, 12-month American Shoulder and Elbow Surgeons score divided by healthcare costs), the Disabilities of the Arm, Shoulder, and Hand questionnaire, and Visual Analog Scale pain. Due to the confidentiality of internal hospital data, all economic outcomes were divided by an undisclosed constant to set the normalized study mean for direct costs to 1000; similarly, patient value was normalized to set the study mean to 100. Outcomes were assessed at baseline, 6 weeks, 3 months, 6 months, and 12 months using mixed-effects models, with sensitivity analyses adjusting for nonlinear improvement trajectories and CSIs. RESULTS Between November 2014 and November 2022, 175 patients were screened, 61 of whom (34.9%) were randomized to WW (31 patients) or PT (30 patients). Forty-seven patients (96%) received at least one CSI, with no significant difference in CSI administration between cohorts (P = .29). Relative to baseline scores, patients from both cohorts improved significantly at each time point for all PROMs (P < .05 for all), with no significant differences in PROMs between groups at any time point (P > .05 for all). However, compared to those assigned WW, patients randomized to PT incurred 10.0× higher costs (normalized mean difference: 1636; 95% CI: 967, 2304; P < .001) and achieved only 16.9% of the patient value (normalized mean difference: -147.0; 95% CI: -207.5, -86.5; P < .001). These results held across all sensitivity analyses. CONCLUSION Relative to WW, patients randomized to PT reported similar PROMs but incurred significantly higher direct costs (10.0×) and imposed a greater economic burden on the healthcare system (3.4-6.0×). Accordingly, WW resulted in significantly higher (5.9×) patient value than PT. Although additional high-level, multicenter studies are needed to corroborate these findings, the present study may support physicians and patients in pursuing the most appropriate treatment plan for each patient based on their individualized needs and preferences.
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Affiliation(s)
- Scott D Martin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Michael C Dean
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA; Mayo Clinic Alix School of Medicine, Rochester, MN, USA.
| | - Christopher T Eberlin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA; Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA
| | - Michael P Kucharik
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA; Department of Orthopaedic Surgery, University of South Florida, Tampa, FL, USA
| | - Paul F Abraham
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA; Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Mark R Nazal
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA; Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA
| | - William K Conaway
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA; Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nathan J Cherian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA; Department of Orthopaedic Surgery, University of Nebraska, Omaha, NE, USA
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Ziegenfuss B, Italia K, Stalin KA, Whitehouse S, Gupta A, Cutbush K. The clinical course and outcomes following arthroscopic frozen shoulder 360° release. JSES Int 2024; 8:1196-1206. [PMID: 39822840 PMCID: PMC11733610 DOI: 10.1016/j.jseint.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2025] Open
Abstract
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 < .001). Within-participant analysis demonstrated that there was no significant difference between the pathological shoulder AROM and the contralateral (healthy) shoulder AROM (collected preoperatively) for any movement at 24 months postoperatively (all 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.
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Affiliation(s)
- Brandon Ziegenfuss
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, Australia
| | - Kristine Italia
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, Australia
- St. Luke’s Medical Center, Manila, Philippines
| | - Kathir Azhagan Stalin
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, Australia
| | - Sarah Whitehouse
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, Australia
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
| | - Ashish Gupta
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, Australia
- Greenslopes Private Hospital, Brisbane, Australia
| | - Kenneth Cutbush
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
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Dehlinger F, Bökeler U, Brandt H, Brunnader L, Eden L, Pfingsten A, Prill R. The S2e Guideline on Shoulder Stiffness. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:521-529. [PMID: 37798915 DOI: 10.1055/a-2123-4952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
The clinical picture of "frozen shoulder" is still poorly understood. In order to present the current state of knowledge on aetiology, diagnosis, and treatment, and to provide recommendations for the professional groups involved, a working group was formed by the DGOU and the DVSE to create a German language, evidence-based guideline, which was published in 2022 by the AWMF. The following summarises the development and the most important results.
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Affiliation(s)
- Friedrich Dehlinger
- Departement for Shoulder and Elbow Surgery, Acura Fachklinik GmbH, Albstadt, Deutschland
| | - Ulf Bökeler
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Zentrum für Schwerbrandverletzte, Marien Hospital Stuttgart, Stuttgart, Deutschland
| | - Hanna Brandt
- Faculty of Applied Social and Health Sciences, Department Physiotherapy, Ostbayerische Technische Hochschule Regensburg, Regensburg, Deutschland
| | - Lars Brunnader
- Abteilung für Orthopädie und Traumatologie, Krankenhaus der Barmherzigen Brüder Eisenstadt, Eisenstadt, Deutschland
| | - Lars Eden
- Klinik für Unfall-, Schulter- und Wiederherstellungschirurgie, Sportmedizin und Sporttraumatologie, Krankenhaus Rummelsberg gGmbH, Schwarzenbruck, Deutschland
| | - Andrea Pfingsten
- Faculty of Applied Social and Health Sciences, Department Physiotherapy, Ostbayerische Technische Hochschule Regensburg, Regensburg, Deutschland
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Deutschland
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Deutschland
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Ammerman BM, Dennis ER, Ling D, Hannafin JA. Ultrasound-Guided Glenohumeral Corticosteroid Injection for the Treatment of Adhesive Capsulitis of the Shoulder: The Role of Clinical Stage in Response to Treatment. Sports Health 2024; 16:333-339. [PMID: 37097090 PMCID: PMC11025513 DOI: 10.1177/19417381231168799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Daphne Ling
- Hospital for Special Surgery, New York, New York
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Pasqualini I, Tanoira I, Hurley ET, Tavella T, Ranalletta M, Rossi LA. Establishing the Minimal Clinically Important Difference and Patient Acceptable Symptom State Thresholds Following Arthroscopic Capsular Release for the Treatment of Idiopathic Shoulder Adhesive Capsulitis. Arthroscopy 2024; 40:1081-1088. [PMID: 37716626 DOI: 10.1016/j.arthro.2023.08.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To determine the minimal clinically important difference (MCID) and the patient acceptable symptom state (PASS) threshold for the visual analog scale (VAS), Constant, Single Assessment Numeric Evaluation (SANE), and American Shoulder and Elbow Surgeons (ASES) scores following arthroscopic capsular release for the treatment of idiopathic shoulder adhesive capsulitis. METHODS A retrospective review of prospective collected data was performed in patients undergoing arthroscopic capsular release for the treatment of idiopathic adhesive capsulitis at a single institution from January 2018 through January 2019. Patient-reported outcome measures were collected preoperatively and 6 months' postoperatively. Delta was defined as the change between preoperative and 6 months' postoperative scores. Distribution-based and anchored-based (response to a satisfaction question at 1 year) approaches were used to estimate MCIDs and PASS, respectively. The optimal cut-off point where sensitivity and specificity were maximized (Youden index) and the percentage of patients achieving those thresholds were also calculated. RESULTS Overall, a total of 100 patients without diabetes who underwent arthroscopic capsular release and completed baseline and 6-month patient-reported outcome measures were included. The distribution-based MCID for VAS, Constant, SANE, and ASES were calculated to be 1.1, 10.1, 9.3, and 8.2, respectively. The rate of patients who achieved MCID thresholds was 98% for VAS, 96% for Constant, 98% for SANE, and 99% for ASES. The PASS threshold values for VAS, Constant, and ASES were ≤2, ≥70, ≥80, and ≥80, respectively. The rate of patients who achieved PASS thresholds was 84% for VAS, 84% for Constant, 89% for SANE, and 78% for ASES. CONCLUSIONS In patients without diabetes and idiopathic adhesive capsulitis, high rates of MCID and PASS thresholds can be achieved with arthroscopic anteroinferior capsular release LEVEL OF EVIDENCE: Level IV, retrospective cohort study.
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Affiliation(s)
- Ignacio Pasqualini
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | | | - Eoghan T Hurley
- Department of Orthopedic Surgery, Division of Hand and Upper Extremity, Duke University, Durham, North Carolina, U.S.A
| | - Tomas Tavella
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Gómez-Muñoz E, Sánchez-Ibáñez I, Garríguez-Pérez D, García-Fernández C, Marco F, Lópiz Y. Functional results of Circumferential Capsular Release in adhesive shoulder capsulitis. Comparative study of patients over and under fifty years of age. Arch Orthop Trauma Surg 2024; 144:1303-1310. [PMID: 38153437 DOI: 10.1007/s00402-023-05175-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION The aim of our study is to evaluate the functional and mobility outcomes in patients who have undergone arthroscopic circumferential arthrolysis of the shoulder and to find out if there are differences in the results in relation to the patient's age. MATERIALS AND METHODS This is a retrospective case series of patients with idiopathic adhesive capsulitis treated by arthroscopic 360º circumferential capsulotomy in lateral position and followed for a minimum of 2 years. Range of motion (ROM), functional outcomes using the Constant Score (CS), health-related quality of life outcomes with the EuroQol Five Dimensions tool (EQ-5D), pain using the Visual Analogue Scale (VAS). RESULTS A total of 26 shoulders were included, 10 men (41.7%) and 14 women (58.3%), with 2 patients being bilateral. The mean age was 48.64 ± 7.5 years, and the mean follow-up was 50.2 months. Postoperative ROM improved significantly compared to preoperative ROM (p < 0.05). Shoulder forward flexion improved by 38.6° (95%CI 22.3-54.9, p < 0.01), abduction by 35.2° (95%CI 17.6-52.8, p < 0.01) and external rotation by 21.9° (95%CI 12.8-30.9, p < 0.01 p < 0.01). Median internal rotation improved from buttock to T12 (p < 0.01). The mean improvement in CS was 54.3 ± 24.4 points (p < 0.01). The EQ-5D and VAS scores at the end of follow-up were 0.73 ± 0.23 and 2.73 ± 2.55, respectively. There were no statistical differences between young patients and patients aged 50 years or older in ROM or functional results. CONCLUSIONS Patient age did not affect outcomes significantly, with patients older than 50 years showing similar results to younger patients.
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Affiliation(s)
- Eduardo Gómez-Muñoz
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Investigation Performed at Hospital Clínico San Carlos Hospital, Madrid, Spain.
| | - Ivan Sánchez-Ibáñez
- Department of Physical Medicine and Rehabilitation, Clínico San Carlos Hospital, Madrid, Spain
| | - Daniel Garríguez-Pérez
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Investigation Performed at Hospital Clínico San Carlos Hospital, Madrid, Spain
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Investigation Performed at Hospital Clínico San Carlos Hospital, Madrid, Spain
| | - Fernando Marco
- Department of Surgery, Complutense University, Madrid, Spain
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Yaiza Lópiz
- Department of Surgery, Complutense University, Madrid, Spain
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
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Kuhn I, Erber B, Goller SS. [Adhesive capsulitis]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:119-124. [PMID: 37801107 DOI: 10.1007/s00117-023-01217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Adhesive capsulitis (CA; also called Frozen shoulder) is a common, usually unilateral disease of the shoulder joint primarily affecting middle-aged women. Primary, idiopathic, and secondary forms are distinguished. Painful active and passive movement restriction are the clinically leading symptoms. COURSE OF THE DISEASE The disease usually progresses in three successive stages: freezing phase, frozen phase, and thawing phase. CLINICAL DIAGNOSIS AND IMAGING CA is primarily diagnosed clinically, with imaging being used to assess or exclude differential diagnoses. Radiography as part of basic diagnostics allows exclusion of common differential diagnoses such as osteoarthritis of the shoulder or calcific tendinitis. Native magnetic resonance imaging (MRI) and MR arthrography (MRA) reveal pathomorphologies typical of CA. Intravenously administered gadolinium increases the sensitivity of MRI. Sonography may be used as a complementary diagnostic modality or as an alternative in case of contraindications to MRI. Fluoroscopy-guided arthrography has been replaced by MRI because of its invasiveness. Computed tomography (CT) has no role in diagnostics due to its radiation exposure and significantly lower sensitivity and specificity compared to MRI. TREATMENT Therapy of CA is stage-adapted and includes conservative measures such as analgesics and physiotherapy and surgical procedures such as arthroscopic arthrolysis. The therapeutic spectrum is supplemented by new, innovative procedures such as transarterial periarticular embolization. PROGNOSIS CA is self-limiting and usually persists for 2-3 years. However, the patients may even suffer from pain and limited range of motion beyond this time.
