Comparison of the Efficacy of Ultrasound-Guided Suprascapular Nerve Blocks and Intraarticular Corticosteroid Injections for Frozen Shoulder: A Randomized Controlled Trial.

BACKGROUND: The current mainstream treatment for frozen shoulder is a combination of physiotherapy and intraarticular corticosteroid injections (IACIs). Recently, the ultrasound-guided suprascapular nerve block (SSNB) has developed as a notable alternative option to the mainstream treatment. OBJECTIVE: We aimed to compare ultrasound-guided SSNBs' effectiveness to IACIs' as treatments for frozen shoulder. STUDY DESIGN: This study was conducted as a prospective single-blind, randomized controlled trial. SETTING: Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, a medical center in Taipei, Taiwan. METHODS: Patients with frozen shoulder (n = 76) were enrolled as participants and allocated to either an SSNB group (n = 38) or an IACI group (n = 38). Both groups received 2 injections of 20 mg of triamcinolone and 3 mL of 1% lidocaine at 2-week intervals and underwent the same physiotherapy protocol for 3 months. The primary outcome measure was the Shoulder Pain and Disability Index (SPADI). The secondary outcome measures were the Shoulder Disability Questionnaire (SDQ), the active and passive range of motion (ROM) of each patient's affected shoulder, and the 36-item Short Form Health Survey (SF-36). Evaluations were performed at baseline and at 4 and 12 weeks after starting treatment. RESULTS: Both groups achieved significant improvements in all outcome measures, except the general health subscale of the SF-36 at 4 and 12 weeks after starting treatment. For time and group interaction, the results for the SDQ (P = .047) and SF-36 (bodily pain, P = .025) indicated significant differences that favored IACIs. Additionally, the IACI group achieved more favorable outcomes than did the SSNB group on the SPADI (P = .094) and in ROM (i.e., abduction [P = .190] and external rotation [P = .081]) as well as on 2 subscales of the SF-36: bodily pain (P = .059) and role-emotional (P = .072). LIMITATIONS: Our study is limited by the lack of participant stratification based on the stages of frozen shoulder and the 12-week follow-up period. CONCLUSIONS: A combination of ultrasound-guided IACIs and physiotherapy should be attempted first as a frozen shoulder treatment.

Association between Shoulder Dysfunction and Concomitant Neck Disability in Patients with Shoulder Disorders.

Objectives: This study aimed to investigate the impact of shoulder dysfunction on concomitant neck disability in patients with shoulder disorders. Methods: The participants were patients with subacromial impingement syndrome (SIS) and frozen shoulder (FS). Twenty patients with SIS and 21 with FS without cervical radiculopathy were enrolled. The participants were assessed for the 4-week prevalence of neck pain, Neck Disability Index (NDI), shoulder strength and range of motion, a short version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (quick-DASH), and the Pain Catastrophizing Scale (PCS). Results: The 4-week prevalence of neck pain was 12 out of 20 (60%) in patients with SIS and 13 out of 21 (62%) in patients with FS. The median NDIs were 13 and 12 for SIS and FS, respectively, with no statistically significant difference. About 41% (17/41) of the participants displayed an NDI greater than the cutoff value for disability in daily living. Although shoulder abduction strength correlated with the NDI in patients with SIS, the PCS score correlated with the NDI in patients with FS. Conclusions: Concomitant neck disability is a critical concern for patients with shoulder disorders. The clinical factors related to concomitant neck disability differ between SIS and FS, with specific interventions recommended for each condition.

Effects of Disturbed Body Perception on Arm Function in Patients With Frozen Shoulder.

