Tuina in a Frozen Shoulder Rat Model: An Efficient and Reproducible Protocol.

Frozen shoulder (FS) is a common condition with no defined optimal therapy. Tuina therapy, a traditional Chinese medicine (TCM) technique used to treat FS patients in Chinese hospitals, has demonstrated excellent results, but its mechanisms are not fully understood. Building on a previous study, this work aimed to develop a Tuina protocol for an FS rat model. We randomly divided 20 SD rats into control (C; n = 5), FS model (M; n = 5), FS model Tuina treatment (MT; n = 5), and FS model oral treatment (MO; n = 5) groups. This study used the cast immobilization method to establish the FS rat model. The effect of Tuina and oral dexamethasone on the glenohumeral range of motion (ROM) was evaluated, and the histological findings were assessed. Our study showed that Tuina and oral dexamethasone were able to improve shoulder active ROM and preserve the structure of the capsule, with Tuina therapy proving to be more effective than oral dexamethasone. In conclusion, the Tuina protocol established in this study was highly effective for FS.

Pes Anserine Bursitis in Symptomatic Osteoarthritis Patients: A Mesotherapy Treatment Study.

BACKGROUND: Pes anserine bursitis strongly affects quality of life in patients with osteoarthritis. Treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, and injections of corticosteroid, with highly variable responses; recovery can take 10 days to 36 months. Mesotherapy is a minimally invasive technique consisting of subcutaneous injections of bioactive substances. The goal is to modulate the pharmacokinetics of the injected substance and prolong the effects at a local level. OBJECTIVE: To evaluate the effects of mesotherapy with diclofenac for anserine bursitis associated with knee osteoarthritis. METHODS: One hundred and seventeen patients with anserine bursitis associated with grade II Kellgren-Lawrence knee osteoarthritis, assessed by clinical, radiographic, and ultrasonographic examination, were evaluated and treated. They were randomly divided into two groups (A, mesotherapy; B, control). Group A completed nine sessions of mesotherapy with sodium diclofenac (25 mg/1 mL; Akis®, IBSA, Lugano, Switzerland), 1 mL for each session, three times per week. Group B received 21 oral administrations of sodium diclofenac (50 mg; Voltaren®, Novartis, Parsippany, NJ), once a day for 3 weeks. Primary outcome measures were pain intensity assessed by visual analogue scale (VAS), along with ability to perform activities of daily living, ability to participate in sports, level of pain, symptoms, and quality of life, as assessed by the Knee injury and Osteoarthritis Outcome Score. These measures were performed before and after the treatment period and at 30 and 90 days' follow up. RESULTS: In both groups pain level decreased significantly after the treatment period. Ultrasonography showed a reduction of the hypoechoic area related to anserine bursitis only in group A. CONCLUSION: Administration of conventional NSAIDs (diclofenac) by mesotherapy is effective in managing anserine bursitis in knee osteoarthritis in the short term and mid-term. These observations could be of interest for efforts to reduce the adverse effects of oral administration of anti-inflammatory drugs.

Frozen shoulder contracture syndrome - Aetiology, diagnosis and management.

Frozen shoulder is a poorly understood condition that typically involves substantial pain, movement restriction, and considerable morbidity. Although function improves overtime, full and pain free range, may not be restored in everyone. Frozen shoulder is also known as adhesive capsulitis, however the evidence for capsular adhesions is refuted and arguably, this term should be abandoned. The aim of this Masterclass is to synthesise evidence to provide a framework for assessment and management for Frozen Shoulder. Although used in the treatment of this condition, manipulation under anaesthetic has been associated with joint damage and may be no more effective than physiotherapy. Capsular release is another surgical procedure that is supported by expert opinion and published case series, but currently high quality research is not available. Recommendations that supervised neglect is preferable to physiotherapy have been based on a quasi-experimental study associated with a high risk of bias. Physiotherapists in the United Kingdom have developed dedicated care pathways that provide; assessment, referral for imaging, education, health screening, ultrasound guided corticosteroid and hydro-distension injections, embedded within physiotherapy rehabilitation. The entire pathway is provided by physiotherapists and evidence exists to support each stage of the pathway. Substantial on-going research is required to better understand; epidemiology, patho-aetiology, assessment, best management, health economics, patient satisfaction and if possible prevention.

A preliminary study of manipulation under anaesthesia for secondary frozen shoulder following breast cancer treatment.

INTRODUCTION: The aim of this paper is to present the results of manipulation under anaesthesia (MUA) and injection of local anaesthetic and corticosteroid followed by a physiotherapy regime for secondary frozen shoulder after breast cancer treatment (surgery, radiotherapy), and to compare them with a control group. METHODS: Patients referred to the senior author for secondary frozen shoulder following breast cancer treatment over a ten-year period were investigated. Recorded data included age, treatment for breast cancer, length of symptoms, Oxford shoulder score (OSS) and range of motion before and after shoulder MUA. These data were compared with a control group of patients with frozen shoulder. RESULTS: A total of 263 patients were referred with 281 frozen shoulders. Of these, 7 patients (7 shoulders) had undergone previous breast cancer treatment and the remaining 256 patients (274 shoulders) formed the control group. None of the patients were diabetic. The mean preoperative OSS was 31 for the study group and 27 for the control group, improving to 43 for both groups following MUA. Forty-two per cent of the study group and fifteen per cent of the control group had a second MUA subsequently. At the long-term follow-up appointment, 71% of the study group patients were satisfied with their result. CONCLUSIONS: The results of this preliminary study suggest that MUA, corticosteroid injection and subsequent physiotherapy have achieved good final results in a series of patients with frozen shoulder secondary to breast cancer treatment. Members of the multidisciplinary team looking after breast cancer patients should be aware of this management option and, on manifestation of this pathology, should refer the patient to an orthopaedic surgeon.

