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JAMA Network Open Dec 2020There are a myriad of available treatment options for patients with frozen shoulder, which can be overwhelming to the treating health care professional. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
There are a myriad of available treatment options for patients with frozen shoulder, which can be overwhelming to the treating health care professional.
OBJECTIVE
To assess and compare the effectiveness of available treatment options for frozen shoulder to guide musculoskeletal practitioners and inform guidelines.
DATA SOURCES
Medline, EMBASE, Scopus, and CINHAL were searched in February 2020.
STUDY SELECTION
Studies with a randomized design of any type that compared treatment modalities for frozen shoulder with other modalities, placebo, or no treatment were included.
DATA EXTRACTION AND SYNTHESIS
Data were independently extracted by 2 individuals. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Random-effects models were used.
MAIN OUTCOMES AND MEASURES
Pain and function were the primary outcomes, and external rotation range of movement (ER ROM) was the secondary outcome. Results of pairwise meta-analyses were presented as mean differences (MDs) for pain and ER ROM and standardized mean differences (SMDs) for function. Length of follow-up was divided into short-term (≤12 weeks), mid-term (>12 weeks to ≤12 months), and long-term (>12 months) follow-up.
RESULTS
From a total of 65 eligible studies with 4097 participants that were included in the systematic review, 34 studies with 2402 participants were included in pairwise meta-analyses and 39 studies with 2736 participants in network meta-analyses. Despite several statistically significant results in pairwise meta-analyses, only the administration of intra-articular (IA) corticosteroid was associated with statistical and clinical superiority compared with other interventions in the short-term for pain (vs no treatment or placebo: MD, -1.0 visual analog scale [VAS] point; 95% CI, -1.5 to -0.5 VAS points; P < .001; vs physiotherapy: MD, -1.1 VAS points; 95% CI, -1.7 to -0.5 VAS points; P < .001) and function (vs no treatment or placebo: SMD, 0.6; 95% CI, 0.3 to 0.9; P < .001; vs physiotherapy: SMD 0.5; 95% CI, 0.2 to 0.7; P < .001). Subgroup analyses and the network meta-analysis demonstrated that the addition of a home exercise program with simple exercises and stretches and physiotherapy (electrotherapy and/or mobilizations) to IA corticosteroid may be associated with added benefits in the mid-term (eg, pain for IA coritocosteriod with home exercise vs no treatment or placebo: MD, -1.4 VAS points; 95% CI, -1.8 to -1.1 VAS points; P < .001).
CONCLUSIONS AND RELEVANCE
The findings of this study suggest that the early use of IA corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes. This treatment should be accompanied by a home exercise program to maximize the chance of recovery.
Topics: Bursitis; Exercise Therapy; Glucocorticoids; Humans; Injections, Intra-Articular; Physical Therapy Modalities; Recovery of Function
PubMed: 33326025
DOI: 10.1001/jamanetworkopen.2020.29581 -
Journal of Rehabilitation Medicine Oct 2019To conduct a systematic review and meta-analysis to identify risk and associated factors for symptomatic rotator cuff tendinopathy. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To conduct a systematic review and meta-analysis to identify risk and associated factors for symptomatic rotator cuff tendinopathy.
DATA SOURCES
PubMed, CINAHL and Scopus were searched from inception to June 2017.
STUDY SELECTION
Participants presented with signs and symptoms suggestive of rotator cuff tendinopathy/tendinosis/tendinitis, shoulder impingement syndrome, or subacromial bursitis diagnosed by clinical tests and/or conventional imaging.
DATA EXTRACTION
Screening, quality assessment and data extraction were carried out by 2 reviewers.