Purpose Considering pain-related beliefs, this study aimed to investigate the influence of disturbed body perception on arm function in patients with frozen shoulder (FS). Methods This study included 90 patients with FS who visited the orthopedic outpatient clinic. We recorded measurements including the Visual Analog Scale (VAS) for pain at rest and during movement, the quick disability of the arm, shoulder, and hand (QDASH) questionnaire for perceived arm function, the short version of the Pain Self-Efficacy Questionnaire-2 (PSEQ-2) for self-efficacy in pain, the short version of the Pain Catastrophizing Scale (PCS-6) for catastrophic thoughts about pain, the short version of the Tampa Scale for Kinesiophobia (TSK-11) for fear of movement, and the Fremantle Shoulder Awareness Questionnaire (FreSHAQ) for disturbed perception around the shoulder. For statistical analysis, we constructed three models. Model 1 used the QDASH score as the dependent variable, with gender, age, duration of disease onset, VAS score at rest, and VAS score during movement as control variables. Model 2 included pain-related beliefs (PSEQ-2, PCS-6, and TSK-11) added to the variables in Model 1. Model 3 further included the FreSHAQ to the variables in Model 2. We calculated the difference in the adjusted coefficients of determination (R² adj) from Model 1 to Model 2 and Model 3 to determine the amount of change (ΔR² adj). Additionally, we calculated the standardized regression coefficient (ß-value) of the input factors to examine their effects. Result Hierarchical multiple regression analysis showed a ΔR² adj of 0.13 and 0.17 for Models 2 and 3, respectively, indicating an increase in ΔR²adj after adding the FreSHAQ. Furthermore, the FreSHAQ had the largest effect of all factors, with ß = 0.27 (p<0.05). Conclusions The influence of disturbed body perception on perceived arm function in patients with FS was demonstrated, suggesting the importance of considering somatosensory factors in clinical practice.

Are patients with newly diagnosed frozen shoulder more likely to be diagnosed with type 2 diabetes? A cohort study in UK electronic health records.

AIM: To estimate the association between newly diagnosed frozen shoulder and a subsequent diagnosis of type 2 diabetes in primary care. METHODS: We conducted an age-, gender- and practice-matched cohort study in UK primary care electronic medical records containing 31 226 adults diagnosed with frozen shoulder, matched to 31 226 without frozen shoulder. Patients with pre-existing diabetes were excluded. Variables were identified using established Read codes. A hazard ratio (HR) for the association between incident frozen shoulder and a subsequent type 2 diabetes diagnosis was estimated using shared frailty Cox regression, adjusted for age and gender. To determine whether the association could be explained by increased testing for type 2 diabetes based on other risk factors, a secondary analysis involved re-running the Cox model adjusting for the mean number of consultations per year, hyperlipidaemia, hypertension, obesity, thyroid dysfunction, ethnicity, deprivation, age, and gender. RESULTS: Participants with frozen shoulder were more likely to be diagnosed with type 2 diabetes (1559 out of 31 226 patients [5%]) than participants without frozen shoulder (88 out of 31 226 patients [0.28%]). The HR for a diagnosis of type 2 diabetes in participants with frozen shoulder versus people without frozen shoulder was 19.4 (95% confidence interval [CI] 15.6-24.0). The secondary analysis, adjusting for other factors, produced similar results: HR 20.0 (95% CI 16.0-25.0). CONCLUSIONS: People who have been newly diagnosed with frozen shoulder are more likely to be diagnosed with type 2 diabetes in the following 15.8 years. The value of screening patients presenting with frozen shoulder for type 2 diabetes at presentation, alongside more established risk factors, should be considered in future research.

A comprehensive scoring system for the diagnosis and staging of adhesive capsulitis: development, application, and implications.

