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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 -
Mayo Clinic Proceedings Sep 2009Patients commonly present to primary care physicians with musculoskeletal symptoms. Clinicians certified in internal medicine must be knowledgeable about the diagnosis... (Review)
Review
Patients commonly present to primary care physicians with musculoskeletal symptoms. Clinicians certified in internal medicine must be knowledgeable about the diagnosis and management of musculoskeletal diseases, yet they often receive inadequate postgraduate training on this topic. The musculoskeletal problems most frequently encountered in our busy injection practice involve, in decreasing order, the knees, trochanteric bursae, and glenohumeral joints. This article reviews the clinical presentations of these problems. It also discusses musculoskeletal injections for these problems in terms of medications, indications, injection technique, and supporting evidence from the literature. Experience with joint injection and the pharmacological principles described in this article should allow primary care physicians to become comfortable and proficient with musculoskeletal injections.
Topics: Adrenal Cortex Hormones; Analgesia; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Bursitis; Humans; Injections, Intra-Articular; Injections, Intramuscular; Joint Diseases; Knee Joint; Musculoskeletal Diseases; Shoulder Joint
PubMed: 19720781
DOI: 10.4065/84.9.831 -
BMJ Case Reports Dec 2017
Topics: Anti-Inflammatory Agents; Antibodies, Monoclonal; Antineoplastic Agents; Bursitis; Carcinoma, Non-Small-Cell Lung; Female; Humans; Lymphatic Metastasis; Middle Aged; Nivolumab; Positron Emission Tomography Computed Tomography; Prednisone; Shoulder Joint; Tenosynovitis; Treatment Outcome
PubMed: 29197854
DOI: 10.1136/bcr-2017-223387 -
Praxis Nov 2022CME-Sonography 106: Subacromial Bursa - A Myth In everyday clinical practice, we frequently encounter bursitis. It can occur in practically any joint region, for... (Review)
Review
CME-Sonography 106: Subacromial Bursa - A Myth In everyday clinical practice, we frequently encounter bursitis. It can occur in practically any joint region, for example in local mechanical overload situations, after a trauma or in the context of an inflammatory systemic disease. In this review we focus on the location of bursitis in the shoulder region and would like to contribute to get away from the "myth" called subacromial bursitis.
Topics: Humans; Shoulder; Bursa, Synovial; Bursitis; Shoulder Impingement Syndrome; Shoulder Joint
PubMed: 36415986
DOI: 10.1024/1661-8157/a003946 -
International Journal of Environmental... Aug 2022Purpose: To investigate the efficacy of manipulation under anesthesia (MUA) compared to other non-surgical therapeutic strategies for patients with frozen shoulder... (Review)
Review
Purpose: To investigate the efficacy of manipulation under anesthesia (MUA) compared to other non-surgical therapeutic strategies for patients with frozen shoulder contracture syndrome (FSCS). Methods: A systematic review of literature was conducted. A literature search was performed in MEDLINE, EMBASE, PEDro, Cochrane Central Library and Scopus. Only randomized controlled trials were included and assessed for critical appraisal through the Cochrane Collaborations tools. Results: Five randomized controlled trials were included. The overall risk of bias (RoB) was high in 4 out of 5 of the included studies. MUA was found to be not superior in terms of reduction of pain and improvement of function when compared to cortisone injections with hydrodilatation (mean regression coefficient MUA −2.77 vs. injection −2.75; 95% CI (−1.11 to 1.15)) and home exercise (mean difference 95% CI: 0.2 (−0.64 to 1.02)) in the short term (3 months), and cortisone injections with hydrodilatation (mean regression coefficient MUA 3.13 vs. injection 3.23; 95% CI (−0.90 to 1.11)) in the long term (>6 months). Moreover, if compared to structured physiotherapy, MUA highlighted a higher Oxford Shoulder Score at final 1-year follow up (mean difference 95% CI: 1.05 (−1.28 to 3.39); p = 0.38). Similar results were obtained for disability, with statistically no significant long-term (>12 months) differences between MUA and home exercise (mean difference 95% CI: 0 (−3.2 to 3.2)) or structured physiotherapy (mean difference 95% CI: −0.50 (−5.70 to 4.70); p = 0.85)). Only two trials reported adverse events. Conclusions: This review suggested that limited and inconsistent evidence currently exists on the efficacy of MUA compared to other non-surgical strategies in the management of patients with FSCS. Future research should focus on clinical trials with higher methodological quality.
