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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 -
Chinese Journal of Traumatology =... 2015Heel pain is a very common foot disease. Varieties of names such as plantar fasciitis, jogger's heel, tennis heal, policeman's heel are used to describe it. Mechanical... (Review)
Review
Heel pain is a very common foot disease. Varieties of names such as plantar fasciitis, jogger's heel, tennis heal, policeman's heel are used to describe it. Mechanical factors are the most common etiology of heel pain. Common causes of hell pain includes: Plantar Fasciitis, Heel Spur, Sever's Disease, Heel bump, Achilles Tendinopathy, Heel neuritis, Heel bursitis. The diagnosis is mostly based on clinical examination. Normally, the location of the pain and the absence of associated symptoms indicating a systemic disease strongly suggest the diagnosis. Several therapies exist including rest, physical therapy, stretching, and change in footwear, arch supports, orthotics, night splints, anti-inflammatory agents, and surgery. Almost all patients respond to conservative nonsurgical therapy. Surgery is the last treatment option if all other treatments had failed. Rest, ice, massage, the use of correct exercise and complying with a doctor's advice all play important part in helping to recover from this hell pain condition, but getting good quality, suitable shoes with the appropriate amount of support for the whole foot is the most important.
Topics: Foot Diseases; Heel; Humans; Pain Management; Physical Examination
PubMed: 26643244
DOI: 10.1016/j.cjtee.2015.03.002 -
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 -
BMC Musculoskeletal Disorders Aug 2016Frozen shoulder is a common yet poorly understood musculoskeletal condition, which for many, is associated with substantial and protracted morbidity. Understanding the... (Review)
Review
BACKGROUND
Frozen shoulder is a common yet poorly understood musculoskeletal condition, which for many, is associated with substantial and protracted morbidity. Understanding the pathology associated with this condition may help to improve management. To date this has not been presented in a systematic fashion. As such, the aim of this review was to summarise the pathological changes associated with this primary frozen shoulder.
DATABASES
Medline, Embase, CINAHL, AMED, BNI and the Cochrane Library, were searched from inception to 2nd May, 2014. To be included participants must not have undergone any prior intervention. Two reviewers independently conducted the; searches, screening, data extraction and assessment of Risk of Bias using the Cochrane Risk of Bias Assessment Tool for non-Randomised Studies of Interventions (ACROBAT-NRSI). Only English language publications reporting findings in humans were included. The findings were summarised in narrative format.
RESULTS
Thirteen observational studies (involving 417 shoulders) were included in the review. Eight studies reported magnetic resonance imaging or arthrography findings and 5 recorded histological findings. When reported mean ages of the participants ranged from 40.0 to 59.8 years. Duration of symptoms ranged from 0 to 30 months. The majority of studies (n = 7) were assessed to be of moderate risk of bias, two studies at high risk and the remaining four were rated as low risk of bias. Study characteristics were poorly reported and there was widespread variety observed between studies in respect of data collection methods and inclusion criteria employed. Pathological changes in the anterior shoulder joint capsule and related structures were commonly reported. Imaging identified pathological changes occurring in the coracohumeral ligament, axillary fold and rotator interval. Obliteration of the subcoracoid fat triangle also appeared to be pathognomonic. Histological studies were inconclusive but suggested that immune, inflammatory and fibrotic changes where associated with primary frozen shoulder.
CONCLUSIONS
This systematic review presents a summary of what is currently known about the tissue pathophysiology of primary frozen shoulder. Further studies that use standardised inclusion and exclusion criteria and investigate changes in naïve tissue at different stages of the condition are required.
Topics: Adult; Arthrography; Bursitis; Humans; Ligaments, Articular; Magnetic Resonance Imaging; Middle Aged; Shoulder Joint; Shoulder Pain
PubMed: 27527912
DOI: 10.1186/s12891-016-1190-9 -
The Cochrane Database of Systematic... Oct 2014Adhesive capsulitis (also termed frozen shoulder) is a common condition characterised by spontaneous onset of pain, progressive restriction of movement of the shoulder... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Adhesive capsulitis (also termed frozen shoulder) is a common condition characterised by spontaneous onset of pain, progressive restriction of movement of the shoulder and disability that restricts activities of daily living, work and leisure. Electrotherapy modalities, which aim to reduce pain and improve function via an increase in energy (electrical, sound, light, thermal) into the body, are often delivered as components of a physical therapy intervention. This review is one in a series of reviews which form an update of the Cochrane review 'Physiotherapy interventions for shoulder pain'.
OBJECTIVES
To synthesise the available evidence regarding the benefits and harms of electrotherapy modalities, delivered alone or in combination with other interventions, for the treatment of adhesive capsulitis.