INTRODUCTION: Adhesive capsulitis (AC), often referred to as frozen shoulder, presents a diagnostic challenge due to its insidious onset and progressive nature. The condition is characterized by pain and restricted motion in the shoulder, with a predilection for individuals between 40 and 60 years of age. A novel scoring system was developed to enhance the accuracy of diagnosing AC and distinguishing between its stages, aiming to streamline clinical decision-making and treatment planning. METHODS: A cohort of patients with symptoms suggestive of AC was assessed using the new scoring system, which integrates clinical, radiological, and patient history factors. Parameters included comorbidities like diabetes mellitus, recent immobility, rotator cuff tears, and specific ultrasound findings. Patients were scored and categorized into definitive AC, uncertain diagnosis, or exclusion from AC, with scores > 7, 6-2, and < 2, respectively. RESULTS: The scoring system effectively categorized patients, with those scoring > 7 demonstrating pronounced symptoms and ultrasound changes consistent with Phase 2 AC. Patients with scores between 6 and 2 were classified into uncertain Phase 1 or Phase 3, necessitating further observation. Scores < 2 effectively excluded AC, indicating a need to explore alternative diagnoses. CONCLUSION: The structured scoring system demonstrated potential as a comprehensive tool for diagnosing AC. By quantitatively assessing a range of contributory factors, it allowed for the stratification of the disease into distinct stages. This system is anticipated to improve early diagnosis and the precision of treatment interventions, although further validation in larger cohorts is warranted. LEVEL OF EVIDENCE: II-III.

Epidemiology of Chronic Shoulder Pain Among Adult Patients in a Tertiary Care Hospital in South India.

Introduction Chronic shoulder pain (CSP) is a significant medical and socioeconomic problem that hinders daily living activities, creating a burden on the individual and society. An epidemiological study will help to find out the risk factors and their impact, thereby giving medical practitioners and policymakers the necessary tools to tackle the problem. Materials and methods This is a cross-sectional study conducted in a tertiary care hospital in South India over a period of four years from 2018 to 2021 using a structured questionnaire, clinical and radiological examination, and visual analog score (VAS). The data were analyzed using SPSS software. Results A statistically significant correlation was found between CSP and increasing age, occupational risk factors like vibrations, repetitive movements, lifting heavy objects, repetitive lifting of the arm above the shoulder and sitting in the same posture for a prolonged time, and work stress. Vitamin D deficiency and diabetes mellitus were found to increase the risk of shoulder pain, smoking, and alcoholism. There was a higher incidence of rotator cuff pathology and frozen shoulder among those who had CSP. Conclusion CSP affects the quality of life and the productivity of the patients. Reducing the physical and psychosocial risk factors is the key to decreasing its prevalence. Maintaining a healthy lifestyle and a good working environment is very essential.

Frozen shoulder: subjects' needs and perspectives and clinicians' beliefs and management strategies: do they align? A cross-sectional study.

OBJECTIVE: Physiotherapists (PTs) play a crucial role in managing individuals with Frozen Shoulder (FS), frequently being the first healthcare professionals involved in the treatment of this condition. AIM: This study aimed to compare the beliefs, expectations, and perspectives of individuals with FS with the knowledge, skills, and strategies of PTs, highlighting similarities and differences. METHOD: This study adhered to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). From May 1st to August 1st, 2023, a two-part survey was conducted involving PTs and individuals diagnosed with FS. The survey focused on comparing key areas such as clinical assessment, patient education, treatment expectations, and the psychological aspects of the patient-clinician relationship. RESULTS: A total of 501 PTs and 110 subjects with FS participated in the survey. Most PTs showed proficiency in FS pathoanatomical conditions and were also attentive to psychological aspects (88.4%), describing the pathology evolution in three or two stages (68.2%). They also highlighted the importance of patient education (89.6%) and recognized the potential benefits of a multiprofessional collaboration in managing FS (82.2%). Reassurance was reported as a priority by 32.3% of PTs. Subjects with FS expressed a preference for PTs who are both expert and empathetic (73.6%). Regarding their understanding of FS, 29.09% of subjects reported receiving a three-phase explanation, while 26.36% felt inadequately informed. Nearly half of the subjects (49.09%) anticipated being managed independently by a PT, with 93.64% prioritizing the improvement of their range of motion. CONCLUSION: This study revealed a general agreement between subjects with FS and PTs regarding aspects of the therapeutic relationship, patient education, pathology management, compliance and motivation strategies, and pain management preferences. However, significant differences emerged concerning the perception of physiotherapy effectiveness, primary treatment goals, subjects' priorities, and the importance of psychological assessment.

