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Search Results for : Shoulder Adhesive Capsulitis
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
Adhesive capsulitis: a case study.
Author(s): Trachsel, JM
Journal: Orthop Nurs 2010 Mar 26; Vol. 28, Issue 6; Page(s) 279-83
[Medline ID - 20016342]

Adhesive capsulitis (AC), also known as frozen shoulder, is a common and painful musculoskeletal disorder. The shoulder is a complex joint comprising 3 bones and multiple muscle groups, ligaments, and tendons. Accompanying the inflammation of the joint is stiffness that greatly restricts the patient's motion and strength. AC is a treatable condition requiring months of daily physical therapy. The reports that 1 in 7 Americans has a musculoskeletal impairment including shoulder problems that accounted for 14 million visits to physicians' offices in 2003. It is imperative that practitioners accurately assess and diagnose the patient with shoulder pain to facilitate an appropriate plan of care. This paper will discuss the case of a patient with AC including differential diagnoses, pathophysiology, and treatment options.

Adhesive capsulitis: a new management protocol to improve passive range of motion.
Author(s): Mitra, R; Harris, A; Umphrey, C; Smuck, M; Fredericson, M
Journal: PM R 2010 Mar 12; Vol. 1, Issue 12; Page(s) 1064-8
[Medline ID - 20006315]

OBJECTIVE: To examine the short-term efficacy of a nonoperative shoulder protocol for the treatment of adhesive capsulitis. DESIGN: A retrospective chart review was used to collect data for a 3-year period. SETTING: Academic tertiary medical center. PATIENTS: 28 consecutive patients diagnosed as having adhesive capsulitis were identified and managed with a new protocol. METHODS: The protocol consisted of the administration of a suprascapular nerve block, the subsequent injection of an intra-articular steroid, and then the injection of an anesthetic agent with brisement normal saline volume dilation. The final step was manipulation of the shoulder. RESULTS: A paired t test was used to examine the difference in the preprocedure and postprocedure passive range of motion (flexion and abduction). The average shoulder abduction before the procedure was 89.5 degrees ; this improved by an average of 51.7 degrees (P < .0001). The average shoulder flexion improved from 117.3 degrees by an average of 37.7 degrees (P < .0001). There was no significant difference in either abduction or flexion based on age, gender, or chronicity of symptoms. White patients experienced significantly more improvement in abduction than did nonwhite patients. CONCLUSIONS: This study suggests that this adhesive capsulitis management protocol is effective and produces a significant improvement in the passive range of motion immediately after the procedure.

Arthroscopic-assisted locking compression plate clavicular hook fixation for unstable fractures of the lateral end of the clavicle: a prospective study.
Author(s): Lee, KW; Lee, SK; Kim, KJ; Kim, YI; Kwon, WC; Choy, WS
Journal: Int Orthop 2009 Dec 10; Vol. 34, Issue 6; Page(s) 839-45
[Medline ID - 19998033]

The aim of this prospective study was to assess the clinical outcomes of an unstable fracture of the lateral end of the clavicle treated with an arthroscopic-assisted locking compressive plate (LCP) clavicular hook plate. Twenty-three patients underwent arthroscopic assisted LCP clavicular hook plate fixation for these fractures. All patients achieved clinical and radiological union over a mean of 4.2 months (range, 3.4-5 months). Four patients (17%) showed some degree of acromial osteolysis. Three patients (13%) showed radiological signs of arthrosis of the acromioclavicular joint. In one patient, a second fracture (stress) was observed between the medial two screws of the plate without an additional injury. Five patients (22%) showed subacromial bursitis on dynamic ultrasonography. The mean Constant and Murley score was 91 points (range, 81-98). The average level of pain in the shoulder at rest and on abduction was 1 (range, 0-2) and 2.4 (range, 0-4), respectively. Based on our experience, arthroscopic-assisted LCP hook plate fixation for the treatment of unstable fractures of the lateral end of the clavicle is not without complications. However, it is an acceptable alternative method that is easy to apply with good results. Furthermore, it prevents rotator cuff impingement, allows early mobilisation and maintains the acromioclavicular joint biomechanics.

