-
Singapore Medical Journal Dec 2017Frozen shoulder, also known as adhesive capsulitis, is a common presentation in the primary care setting and can be significantly painful and disabling. The condition...
Frozen shoulder, also known as adhesive capsulitis, is a common presentation in the primary care setting and can be significantly painful and disabling. The condition progresses in three stages: freezing (painful), frozen (adhesive) and thawing, and is often self-limiting. Common conservative treatments include nonsteroidal anti-inflammatory drugs, oral glucocorticoids, intra-articular glucocorticoid injections and/or physical therapy. However, many physicians may find themselves limited to prescribing medications for treatment. This article elaborates on physical therapy exercises targeted at adhesive capsulitis, which can be used in combination with common analgesics.
Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Bursitis; Exercise Therapy; Glucocorticoids; Humans; Injections, Intra-Articular; Motion; Pain; Physical Therapy Modalities; Range of Motion, Articular; Shoulder Joint
PubMed: 29242941
DOI: 10.11622/smedj.2017107 -
Clinics in Orthopedic Surgery Sep 2019Frozen 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... (Review)
Review
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.
Topics: Bursitis; Humans
PubMed: 31475043
DOI: 10.4055/cios.2019.11.3.249 -
American Family Physician Mar 2019Adhesive capsulitis, also known as "frozen shoulder," is a common shoulder condition characterized by pain and decreased range of motion, especially in external...
Adhesive capsulitis, also known as "frozen shoulder," is a common shoulder condition characterized by pain and decreased range of motion, especially in external rotation. Adhesive capsulitis is predominantly an idiopathic condition and has an increased prevalence in patients with diabetes mellitus and hypothyroidism. Although imaging is not necessary to make the diagnosis, a finding of coracohumeral ligament thickening on noncontrast magnetic resonance imaging yields high specificity for adhesive capsulitis. Traditionally, it was thought that adhesive capsulitis progressed through a painful phase to a recovery phase, lasting one to two years with full resolution of symptoms without treatment. Recent evidence of persistent functional limitations if left untreated has challenged this theory. The most effective treatment for adhesive capsulitis is uncertain. Nonsurgical treatments include nonsteroidal anti-inflammatory drugs, short-term oral corticosteroids, intra-articular corticosteroid injections, physiotherapy, acupuncture, and hydrodilatation. Physiotherapy and corticosteroid injections combined may provide greater improvement than physiotherapy alone. Surgical treatment options for patients who have minimal improvement after six to 12 weeks of nonsurgical treatment include manipulation under anesthesia and arthroscopic capsule release.
Topics: Bursitis; Humans
PubMed: 30811157
DOI: No ID Found -
American Family Physician Feb 2011Adhesive capsulitis is a common, yet poorly understood, condition causing pain and loss of range of motion in the shoulder. It can occur in isolation or concomitantly... (Review)
Review
Adhesive capsulitis is a common, yet poorly understood, condition causing pain and loss of range of motion in the shoulder. It can occur in isolation or concomitantly with other shoulder conditions (e.g., rotator cuff tendinopathy, bursitis) or diabetes mellitus. It is often self-limited, but can persist for years and may never fully resolve. The diagnosis is usually clinical, although imaging can help rule out other conditions. The differential diagnosis includes acromioclavicular arthropathy, autoimmune disease (e.g., systemic lupus erythematosus, rheumatoid arthritis), biceps tendinopathy, glenohumeral osteoarthritis, neoplasm, rotator cuff tendinopathy or tear (with or without impingement), and subacromial and subdeltoid bursitis. Several treatment options are commonly used, but few have high-level evidence to support them. Because the condition is often self-limited, observation and reassurance may be considered; however, this may not be acceptable to many patients because of the painful and debilitating nature of the condition. Nonsurgical treatments include analgesics (e.g., acetaminophen, nonsteroidal anti-inflammatory drugs), oral prednisone, and intra-articular corticosteroid injections. Home exercise regimens and physical therapy are often prescribed. Surgical treatments include manipulation of the joint under anesthesia and capsular release.