Topics: Anesthesia; Bursitis; Contracture; Cortisone; Humans; Physical Therapy Modalities
PubMed: 35955074
DOI: 10.3390/ijerph19159715 -
The Western Journal of Medicine Nov 1988
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Acta Bio-medica : Atenei Parmensis May 2020With the term "Haglund›s syndrome" we define a condition characterized clinically by pain at the insertion of Achille›s tendon and, anatomopathologically, due to the...
BACKGROUND AND AIM OF THE WORK
With the term "Haglund›s syndrome" we define a condition characterized clinically by pain at the insertion of Achille›s tendon and, anatomopathologically, due to the presence of retrocalcaneal bursitis and at times associated with an insertional Achille›s tendinopathy. The aim of the work is to correlate the most reliable and reproducible treatment possible to the aforementioned variables of Haglund›s syndrome.
METHODS
The classic syndromic picture is characterized by pain caused by retrocalcaneal bursitis. In some cases, symptoms of insertional tendinopathy are associated with bursitis pain. In those frameworks where symptoms were mainly exacerbated by the bursitis inflammation we have used an endoscopic technique for the resection of the underlying bone deformation and the bursa. An open technique, described in the literature as bridge sutures, was used for those patients with tendinopathic problems. While a homologous PRP unit was infiltrated in patients with degenerative insertional tendinopathy.
RESULTS
The group of patients that participated to the study was heterogeneous in age and functional requirements therefore presenting different anatomopathological characteristics. For these reasons considerations with correct statistical meaning are not possible. Despite different post-operative programs, patients demonstrated optimal clinical and functional recovery. There were no local neurological or skin complications.
CONCLUSIONS
Haglund›s syndrome can have different clinical and anatomopathological patterns where conservative treatment is unsuccessful surgical solutions must be adopted. The latter have shown to be reliable and reproducible with a very low rate of complications. (www.actabiomedica.it).
Topics: Achilles Tendon; Ankle Joint; Bursitis; Endoscopy; Female; Humans; Male; Orthopedic Procedures; Syndrome; Tendinopathy
PubMed: 32555092
DOI: 10.23750/abm.v91i4-S.9576 -
Medicine Nov 2023To investigate the causal relationship between dried fruit intake and frozen shoulder using Mendelian randomization (MR). Genome wide association studies were conducted...
To investigate the causal relationship between dried fruit intake and frozen shoulder using Mendelian randomization (MR). Genome wide association studies were conducted to pool data and select genetic loci independently associated with dried fruit intake and frozen shoulder in people of European ancestry as instrumental variables. Three MR analyses, inverse variance weighting, weighted median and MR-Egger, were used to investigate the causal relationship between dried fruit intake and frozen shoulder. Heterogeneity and multiplicity tests were used, and sensitivity analyses were conducted using the leave-one-out method to explore the robustness of the results. The inverse variance weighting results showed an OR (95 % CI) of 0.52 (0.34-0.80), P = .003, suggesting that there is a causal relationship between dried fruit intake and frozen shoulder. And no heterogeneity and multiplicity were found by the test and sensitivity analysis also showed robust results. The present study used a two-sample MR analysis, and by analyzing and exploring the genetic data, the study showed that too little intake of dry fruits is a risk factor for developing frozen shoulder.
Topics: Humans; Fruit; Genome-Wide Association Study; Mendelian Randomization Analysis; Causality; Bursitis
PubMed: 37986373
DOI: 10.1097/MD.0000000000036099 -
BMC Musculoskeletal Disorders Aug 2022Severe frozen shoulder (FS) is often resistant to treatment and can thus result in long-term functional impairment. However, its etiology remains unknown. We...
BACKGROUND
Severe frozen shoulder (FS) is often resistant to treatment and can thus result in long-term functional impairment. However, its etiology remains unknown. We hypothesized that gene expression of FS would vary by synovial location.