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Affiliation(s)
- Isabella Kuhn
- Muskuloskelettales Universitätszentrum München (MUM), LMU Klinikum, Ziemssenstr. 5, 80336, München, Deutschland
| | - Bernd Erber
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - Sophia Samira Goller
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
- Radiologie, Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz.
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Takahashi R, Kajita Y, Fujii S, Harada Y. Risk factors for recurrence of frozen shoulder after shoulder manipulation under ultrasound-guided cervical nerve root block. JSES Int 2024; 8:90-94. [PMID: 38312279 PMCID: PMC10837711 DOI: 10.1016/j.jseint.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background This study aimed to investigate risk factors for recurrence of frozen shoulder after shoulder manipulation under ultrasound-guided cervical nerve root block (MUC). Methods We retrospectively reviewed 135 frozen shoulders in 121 patients who underwent MUC. We defined frozen shoulder as a limited shoulder range of motion (ROM) (passive forward flexion <120°, external rotation <30°, or internal rotation lower than L3). Patients fulfilling any one criteria were considered to have frozen shoulder. If patients continued to have severe pain and limited ROM at 3 months after MUC, we defined as recurrence of frozen shoulder and they were offered a further MUC or arthroscopic capsular release (ACR). We compared the ROM, Constant Shoulder (CS) score, and University of California, Los Angeles score before and 3 months after MUC between patients with the successful of MUC group (Success group) with those recurrence of frozen shoulder who required a further MUC or ACR group (Recurrence group). Multiple logistic regression analysis was used to identify risk factors for recurrence of frozen shoulder after MUC. Results Patients who underwent MUC were retrospectively enrolled and divided into: the successful of MUC group (Success group, n = 112) and required a further MUC or ACR group (Recurrence group, n = 9). The Recurrence group had significantly lower external rotation and CS score before MUC than those in the Success group (P < .05). The Recurrence group showed significantly inferior all ROM and functional scores 3 months after MUC (P < .05). The levels of blood glucose and hemoglobin A1c both before and 3 months after MUC in the Recurrence group showed inferior compared with those of Success group. The difference, although not statistically significant, trended towards significance (before MUC/3 months after MUC; the glucose levels P = .06/.06, the hemoglobin A1c levels P = .07/.09, respectively). The visual analog scale pain score (at rest, during activity, at night) both before and 3 months after MUC in the Recurrence group showed significantly higher scores compared with those of Success group (P < .05). Multiple logistic regression analysis revealed that lower CS score before MUC was independent risk factor for recurrence of frozen shoulder after MUC. Conclusion The overall incidence of recurrence of frozen shoulder after MUC was 7.4%. The lower CS score before MUC was an independent risk factor for recurrence of frozen shoulder after MUC. Moreover, patients in the Recurrence group tended to have poorly controlled diabetes and higher visual analog scale pain score both before and 3 months after MUC.
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Affiliation(s)
- Ryosuke Takahashi
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | - Shunsuke Fujii
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
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Flintoft-Burt M, Stanier P, Planner A, Thahal H, Woods D. Recurrence of the frozen shoulder after hydrodilatation, what is the true incidence? Shoulder Elbow 2023; 15:610-618. [PMID: 37981967 PMCID: PMC10656972 DOI: 10.1177/17585732221124914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/05/2022] [Accepted: 08/23/2022] [Indexed: 11/21/2023]
Abstract
Purpose of the study To assess the outcome and recurrence rates of frozen shoulder treated by hydrodilatation in an independent hospital setting. Method Patients presenting to a shoulder clinic from August 2019 to July 2021 with a diagnosis of frozen shoulder were offered hydrodilatation. Data included primary or secondary frozen shoulder, length of symptoms, and diabetic status. An Oxford Shoulder Score was completed prior to hydrodilatation. Using ultrasound guidance, 40 mg Triamcinolone and local anaesthetic (10-25 mL depending on patient tolerance) were injected into the rotator interval. At a mean of 9 months, patients recorded their tolerance of the procedure, subsequent progress, the need for further treatment, and their current Oxford Shoulder Score. Results From 55 shoulders, six patients had a failure to improve and 10 patients had a transient improvement followed by recurrence (29%). 2/21 (9.5%) patients had 25 mL injected compared to 14/34 (41%) who had < = 20 mL (p = 0.012). 14/43 (33%) of primary frozen shoulder patients had a recurrence, compared with 2/12 (16%) secondary frozen shoulder patients, p = 0.019. Conclusion Further treatment was indicated in 14/34 (41%) of patients who underwent hydrodilatation in the frozen stage of frozen shoulder and could not tolerate more than 20 mL of injection, and was more commonly required in primary (33%) versus secondary (16%) frozen shoulder.
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Affiliation(s)
| | - Paul Stanier
- Trauma and Orthopaedics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Andy Planner
- Radiology, BMI The Ridgeway Hospital, Swindon, UK
| | | | - David Woods
- Orthopaedics, BMI The Ridgeway Hospital, Swindon UK
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De Virgilio-Salgado L, Deliz-Jimenez D, Ruberte H, Cedeño-Rodriguez F, Rivera-Rodriguez G, Ramírez N, Soler-Salas A, Deliz-Asmar E. Effect of surgical timing in outcomes in Hispanic patients after arthroscopic capsular release in diabetic and idiopathic adhesive capsulitis. JSES Int 2023; 7:786-792. [PMID: 37719808 PMCID: PMC10499843 DOI: 10.1016/j.jseint.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Adhesive capsulitis of the shoulder is a painful and debilitating condition. While the majority of patients improve with conservative treatment, those who do not improve require surgery such as arthroscopic capsular release (ACR) for symptom relief. However, there is limited literature regarding the optimal timeframe to proceed with surgery. Methods This retrospective cohort evaluated 134 Hispanic patients who underwent ACR for the treatment of adhesive capsulitis. Patients were divided into an early and a delayed treatment group that included all patients. Patients were then divided into diabetic and idiopathic subgroups. Early vs. delayed treatment outcomes (forward flexion, external rotation, Visual Analog Scale pain scores, and recurrence requiring reoperation) were assessed in all patients and in each subgroup. Results No statistically significant differences were found between the early and delayed release groups in postoperative forward flexion, external rotation, pain intensity scores, and recurrence requiring reoperation at 1 month, 3 months, and 6 months of follow-up in the all-patient group. In the idiopathic frozen shoulder subgroup, no significant differences were observed in postoperative forward flexion, external rotation, pain intensity scores, and recurrence requiring reoperation at 1 month, 3 months, and 6 months of follow-up. In the diabetic frozen shoulder subgroup, no significant differences were observed in postoperative forward flexion, external rotation, pain intensity scores, and recurrence requiring reoperation at 1 month and 6 months of follow-up visits. Conclusions There was no difference in outcomes following ACR for adhesive capsulitis between patients who underwent early release vs. delayed release. There were no significant differences in outcomes between early and delayed arthroscopic release in patients with a history of diabetes mellitus.
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Affiliation(s)
- Lucas De Virgilio-Salgado
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | - David Deliz-Jimenez
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | - Henry Ruberte
- General Surgery Department, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Francis Cedeño-Rodriguez
- University of Puerto Rico School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | | | - Norman Ramírez
- Orthopaedic Surgery Department, Mayagüez Medical Center, Mayagüez, PR, USA
| | - Antonio Soler-Salas
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PR, USA
| | - Efrain Deliz-Asmar
- Department of Orthopaedic Surgery, Hospital HIMA San Pablo, Bayamon, PR, USA
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12
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Erdogan S, Sakha S, Shanmugaraj A, Prada C, Frank RM, Leroux T, Khan M. Comparing surgical outcomes of anterior capsular release vs circumferential release for persistent capsular stiffness. Shoulder Elbow 2023; 15:360-372. [PMID: 37538519 PMCID: PMC10395412 DOI: 10.1177/17585732221092016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 08/05/2023]
Abstract
Purpose To consolidate the existing literature evaluating anterior capsular release and circumferential capsular release in the treatment of adhesive capsulitis (AC) of the shoulder. Methods The electronic databases PUBMED, EMBASE, MEDLINE and CENTRAL (Cochrane Central Register of Controlled Trials) were searched from data inception to October 8, 2020. Data are presented descriptively where appropriate. A meta-analysis was conducted for patient-reported outcomes. Results Overall, there were forty-six articles included. The majority of patients underwent circumferential release compared to anterior release (80.1% vs. 19.9%). Concomitant Manipulation Under Anesthesia (MUA) was employed in 25 studies, with a higher occurrence in the anterior compared to the circumferential release group (70% vs 60%). Both groups experienced significant improvements postoperatively in range of motion (ROM) and patient-reported outcomes. Complication rates were low for both anterior release (0.67%) and 360° release (0.44%). Conclusion Both anterior and circumferential release are effective techniques for treating AC with low complication rates. Future studies should improve documentation of patient demographics, surgical techniques and outcomes to determine an individualized treatment protocol for patients. Level of evidence Level IV, Systematic Review of Level I-IV studies.