Inferior glenohumeral joint capsule thickness in frozen shoulder via ultrasonography.

Background: The thickening of the inferior glenohumeral joint capsule (IGC) is a characteristic finding in frozen shoulders. However, the relationship between the thickness of the IGC measured using ultrasonography (US) and the range of motion (ROM) remains unclear. This study aimed to investigate a suitable IGC thickness measurement site that can reflect the ROM of frozen shoulders. Methods: The participants were 29 patients with frozen shoulder and 20 healthy shoulders of 10 healthy adult. US measurements of the IGC were performed at 80° elevation in the scapular plane, with thickness was measured at 3 levels in both groups: just above the surgical neck, just above the anatomical neck, and at the parenchymal level. The relationship between thickness and ROM at the 3 levels was also assessed. The thickness of the IGC was evaluated using magnetic resonance imaging and US, as well as the validity of US evaluation. Results: There was a positive correlation (r = 0.72) between magnetic resonance imaging-measured and US-measured IGC thickness. The IGC was thicker in the frozen shoulder group than in the control group at all 3 levels (P < .001). The thickness of the IGC at the parenchymal level showed a significant negative correlation with all ROMs: flexion (r = -0.63), abduction (r = -0.60), external rotation (r = -0.50), and internal rotation (r = -0.52). Conclusion: The thickness of the IGC at the parenchymal level is negatively correlated with the ROM. The evaluation of the IGC in this study will be helpful in selecting treatment options for frozen shoulders.

The clinical efficacy and safety of platelet-rich plasma on frozen shoulder: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To systematically review the clinical efficacy (pain, function, quality of life) and safety of platelet-rich plasma (PRP) in the treatment of frozen shoulder through meta-analysis, and provide evidence-based medical evidence for the effectiveness of PRP in the treatment of frozen shoulder. METHODS: A search was conducted on international databases (Pubmed, Web of science, Embase) and Chinese databases (CNKI, Wanfang, VIP) to search the clinical studies on the efficacy of platelet-rich plasma in treating frozen shoulder (adhesive capsulitis/periarthritis/50 shoulder) and their corresponding references published from inception until January 2024. Thoroughly excluded literature not meeting the predetermined inclusion criteria, extracted relevant data from the literature, and input it into RevMan5.4 for meta-analysis. RESULTS: This study ultimately included 14 RCTs, with a total of 1024 patients. The results showed that PRP has significant advantages compared with control groups in VAS (mean difference (MD) =-0.38, 95% confidence interval(CI)(-0.73, -0.03), P = 0.03), UCLA (MD = 3.31, 95% CI (1.02,5.60),P = 0.005), DASH (MD = -4.94,95% CI (-9.34, -0.53),P = 0.03), SPADI (SPADI Total: MD =-16.87, 95% CI (-22.84, -10.91), P < 0.00001; SPADI Pain: MD =-5.38, 95% CI (-7.80, -2.97), P < 0.0001; SPADI Disability: MD =-11.00, 95% CI (-13.61,-8.39), P < 0.00001), and the active and passive Range of Motion (active flexion: MD = 12.70, 95% CI (7.44, 17.95), P < 0.00001; passive flexion: MD = 9.47, 95% CI(3.80, 15.14), P = 0.001; active extension: MD = 3.45, 95% CI(2.39, 4.50), P < 0.00001; active abduction: MD = 13.54, 95% CI(8.42, 18.67), P < 0.00001; passive abduction: MD = 14.26, 95% CI (5.97, 22.56), P = 0.0008; active internal rotation: MD = 5.16, 95% CI (1.84, 8.48), P = 0.002; passive internal rotation: MD = 3.65, 95% CI(1.15, 6.15), P = 0.004; active external rotation: MD = 10.50, 95% CI(5.47, 15.53), P < 0.0001; passive external rotation: MD = 6.00, 95% CI (1.82, 10.19), P = 0.005) except passive extension (MD = 2.25, 95% CI (-0.77, 5.28), P = 0.14). In terms of safety, most studies reported no adverse effects, and only one study reported common complications of joint puncture such as swelling and pain after treatment in both PRP and control groups. Previous studies have shown a risk of osteonecrosis caused by corticosteroids. Therefore, the safety of PRP treatment is more reliable. CONCLUSION: The results showed that PRP was more durable and safer than corticosteroids and other control groups in the treatment of frozen shoulder. STUDY DESIGN: Systematic review. TRIAL REGISTRATION: PROSPERO CRD42022359444, date of registration: 22-09-2022.