DATA SYNTHESIS
Sixteen studies were included in this review. Overall, 22 factors were identified and 5 factors were explored using meta-analysis. Pooled analyses provided strong evidence that age above 50 years (odds ratio (OR)?=?3.31, 95% confidence interval (95% CI)?=?2.304.76, I2?=?0%, p<0.001) and diabetes (OR?=?2.24, 95% CI?=?1.373.65, I2?=?0%, p?=?0.001) were associated with increased risk of rotator cuff tendinopathy. In addition, moderate evidence showed that work with the shoulder above 90° was associated with increased risk of rotator cuff tendinopathy (OR?=?2.41, 95% CI?=?1.314.45, I2=?83%, p?=?0.005).
CONCLUSION
Age above 50 years, diabetes and overhead activities were associated with increased risk of rotator cuff tendinopathy.
Topics: Female; Humans; Male; Middle Aged; Risk Factors; Rotator Cuff; Tendinopathy
PubMed: 31489438
DOI: 10.2340/16501977-2598 -
Journal of Musculoskeletal & Neuronal... Dec 2019This systematic review aims to determine the effectiveness of proprioceptive neuromuscular facilitation (PNF) treatment techniques in adhesive capsulitis for decreasing... (Meta-Analysis)
Meta-Analysis
This systematic review aims to determine the effectiveness of proprioceptive neuromuscular facilitation (PNF) treatment techniques in adhesive capsulitis for decreasing pain and disability and increasing range of motion (ROM) and function. A thorough, computerized search was done using database search engines by two reviewers. After meticulous scrutiny and screening of 410 studies, according to the selection criteria, 10 full-text articles were included in the review and meta-analysis. All 10 studies had undergone a methodological quality assessment by the Physiotherapy Evidence Database Scale. Meta-analysis was done for external rotation, abduction ROM and pain. The most common PNF techniques used by most of the studies were, hold-relax and contract-relax in upper limb D2 flexion, abduction, and an external rotation pattern, while some studies used scapular PNF patterns. Among the 10 included studies, nine showed that the PNF group is superior in decreasing pain and reducing disability, increasing ROM, improving function. The meta-analysis also showed a significant effect size and that the PNF is superior than conventional physical therapy in decreasing pain, increasing external rotation, and abduction ROM.
Topics: Bursitis; Humans; Physical Therapy Modalities; Proprioception; Range of Motion, Articular; Treatment Outcome
PubMed: 31789299
DOI: No ID Found -
International Journal of Environmental... Feb 2022Adhesive capsulitis occurs with synovial inflammation and capsular fibrosis in the glenohumeral joint, leading to restriction of joint motion and pain. Heat therapy... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Adhesive capsulitis occurs with synovial inflammation and capsular fibrosis in the glenohumeral joint, leading to restriction of joint motion and pain. Heat therapy modalities, which aim at modifying dense collagenous tissues are commonly practiced interventions for patients with adhesive capsulitis; however, the effectiveness of ultrasound deep heat therapy (UST) on adhesive capsulitis is still unclear.
PURPOSE
This systematic review and meta-analysis study was conducted to evaluate the effects of UST on the improvement of pain and glenohumeral joint function in adhesive capsulitis compared to (1) no treatment or placebo, and (2) any other therapeutic modalities.
METHODS
A literature search was carried out in January 2021 in Cochrane Central Register of Controlled Trials, PubMed, EMBASE, PEDro, Web of Science, and Google Scholar. The main outcomes of interest were self-reported pain scores, disability scores, and the range of motion. This study was conducted based on the guidelines of the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) protocols, using random-effects models.
RESULTS
Seven studies were included in the systematic review with five studies forming the basis for meta-analyses. The effects of UST in patients with adhesive capsulitis were compared with placebo, shockwave therapy, corticosteroid injection, platelet-rich plasma injection, or cryotherapy. The results indicated that UST significantly improved pain scores when performed together with exercise and/or other physical modalities compared to placebo; however, whether UST provides benefits for the improvement of disability and/or the range of motion was uncertain in the present results.
CONCLUSIONS
The present findings suggest that UST as a co-intervention combined with other physical modalities is an effective means of improving the overall pain in patients with adhesive capsulitis.