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Affiliation(s)
- Safiya Erdogan
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Seaher Sakha
- Faculty of Life Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Carlos Prada
- Division of Orthopaedics, McMaster University, Hamilton, Ontario, Canada
| | | | - Timothy Leroux
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedics, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Cognetti DJ, Hartzler RU, Burkhart SS. Arthroscopic Rotator Cuff Repair, Manipulation Under Anesthesia, and Capsular Release for Concurrent Rotator Cuff Tear and Adhesive Capsulitis Maintain Improvements in Outcomes and Range of Motion at Minimum 5-Year Follow-Up. Arthrosc Sports Med Rehabil 2023; 5:e597-e605. [PMID: 37388863 PMCID: PMC10300550 DOI: 10.1016/j.asmr.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To characterize the outcomes and range of motion at a minimum 5-year follow-up in patients undergoing arthroscopic rotator cuff repair (ARCR) with simultaneous manipulation under anesthesia (MUA) and capsular release (CR) for concurrent RC and adhesive capsulitis and to compare active range of motion of the operative and nonoperative shoulder. Methods Patients undergoing ARCR with MUA and CR by a single surgeon were retrospectively reviewed and prospectively evaluated at a minimum of 5 years postoperatively. Standardized surveys, examinations, and patient-reported outcomes were recorded pre- and postoperatively. Outcome measures included range of motion, American Shoulder and Elbow Surgeon Score (ASES), visual analog score (VAS) for pain, Simple Shoulder Test (SST), subjective shoulder value (SSV), functional level, and satisfaction. Results Fourteen consecutive patients were evaluated at 7.5 ± 1.6 years' follow-up. At final follow-up, the affected shoulder had substantial improvements in ASES (P < .001), VAS (P < .001), SST (P = .001), and SSV (P < .001), with similar ASES, VAS, SST, and SSV compared with the contralateral side. Range of motion was also similar to the contralateral side at final follow-up for forward elevation and internal rotation, but external rotation was noted to be 10.77 ± 17.06° (95% confidence interval 0.46-21.08, P = .042) more limited. Two patients (14%) underwent revision MUA and CR for stiffness at 6 months and 12 months' postoperatively. Conclusions This study highlights significantly improved and maintained patient-reported outcomes and range of motion at minimum 5-year follow-up in patients undergoing concomitant ARCR, MUA, and CR. These results provide further evidence that preoperative stiffness in the setting of rotator cuff tear can be managed concurrently; however, patients may remain at an increased risk for recurrent stiffness and external rotation loss. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
| | - Robert U. Hartzler
- The San Antonio Orthopedic Group, San Antonio, Texas, U.S.A
- Burkhart Research Institute for Orthopedics, San Antonio, Texas, U.S.A
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Fairclough A, Waters C, Davies T, Dacombe P, Woods D. Long-Term Outcomes Following Manipulation Under Anaesthetic for Patients with Primary and Secondary Frozen Shoulder. Shoulder Elbow 2023; 15:173-180. [PMID: 37035609 PMCID: PMC10078811 DOI: 10.1177/17585732211070007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/09/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022]
Abstract
Background Frozen Shoulder (FS) is a common, debilitating condition for which manipulation under anaesthetic (MUA) is a non-invasive and effective treatment option. Current literature evaluates short to medium-term outcomes, but there is a paucity of long-term (>10 years) studies. Knowledge of long-term outcomes is also needed to evaluate whether FS or its treatment pre-disposes to other shoulder pathology in the long-term. Methods A retrospective analysis of 398 shoulders undergoing MUA for FS between Jan 1999 and Jan 2010; 240 complete datasets were obtained. Outcomes were Oxford Shoulder Score (OSS), recurrence and development of other shoulder pathology (arthritis or rotator cuff tear). Results At long-term follow-up (mean 13.2 years), 71.3% had no symptoms (OSS 48), 16.6% had minor symptoms (OSS 42-47) and 12.1% had significant symptoms (OSS < 42). There were 4/240 (1.7%) self-reported recurrences > 5 years after initial MUA and 2/240 (0.8%) repeat MUAs. In the long-term 6.7% developed rotator cuff pathology and 3.8% shoulder OA. Discussion This study suggests that long-term outcome after MUA for FS is favourable. Late recurrence of FS is uncommon and the development of OA or rotator cuff pathology is no greater than that of the general population.
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Affiliation(s)
- Anna Fairclough
- CT3 General Surgery, Great Western Hospital, Swindon SN3 6BB
| | - Christopher Waters
- Clinical Teaching Fellow, Swindon Academy, Great Western Hospital, Swindon SN3 6BB
| | - Thomas Davies
- Foundation Year 2, Aintree University Hospital, Lower Lane, Liverpool, L9 7AL
| | - Peter Dacombe
- Consultant Shoulder and Elbow Surgeon, Great Western Hospital, Swindon SN3 6BB
| | - David Woods
- Consultant Orthopaedic Surgeon, Ridgeway Hospital, Wroughton, Swindon, SN4 9DD, Surgical Tutor, Great Western Hospital, Swindon SN3 6BB
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15
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Miyamoto R, Shitara H, Ichinose T, Sasaki T, Hamano N, Kamiyama M, Nakase K, Chikuda H. Triamcinolone acetonide with arthroscopic capsular release for frozen shoulder promotes early recovery of shoulder abduction. JSES Int 2023. [DOI: 10.1016/j.jseint.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Sex Is Associated with the Success or Failure of Manipulation Alone for Joint Stiffness Associated with Rotator Cuff Repair. J Clin Med 2022; 11:jcm11237192. [PMID: 36498766 PMCID: PMC9739455 DOI: 10.3390/jcm11237192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/22/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose: One-stage arthroscopic rotator cuff repair with manipulation has been recently performed for rotator cuff tears with shoulder stiffness, whereas some patients require capsular release due to severe stiffness that is difficult to treat with manipulation. The purpose of this study was to analyze patient backgrounds and related factors of success or failure of manipulation alone for the treatment of shoulder stiffness associated with rotator cuff tears. Methods: This study included 64 patients with rotator cuff tears and shoulder stiffness who underwent arthroscopic rotator cuff repair with manipulation alone or with manipulation and capsular release of the glenohumeral joint at our institution between January 2015 and September 2019. The patients were divided into two groups: those whose shoulder stiffness could be improved by manipulation alone (Manipulation group) and those whose stiffness could not be improved by manipulation alone and required capsular release (Capsular release addition group). Analysis was performed between the two groups regarding patient backgrounds and related factors, including rotator cuff tear morphology and range of motions pre- and postoperatively. Results: Exactly 45 patients and 19 patients were included in Manipulation group and Capsular release addition group, respectively. A comparison between the two groups showed that patient age (p = 0.0040), sex (p = 0.0005), and injury due to trauma (p = 0.0018) were significantly related to the success or failure of manipulation alone. Multivariate logistic regression analysis on these three factors showed that sex (odds ratio, 5.5; p = 0.048) was significantly associated with the success or failure of manipulation alone. In both groups, the passive ROM of all patients improved at the last postoperative follow-up compared to their pre-operative values (p < 0.001), except for internal rotation in the Capsular release addition group (p = 0.49). Conclusion: Young male patients who have shoulder stiffness associated with rotator cuff tears should be considered for arthroscopic capsular release rather than manipulation.
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17
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Arthroscopic Pan-Capsular and Transverse Humeral Ligament Release with Biceps Tenodesis for Patients with Refractory Frozen Shoulder. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121712. [PMID: 36556913 PMCID: PMC9781116 DOI: 10.3390/medicina58121712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Abstract
Arthroscopic capsular release allows direct visualization and release of inflamed tissues in refractory frozen shoulder. The reticular neural network in the long head of the biceps tendon (LHBT) and nerve endings of the transverse humeral ligament (THL) might be responsible for shoulder pain. We hypothesized that patients with painful refractory frozen shoulder benefited from pan-capsular release, THL release, and LHBT tenodesis. The LHBT tenodesis decreased the possibility of LHBT instability. The balance of the shoulder joint was maintained after such extensive release. From October 2013 to June 2019, patients with painful refractory frozen shoulder were enrolled consecutively at the same institute. All patients received arthroscopic pan-capsular, THL release, and suprapectoral LHBT tenodesis with a minimum of 2-year follow-up. Preoperative and postoperative shoulder range of motion (ROM), pain visual analog scale (PVAS), subjective shoulder value (SSV), constant score, LHBT score, acromio-humeral distance (AHD), and critical shoulder angle (CSA) were recorded. In total, 35 patients with an average age of 53.1 ± 9 years were enrolled. The average follow-up period was 24 ± 1.5 months. Forward elevation improved from 105.1° ± 17° to 147° ± 12° (p < 0.001), external rotation improved from 24.1° ± 13.3° to 50.9° ± 9.7° (p < 0.001), and internal rotation improved from L3 to T9 (p < 0.001), respectively, at final follow-up. PVAS improved from 7.3 ± 1.1 to 1.8 ± 0.6 (p < 0.001), constant score from 23.4 ± 11 to 80.7 ± 5.2 (p < 0.001), and SSV from 27.7 ± 10.5 to 77.4 ± 3.8, respectively, at follow-up. No differences were found in AHD and CSA after surgery (p = 0.316, and p = 0.895, respectively). Patients with painful refractory frozen shoulder benefited from pan-capsular and THL release. A radiographically balanced shoulder joint was maintained even after such extensive release.
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18
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Sundararajan SR, Dsouza T, Rajagopalakrishnan R, Bt P, Arumugam P, Rajasekaran S. Arthroscopic capsular release versus manipulation under anaesthesia for treating frozen shoulder - a prospective randomised study. INTERNATIONAL ORTHOPAEDICS 2022; 46:2593-2601. [PMID: 36048234 DOI: 10.1007/s00264-022-05558-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/17/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Arthroscopic capsular release (ACR) and Manipulation under anaesthesia(MUA) have been widely used in the treatment of frozen shoulder (FS). However, there is only limited Level-I evidence to prefer ACR over MUA. The purpose of our study was to conduct a randomised trial comparing ACR versus MUA to assess the difference in outcome, complications and cost-effectiveness of both procedures. METHODS From May 2020 to June 2021, patients presenting with FS were randomised into two groups ACR (n = 44) and MUA (n = 41). Patients with arthritis, full-thickness cuff tears, history of trauma/previous surgery around the shoulder were excluded from the study. Range of movement (ROM), pain grading using visual analogue scale (VAS), functional scores- UCLA, CONSTANT and EuroQol-5D scores were measured pre-operatively and post-operatively. MRI was done at three weeks post-operatively for screening complications of either procedure. Quality-adjusted life years (QALY) was used for cost-analysis. RESULTS Post-operatively, patients had significant improvement in pain, ROM and functional scores in both groups (P < 0.001) with no significant difference between groups at 24 weeks of follow-up. Diabetic patients undergoing ACR had lesser improvement in abduction and external rotation when compared to non-diabetic patients. Labral tears in MUA group and bone bruises in ACR group were the most common complications noted on the post-operative MRI. For ACR cost per QALY gained was 896 USD while that for MUA was 424 USD. CONCLUSION Both ACR and MUA resulted in good improvement in pain and shoulder function. Good outcomes, simple technique and better cost-effectiveness would still make MUA an attractive option over ACR for treating FS.
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Affiliation(s)
| | - Terence Dsouza
- Department of Arthroscopy and Sports Medicine, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Ramakanth Rajagopalakrishnan
- Department of Arthroscopy and Sports Medicine, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Pushpa Bt
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Palanisamy Arumugam
- Department of physiotherapy, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics & Spine Surgery, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
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19
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Abstract
Frozen shoulder is a common debilitating disorder characterized by shoulder pain and progressive loss of shoulder movement. Frozen shoulder is frequently associated with other systemic conditions or occurs following periods of immobilization, and has a protracted clinical course, which can be frustrating for patients as well as health-care professionals. Frozen shoulder is characterized by fibroproliferative tissue fibrosis, whereby fibroblasts, producing predominantly type I and type III collagen, transform into myofibroblasts (a smooth muscle phenotype), which is accompanied by inflammation, neoangiogenesis and neoinnervation, resulting in shoulder capsular fibrotic contractures and the associated clinical stiffness. Diagnosis is heavily based on physical examination and can be difficult depending on the stage of disease or if concomitant shoulder pathology is present. Management consists of physiotherapy, therapeutic modalities such as steroid injections, anti-inflammatory medications, hydrodilation and surgical interventions; however, their effectiveness remains unclear. Facilitating translational science should aid in development of novel therapies to improve outcomes among individuals with this debilitating condition.