Translational manipulation after failed arthroscopic capsular release for recalcitrant adhesive capsulitis: a case report.

OBJECTIVE: This article reports the use of translational manipulation after failed arthroscopic capsular release for adhesive capsulitis. CLINICAL FEATURES: The patient was a 40-year-old woman, insulin-dependent diabetic with the insidious onset of right shoulder adhesive capsulitis. The patient underwent physical therapy 3 times a week for 6 weeks with minimal changes in her range of motion or pain. After failing physical therapy, the patient had arthroscopic capsular release and long-lever arm rotational manipulation of the right shoulder. The patient participated in physical therapy again, failing to regain her range of motion. INTERVENTION AND OUTCOME: Subsequently, the patient underwent interscalene block and translational manipulation by the same therapist followed by physical therapy. The patient's range-of-motion measures, strength testing, pain scale measurements, and functional scoring were recorded throughout her rehabilitation. She returned 2 years postdischarge for the same tests and measurements. CONCLUSION: Adhesive capsulitis in association with diabetes mellitus poses a serious treatment dilemma. Arthroscopic release may have limited benefits secondary to limited release and/or postoperative pain limiting rehabilitation. Translational manipulation under interscalene block may be considered in this difficult treatment group.

Unresolving hip tendonitis leads to discovery of malignant tumor.

OBJECTIVE: To discuss a case of malignant bone tumor in the left hip of a patient who sought treatment following a tennis injury. CLINICAL FEATURES: A 27-year-old male patient visited a chiropractic clinic 6 months after a twisting injury to his left hip which occurred while playing tennis. His pain had remained moderate in intensity and intermittent to frequent in frequency since it originated but became more intense the week prior to his visit. INTERVENTION AND OUTCOME: The patient was diagnosed with a tendonitis/bursitis and received 3 weeks of treatment. Care consisted of various forms of passive modalities to reduce pain and inflammation, as well as hip mobilization and tissue stretching. Plain film examination was then performed, due to lack of progress, and revealed a possible chondroblastoma of the femoral head. The patient was referred to his primary care physician (PCP) for follow-up imaging. Surgical resection of the lesion occurred approximately 2 months later. Biopsy of the resected cells confirmed a new diagnosis of clear cell chondrosarcoma. A computed tomography (CT) scan of the chest was performed to rule out metastasis to the lungs. Regular follow-up care and imaging continued and revealed, 9 months following, that the femoral head lesion had returned and hip replacement surgery would be needed. CONCLUSION: Tendonitis, bursitis, and sprains commonly occur following sports-related trauma to the appendicular skeleton. A conservative trial of care should be performed on suspected soft tissue injuries. However, when lack of improvement occurs within the first month, further examination, special studies, or referral are warranted to ensure a proper diagnosis and to rule out a pathological condition.

Physical therapy for spinal accessory nerve injury complicated by adhesive capsulitis.

BACKGROUND AND PURPOSE: The authors found no literature describing adhesive capsulitis as a consequence of spinal accessory nerve injury and no exercise program or protocol for patients with spinal accessory nerve injury. The purpose of this case report is to describe the management of a patient with adhesive capsulitis and spinal accessory nerve injury following a carotid endarterectomy. CASE DESCRIPTION: The patient was a 67-year-old woman referred for physical therapy following manipulation of the left shoulder and a diagnosis of adhesive capsulitis by her orthopedist. Spinal accessory nerve injury was identified during the initial physical therapy examination, and a program of neuromuscular electrical stimulation was initiated. OUTCOMES: The patient had almost full restoration of the involved muscle function after 5 months of physical therapy. DISCUSSION: This case report illustrates the importance of accurate diagnosis and suggests physical therapy intervention to manage adhesive capsulitis as a consequence of spinal accessory nerve injury.

Compromised wound repair caused by perioperative use of ibuprofen.

Nonsteroidal anti-inflammatory drugs have been shown to inhibit inflammation, an integral part of the wound-healing process. Compromised wound repair has been demonstrated in laboratory animals administered high-dose nonsteroidal anti-inflammatory drugs, a phenomenon we speculate could occur in humans undergoing surgery. We report a dramatic case of impaired wound healing in a patient ingesting high-dose perioperative ibuprofen, a nonsteroidal anti-inflammatory drug.

Sub-deltoid bursitis due to calcific tendonosis of the rotator cuff: a case report.

A case was reported at this private Chiropractic Office of a 50 year old white female with acute pain in the right anterior shoulder. Physical, neurological, and roentgenologic examinations revealed a diagnosis of calcific tendonosis of the right rotator cuff muscles with resultant Sub-Deltoid bursitis. A conservative regimen of therapy was instituted which included immobilization, physical therapy, manipulation, and eventually rehabilitative exercises.

The rheumatoid shoulder.

The rheumatoid shoulder is a frequent manifestation in the rheumatoid patient. Most of the symptoms are of a mild to moderate degree and can usually be ameliorated by heat, massage, and gently exercise. Local injection therapy may be of value in selected cases. Strenuous exercise or manipulation is contraindicated. Tendon ruptures and rotator cuff tears are not amenable to surgical reconstruction and are adequately treated with a conservative regimen. Prophylactic synovectomy is not performed as a routine, because the majority of patients do not develop disabling symptoms. This procedure is usually restricted to the few patients who exhibit uncontrollable proliferative synovitis. Prosthetic replacement is employed for intractable pain with full anticipation of limitied mobility. Various designs of a "total shoulder" are undergoing clinical evaluation, but their application has not been defined.