Topics: Anti-Inflammatory Agents; Bursitis; Humans; Orthopedic Procedures; Physical Therapy Modalities; Shoulder Joint
PubMed: 21322517
DOI: No ID Found -
BMC Musculoskeletal Disorders Apr 2022Frozen shoulder is a common painful disease of the shoulder joint characterized by structural changes in the shoulder joint, restricting both active and passive shoulder... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND OBJECTIVES
Frozen shoulder is a common painful disease of the shoulder joint characterized by structural changes in the shoulder joint, restricting both active and passive shoulder joint activities. Proprioceptive neuromuscular facilitation (PNF) effectively improved and maintained the range of motion; however, it is not clear whether it can improve the shoulder joint structure in patients with frozen shoulder. This pilot study used magnetic resonance imaging (MRI) observation to assess the improvement of the local structure of the shoulder joint upon PNF treatment to elucidate a target based on structure for the treatment of frozen shoulder.
MATERIALS AND METHODS
Forty-eight patients with frozen shoulder were randomly divided into the traditional manual therapy group and the PNF technique group. Changes in the thicknesses of the coracohumeral ligament (CHL) and capsule in axillary recess (CAR) of the shoulder joint were observed via MRI upon admission and at 4 weeks after treatment. A visual analog scale (VAS) and passive shoulder range of motion (ROM) at abduction, anteflexion and external rotation position were used to evaluate the improvement of shoulder joint pain and function in the initial, mid-term, and discharge of the two groups of patients.
RESULTS
The primary outcome results shown that the PNF joint mobilization significantly reduced the thickness of the CHL (p = 0.0217) and CAR (p = 0.0133). Compared with simple joint mobilization, The mid-term and discharge rehabilitation assessment results showed that PNF has a better effect on shoulder pain. At the mid-term evaluation, the ROM of the PNF group was significantly better than that of the Control group in the three directions (p < 0.05).
CONCLUSION
As an adjunctive therapy, PNF can improve the shoulder joint structure of patients with frozen shoulder and is an effective treatment strategy for frozen shoulder.
Topics: Bursitis; Humans; Muscle Stretching Exercises; Pilot Projects; Range of Motion, Articular; Shoulder Joint; Shoulder Pain
PubMed: 35443651
DOI: 10.1186/s12891-022-05327-4 -
Australian Journal of General Practice Nov 2019Shoulder pain and stiffness affects at least one-quarter of the Australian population, with the primary care physician seeing 95% of these patients. Idiopathic frozen... (Review)
Review
BACKGROUND
Shoulder pain and stiffness affects at least one-quarter of the Australian population, with the primary care physician seeing 95% of these patients. Idiopathic frozen shoulder affects >250,000 Australians, making it a significant burden on both the individual and society. The primary care physician plays a major part in recognising the condition and formulating an evidence-based management plan in conjunction with the physiotherapist.
OBJECTIVE
This article provides the reader with an understanding of the natural history, pathophysiology, phases and clinical features of idiopathic frozen shoulder. It also outlines patients at risk of developing idiopathic frozen shoulder and addresses an evidence-based conservative approach to the management of this condition.
DISCUSSION
The primary care physician plays a pivotal part in the identification and management of idiopathic frozen shoulder, with the vast majority of patients responding to conservative management. A shared care approach with a skilled physiotherapist is essential.
Topics: Bursitis; Glucocorticoids; Humans; Injections, Intra-Articular; Patient Education as Topic; Physical Therapy Modalities; Prognosis
PubMed: 31722459
DOI: 10.31128/AJGP-07-19-4992 -
The Journal of Bone and Joint Surgery.... Jan 2012Frozen shoulder is commonly encountered in general orthopaedic practice. It may arise spontaneously without an obvious predisposing cause, or be associated with a... (Review)
Review
Frozen shoulder is commonly encountered in general orthopaedic practice. It may arise spontaneously without an obvious predisposing cause, or be associated with a variety of local or systemic disorders. Diagnosis is based upon the recognition of the characteristic features of the pain, and selective limitation of passive external rotation. The macroscopic and histological features of the capsular contracture are well-defined, but the underlying pathological processes remain poorly understood. It may cause protracted disability, and imposes a considerable burden on health service resources. Most patients are still managed by physiotherapy in primary care, and only the more refractory cases are referred for specialist intervention. Targeted therapy is not possible and treatment remains predominantly symptomatic. However, over the last ten years, more active interventions that may shorten the clinical course, such as capsular distension arthrography and arthroscopic capsular release, have become more popular. This review describes the clinical and pathological features of frozen shoulder. We also outline the current treatment options, review the published results and present our own treatment algorithm.