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20
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Tawfeek W, Addosooki A, Elsayed M. Arthroscopic rotator interval release for frozen shoulder, comparative study between diabetic and non-diabetic patients. SICOT J 2022; 8:35. [PMID: 35984241 PMCID: PMC9390058 DOI: 10.1051/sicotj/2022036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/30/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The objective of this study is to evaluate the outcomes of arthroscopic rotator interval release for the treatment of frozen shoulder and compare the results in patients with and without diabetes. METHODS thirty-two patients with frozen shoulders were divided into two groups; 19 diabetics and 13 non-diabetics. All patients underwent arthroscopic rotator interval release. The VAS and UCLA score were assessed pre-operatively and post-operatively; after 1, 3, and 12 months and compared between groups. RESULTS The VAS and UCLA score was significantly improved in both groups during follow-up intervals (p < 0.01). There was no significant difference between diabetic and non-diabetic patients in VAS and UCLA scores during follow-up times (p-values > 0.05). CONCLUSION Arthroscopic rotator interval release provides significant improvement of frozen shoulder with no difference in results between diabetic and non-diabetic patients. LEVEL OF EVIDENCE Level 2; Prospective Comparative study.
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Affiliation(s)
- Wessam Tawfeek
- Orthopaedic Department, Sohag University Hospital, 82524 Sohag, Egypt
| | - Ahmad Addosooki
- Orthopaedic Department, Sohag University Hospital, 82524 Sohag, Egypt
| | - Moustafa Elsayed
- Orthopaedic Department, Sohag University Hospital, 82524 Sohag, Egypt
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21
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Willmore EG, Millar NL, van der Windt D. Post-surgical physiotherapy in frozen shoulder: A review. Shoulder Elbow 2022; 14:438-451. [PMID: 35846406 PMCID: PMC9284307 DOI: 10.1177/1758573220965870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022]
Abstract
Despite its prevalence, the optimal management of frozen shoulder is unclear. A range of conservative measures are often undertaken with varying degrees of success. In cases of severe and persistent symptoms, release procedures which could include any combination of manipulation under anaesthetic, arthroscopic capsular release or hydrodilatation are frequently offered, none of which has been shown to offer superior outcome over the others. When surgical release is performed a period of rehabilitation is normally recommended but no best practice guidelines exist resulting in considerable variations in practice which may or may not directly affect patient outcome. During this narrative review, we hypothesise that these differing responses to treatment (both conservative and surgical options) are potentially the result of different causal mechanisms for frozen shoulder and may also suggest that post-release rehabilitation may need to take this into account.
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Affiliation(s)
- Elaine G Willmore
- Therapy Department, Gloucestershire
Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Neal L Millar
- Institute of Infection, Immunity and
Inflammation, College of Medicine, Veterinary and Life Sciences, University of
Glasgow, Glasgow, UK
| | - Daniëlle van der Windt
- School for Primary, Community and Social
Care, Centre for Prognosis Research, Primary Centre, Versus Arthritis, Keele
University, Staffordshire, UK
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22
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Does the timing of shoulder manipulation under ultrasound-guided cervical nerve root block for frozen shoulder affect the clinical outcome? J Orthop Sci 2022; 27:122-125. [PMID: 33358448 DOI: 10.1016/j.jos.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/09/2020] [Accepted: 11/09/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although the clinical outcomes of manipulation under ultrasound-guided fifth and sixth cervical nerve root block for frozen shoulder have been reported, few studies have focused on the timing of manipulation. This study aimed to determine whether the timing of manipulation impacts the clinical outcomes. METHODS We retrospectively reviewed the outcomes of 103 frozen shoulder patients (mean age 51.5 years) who underwent manipulation in one shoulder (n = 103 shoulders) between January 2012 and April 2019. Stiff shoulder was defined as limited range of motion in at least three directions, i.e., passive forward flexion of ≤100°, passive external rotation at the side of ≤10°, and internal rotation of ≤L5. The patients were categorized into two groups: those mobilized within 6 months after symptom onset (early group, 44 shoulders) and those mobilized >6 months after symptom onset (late group, 59 shoulders). The range of motion (forward flexion, external rotation, and internal rotation), Japanese Orthopaedic Association shoulder scores, Constant Shoulder Score, and University of California, Los Angeles scores before and 3, 6, and 12 months after manipulation were compared between groups. RESULTS The late group exhibited significant improvement in forward flexion, external rotation, internal rotation, Japanese Orthopaedic Association scores, Constant Shoulder Score, and University of California, Los Angeles scores at 3 months; forward flexion at 6 months; and forward flexion and University of California, Los Angeles scores at 12 months after manipulation compared to the early group. CONCLUSIONS Our results indicate that timing has a significant influence on the outcome of manipulation for frozen shoulders. The optimal time for manipulation may be >6 months after symptom onset. These findings can be applied in counselling for frozen shoulder patients and for improved outcomes after manipulation.
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Miyatake K, Fujisawa T, Otoshi A, Kawabata Y, Kusaba Y, Tsujiku S, Inaba Y. Silent Manipulation for Adhesive Capsulitis. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00332-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Surgical versus Nonsurgical Multimodality Treatment in an Idiopathic Frozen Shoulder: A Retrospective Study of Clinical and Functional Outcomes. J Clin Med 2021; 10:jcm10215185. [PMID: 34768705 PMCID: PMC8584489 DOI: 10.3390/jcm10215185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/23/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
This retrospective study compared the clinical and functional outcomes of patients diagnosed with an idiopathic frozen shoulder with symptom onset of a maximum of six months, treated by arthroscopic capsular release followed by corticosteroid injection and physiotherapy to patients who received only corticosteroid injection followed by physiotherapy. The patients who underwent arthroscopic capsular release, intraoperative corticosteroid injection, and physiotherapy (Group I, n = 30) or received only corticosteroids injection and physiotherapy (Group II, n = 29) were examined in terms of shoulder range of motion (ROM), pain intensity, and function before a given treatment and three, six, and twelve months later. The groups were comparable pre-treatment in terms of ROM, pain, and functional outcome. Group I had statistically and clinically significantly better ROM and function at three and six months post-treatment than Group II. Despite being statistically significant, the between-group differences at twelve-month follow-up in ROM and function were too small to be considered clinically notable. The between-group comparison of pain revealed no significant differences at any post-treatment point of time. The early arthroscopic capsular release preceding corticosteroid injection and physiotherapy seemed more effective at three- and six-month follow-up; however, it brought a comparable result to corticosteroid injection and subsequent physiotherapy at twelve months follow-up.
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25
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Huang J, Zhu S, Zhao C, Huang W, Shui W, Hu N, Chen H. [Effectiveness of arthroscopic 360° capsular release for frozen shoulder]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1141-1146. [PMID: 34523279 DOI: 10.7507/1002-1892.202103080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of arthroscopic 360° capsular release for frozen shoulder. Methods Between April 2018 and April 2019, 42 patients with frozen shoulders were treated with arthroscopic 360° capsular release. There were 13 males and 29 females, with an average age of 52.3 years (range, 45-56 years). There were 14 left shoulders and 28 right shoulders. The disease duration ranged from 5 to 18 months (mean, 11.1 months). The main clinical symptoms were limited active and passive movement of the shoulder joint with severe pain. All patients excluded impingement syndrome and shoulder osteoarthritis. Preoperative range of motion was as follows: forward flexion (93.2±15.4)°, external rotation at side (15.9±6.0)°, external rotation at 90° abduction (18.4±9.9)°, and internal rotation reaching the greater trochanter in 5 cases, buttocks in 20 cases, S 1 level in 17 cases. The visual analogue scale (VAS) score was 6.7±1.7 and the American Society of Shoulder and Elbow Surgery (ASES) score was 41.6±9.3. The active range of motion of shoulder joint, VAS score, and ASES score were recorded during follow-up. Results All incisions healed by first intention, and no early complications occurred. Patients were followed up 12-24 months (mean, 15.6 months). After operation, forward flexion, external rotation at side, and external rotation at 90° abduction significantly improved when compared with preoperatively ( P<0.05). The range of internal rotation restored to the level of T 6-12 at 3 weeks, which was equivalent to that of the normal side at 12 months after operation ( Z=-0.943, P=0.346). VAS scores decreased and ASES scores increased after operation, and the differences between pre- and post-operation were significant ( P<0.05); and with time, the VAS scores and ASES scores improved further ( P<0.05). Conclusion Arthroscopic 360° capsular release can significantly increase the range of motion of the shoulder joint, release pain, and improve function. It is an effective method for the treatment of frozen shoulders.
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Affiliation(s)
- Jiaxing Huang
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Sizheng Zhu
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Chen Zhao
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Wei Huang
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Wei Shui
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Ning Hu
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
| | - Hong Chen
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China
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Mardani-Kivi M, Hashemi-Motlagh K, Darabipour Z. Arthroscopic release in adhesive capsulitis of the shoulder: a retrospective study with 2 to 6 years of follow-up. Clin Shoulder Elb 2021; 24:172-177. [PMID: 34488298 PMCID: PMC8423526 DOI: 10.5397/cise.2021.00311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background This study aimed to evaluate the response rate to arthroscopic release treatment in adhesive capsulitis of the shoulder (ACS) for patients with refractory to conservative treatment. Methods In this retrospective study, 51 patients (age mean, 49.1±5.6 years) with unilateral adherent capsule underwent arthroscopic releasing surgery for the shoulder capsule. Etiologies of the ACS in 30 patients were idiopathic: 10 patients were affected after surgery and 11 patients following trauma. The patients were evaluated in terms of shoulder function, satisfaction rate, pain intensity, and joint range of motion (ROM) based on a Constant score, a Simple Shoulder Test, the visual analog scale, and four movements, respectively. Results The mean Constant score before surgery was 48.2±3.5 and reached 74.4±6 and 77.0±6.3 at 6 months and the final follow-up, respectively (p<0.001). The mean scores of pain intensity, a Simple Shoulder Test, and ROM showed significant improvement at all follow-ups (p<0.001). Sex, age, and diabetes did not have any significant effect on patient recovery. However, patients who experienced ACS after surgery had poorer results than others at all follow-up points. Conclusions Arthroscopic releasing surgery of the shoulder in patients with ACS refractory to conservative treatment produces rare complications and an effective injury response. It seems that patients suffering ACS following surgery have a weaker response to the treatment.