Randomized controlled trial for efficacy of intra-articular injection for adhesive capsulitis: ultrasonography-guided versus blind technique.
Author(s): Lee, HJ; Lim, KB; Kim, DY; Lee, KT
Journal: Arch Phys Med Rehabil 2010 Jan 27; Vol. 90, Issue 12; Page(s) 1997-2002
[Medline ID - 20510993]

Lee H-J, Lim K-B, Kim D-Y, Lee K-T. Randomized controlled trial for efficacy of intra-articular injection for adhesive capsulitis: ultrasonography-guided versus blind technique. OBJECTIVE: To evaluate the clinical effect of ultrasonography (US)-guided intra-articular injections compared with a blind (unguided) technique for the treatment of adhesive capsulitis. DESIGN: Randomized controlled trial. SETTING: Outpatient rehabilitation clinic. PARTICIPANTS: Patients (N=43) diagnosed as having adhesive capsulitis after clinical examinations and radiologic and ultrasonographic study. INTERVENTION: Under either US-guided or a blind technique, patients received a 20-mg intra-articular injection of triamcinolone mixed with 1.5mL 2% lidocaine and 4mL normal saline in the first week followed by 5 weekly injections of sodium hyaluronate. MAIN OUTCOME MEASURES: A visual analog scale for pain intensity, range of motion (ROM) of the shoulder (flexion, abduction, external rotation, an d internal rotation), and general shoulder function during daily activities at preinjection as a baseline and then every week after injection for 6 weeks for each patient. RESULTS: Twenty patients out of 22 in the blind injection group and 20 out of 21 in the US-guided group finished the entire 6-week study period. The improvement in pain intensity, ROM, and shoulder function score was significantly greater in the US-guided injection group than in the blind injection group by the second week postinjection (P < .05). However, there were no further significant differences in the improvement between the 2 groups beyond the third week. CONCLUSIONS: US-guided intra-articular injections may offer advantages over a blind technique for the treatment of adhesive capsulitis and may deliver clinical benefits during the first few weeks of treatment. This finding suggests that the improved targeting to the intra-articular space by using US can result in better treatment of adhesive capsulitis.

Effect of posteroinferior capsule tightness on contact pressure and area beneath the coracoacromial arch during pitching motion.
Author(s): Muraki, T; Yamamoto, N; Zhao, KD; Sperling, JW; Steinmann, SP; Cofield, RH; An, KN
Journal: Am J Sports Med 2010 Jun 15; Vol. 38, Issue 3; Page(s) 600-7
[Medline ID - 19966101]

BACKGROUND: Tightness of the posteroinferior capsule is assumed to be the cause of internal rotation loss in baseball pitchers. Although the relationship between posterior capsule and subacromial impingement has been recognized, this relationship during the baseball-pitching motion is unclear. HYPOTHESIS: Contact pressure during baseball-pitching motion increases with posterior capsule tightness. STUDY DESIGN: Controlled laboratory study. METHODS: Eight fresh-frozen shoulders were used. The peak contact pressure and area on the coracoacromial arch were measured on a custom-designed shoulder experimental device capable of 6 degrees of freedom motion. Simultaneously, the sites of peak pressure on the coracoacromial arch and humerus were observed from various angles. The posteroinferior capsule tightness was simulated by plicating the capsule in the region from 6 to 8 o'clock. The static testing positions correlated to the early cocking, late cocking, acceleration, deceleration, and follow-through phases of the pitching motion. RESULTS: The peak contact pressure during the follow-through phase (0.63 + or - 0.50 MPa) significantly increased with posteroinferior capsule tightness (1.00 + or - 0.65 MPa) (P = .014). Additionally, the contact area on the coracoacromial ligament during the follow-through phase (0.98 + or - 0.67 cm(2)) significantly increased with posteroinferior capsule tightness (1.47 + or - 0.91 cm(2)) (P < .001). The site of the peak contact pressure did not change between the 2 conditions. CONCLUSION: Our findings demonstrate that posteroinferior capsule tightness leads to higher contact pressure under the subacromial arch and increased contact area, particularly on the coracoacromial ligament during the follow-through phase. CLINICAL RELEVANCE: This tightness may affect risk of injury of the rotator cuff and its surrounding tissues by increasing subacromial contact during pitching.