Topics: Bursitis; Hot Temperature; Humans; Range of Motion, Articular; Shoulder Joint; Shoulder Pain; Treatment Outcome
PubMed: 35162881
DOI: 10.3390/ijerph19031859 -
The Journal of Manual & Manipulative... Feb 2022To assess the effects of mobilization with movement (MWM) on pain, range of motion (ROM), and disability in the management of shoulder musculoskeletal disorders. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the effects of mobilization with movement (MWM) on pain, range of motion (ROM), and disability in the management of shoulder musculoskeletal disorders.
METHODS
Six databases and Scopus, were searched for randomized control trials. The ROB 2.0 tool was used to determine risk-of-bias and GRADE used for quality of evidence. Meta-analyses were performed for the sub-category of frozen shoulder and shoulder pain with movement dysfunction to evaluate the effect of MWM in isolation or in addition to exercise therapy and/or electrotherapy when compared with other conservative interventions.
RESULTS
Out of 25 studies, 21 were included in eight separate meta-analyses for pain, ROM, and disability in the two sub-categories. For frozen shoulder, the addition of MWM significantly improved pain (SMD -1.23, 95% CI -1.96, -0.51)), flexion ROM (MD -11.73, 95% CI -17.83, -5.64), abduction ROM (mean difference -13.14, 95% CI -19.42, -6.87), and disability (SMD -1.50, 95% CI (-2.30, -0.7). For shoulder pain with movement dysfunction, the addition of MWM significantly improved pain (SMD -1.07, 95% CI -1.87, -0.26), flexion ROM (mean difference -18.48, 95% CI- 32.43, -4.54), abduction ROM (MD -32.46, 95% CI - 69.76, 4.84), and disability (SMD -0.88, 95% CI -2.18, 0.43). The majority of studies were found to have a high risk of bias.
DISCUSSION
MWM is associated with improved pain, mobility, and function in patients with a range of shoulder musculoskeletal disorders and the effects clinically meaningful. However, these findings need to be interpreted with caution due to the high levels of heterogeneity and risk of bias.
LEVEL OF EVIDENCE
Treatment, level 1a.
Topics: Bursitis; Humans; Musculoskeletal Manipulations; Range of Motion, Articular; Shoulder; Shoulder Pain
PubMed: 34334099
DOI: 10.1080/10669817.2021.1955181 -
Cureus Jul 2022Posterosuperior calcaneal prominence, also known as Haglund's deformity, can often lead to retrocalcaneal bursitis, a significant cause of posterior heel pain. Surgery... (Review)
Review
Posterosuperior calcaneal prominence, also known as Haglund's deformity, can often lead to retrocalcaneal bursitis, a significant cause of posterior heel pain. Surgery is indicated for symptomatic patients, after a period of conservative treatment including analgesia, physiotherapy, activity, and shoe wear modification has failed. Surgical options include both open and endoscopic techniques, and typically involve excision of the retrocalcaneal bursa, resection of the calcaneal prominence, and debridement of the diseased Achilles tendon. This article aims to provide an evidence-based literature review for the surgical management of Haglund's deformity. A comprehensive evidence-based literature review of the PubMed database conducted in July 2021 identified 20 relevant articles assessing the efficacy of surgical modalities for Haglund's deformity. The 20 studies were assigned to a level of evidence (I-IV). Individual studies were reviewed to provide a grade of recommendation (A-C, I) according to the Wright classification in support of or against the surgical modality. Qualitative and quantitative analysis was performed for the 20 studies. The results show that both open and endoscopic surgical modalities are efficacious in the treatment of Haglund's deformity, significantly improving functional outcome scores such as American Orthopaedic Foot & Ankle Society (AOFAS) scores and patient satisfaction post-operatively. Endoscopic surgery appears to have the advantage of shorter operative times, lower complication rates, and better cosmesis. More studies are required to further validate and optimize these surgical techniques.