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Affiliation(s)
- Mohsen Mardani-Kivi
- Orthopedic Research Center, Department of Orthopedics, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Keyvan Hashemi-Motlagh
- Guilan Road Trauma Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zohre Darabipour
- Department of Orthopedics, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Wang YD, Ming YX, Pang YH, Chen WN, Zong XH, Wu JY, Deng YK. Effectiveness of arthroscopic management of idiopathic shoulder stiffness: A meta-analysis. J Back Musculoskelet Rehabil 2021; 34:565-572. [PMID: 33554887 DOI: 10.3233/bmr-200267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Persisting shoulder stiffness adversely affects quality of life by causing pain and motion restrictions especially in patients with diabetes. OBJECTIVE The aim of this study was to evaluate the outcomes of arthroscopic capsular release in patients with idiopathic shoulder stiffness. METHOD A literature search was conducted in electronic databases and studies were selected by following precise eligibility criteria. Random-effects meta-analyses were performed to estimate the changes at latest follow-up in scores of the Constant, American Shoulder and Elbow Surgeons (ASES), and University of California at Los Angelis (UCLA) scales, Visual Analogue Scale (VAS), and shoulder range of motion. RESULTS Nineteen studies were included. The follow-up duration was 42 months [95% confidence interval (CI): 32, 51]. Improvements in scores of the Constant, ASES, UCLA scales, and VAS were 48.3 [95% CI: 38.0, 58.6], 44.6 [95% CI: 24.6, 64.6], 19.3 [95% CI: 16.6, 22.0], and -6.1 [95% CI: -6.9, -5.4] respectively (P< 0.05 all). Improvements in the shoulder range of motion were: abduction 82.0 [95% CI: 65.0, 98.9]; forward flexion 75.9 [95% CI: 59.7, 92.1]; external rotation 43.2 [95% CI: 37.5, 49.0]; and internal rotation 25.4 [95% CI: 15.2, 35.5] degrees; P< 0.05 all). CONCLUSION Arthroscopic capsular release effectively improves shoulder function in patients with idiopathic shoulder stiffness.
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Willmore E, McRobert C, Foy C, Stratton I, van der Windt D. What is the optimum rehabilitation for patients who have undergone release procedures for frozen shoulder? A UK survey. Musculoskelet Sci Pract 2021; 52:102319. [PMID: 33588155 DOI: 10.1016/j.msksp.2021.102319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 11/25/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Despite usually being considered necessary, the rehabilitation regime that optimises outcomes for patients following release procedures for frozen shoulder has not been established and no accepted best practice guidelines currently exist. The purpose of this study was to gain insight into what physiotherapists considered best practice and factors they considered likely to affect patient outcome. METHODS A cross-sectional, self-administered online questionnaire was developed and distributed to UK based Physiotherapists, undergraduate students and support workers via email, social media and professional networks. RESULTS 260 eligible and fully completed surveys were received. Clear preference for early (within 72 h), frequent (2-3 times per week or weekly) and prolonged (greater than 6 weeks) treatment delivered in a 1:1 setting was expressed. 99% were highly likely/likely to advocate education and advice, range of movement exercises (99.6%), stretching (73.5%) and strengthening (61.9%). More passive modalities (manual therapy, massage, electrotherapy, acupuncture) were highly unlikely/unlikely to be used and lack of manual therapy and insufficient contact with a physiotherapist were the reasons deemed least likely to affect outcome. Most clinicians (89.2%) were likely to prescribe exercises that patients reported as painful but persistent pain and poor adherence by patients to exercises were the top reasons given for poor outcome along with psychological and psychosocial patient characteristics. CONCLUSION Physiotherapists consistently advocate early, frequent, prolonged, 1:1 treatment following release procedures for frozen shoulder. Most patients are discharged whilst still experiencing symptoms, particularly pain. Further work is needed to establish high value pathways for this patient group.
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Affiliation(s)
| | - Cliona McRobert
- School of Health Sciences, Institute of Population Health, University of Liverpool, UK
| | - Chris Foy
- Gloucestershire Hospitals NHS Foundation Trust, UK
| | | | - Danielle van der Windt
- School for Primary, Community and Social Care, Centre for Prognosis Research, Primary Centre, Versus Arthritis, Keele University, Staffordshire, ST5 3BG, UK
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Hasegawa A, Mihata T, Fukunishi K, Neo M. Does the timing of surgical intervention impact the clinical outcomes and overall duration of symptoms in frozen shoulder? J Shoulder Elbow Surg 2021; 30:836-843. [PMID: 32750533 DOI: 10.1016/j.jse.2020.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal timing of arthroscopic capsular release in patients with frozen shoulder is controversial. Some surgeons delay surgery in the belief that early surgical intervention results in a poorer prognosis. However, whether early surgical intervention causes inferior clinical outcomes and a longer duration of symptoms in frozen shoulder remains unclear. The objective of this study was to compare the clinical outcomes and overall duration of symptoms in frozen shoulder between patients who underwent early surgical intervention and those subjected to late surgical intervention. Our hypotheses were that (1) early surgical intervention would provide significant improvement in symptoms but inferior clinical outcomes because of more severe synovitis compared with late surgical intervention and (2) early surgical intervention would shorten the overall duration of symptoms compared with late surgical intervention. METHODS We reviewed 60 consecutive patients with frozen shoulder who underwent arthroscopic capsular release. We compared clinical outcomes and the overall duration of symptoms between 2 groups: Group I comprised 27 patients who underwent surgery <6 months after onset (mean, 3.8 months), whereas group II comprised 33 patients who underwent surgery ≥6 months after onset (mean, 11.1 months). The severity of glenohumeral synovitis at the time of surgery was evaluated. Patient-reported pain, shoulder function, and range of motion, as well as the presence of sleep disturbance, were assessed preoperatively and at 3 and 6 months after surgery. RESULTS Both groups showed significant improvements in the visual analog scale pain score, Japanese Orthopaedic Association score, American Shoulder and Elbow Surgeons score, and prevalence of sleep disturbance after surgery (P < .001), although the glenohumeral synovitis score was significantly higher in group I than in group II (P < .0001). Forward flexion at 6 months after surgery was significantly greater in group I than in group II (P = .007). The overall duration of symptoms was shorter in group I than in group II (P < .0001). Neither the pain score, functional score, prevalence of sleep disturbance, nor postoperative recovery time differed between groups. CONCLUSIONS Arthroscopic capsular release provided significant pain relief and improvement in shoulder function in patients with frozen shoulder regardless of the timing of surgery. Early surgical intervention might shorten the overall duration of symptoms in frozen shoulder and is not associated with inferior clinical outcomes when compared with late surgical intervention. Surgeons do not need to delay surgical intervention for patients who have intolerable pain and/or nocturnal pain with sleep disturbance.
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Affiliation(s)
- Akihiko Hasegawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan.
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan
| | - Kunimoto Fukunishi
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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Abstract
Among all the prevalent painful conditions of the shoulder, frozen shoulder remains one of the most debated and ill-understood conditions. It is a condition often associated with diabetes and thyroid dysfunction, and which should always be investigated in patients with a primary stiff shoulder. Though the duration of 'traditional clinicopathological staging' of frozen shoulder is not constant and varies with the intervention(s), the classification certainly helps the clinician in planning the treatment of frozen shoulder at various stages. Most patients respond very well to combination of conservative treatment resulting in gradual resolution of symptoms in 12-18 months. However, the most effective treatment in isolation is uncertain. Currently, resistant cases that do not respond to conservative treatment for 6-9 months could be offered surgical treatment as either arthroscopic capsular release or manipulation under anaesthesia. Though both invasive options are not clinically superior to another, but manipulation could result in unwarranted complications like fractures of humerus or rotator cuff tear.
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Oshiro T, Yagi M, Harada K, Park K. Results of repeat manipulation under ultrasound-guided cervical nerve root block with corticosteroid and local anaesthetic injection for recurrence of frozen shoulder. J Orthop Surg Res 2020; 15:586. [PMID: 33287845 PMCID: PMC7720550 DOI: 10.1186/s13018-020-02120-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the clinical results of a repeat manipulation under ultrasound-guided cervical nerve root block (MUC) with corticosteroid and local anaesthetic injection for recurrence of idiopathic frozen shoulder after MUC. METHODS A consecutive series of 42 shoulders in 39 patients with idiopathic frozen shoulder underwent MUC. All patients were assessed according to the American Shoulder Elbow Surgeon (ASES) score and shoulder range of motion (ROM) both before MUC and at 1 year thereafter. If patients continued to have pain and limited ROM at 3 months after the procedure, they were offered a repeat MUC. Such patients were also assessed before the procedure and at 3 months and 1 year thereafter. RESULTS The initial MUC was successful in 31 shoulders (single group). Repeat MUC was required in 11 shoulders (repeat group). Patients in the single group showed significant improvement in ROM and ASES score at 1 year after the procedure (p < 0.001); similarly, patients in the repeat group had significant improvement in ROM and ASES score at 3 months and 1 year after the procedure (p < 0.001). Patients in the repeat group had had significantly more severely limited ROM (p < 0.01) and decreased ASES score (p < 0.001) before the procedure compared with those in the single group. CONCLUSIONS A repeat MUC with corticosteroid and local anaesthetic injection is a valuable option before proceeding to surgery for recurrence of idiopathic frozen shoulder. When there is severely limited ROM and decreased ASES score before the MUC, a repeat MUC may be necessary, which would require the patient's informed consent. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Tatsuki Oshiro
- Yagi Orthopaedic Clinic, 47-1, Zike-machi, Kakogawa-cho, Kakogawa, Hyogo, 675-0066, Japan.
| | - Masayoshi Yagi
- Yagi Orthopaedic Clinic, 47-1, Zike-machi, Kakogawa-cho, Kakogawa, Hyogo, 675-0066, Japan
| | - Kazuki Harada
- Yagi Orthopaedic Clinic, 47-1, Zike-machi, Kakogawa-cho, Kakogawa, Hyogo, 675-0066, Japan
| | - Kieun Park
- Paku Pain Clinic, 6-1-20, Gokodori, Chuo-ku, Kobe, Hyogo, 651-0087, Japan
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Lee SJ, Jang JH, Hyun YS. Can manipulation under anesthesia alone provide clinical outcomes similar to arthroscopic circumferential capsular release in primary frozen shoulder (FS)?: the necessity of arthroscopic capsular release in primary FS. Clin Shoulder Elb 2020; 23:169-177. [PMID: 33330254 PMCID: PMC7726365 DOI: 10.5397/cise.2020.00283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/01/2020] [Accepted: 11/04/2020] [Indexed: 12/25/2022] Open
Abstract
Background We evaluated the need for arthroscopic capsular release (ACR) in refractory primary frozen shoulder (FS) by comparing clinical outcomes of patients treated with ACR and manipulation under anesthesia (MUA). Methods We assessed patients with refractory primary FS, 57 patients (group A) who were treated with MUA and 22 patients (group B) who were treated with ACR. In group A, manipulation including a backside arm-curl maneuver was performed under interscalene brachial block. In group B, manipulation was performed only to release the inferior capsule before arthroscopic circumferential capsular release, which was carried out for the unreleased capsule after manipulation. Pain, range of shoulder motion, and American Shoulder and Elbow Surgeons score were recorded at 1 week, 3 months, 6 months, and 1 year after surgery. We compared outcome variables between treatment groups and between diabetics and non-diabetics and also evaluated the numbers of patients receiving additional intra-articular steroid injection. Results Outcome variables at 3 months after surgery and improvements in outcome variables did not differ between groups. Group A showed significantly better results than group B in the evaluation of pain and range of motion at 1 week. Diabetics showed comparable outcomes to non-diabetics for most variables. Eleven patients required additional steroid injections between 8 to 16 weeks after surgery: 12.2% in group A, 18.2% in group B. Additional injections were given three times more often in diabetics compared to non-diabetics. Conclusions MUA alone can yield similar clinical outcomes to ACR in refractory FS.