Some factors predict successful short-term outcomes in individuals with shoulder pain receiving cervicothoracic manipulation: a single-arm trial.
Author(s): Mintken, PE; Cleland, JA; Carpenter, KJ; Bieniek, ML; Keirns, M; Whitman, JM
Journal: Phys Ther 2010 Jan 26; Vol. 90, Issue 1; Page(s) 26-42
[Medline ID - 20360056]

BACKGROUND: It has been reported that manipulative therapy directed at the cervical and thoracic spine may improve outcomes in patients with shoulder pain. To date, limited data are available to help physical therapists determine which patients with shoulder pain may experience changes in pain and disability following the application of these interventions. OBJECTIVE: The purpose of this study was to identify prognostic factors from the history and physical examination in individuals with shoulder pain who are likely to experience rapid improvement in pain and disability following cervical and thoracic spine manipulation. DESIGN: This was a prospective single-arm trial. SETTING: This study was conducted in outpatient physical therapy clinics. PARTICIPANTS: The participants were individuals who were seen by physical therapists for a primary complaint of shoulder pain. INTERVENTION AND MEASUREMENTS: Participants underwent a standardized examination and then a series of thrust and nonthrust manipulations directed toward the cervicothoracic spine. Individuals were classified as having achieved a successful outcome at the second and third sessions based on their perceived recovery. Potential prognostic variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for prediction of treatment success. RESULTS: Data for 80 individuals were included in the data analysis, of which 49 had a successful outcome. Five prognostic variables were retained in the final regression model. If 3 of the 5 variables were present, the chance of achieving a successful outcome improved from 61% to 89% (positive likelihood ratio=5.3). LIMITATIONS: A prospective single-arm trial lacking a control group does not allow for inferences to be made regarding cause and effect. The statistical procedures used may result in "overfitting" of the model, which can result in low precision of the prediction accuracy, and the bivariate analysis may have resulted in the rejection of some important variables. CONCLUSIONS: The identified prognostic variables will allow clinicians to make an a priori identification of individuals with shoulder pain who are likely to experience short-term improvement with cervical and thoracic spine manipulation. Future studies are necessary to validate these findings.

Evaluation, diagnosis, and treatment of shoulder injuries in athletes.
Author(s): Hudson, VJ
Journal: Clin Sports Med 2010 May 21; Vol. 29, Issue 1; Page(s) 19-32, table of contents
[Medline ID - 19945585]

The shoulder remains one of the more challenging joints for clinicians to clearly identify, diagnose, and treat within the athletic population. Its complexities involving the glenohumeral, acromioclavicular, sternoclavicular, and scapulothoracic joints moving in tandem require the physician and rehabilitation specialist to have a comprehensive understanding of the biomechanics and arthrokinematics associated with athletic activity. This chapter focuses on the evaluation, classification, mechanism of injury, and initial treatment of widespread shoulder injuries involved in sports.