METHODS
The synovial tissues of patients with FS were collected prospectively and analyzed for the expression of 19 genes. Synovial tissues from patients with rotator cuff tear (RCT) or shoulder instability (SI) were also analyzed as controls. A total of 10 samples were analyzed from each group. The specimens were arthroscopically taken from three different locations: rotator interval (RI), axillary recess (AX), and subacromial bursa (SAB). Total RNA was extracted from the collected tissues and was analyzed by real-time polymerase chain reaction for the following genes: matrix metalloproteinases (MMPs); tissue inhibitors of metalloproteinases (TIMPs); inflammatory cytokines (IL1B, TNF, and IL6); type I and II procollagen (COL1A1 and COL2A1); growth factors (IGF1 and TGFB1); neural factors (NGF and NGFR); SOX9; and ACTA2.
RESULTS
Site-specific analysis showed that MMP13, IL-6, SOX9, and COL1A1 were increased in all three sites. Four genes (MMP3, MMP9, COL2A1, and NGFR) were increased in the AX, MMP3 in the RI, and NGFR in the SAB were increased in the FS group than in the RCT and SI groups. In the FS group, there was a correlation between the expression of genes related to chondrogenesis (MMP2, IGF1, SOX9, COL2A1, NGF, and NGFR) or fibrosis (MMP9, TGFB1, and COL1A1).
CONCLUSION
The expression levels of numerous MMPs, pro-inflammatory cytokines, and collagen-related genes were increased in the FS group, suggesting that catabolic and anabolic changes have simultaneously occurred. In addition, genes related to chondrogenesis or fibrosis were highly expressed in the FS group, which might have affected the range of motion limitation of the shoulder. Compared to RI and SAB, the AX was the most common site of increased expression in FS. Analyzing the lower region of the shoulder joint may lead to the elucidation of the pathogenesis of FS.
Topics: Bursitis; Cytokines; Fibrosis; Gene Expression; Humans; Joint Instability; Matrix Metalloproteinase 3; Matrix Metalloproteinase 9; Nerve Growth Factor; Rotator Cuff Injuries; Shoulder Joint
PubMed: 36008780
DOI: 10.1186/s12891-022-05762-3 -
RMD Open Nov 2022Adhesive capsulitis is a common painful shoulder condition. Treatment for the condition remains unsatisfactory. Suprascapular nerve block (SSNB) shows promise as a... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Adhesive capsulitis is a common painful shoulder condition. Treatment for the condition remains unsatisfactory. Suprascapular nerve block (SSNB) shows promise as a treatment option for adhesive capsulitis but there are no randomised controlled trials that examine its effect on pain or duration of the condition. The objective of this study was to examine the efficacy of SSNB for the management of adhesive capsulitis.
METHODS
A randomised double-blind placebo-controlled trial of SSNB and standard therapy versus placebo and standard therapy was performed. In total, 54 patients were enrolled in the study. 27 patients received a glenohumeral joint (GHJ) injection and physiotherapy plus a 3-month SSNB, and 27 patients received a GHJ injection and physiotherapy plus a 3-month placebo injection. Patients were followed to resolution of their symptoms as measured by a combination of range of movement, pain scores, Shoulder Pain and Disability Index (SPADI) scores and perceived recovery scores. The primary outcome measure was time to resolution of symptoms.
RESULTS
Participants who received the SSNB reduced the duration of their symptoms of adhesive capsulitis by an average of 6 months (mean time to resolution 5.4 (95% CI 4.4 to 6.3) months vs 11.2 (95% CI 9.3 to 13) months) in the placebo group. They also had reduced pain scores, improved range of movement and lower SPADI scores compared with the placebo group across all time points.
CONCLUSION
SSNB reduced the duration of adhesive capsulitis and resulted in improved pain and disability experience for patients.
TRIAL REGISTRATION NUMBER
Australian New Zealand Clinical Trials Registry (ANCTRN 12615001378516).
Topics: Humans; Treatment Outcome; Australia; Bursitis; Shoulder Pain; Nerve Block
PubMed: 36418088
DOI: 10.1136/rmdopen-2022-002648