PubMed: 36060327
DOI: 10.7759/cureus.27500 -
Medicine Aug 2019Previous clinical trials have reported that physical therapy (PT) can be used for the treatment of frozen shoulder (FS). However, its effectiveness is still...
BACKGROUND
Previous clinical trials have reported that physical therapy (PT) can be used for the treatment of frozen shoulder (FS). However, its effectiveness is still inconclusive. In this systematic review study, we will aim to evaluate the effectiveness and safety of PT alone for the treatment of FS.
METHODS
The following electronic databases will be searched from the inception to the present to identify any eligible studies focusing on PT for the treatment of FS. These databases comprise of Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, and 4 Chinese databases of Chinese Biomedical Literature Database, China National Knowledge Infrastructure (which includes the database China Academic Journals), VIP Information, and Wanfang Data. All randomized controlled trials (RCTs) of PT for FS will be considered for inclusion without language restrictions. Cochrane risk of bias tool will be used to assess the methodological quality for all included RCTs.
RESULTS
The effectiveness and safety of this study will be assessed by shoulder pain intensity, shoulder function, quality of life, and any adverse events.
CONCLUSION
The findings of this study may provide most recent evidence on the effectiveness and safety of PT for patients with FS.
Topics: Bursitis; Humans; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Research Design
PubMed: 31393406
DOI: 10.1097/MD.0000000000016784 -
Medicine Jun 2023The aim of this study was to determine the effectiveness of scapular mobilization on range of motion, shoulder disability, and pain intensity in patients with primary... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The aim of this study was to determine the effectiveness of scapular mobilization on range of motion, shoulder disability, and pain intensity in patients with primary adhesive capsulitis (AC).
METHODS
An electronic search was performed in the MEDLINE, EMBASE, SCOPUS, CENTRAL, LILACS, CINAHL, SPORTDiscus, and Web of Science databases up to March 2023. The eligibility criteria for selected studies included randomized clinical trials that included scapular mobilization with or without other therapeutic interventions for range of motion, shoulder disability, and pain intensity in patients older than 18 years with primary AC. Two authors independently performed the search, study selection, and data extraction, and assessed the risk of bias using the Cochrane Risk of Bias 2 tool.
RESULTS
Six randomized clinical trials met the eligibility criteria. For scapular mobilization versus other therapeutic interventions, there was no significant difference in the effect sizes between groups: the standard mean difference was -0.16 (95% confidence interval [CI] = -0.87 to 0.56; P = .66) for external rotation, -1.01 (95% CI = -2.33 to 0.31; P = .13) for flexion, -0.29 (95% CI = -1.17 to 0.60; P = .52) for shoulder disability, and 0.65 (95% CI = -0.42 to 1.72; P = .23) for pain intensity.
CONCLUSIONS
Scapular mobilization with or without other therapeutic interventions does not provide a significant clinical benefit regarding active shoulder range of motion, disability, or pain intensity in patients with primary AC, compared with other manual therapy techniques or other treatments; the quality of evidence was very low to moderate according to the grading of recommendation, assessment, development and evaluation approach.
Topics: Humans; Bursitis; Musculoskeletal Manipulations; Shoulder Pain; Shoulder Joint
PubMed: 37266649
DOI: 10.1097/MD.0000000000033929 -
Orthopaedics & Traumatology, Surgery &... Feb 2021This systematic review and meta-analysis aims to provide consensus regarding the degree of optimal extended arthroscopic capsular release in addition to a standard... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This systematic review and meta-analysis aims to provide consensus regarding the degree of optimal extended arthroscopic capsular release in addition to a standard rotator interval release in the treatment of idiopathic frozen shoulder.