[Shoulder-loosening techniques on severe frozen shoulder]
Author(s): Zhang, TW; Cheng, SD; Wang, HF; Xu, HL
Journal: Zhongguo Gu Shang 2009 Nov 13; Vol. 22, Issue 9; Page(s) 718-9
[Medline ID - 19817218]

ABSTRACT NOT AVAILABLE

Longitudinal examination with shoulder ultrasound of patients with polymyalgia rheumatica.
Author(s): Macchioni, P; Catanoso, MG; Pipitone, N; Boiardi, L; Salvarani, C
Journal: Rheumatology (Oxford) 2010 Mar 27; Vol. 48, Issue 12; Page(s) 1566-9
[Medline ID - 19808693]

OBJECTIVE: To determine if ultrasonography (US) and power Doppler (PD) may be useful in identifying polymyalgia rheumatica (PMR) patients with relapsing disease. METHODS: For a mean of 41 months, 57 consecutive untreated patients with PMR were prospectively assessed for relapses/recurrences. This cohort represented all the patients diagnosed over a 18-month period in one Italian secondary referral centre. Clinical signs and symptoms as well as ESR and CRP were evaluated. US examination of the shoulders was performed in all 57 patients at diagnosis and after the onset of prednisone treatment (mean 24 +/- 3 weeks). Power Doppler ultrasonography (PDUS) was performed in 24 patients. Shoulder sonograms were obtained according to standardized techniques. RESULTS: Prednisone therapy significantly reduced the frequency and the degree of subacromial/subdeltoid bursitis, long head biceps tenosynovitis and glenohumeral synovitis. At diagnosis, a positive PD signal was observed more frequently in the subacromial/subdeltoid bursae (33%). Prednisone therapy significantly reduced the frequency of patients with positive PD signal. Of the 44 patients in remission or with low disease activity at the time of the second US, 26 (59%) still had evidence of persistent inflammatory lesions. There was no association between the persistence of inflammation at US and relapses/recurrences; in contrast, a positive PD signal at diagnosis was significantly a ssociated with the occurrence of relapses/recurrences at follow-up. CONCLUSION: Subclinical inflammation detected by US persists in most PMR patients despite glucocorticoid treatment. PDUS may be useful to detect at diagnosis the patients with most active inflammation who have a higher risk of relapses/recurrences.

Nonoperative management of adhesive capsulitis of the shoulder: oral cortisone application versus intra-articular cortisone injections.
Author(s): Lorbach, O; Anagnostakos, K; Scherf, C; Seil, R; Kohn, D; Pape, D
Journal: J Shoulder Elbow Surg 2010 Jun 3; Vol. 19, Issue 2; Page(s) 172-9
[Medline ID - 19800262]

HYPOTHESIS: Oral and intra-articular injections of cortisone will lead to significant improvement and comparable results in the treatment of adhesive capsulitis of the shoulder. MATERIALS AND METHODS: In a prospective randomized evaluation, 40 patients with idiopathic adhesive capsulitis of the shoulder were treated with an oral corticoid treatment regimen or 3 intra-articular injections of corticosteroids. Follow-up was after 4, 8, and 12 weeks, and 6 and 12 months. For the clinical evaluation, the Constant-Murley (CM) score, the Simple Shoulder Test (SST) and visual analog scales (VAS) for pain, function, and satisfaction were us ed. RESULTS: In the patients treated with oral glucocorticoids, significant improvements were found for the CM score (P < .0001), SST (P=.035), VAS (P < .0001), and range of motion (P < .05) at the 4-week follow-up. The patients treated with an intra-articular glucocorticoid injection series also significantly improved in the CM score (P < .0001), SST (P < .0001), the VAS (P < .0001), and range of motion (P < .05) after 4 weeks. These results were confirmed at all other follow-up visits. Superior results were found for intra-articular injections in range of motion, CM score, SST, and patient satisfaction (P < .05). Differences in the VAS for pain and function were not significant (P > .05). DISCUSSION: The use of cortisone in the treatment of idiopathic shoulder adhesive capsulitis leads to fast pain relief and improves range of motion. Intra-articular injections of glucocorticoids showed superior results in objective shoulder scores, range of motion, and patient satisfaction compared with a short course of oral corticosteroids.
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