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Affiliation(s)
- Seung-Jin Lee
- Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jun-Hyuk Jang
- Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Yoon-Suk Hyun
- Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
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Hagiwara Y, Kanazawa K, Ando A, Sekiguchi T, Koide M, Yabe Y, Itoi E. Effects of arthroscopic pancapsular release for proximal humeral fractures treated with intramedullary nailing: a retrospective study. JSES Int 2020; 4:546-550. [PMID: 32939483 PMCID: PMC7479035 DOI: 10.1016/j.jseint.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Proximal humeral fractures are one of the most common fractures in adults. Some patients treated operatively have restriction in range of motion (ROM) after surgery. This study aimed to evaluate arthroscopic pancapsular release in patients with severe stiffness after treatment with intramedullary nailing for proximal humeral fractures. Methods This study included 12 patients (7 women and 5 men) who underwent arthroscopic pancapsular release in the beach-chair position between May 2015 and February 2018. Intraoperative findings were recorded, and ordinary (with scapulothoracic motion) and true (without scapulothoracic motion) glenohumeral ROMs were measured with a goniometer. The American Shoulder and Elbow Surgeons shoulder score, Shoulder Rating Scale score of the University of California, Los Angeles scoring system, and Constant score were compared before and after the release. The Wilcoxon signed rank and Mann-Whitney U tests were used to analyze data. Results The average age of the patients was 65.1 years (standard deviation, 9.5 years), and the mean follow-up period after the release was 30.6 months (standard deviation, 11.7 months). All ROMs on the affected side after surgery were significantly greater than those before surgery in all directions. However, ROMs in forward flexion, lateral elevation, and external rotation with the arm at the side and at 90° of forward flexion on the affected side postoperatively were significantly lower than those on the unaffected side. All scores were significantly greater after surgery than before surgery. Conclusion Arthroscopic pancapsular release is effective for patients with proximal humeral fractures treated with intramedullary nailing.
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Affiliation(s)
- Yoshihiro Hagiwara
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kenji Kanazawa
- Department of Orthopaedic Surgery, South Miyagi Medical Center, Ōgawara, Japan
| | - Akira Ando
- Department of Orthopaedic Surgery, Matsuda Hospital, Sendai, Japan
| | - Takuya Sekiguchi
- Department of Orthopaedic Surgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Masashi Koide
- Department of Orthopaedic Surgery, Matsuda Hospital, Sendai, Japan
| | - Yutaka Yabe
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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Surendran S, Patinharayil G, Karuppal R, Marthya A, Fazil M, Mohammed Ali S. Arthroscopic capsular release and continuous upper arm brachial block in frozen shoulder - A midterm outcome analysis. J Orthop 2020; 21:459-464. [PMID: 32982101 PMCID: PMC7494934 DOI: 10.1016/j.jor.2020.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE This prospective study aims to evaluate the efficacy of Continuous upper arm brachial block (modified interscalene block) with an arthroscopic capsular release in the outcome of resistant frozen shoulder cases. METHODS We studied 123 patients who underwent arthroscopic capsular release and subacromial decompression for resistant frozen shoulder cases between June 2016 and July 2019. Postoperative analgesia was provided with Continuous upper arm brachial block and ambulatory patient-controlled analgesia pump for 2-3 weeks. The patients were started on regular physiotherapy on the first postoperative day. All the patients were followed up at 3rd week, 6th week, 3rdmonth, 6th month, 1st year, and 2nd year with VAS and Constant-Murley scores. RESULTS At a mean follow-up period of 18 months, there was a statistically significant improvement in the range of motion, VAS scores, and Constant-Murley scores postoperatively (p < .01). None of the cases required postoperative opioid administration for pain control. Minor neurological complications like recurrent laryngeal nerve palsy and Horner's syndrome were seen in few cases that resolved with titration of the drug dose. CONCLUSION Our study verifies the use of continuous upper arm brachial block (CUABB) with a portable infusion pump for 2-3 weeks in arthroscopic capsular release for resistant frozen shoulder cases. It significantly reduced postoperative pain in the initial two weeks that aided with early recovery of the shoulder movements and functions without an increased incidence of acute or chronic neurologic complications.
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Affiliation(s)
- Sibin Surendran
- Department of Orthopaedics, Government Medical College, Kozhikode, Kerala, India
| | | | - Raju Karuppal
- Department of Orthopaedics, Government Medical College, Kozhikode, Kerala, India
| | - Anwar Marthya
- IQRAA International Hospital and Research Centre, Kozhikode, Kerala, India
| | - Muhammed Fazil
- IQRAA International Hospital and Research Centre, Kozhikode, Kerala, India
| | - Shibi Mohammed Ali
- IQRAA International Hospital and Research Centre, Kozhikode, Kerala, India
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Jayasekara M, Lam PH, Murrell GAC. Return to Work Following Shoulder Surgery: An Analysis of 1,773 Cases. JB JS Open Access 2020; 5:JBJSOA-D-19-00081. [PMID: 32803105 PMCID: PMC7386555 DOI: 10.2106/jbjs.oa.19.00081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background There is limited information on patients' ability to return to work (RTW) after the majority of shoulder surgical procedures. Methods This study was a retrospective analysis of prospectively collected data on 1,773 consecutive patients who underwent shoulder surgery performed by a single surgeon from 2004 to 2017. A validated L'Insalata Shoulder Questionnaire was used to collect information on 32 preoperative factors, which were used for analysis. The questionnaire included the premorbid level of work and the levels preoperatively and at 6 months postoperatively. Results Six months following the shoulder operations, 77% of the patients returned to work (40% with full duties and 37% with light duties). Concomitant rotator cuff repair and stabilization was associated with the highest RTW rate (90%) whereas some of the lowest RTW rates were associated with reverse total shoulder arthroplasty (56%) and total shoulder arthroplasty (71%). The highest rate of RTW with full duties was associated with debridement for calcific tendinitis (62%). Capsular release provided a significant improvement in work level (on a scale ranging from none to strenuous) from preoperatively to postoperatively (p = 0.0116). Older patients with stiffer shoulders who were not working preoperatively had the lowest RTW rate at 6 months. Conclusions To our knowledge, this is the largest study of RTW outcomes of shoulder surgical procedures, and it showed that 4 out of 5 patients were able to RTW 6 months postoperatively with approximately half resuming full duties and half, lighter duties. Capsular release was the only procedure to result in a significant improvement in work level within 6 months. The best independent predictors of RTW were younger age, less stiffness, and working preoperatively. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mudith Jayasekara
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia
| | - Patrick H Lam
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia
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郑 小, 李 焱, 穆 米, 杨 瑷, 陈 前, 陈 万, 周 兵, 唐 康. [Mid-term effectiveness of manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement for primary frozen shoulder]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:737-743. [PMID: 32538565 PMCID: PMC8171525 DOI: 10.7507/1002-1892.201911033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/21/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate mid-term effectiveness of manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement for primary frozen shoulder. METHODS Between January 2013 and December 2017, 33 patients of primary frozen shoulder were treated with manipulation under anesthesia combined with 360° arthroscopic capsular release and subacromial debridement. There were 10 males and 23 females, aged from 37 to 65 years, with a mean age of 50.9 years. The affected shoulder on left side in 17 cases and on right side in 16 cases. The disease duration was 6-13 months (mean, 8.4 months). Before and after operation, the visual analogue scale (VAS) score was used to evaluate the shoulder joint pain, Constant score was used to evaluate the shoulder joint function, and the flexion, abduction, and external rotation of shoulder joint were recorded. The internal rotation function was assessed based on the vertebral plane that the thumb could reach after internal rotation of the affected shoulder joint (the rank of internal rotation vertebra). X-ray film was taken to measure the distance of the subacromial space. RESULTS There was no fracture or labrum tear in all patients, and all the incisions healed by first intention. All the 33 patients were followed up 20-31 months, with an average of 24.1 months. During the follow-up, there was no complication such as wound infection and nerve injury. At last follow-up, the range of motion of shoulder flexion, abduction, and external rotation, the rank of internal rotation vertebra, the VAS score, Constant score, and subacromial space were significantly improved when compared with preoperative ones ( P<0.05). CONCLUSION Manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement can achieve a good mid-term effectiveness without complication for primary frozen shoulder.
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Affiliation(s)
- 小龙 郑
- 陆军军医大学第一附属医院骨科运动医学中心（重庆 400038）Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - 焱 李
- 陆军军医大学第一附属医院骨科运动医学中心（重庆 400038）Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - 米多 穆
- 陆军军医大学第一附属医院骨科运动医学中心（重庆 400038）Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - 瑷宁 杨
- 陆军军医大学第一附属医院骨科运动医学中心（重庆 400038）Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - 前博 陈
- 陆军军医大学第一附属医院骨科运动医学中心（重庆 400038）Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - 万 陈
- 陆军军医大学第一附属医院骨科运动医学中心（重庆 400038）Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - 兵华 周
- 陆军军医大学第一附属医院骨科运动医学中心（重庆 400038）Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - 康来 唐
- 陆军军医大学第一附属医院骨科运动医学中心（重庆 400038）Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
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Clinical results of shoulder manipulation under ultrasound-guided cervical nerve root block for frozen shoulder in patients with diabetes. J Orthop 2020; 21:297-301. [PMID: 32565643 DOI: 10.1016/j.jor.2020.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/23/2020] [Indexed: 11/20/2022] Open
Abstract
Background We investigated clinical results of manipulation under ultrasound-guided cervical nerveroot block (MUC) in frozen shoulder (FS). Methods FS was defined refractory to conservative treatment and ≦100° in passive forward flexion. 15 shoulders were diabetes mellitus (DM) group and 81 were non-DM group. We evaluated ROM, JOA scores, Constant Shoulder Score, and UCLA scores pre and post-MUC. Results Although there were significantly improved the forward flexion, internal rotation, JOA scores, Constant Shoulder Score, and UCLA scores between pre and post-MUC in both groups, external rotation after MUC in DM group were significantly inferior to those in non-DM group.
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Effect Size in Surgical Intervention Into Shoulder: What Procedures Are Game Changers and What Are Not? JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:JAAOSGlobal-D-20-00022. [PMID: 32440636 PMCID: PMC7209793 DOI: 10.5435/jaaosglobal-d-20-00022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 12/31/2022]
Abstract
A number of surgical procedures are performed to treat a variety of shoulder pathologies. What is currently not understood is which of these surgical interventions provide the most improvement in patient-reported pain and function. Questions We aimed to determine, from a patient's perspective, which were the most effective commonly performed surgical procedures for disorders of the shoulder and which were not. Methods This study was a retrospective analysis of prospectively collected data from patients who underwent shoulder surgery by a single surgeon. To be included, at least 20 patients needed to have undergone that procedure and completed a questionnaire evaluating their shoulders function preoperatively and 6 months postoperatively. The primary outcome was change in response to the question "how is your shoulder overall?" Effect size is reported as Cohen's d (standardized mean difference). Results Two thousand two hundred six surgical procedures in 13 categories met the inclusion criteria. All procedures were associated with improvements in the patient-ranked overall shoulder status at 6 months (P < 0.01 to P < 0.0001). Reverse total shoulder arthroplasty (RTSA) provided the greatest effect size (improvement) in the overall shoulder status (d = 3.14, 95% CI, 2.49 to 3.79), followed by total shoulder arthroplasty (d = 2.60, 95% CI, 2.10 to 3.10) and capsular release (d = 1.41, 95% CI, 1.08 to 1.75). RTSA provided the greatest effect size in patient-reported shoulder pain, whereas capsular release provided the greatest effect size in patient-reported shoulder function. Acromioclavicular joint resection (d = 1.22, 95% CI, 0.56 to 1.88) and acromioplasty (d = 1.29, 95% CI, 0.96 to 1.61) provided the least effect size overall. Conclusion All shoulder surgical procedures in this study provided a notable patient-perceived therapeutic benefit in a relatively short period of time (6 months). RTSA, total shoulder arthroplasty, and capsular release are the most effective procedures. Acromioplasty and acromioclavicular resection are the least effective.