SEARCH METHODS
We searched CENTRAL, MEDLINE, EMBASE, CINAHL Plus and the ClinicalTrials.gov and World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) clinical trials registries up to May 2014, unrestricted by language, and reviewed the reference lists of review articles and retrieved trials to identify any other potentially relevant trials.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and controlled clinical trials using a quasi-randomised method of allocation that included adults with adhesive capsulitis and compared any electrotherapy modality to placebo, no treatment, a different electrotherapy modality, or any other intervention. The two main questions of the review focused on whether electrotherapy modalities are effective compared to placebo or no treatment, or if they are an effective adjunct to manual therapy or exercise (or both). The main outcomes of interest were participant-reported pain relief of 30% or greater, overall pain, function, global assessment of treatment success, active shoulder abduction, quality of life, and the number of participants experiencing any adverse event.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected trials for inclusion, extracted the data, performed a risk of bias assessment, and assessed the quality of the body of evidence for the main outcomes using the GRADE approach.
MAIN RESULTS
Nineteen trials (1249 participants) were included in the review. Four trials reported using an adequate method of allocation concealment and six trials blinded participants and personnel. Only two electrotherapy modalities (low-level laser therapy (LLLT) and pulsed electromagnetic field therapy (PEMF)) have been compared to placebo. No trial has compared an electrotherapy modality plus manual therapy and exercise to manual therapy and exercise alone. The two main questions of the review were investigated in nine trials.Low quality evidence from one trial (40 participants) indicated that LLLT for six days may result in improvement at six days. Eighty per cent (16/20) of participants reported treatment success with LLLT compared with 10% (2/20) of participants receiving placebo (risk ratio (RR) 8.00, 95% confidence interval (CI) 2.11 to 30.34; absolute risk difference 70%, 95% CI 48% to 92%). No participants in either group reported adverse events.We were uncertain whether PEMF for two weeks improved pain or function more than placebo at two weeks because of the very low quality evidence from one trial (32 participants). Seventy-five per cent (15/20) of participants reported pain relief of 30% or more with PEMF compared with 0% (0/12) of participants receiving placebo (RR 19.19, 95% CI 1.25 to 294.21; absolute risk difference 75%, 95% CI 53% to 97%). Fifty-five per cent (11/20) of participants reported total recovery of joint function with PEMF compared with 0% (0/12) of participants receiving placebo (RR 14.24, 95% CI 0.91 to 221.75; absolute risk difference 55%, 95% CI 31 to 79).Moderate quality evidence from one trial (63 participants) indicated that LLLT plus exercise for eight weeks probably results in greater improvement when measured at the fourth week of treatment, but a similar number of adverse events, compared with placebo plus exercise. The mean pain score at four weeks was 51 points with placebo plus exercise, while with LLLT plus exercise the mean pain score was 32 points on a 100 point scale (mean difference (MD) 19 points, 95% CI 15 to 23; absolute risk difference 19%, 95% CI 15% to 23%). The mean function impairment score was 48 points with placebo plus exercise, while with LLLT plus exercise the mean function impairment score was 36 points on a 100 point scale (MD 12 points, 95% CI 6 to 18; absolute risk difference 12%, 95% CI 6 to 18). Mean active abduction was 70 degrees with placebo plus exercise, while with LLLT plus exercise mean active abduction was 79 degrees (MD 9 degrees, 95% CI 2 to 16; absolute risk difference 5%, 95% CI 1% to 9%). No participants in either group reported adverse events. LLLT's benefits on function were maintained at four months.Based on very low quality evidence from six trials, we were uncertain whether therapeutic ultrasound, PEMF, continuous short wave diathermy, Iodex phonophoresis, a combination of Iodex iontophoresis with continuous short wave diathermy, or a combination of therapeutic ultrasound with transcutaneous electrical nerve stimulation (TENS) were effective adjuncts to exercise. Based on low or very low quality evidence from 12 trials, we were uncertain whether a diverse range of electrotherapy modalities (delivered alone or in combination with manual therapy, exercise, or other active interventions) were more or less effective than other active interventions (for example glucocorticoid injection).
AUTHORS' CONCLUSIONS
Based upon low quality evidence from one trial, LLLT for six days may be more effective than placebo in terms of global treatment success at six days. Based upon moderate quality evidence from one trial, LLLT plus exercise for eight weeks may be more effective than exercise alone in terms of pain up to four weeks, and function up to four months. It is unclear whether PEMF is more or less effective than placebo, or whether other electrotherapy modalities are an effective adjunct to exercise. Further high quality randomised controlled trials are needed to establish the benefits and harms of physical therapy interventions (that comprise electrotherapy modalities, manual therapy and exercise, and are reflective of clinical practice) compared to interventions with evidence of benefit (for example glucocorticoid injection or arthrographic joint distension).