MATERIALS AND METHODS
The systematic review was conducted using the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. All articles that reported the outcomes of capsular release in idiopathic frozen shoulder were included. A total of 18 articles with 629 patients and 811 shoulders were included. Clinical outcomes analysed include differences between pre and postoperative ranges of motion (ROM), Visual Analog Score (VAS) reduction, Simple Shoulder Test (SST) scores and Constant scores. Patients were grouped by technique: anterior-inferior capsular release (Group 1), anterior-inferior-posterior capsular release (Group 2), and 360-degree capsular release (Group 3) at follow up points 3,6 and 12 months.
RESULTS
Comparing ROM, Group 1 had greater early abduction (p<0.01), early (p<0.01) and overall external rotation (p<0.01) than Group 2, as well as greater early flexion (p<0.01), early abduction (p<0.01), early (p<0.01) and overall internal rotation (p<0.01) than Group 3. Group 2 had greater early (p=0.03) and overall flexion (p<0.01) than Group 1, as well as greater early (p<0.01) and overall flexion (p<0.01), early abduction (p<0.01) and early internal rotation (p<0.01) than Group 3. Group 3 had greater overall flexion (p<0.01) than Group 1 and greater overall external rotation (p<0.01) than Group 2. Comparing VAS scores, the less extensive releases saw the greatest significant postoperative reduction. Group 2 had greater mean improvements in postoperative Constant scores than Group 1 (p<0.01) and Group 3 (p<0.01), while SST scores were significantly higher in Group 1 (p<0.01).
CONCLUSION
This systematic review and meta-analysis suggests that less extensive releases may result in better functional and pain scores. Addition of a posterior release offers increased early internal rotation, which was not sustained over time, but provides early and sustained flexion improvements. A complete 360 release may not provide any further benefit. There were no significant differences in the complication rates amongst the 3 techniques.
LEVEL OF STUDY
II; Meta-analysis and systematic review.
Topics: Arthroscopy; Bursitis; Humans; Joint Capsule Release; Range of Motion, Articular; Shoulder Joint; Treatment Outcome
PubMed: 33333264
DOI: 10.1016/j.otsr.2020.102766 -
The Journal of Manual & Manipulative... Oct 2023Adhesive capsulitis (AC) affects approximately 1% of the general population. Current research lacks clear guidance on the dosage of manual therapy and exercise... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Adhesive capsulitis (AC) affects approximately 1% of the general population. Current research lacks clear guidance on the dosage of manual therapy and exercise interventions.
OBJECTIVE
The purpose of this systematic review was to assess the effectiveness of manual therapy and exercise in the management of AC, with a secondary aim of describing the available literature present on the dosage of interventions.
METHODS
Eligible studies were randomized clinical/quasi-experimental trials with complete data analysis and no limits on date of publication, published in English, recruited participants >18 years of age with primary adhesive capsulitis, that had at least two groups with one group receiving manual therapy (MT) alone, exercise alone, or MT and exercise, that included at least one outcome measure of pain, disability, or external rotation range of motion, and that had dosage of visits clearly defined. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias 2 Tool. The Grading of Recommendations Assessment, Development, and Evaluation was used to provide an overall assessment of the quality of evidence. Meta-analyses were conducted when possible, and dosage was discussed in narrative form.
RESULTS
Sixteen studies were included. All meta-analyses revealed non-significant effects of pain, disability, and external rotation range of motion at short- and long-term follow-up, with an overall level of evidence ranging from very low to low.
CONCLUSION
Non-significant findings with low-to-very-low-quality of evidence were found across meta-analyses, preventing seamless transition of research evidence to clinical practice. Lack of consistency in study designs, manual therapy techniques, dosing parameters, and duration of care impedes the ability to make strong recommendations regarding optimal dosage of physical therapy for individuals with AC.
Topics: Humans; Exercise; Musculoskeletal Manipulations; Physical Therapy Modalities; Shoulder Pain; Bursitis; Randomized Controlled Trials as Topic
PubMed: 36861780
DOI: 10.1080/10669817.2023.2180702