Effects of moderate physical activity on diabetic adhesive capsulitis: a randomized clinical trial.

Background: Moderate physical activity (MPA) has proven advantages for glycemic control, cardiovascular health, and functional independence. However, physical activity is not part of routine conventional physical therapy (CPT) in managing diabetic adhesive capsulitis patients. Objective: To determine the effects of moderate MPA on diabetic adhesive capsulitis (AC). Methodology: A randomized control trial was conducted at the Combined Military Hospital (CMH), Muzaffarabad, Pakistan from March 2022 to October 2022. A total of n = 44 patients with diabetic AC, aged 40 to 65 years, HbA1c > 6.5% were enrolled. Group A received MPA and CPT, while Group B only received CPT for six weeks. The upper extremity function, pain, and range of motion were assessed at baseline, third week, and sixth week through the disability of arm, shoulder, and hand (DASH) questionnaire, numeric pain rating scale (NPRSS), and goniometer respectively. Results: The NPRS score and ROMs showed significant improvement (p < 0.05) in group A compared to group B with a large effect size. When comparing the mean difference of the DASH score (73 + 7.21 vs. 57.9 + 12.64, p < 0.001, Cohen's d = 1.46) was significantly improved with large effect size in group A as compared to group B. Conclusion: MPA along with CPT has positive effects on patient pain, range of motion, and disability in patients with diabetic adhesive capsulitis.

Comparative outcome of ultrasound guided vs. fluoroscopy guided hydrodilatation in adhesive capsulitis: a prospective study.

BACKGROUND: The incidence of adhesive capsulitis varies from 2-5% in the general population to 20% in people with diabetes. One of the most effective treatment methods is hydrodilatation, which can be done under US-guidance or Fluoroscopic guidance. However, the clinical effectiveness of US-guided injections in comparison to fluoroscopy-guided injections is still debatable. The possibility of severe side effects, the expense, and the time required to carry out this minimally invasive procedure highlight how crucial it is for patients to have a precise intra-articular injection. This study aims to compare the effectiveness of Ultrasound-guided vs. Fluoroscopic guided hydrodilatation for patients with adhesive capsulitis. METHODS: Sixty-four patients were randomly selected for hydrodilatation using any one of the techniques. The patients were evaluated for clinical improvements using the visual analog scale (VAS), oxford shoulder score (OSS), and range of motion (ROM). RESULTS: The US-guided group experienced more pain reduction than the fluoroscopy group within the first four weeks (P < 0.001). The increase in ROM was much more significant in the US-guided group for the first 8 weeks. Improvement in Abduction and External rotation was much more significant (P < 0.001) in the first 4 weeks after hydrodilatation in the US-guided group. The improvement in ROM was maintained on long-term follow-up (mean 24 months), with 45 out of 64 (70.3%) reporting a normal or near normal ROM. On assessing the Oxford shoulder score improvements, the US-guided group's score significantly increased after the first week (P = 0.003), but the fluoroscopy-guided group's score increased after the second week. On comparison between the two groups, the amount of score improvement was more significant in the US-guided group than in the fluoroscopy-guided group in the first 4 weeks (P < 0.001). CONCLUSION: US-guided technique for intra-articular injection for patients with adhesive capsulitis provided a quicker pain reduction and a larger improvement in range of motion and overall shoulder functions.