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Houck DA, Belk JW, Vidal AF, McCarty EC, Bravman JT, Seidl AJ, Frank RM. Outcomes of Arthroscopic Capsular Release in the Beach-Chair Versus Lateral Decubitus Position: A Systematic Review. Orthop J Sports Med 2019; 7:2325967119888173. [PMID: 31903397 PMCID: PMC6923698 DOI: 10.1177/2325967119888173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Arthroscopic capsular release (ACR) for the treatment of adhesive capsulitis of the
shoulder can be performed in either the beach-chair (BC) or lateral decubitus (LD)
position. Purpose: To determine the clinical outcomes and recurrence rates after ACR in the BC versus LD
position. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analyses) guidelines was performed by searching PubMed, Embase, and the Cochrane
Library databases for studies reporting clinical outcomes of patients undergoing ACR in
either the BC or LD position. All English-language literature from 1990 through 2017
reporting on clinical outcomes after ACR with a minimum 3-month follow-up were reviewed
by 2 independent reviewers. Recurrence rates, range of motion (ROM) results, and
patient-reported outcome (PRO) scores were collected. Study methodological quality was
evaluated using the modified Coleman Methodology Score (MCMS). Results: A total of 30 studies (3 level 1 evidence, 2 level 2 evidence, 4 level 3 evidence, 21
level 4 evidence) including 665 shoulders undergoing ACR in the BC position (38.1% male;
mean age, 52.0 ± 3.9 years; mean follow-up, 35.4 ± 18.4 months) and 603 shoulders in the
LD position (41.8% male; mean age, 53.0 ± 2.3 years; mean follow-up, 37.2 ± 16.8 months)
were included. There were no significant differences in overall mean recurrence rates
between groups (BC, 2.5%; LD, 2.4%; P = .81) or in any PRO scores
between groups (P > .05). There were no significant differences in
improvement in ROM between groups, including external rotation at the side (BC, 36.4°;
LD, 42.8°; P = .91), forward flexion (BC, 64.4°; LD, 79.3°;
P = .73), abduction (BC, 77.8°; LD, 81.5°; P = .82),
or internal rotation in 90° of abduction (BC, 40.8°; LD, 45.5°; P =
.70). Significantly more patients in the BC group (91.6%) underwent concomitant
manipulation than in the LD group (63%) (P < .0001). There were
significantly more patients with diabetes in the LD group (22.4%) versus the BC group
(9.6%) (P < .0001). Conclusion: Low rates of recurrent shoulder stiffness and excellent improvements in ROM can be
achieved after ACR in either the LD or BC position. Concomitant manipulation under
anesthesia is performed more frequently in the BC position compared with the LD
position.
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Affiliation(s)
- Darby A Houck
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John W Belk
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Eric C McCarty
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan T Bravman
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Adam J Seidl
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rachel M Frank
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Su YD, Lee TC, Lin YC, Chen SK. Arthroscopic release for frozen shoulder: Does the timing of intervention and diabetes affect outcome? PLoS One 2019; 14:e0224986. [PMID: 31710642 PMCID: PMC6844453 DOI: 10.1371/journal.pone.0224986] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/26/2019] [Indexed: 01/30/2023] Open
Abstract
Purpose To evaluate the effect of timing of arthroscopic release and manipulation under anesthesia for frozen shoulder in patients with diabetes and non-diabetes. Methods One hundred and twenty-seven patients with frozen shoulder were included in the study. Each patient was assigned to: 1) one of four groups according to the duration from symptom onset to surgery (group A: ≤3 months; group B: 3–6 months; group C: 6–12 months; group D: >12 months), 2) diabetic or nondiabetic group. The outcomes were measured by shoulder range of motion (ROM), Disabilities of the Arm, Shoulder, and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) Shoulder score, the period of pain relief, overall duration of disease, and satisfaction. Results All the patients got great improvement in shoulder ROM (P < .0001) after arthroscopic surgery, but there was no statistical difference in the pre-operative and post-operative shoulder ROM between the four groups and between diabetic and nondiabetic groups. The overall duration of disease was mean 55.4~68.7 weeks, which demonstrated much shorter disease course compared with nature course. Improvement were also seen in shoulder ROM at one week to one month, and the period of total pain relief was at a mean time of 3.7 to 3.8 weeks. There were higher ASES Shoulder score in group B than in group C (P = 0.02) and higher DASH score in diabetic group in short term follow-up. Conclusions Arthroscopic release provides effective and rapid improvements to shoulder motion and function, unrelated to the timing of surgery, in patients with frozen shoulder. The diabetic patients do not have functional outcomes as good as the nondiabetic patient at short-term follow-up.
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Affiliation(s)
- Yu-De Su
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tien-Ching Lee
- Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail:
| | - Yu-Chuan Lin
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shen-Kai Chen
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Rizvi SM, Harisha AJ, Lam PH, Murrell GAC. Factors Affecting the Outcomes of Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis. Orthop J Sports Med 2019; 7:2325967119867621. [PMID: 31588409 PMCID: PMC6740201 DOI: 10.1177/2325967119867621] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Arthroscopic capsular release has been shown to provide excellent short- and long-term outcomes in patients with idiopathic frozen shoulder. Some surgeons delay surgery in the belief that operating in the early stages of adhesive capsulitis results in a poorer prognosis. However, it is unclear which factors, particularly the stage of the disorder, affect the surgical outcome of this procedure. Hypothesis: Patients who undergo capsular release during the early symptomatic stage of idiopathic adhesive capsulitis would have less improvement in range of motion compared with those who undergo surgery at a later stage. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 189 shoulders with idiopathic adhesive capsulitis that underwent arthroscopic capsular release were evaluated. All patients completed a L’Insalata questionnaire and had their range of motion and strength tested prior to surgery and at 1, 6, and 12 weeks and 6 months post–capsular release. Post hoc, patients were grouped by whether they had symptoms lasting <10 months (shorter symptoms group; n = 131) or ≥10 months (longer symptoms group; n = 38). Multiple linear regression analysis was performed to determine which preoperative factors were independently associated with a favorable outcome. Results: Patients in the shorter symptoms group were more restricted prior to surgery than were those in the longer symptoms group (mean ± SEM: external rotation, 17° ± 2° vs 27° ± 4° [P = .04]; abduction, 78° ± 3° vs 92° ± 6° [P = .04]; internal rotation, S3 ± 1 vs S1 ± 1 [P = .03]). The shorter symptoms group had greater postoperative improvement in internal rotation (from S3 ± 1 preoperatively to T12 ± 1 vertebral levels) compared with the longer symptoms cohort (from S1 ± 1 to L2 ± 1) (P = .02). Conclusion: Patients with a frozen shoulder and a duration of symptoms <10 months made greater improvements in internal rotation and had similar final results for flexion, abduction, and external rotation following arthroscopic capsular release when compared with patients who had a longer duration of symptoms, so there is no reason to delay surgery.
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Affiliation(s)
- Syed M Rizvi
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, Australia
| | - Ahmed J Harisha
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, Australia
| | - Patrick H Lam
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, Australia
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Comparison of outcomes following arthroscopic capsular release for idiopathic, diabetic and secondary shoulder adhesive capsulitis: A Systematic Review. Orthop Traumatol Surg Res 2019; 105:839-846. [PMID: 31202716 DOI: 10.1016/j.otsr.2019.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/24/2018] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Arthroscopic capsular release for adhesive capsulitis of the shoulder is a treatment option. The present study aimed to investigate the clinical outcomes following arthroscopic capsular release among idiopathic, diabetic and secondary adhesive capsulitis. HYPOTHESIS Different aetiological groups yield variable outcomes following arthroscopic capsular release. MATERIALS AND METHODS A literature search was performed using MEDLINE, EMBASE, CINAHL and the Cochrane Database in April 2017. Comparative studies that reported range of motion or functional outcomes following arthroscopic capsular release in patients with adhesive capsulitis were included. A systematic review of the studies was conducted following the PRISMA guidelines. RESULTS Six studies met the eligibility criteria. The overall population included 463 patients; 203 idiopathic, 61 diabetic and 199 secondary cases. Of four studies comparing idiopathic and diabetic patients, three reported significantly worse range of movement and function in the diabetic group at various follow up points. No significant difference in function and motion was reported between the idiopathic and secondary groups. Recurrent pain was highest in diabetic patients (26%) compared to idiopathic groups (0%) and the secondary group had a higher rate of revision surgery when compared to the idiopathic group (8.1% vs. 2.4%) DISCUSSION: Arthroscopic capsular release has a high success rate regardless of the underlying aetiology. However, diabetic patients are reported to have more residual pain, reduced motion and inferior function compared to idiopathic cases. The rate of revision capsular release is higher among patients with post-surgical adhesive capsulitis when compared to idiopathic cases. LEVEL OF EVIDENCE IV, systematic review.
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Abstract
Frozen shoulder (FS) is a common shoulder disorder characterized by a gradual increase of pain of spontaneous onset and limitation in range of motion of the glenohumeral joint. The pathophysiology of FS is relatively well understood as a pathological process of synovial inflammation followed by capsular fibrosis, but the cause of FS is still unknown. Treatment modalities for FS include medication, local steroid injection, physiotherapy, hydrodistension, manipulation under anesthesia, arthroscopic capsular release, and open capsular release. Conservative management leads to improvement in most cases. Failure to obtain symptomatic improvement and continued functional disability after 3 to 6 months of conservative treatment are general indications for surgical management. However, there is no consensus as to the most efficacious treatments for this condition. In this review article, we provide an overview of current treatment methods for FS.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Ki-Choer Bae
- Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Abstract
Adhesive capsulitis presents clinically as limited, active and passive range of motion caused by the formation of adhesions of the glenohumeral joint capsule. Radiographically, it is thickening of the capsule and rotator interval. The pathology of the disease, and its classification, relates to inflammation and formation of extensive scar tissue. Risk factors include diabetes, hyperthyroidism, and previous cervical spine surgery. Nonsurgical management includes physical therapy, corticosteroid injections, extracorporeal shock wave therapy, calcitonin, ultrasonography-guided hydrodissection, and hyaluronic acid injections. Most patients will see complete resolution of symptoms with nonsurgical management, and there appears to be a role of early corticosteroid injection in shortening the overall duration of symptoms. Surgical intervention, including manipulation under anesthesia, arthroscopic capsular release both limited and circumferential, and the authors' technique are described in this article. Complications include fracture, glenoid and labral injuries, neurapraxia, and rotator cuff pathology. Postoperative care should always include early physical therapy.
