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Nature Reviews. Disease Primers Sep 2022Frozen shoulder is a common debilitating disorder characterized by shoulder pain and progressive loss of shoulder movement. Frozen shoulder is frequently associated with... (Review)
Review
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.
Topics: Bursitis; Fibrosis; Humans; Physical Therapy Modalities
PubMed: 36075904
DOI: 10.1038/s41572-022-00386-2 -
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 -
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 -
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 -
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 -
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 -
Journal of Musculoskeletal & Neuronal... Sep 2019This study aimed to compare the superiority of scapular mobilization, manual capsule stretching, and the combination of these two techniques in the treatment of frozen... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
This study aimed to compare the superiority of scapular mobilization, manual capsule stretching, and the combination of these two techniques in the treatment of frozen shoulder patients to evaluate the acute effects of these techniques on shoulder movements.
METHODS
This study designed to a single-blinded, randomized, and pre-post assessment study. This study was included 54 patients diagnosed with stage 3 frozen shoulder. Group 1 (n=27) received scapular mobilization, and Group 2 (n=27) received manual posterior capsule stretching. After the patients were assessed, the interventions were re-applied with a crossover design to obtain results for the combined application (n=54). The range of motion, active total elevation, active internal rotation, and posterior capsule tensions of the shoulder joint were recorded before and immediately after mobilization.
RESULTS
Statistical analysis showed an increase in all range of motion values (p<0.05), except for shoulder internal rotation (p>0.05), without significant difference among the groups (p>0.05). The posterior capsule flexibility did not change in any group (p>0.05).
CONCLUSIONS
Scapular mobilization and manual posterior capsule interventions were effective in improving the acute joint range of motion in frozen shoulder patients.
Topics: Adult; Aged; Bursitis; Female; Humans; Male; Middle Aged; Muscle Stretching Exercises; Physical Therapy Modalities; Range of Motion, Articular; Scapula; Shoulder Joint; Single-Blind Method
PubMed: 31475938
DOI: No ID Found -
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 American Journal of Occupational... 2017People with musculoskeletal disorders of the shoulder commonly experience pain, decreased strength, and restricted range of motion (ROM) that limit participation in... (Review)
Review
People with musculoskeletal disorders of the shoulder commonly experience pain, decreased strength, and restricted range of motion (ROM) that limit participation in meaningful occupational activities. The purpose of this systematic review was to evaluate the current evidence for interventions within the occupational therapy scope of practice that address pain reduction and increase participation in functional activities. Seventy-six studies were reviewed for this study-67 of Level I evidence, 7 of Level II evidence, and 2 of Level III evidence. Strong evidence was found that ROM, strengthening exercises, and joint mobilizations can improve function and decrease pain. The evidence to support physical modalities is moderate to mixed, depending on the shoulder disorder. Occupational therapy practitioners can use this evidence to guide daily clinical decision making.
Topics: Bursitis; Exercise Therapy; Humans; Humeral Fractures; Muscle Stretching Exercises; Musculoskeletal Diseases; Neck Pain; Occupational Therapy; Range of Motion, Articular; Rotator Cuff Injuries; Shoulder Impingement Syndrome; Shoulder Pain; Treatment Outcome
PubMed: 28027039
DOI: 10.5014/ajot.2017.023127 -
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