Topics: Algorithms; Arthroscopy; Bursitis; Diagnosis, Differential; Humans; Physical Therapy Modalities; Terminology as Topic
PubMed: 22219239
DOI: 10.1302/0301-620X.94B1.27093 -
Clinical Journal of Sport Medicine :... Sep 2011Trochanteric bursitis (TB) is a self-limiting disorder in the majority of patients and typically responds to conservative measures. However, multiple courses of... (Review)
Review
OBJECTIVE
Trochanteric bursitis (TB) is a self-limiting disorder in the majority of patients and typically responds to conservative measures. However, multiple courses of nonoperative treatment or surgical intervention may be necessary in refractory cases. The purpose of this systematic review was to evaluate the efficacy of the treatment of TB.
DATA SOURCES
A literature search in the PubMed, MEDLINE, CINAHL, and ISI Web of Knowledge databases was performed for all English language studies up to April 2010. Terms combined in a Boolean search were greater trochanteric pain syndrome, trochanteric bursitis, trochanteric, bursitis, surgery, therapy, drug therapy, physical therapy, rehabilitation, injection, Z-plasty, Z-lengthening, aspiration, bursectomy, bursoscopy, osteotomy, and tendon repair.
STUDY SELECTION
All studies directly involving the treatment of TB were reviewed by 2 authors and selected for further analysis. Expert opinion and review articles were excluded, as well as case series with fewer than 5 patients. Twenty-four articles were identified. According to the system described by Wright et al, 2 studies, each with multiple arms, qualified as level I evidence, 1 as level II, 1 as level III, and the rest as level IV. More than 950 cases were included.
DATA EXTRACTION
The authors extracted data regarding the type of intervention, level of evidence, mean age of patients, patient gender, number of hips in the study, symptom duration before the study, mean number of injections before the study, prior hip surgeries, patient satisfaction, length of follow-up, baseline scores, and follow-up scores for the visual analog scale (VAS) and Harris Hip Scores (HHS).
DATA SYNTHESIS
Symptom resolution and the ability to return to activity ranged from 49% to 100% with corticosteroid injection as the primary treatment modality with and without multimodal conservative therapy. Two comparative studies (levels II and III) found low-energy shock-wave therapy (SWT) to be superior to other nonoperative modalities. Multiple surgical options for persistent TB have been reported, including bursectomy (n = 2), longitudinal release of the iliotibial band (n = 2), proximal or distal Z-plasty (n = 4), osteotomy (n = 1), and repair of gluteus medius tears (n = 4).
CONCLUSIONS
Efficacy among surgical techniques varied depending on the clinical outcome measure, but all were superior to corticosteroid therapy and physical therapy according to the VAS and HHS in both comparison studies and between studies. This systematic review found that traditional nonoperative treatment helped most patients, SWT was a good alternative, and surgery was effective in refractory cases.
Topics: Adrenal Cortex Hormones; Bursitis; Combined Modality Therapy; Hip Joint; Humans; Physical Therapy Modalities; Treatment Outcome
PubMed: 21814140
DOI: 10.1097/JSM.0b013e318221299c -
BioMed Research International 2018It is fairly well understood that frozen shoulder involves several stages, which reflect the series of process from capsular inflammation and fibrosis to spontaneous... (Review)
Review
It is fairly well understood that frozen shoulder involves several stages, which reflect the series of process from capsular inflammation and fibrosis to spontaneous resolution of this fibrosis. However, the underlying pathophysiologic process remains poorly determined. For this reason, management of frozen shoulder remains controversial. Determining the pathophysiological processes of frozen shoulder is a pivotal milestone in the development of novel treatment for patients with frozen shoulder. This article reviews what is known to date about the biological pathophysiology of frozen shoulder. Although articles for the pathophysiology of frozen shoulder provide inconsistent and inconclusive results, they have suggested both inflammation and fibrosis mediated by cytokines, growth factors, matrix metalloproteinases, and immune cells. Proinflammatory cytokines and growth factors released from immune cells control the action of fibroblast and matrix remodeling is regulated by the matrix metalloproteinases and their inhibitors. To improve our understanding of the disease continuum, better characterizing the biology of these processes at clearly defined stages will be needed. Further basic studies that use standardized protocols are required to more narrowly identify the role of cytokines, growth factors, matrix metalloproteinases, and immune cells. The results of these studies will provide needed clarity into the control mechanism of the pathogenesis of frozen shoulder and help identify new therapeutic targets for its treatment.
Topics: Bursitis; Cytokines; Fibrosis; Humans; Inflammation; Matrix Metalloproteinases
PubMed: 29992159
DOI: 10.1155/2018/7274517 -
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