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Barbosa F, Swamy G, Salem H, Creswell T, Espag M, Tambe A, Clark D. Chronic adhesive capsulitis (Frozen shoulder): Comparative outcomes of treatment in patients with diabetes and obesity. J Clin Orthop Trauma 2019; 10:265-268. [PMID: 30828190 PMCID: PMC6383066 DOI: 10.1016/j.jcot.2018.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/16/2018] [Accepted: 02/24/2018] [Indexed: 11/22/2022] Open
Abstract
Despite an abundance of information about frozen shoulders, larger prospective studies on the outcomes of intervention are limited. The purpose of our study was to assess the functional and clinical outcomes with a further aim to analyse the independent effects of diabetes and BMI. A prospective cohort study of all 210 primary frozen shoulders over a 12 - month period was analysed. The Oxford Shoulder score was used to assess functional outcomes before and after interventions. Further demographic data was collected. The effect of interventions including steroid injections, arthroscopic release and manipulation was analysed. 54% patients responded to intra-articular steroid injections. Patients with recalcitrant symptoms (46%) had an arthroscopic release. Failure of initial injection therapy was higher in diabetes [70%] than non-diabetes [44%] patients. After surgery, the Oxford shoulder score improved from a mean of 41.6 to 27.2 at 3 months [p < 0.05]. 85% of patients had satisfactory resolution of symptoms with external rotation improving from a mean of 10.5 ° to 61.3 ° [p < 0.05]. There was no statistical significance in outcomes of patients with BMI of >_30 and <30. Understanding the outcomes of surgical intervention is important in counselling patients with frozen shoulder. We found that patients with diabetes had higher failure rates of conservative management and increasing needs for multiple surgery but complete resolution of symptoms can still be achieved and that BMI status in isolation was not a predictor of poorer outcome.
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Kraal T, Beimers L, The B, Sierevelt I, van den Bekerom M, Eygendaal D. Manipulation under anaesthesia for frozen shoulders: outdated technique or well-established quick fix? EFORT Open Rev 2019; 4:98-109. [PMID: 30993011 PMCID: PMC6440298 DOI: 10.1302/2058-5241.4.180044] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Manipulation under anaesthesia (MUA) for frozen shoulder (FS) leads to a considerable increase in range of motion and Oxford shoulder score, a significant reduction in pain and around 85% satisfaction.A clearly defined indication for MUA in FS patients cannot be extracted from this review or the available literature. The associating criteria before proceeding to MUA vary widely.All but one study in this review lacked a control group without intervention. Therefore, firm conclusions about the role of MUA in the treatment of FS cannot be drawn from the current literature.An overall complication rate of 0.4% was found and a re-intervention rate of 14%, although most of the included papers were not designed to monitor complications.The following criteria before proceeding to MUA are proposed: a patient unable to cope with a stiff and painful shoulder; clinical signs of a stage 2 idiopathic FS; lessening pain in relation to stage 1; external rotation < 50% compared to contralateral shoulder joint; a minimal duration of symptoms of three months; and failure to respond to an intra-articular corticosteroid infiltration. Cite this article: EFORT Open Rev 2019;4:98-109. DOI: 10.1302/2058-5241.4.180044.
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Affiliation(s)
- Tim Kraal
- Department of Orthopaedic Surgery, Amphia Hospital, The Netherlands
| | - Lijkele Beimers
- Department of Orthopaedic Surgery, Slotervaart Center of Orthopedic Research & Education (SCORE), The Netherlands
| | - Bertram The
- Department of Orthopaedic Surgery, OLVG Hospital, The Netherlands
| | - Inger Sierevelt
- Department of Orthopaedic Surgery, Slotervaart Center of Orthopedic Research & Education (SCORE), The Netherlands
| | | | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amphia Hospital, The Netherlands
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Takahashi R, Iwahori Y, Kajita Y, Harada Y, Muramatsu Y, Ikemoto T, Deie M. Clinical Results and Complications of Shoulder Manipulation under Ultrasound-Guided Cervical Nerve Root Block for Frozen Shoulder: A Retrospective Observational Study. Pain Ther 2019; 8:111-120. [PMID: 30742255 PMCID: PMC6513960 DOI: 10.1007/s40122-018-0109-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction Manipulation under ultrasound-guided fifth and sixth cervical nerve root block (MUC) is a recognized form of treatment for patients with persistent frozen shoulder (FS). This study aimed to investigate the confirmatory hypothesis testing that the MUC has a significant clinical effect on FS refractory to conservative treatments and to assess its adverse events. Methods This is a retrospective observational study on patients with FS treated in the past 8 years. Although 77 patients were eligible for this study, only 68 were enrolled. The patients were evaluated immediately before the MUC and at 1, 3, and 6 months after with the use of the Japanese Orthopaedic Association shoulder score. Simultaneously, ranges of motion of the affected shoulder were measured in two directions: forward flexion and external rotation. A paired t test or a Wilcoxon signed-rank test was used to compare differences in outcomes between before and 6 months after MUC. We also assessed any adverse events during and after the MUC. Results Regarding the primary outcome, confirmatory testing showed statistically significant improvements in every outcome value at 6 months after MUC (p < 0.001). In terms of adverse events, two patients (2.9%) had vasovagal reflex, one (1.5%) had a panic attack during the block procedure, and a 72-year-old female patient (1.2%) had an avulsion fracture of the inferior glenoid during the manipulation procedure, although all of them recovered spontaneously without any residual functional impairment. Conclusion The results showed that significant clinical effects of the MUC on FS were observed through a confirmatory analysis with a sufficient sample size. However, several complications that could occur during the block and manipulation procedures should be considered.
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Affiliation(s)
- Ryosuke Takahashi
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan.
| | - Yusuke Iwahori
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yukihiro Kajita
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yohei Harada
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yoshitaka Muramatsu
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tatsunori Ikemoto
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Masataka Deie
- Department of Orthopedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
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Abstract
Shoulder stiffness affects a diverse population of patients suffering a decrease in function and shoulder pain. Arthroscopic management of this debilitating spectrum of pathology is a safe and effective course of action in cases recalcitrant to nonoperative therapy. Arthroscopic management of the stiff shoulder has been reported to be effective in the treatment of stiffness due to adhesive capsulitis, birth palsy, stiffness in the setting of rotator cuff tears, and osteoarthritis in the posttraumatic patient, in the postoperative patient, and in the throwing athlete. Arthroscopic management is most effective in treating the stiff shoulder in the setting of adhesive capsulitis recalcitrant to nonoperative therapy or posttraumatic stiffness. Results are more guarded in the treatment of postoperative stiffness. Excessive force and trauma to the shoulder, including fracture of the humerus, can be avoided with a 360[degrees] capsular release for shoulder stiffness rather than manipulation under anesthesia.
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Affiliation(s)
- Vasili Karas
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Longo UG, Ciuffreda M, Locher J, Buchmann S, Maffulli N, Denaro V. The effectiveness of conservative and surgical treatment for shoulder stiffness: a systematic review of current literature. Br Med Bull 2018; 127:111-143. [PMID: 30137234 DOI: 10.1093/bmb/ldy025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/15/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Currently, no therapeutic intervention is universally accepted, and the most effective management for restoring motion and diminishing pain in patients with shoulder stiffness has yet to be defined. This systematic review analyses outcomes of conservative and surgical interventions to treat shoulder stiffness. SOURCE OF DATA A systematic review of literature according to the PRISMA guidelines was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, Ovid and Google Scholar databases using various combinations of the keywords 'shoulder', 'shoulder stiffness', 'stiff shoulder', 'conservative', since inception of databases to June 2018 was performed. AREAS OF AGREEMENT Shoulder stiffness could be treated with conservative means including nonsteroidal anti-inflammatory medications, corticosteroid injections, or transcutaneous electrical nerve stimulation, manipulation under anaesthesia, and arthroscopic capsular release. AREAS OF CONTROVERSY No therapeutic intervention is universally accepted, and the most effective management to restore motion and diminish pain in patients with shoulder stiffness has yet to be defined. GROWING POINTS The rate of failure after treatment for stiff shoulder is higher in the surgical group than in the conservative group. AREAS TIMELY FOR DEVELOPING RESEARCH There is insufficient evidence to establish whether surgical or conservative management is the best choice to manage shoulder stiffness. Prospective, randomized studies are needed to establish whether surgical or conservative management produce a clinically relevant difference in functional outcome.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria, Rome, Italy
| | - Mauro Ciuffreda
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria, Rome, Italy
| | - Joel Locher
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria, Rome, Italy
| | - Stefan Buchmann
- Department of Orthopaedic Sports Medicine, Klinikumrechts der Isar, Technical University of Munich, Ismaningerstr. 22, Munich, Germany
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria, Rome, Italy
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Lamplot JD, Lillegraven O, Brophy RH. Outcomes From Conservative Treatment of Shoulder Idiopathic Adhesive Capsulitis and Factors Associated With Developing Contralateral Disease. Orthop J Sports Med 2018; 6:2325967118785169. [PMID: 30023406 PMCID: PMC6047247 DOI: 10.1177/2325967118785169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background: Idiopathic adhesive capsulitis is a common condition resulting in painful multidirectional restriction of motion without other identifiable shoulder abnormality. First-line therapies for this condition are nonoperative, but limited data are available regarding which treatments are most effective. Factors associated with contralateral disease are not well established. Hypothesis: Younger patients will have a better response to treatments, and older patients and patients with diabetes will be more likely to develop contralateral disease. Study Design: Cohort study; Level of evidence, 3. Methods: Patients diagnosed with idiopathic adhesive capsulitis were treated with a single intra-articular glenohumeral injection of local anesthetic and corticosteroid as well as 4 weeks of supervised physical therapy (PT). Patients were re-evaluated monthly and received additional conservative treatment based on failure to restore normal motion. Patient-reported outcome scores and range of motion were used to assess treatment efficacy. Results: Minimum 2-year follow-up data (mean, 3.4 years) were available for 60 of 75 eligible patients (80%). Patients who did not attend supervised PT as prescribed were more likely to undergo repeat injection due to a lack of adequate range of motion at follow-up (P = .003). Conservative therapy failed in 2 patients (3.3%), and they underwent arthroscopic release and manipulation under anesthesia. Twenty-two patients (36.7%) were subsequently diagnosed with contralateral idiopathic adhesive capsulitis, with a higher incidence in patients with diabetes (P = .009) and patients younger than 50 years (P = .005). American Shoulder and Elbow Surgeons score improved from 41.2 (95% CI, 33.0-49.4) at baseline to 92.0 (95% CI, 88.4-95.6) at final follow-up (P < .0001). Patients with diabetes had a decrease in Shoulder Activity Scale score at final follow-up (P = .049). Conclusion: Conservative treatment for idiopathic adhesive capsulitis resulted in good clinical outcomes with a low incidence of surgical intervention. Physical therapy reduced the use of a second injection as part of treatment in this treatment algorithm. Young patients and patients with diabetes may be more likely to develop contralateral disease.
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Affiliation(s)
- Joseph D Lamplot
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Olivia Lillegraven
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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