Topics: Adult; Bursitis; Electric Stimulation Therapy; Humans; Randomized Controlled Trials as Topic; Shoulder Pain
PubMed: 25271097
DOI: 10.1002/14651858.CD011324 -
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 -
The Cochrane Database of Systematic... Apr 2013Impingement is a common cause of shoulder pain. Impingement mechanisms may occur subacromially (under the coraco-acromial arch) or internally (within the shoulder... (Review)
Review
BACKGROUND
Impingement is a common cause of shoulder pain. Impingement mechanisms may occur subacromially (under the coraco-acromial arch) or internally (within the shoulder joint), and a number of secondary pathologies may be associated. These include subacromial-subdeltoid bursitis (inflammation of the subacromial portion of the bursa, the subdeltoid portion, or both), tendinopathy or tears affecting the rotator cuff or the long head of biceps tendon, and glenoid labral damage. Accurate diagnosis based on physical tests would facilitate early optimisation of the clinical management approach. Most people with shoulder pain are diagnosed and managed in the primary care setting.
OBJECTIVES
To evaluate the diagnostic accuracy of physical tests for shoulder impingements (subacromial or internal) or local lesions of bursa, rotator cuff or labrum that may accompany impingement, in people whose symptoms and/or history suggest any of these disorders.
SEARCH METHODS
We searched electronic databases for primary studies in two stages. In the first stage, we searched MEDLINE, EMBASE, CINAHL, AMED and DARE (all from inception to November 2005). In the second stage, we searched MEDLINE, EMBASE and AMED (2005 to 15 February 2010). Searches were delimited to articles written in English.
SELECTION CRITERIA
We considered for inclusion diagnostic test accuracy studies that directly compared the accuracy of one or more physical index tests for shoulder impingement against a reference test in any clinical setting. We considered diagnostic test accuracy studies with cross-sectional or cohort designs (retrospective or prospective), case-control studies and randomised controlled trials.
DATA COLLECTION AND ANALYSIS
Two pairs of review authors independently performed study selection, assessed the study quality using QUADAS, and extracted data onto a purpose-designed form, noting patient characteristics (including care setting), study design, index tests and reference standard, and the diagnostic 2 x 2 table. We presented information on sensitivities and specificities with 95% confidence intervals (95% CI) for the index tests. Meta-analysis was not performed.
MAIN RESULTS
We included 33 studies involving 4002 shoulders in 3852 patients. Although 28 studies were prospective, study quality was still generally poor. Mainly reflecting the use of surgery as a reference test in most studies, all but two studies were judged as not meeting the criteria for having a representative spectrum of patients. However, even these two studies only partly recruited from primary care.The target conditions assessed in the 33 studies were grouped under five main categories: subacromial or internal impingement, rotator cuff tendinopathy or tears, long head of biceps tendinopathy or tears, glenoid labral lesions and multiple undifferentiated target conditions. The majority of studies used arthroscopic surgery as the reference standard. Eight studies utilised reference standards which were potentially applicable to primary care (local anaesthesia, one study; ultrasound, three studies) or the hospital outpatient setting (magnetic resonance imaging, four studies). One study used a variety of reference standards, some applicable to primary care or the hospital outpatient setting. In two of these studies the reference standard used was acceptable for identifying the target condition, but in six it was only partially so. The studies evaluated numerous standard, modified, or combination index tests and 14 novel index tests. There were 170 target condition/index test combinations, but only six instances of any index test being performed and interpreted similarly in two studies. Only two studies of a modified empty can test for full thickness tear of the rotator cuff, and two studies of a modified anterior slide test for type II superior labrum anterior to posterior (SLAP) lesions, were clinically homogenous. Due to the limited number of studies, meta-analyses were considered inappropriate. Sensitivity and specificity estimates from each study are presented on forest plots for the 170 target condition/index test combinations grouped according to target condition.
AUTHORS' CONCLUSIONS
There is insufficient evidence upon which to base selection of physical tests for shoulder impingements, and local lesions of bursa, tendon or labrum that may accompany impingement, in primary care. The large body of literature revealed extreme diversity in the performance and interpretation of tests, which hinders synthesis of the evidence and/or clinical applicability.
Topics: Arthroscopy; Bursa, Synovial; Bursitis; Glenoid Cavity; Humans; Joint Instability; Physical Examination; Prospective Studies; Randomized Controlled Trials as Topic; Rotator Cuff Injuries; Rupture; Shoulder Impingement Syndrome; Tendinopathy
PubMed: 23633343
DOI: 10.1002/14651858.CD007427.pub2 -
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 -
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 -
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