Causal associations of hypothyroidism with frozen shoulder: a two-sample bidirectional Mendelian randomization study.

BACKGROUND: Many studies have investigated the association between hypothyroidism and frozen shoulder, but their findings have been inconsistent. Furthermore, earlier research has been primarily observational, which may introduce bias and does not establish a cause-and-effect relationship. To ascertain the causal association, we performed a two-sample bidirectional Mendelian randomization (MR) analysis. METHODS: We obtained data on "Hypothyroidism" and "Frozen Shoulder" from Summary-level Genome-Wide Association Studies (GWAS) datasets that have been published. The information came from European population samples. The primary analysis utilized the inverse-variance weighted (IVW) method. Additionally, a sensitivity analysis was conducted to assess the robustness of the results. RESULTS: We ultimately chose 39 SNPs as IVs for the final analysis. The results of the two MR methods we utilized in the investigation indicated that a possible causal relationship between hypothyroidism and frozen shoulder. The most significant analytical outcome demonstrated an odds ratio (OR) of 1.0577 (95% Confidence Interval (CI):1.0057-1.1123), P = 0.029, using the IVW approach. Furthermore, using the MR Egger method as a supplementary analytical outcome showed an OR of 1.1608 (95% CI:1.0318-1.3060), P = 0.017. Furthermore, the results of our sensitivity analysis indicate that there is no heterogeneity or pleiotropy in our MR analysis. In the reverse Mendelian analysis, no causal relationship was found between frozen shoulders and hypothyroidism. CONCLUSION: Our MR analysis suggests that there may be a causal relationship between hypothyroidism and frozen shoulder.

The Disease-Modifying Effects of a Single Intra-Articular Corticosteroid Injection during the Freezing Phase of Frozen Shoulder in an Animal Model.

Although frequently prescribed for frozen shoulder, it is not known if corticosteroid injections improve the course of frozen shoulder. This study aimed to assess the disease-modifying effects of an intra-articular corticosteroid administration at the freezing phase of frozen shoulder. Twenty-four Sprague-Dawley rats were divided into four groups. Their unilateral shoulders were immobilized for the first 3 days in all groups, followed by an intra-articular corticosteroid injection in Group A, an injection and the cessation of immobilization in Group B, no further intervention in Group C, and the cessation of immobilization in Group D. All rats were sacrificed in Week 3 of study, at which point the passive shoulder abduction angles were measured and the axillary recess tissues were retrieved for histological and Western blot analyses. The passive shoulder abduction angles at the time of sacrifice were 138° ± 8° (Group A), 146° ± 5° (Group B), 95° ± 11° (Group C), 132° ± 8° (Group D), and 158° ± 2° (Control). The histological assessments and Western blots showed greater fibrosis and inflammation in the groups that did not receive the corticosteroid injection (Groups C and D) compared to the corticosteroid-injected groups (Groups A and B). These findings demonstrate the anti-inflammatory and disease-modifying effects of corticosteroid injections during the freezing phase of frozen shoulder in an animal model.

Satisfaction of patients with frozen shoulder following silent manipulation: a prospective observation study.

Silent manipulation is a procedure for frozen shoulders that involves manipulating the shoulder while the patient is awake by performing C5, C6, and C7 cervical nerve root block under ultrasound guidance. This retrospective study, conducted at Yokohama City University Hospital, aimed to evaluate the clinical outcomes of silent manipulation and assess whether the experience level of the practitioner influenced treatment efficacy. Between October 2020 and January 2022, 53 patients who met the inclusion criteria underwent silent manipulation for frozen shoulder. The procedure was performed by either an experienced or a less experienced practitioner, and the patients were followed-up for up to 1 year post-treatment. Silent manipulation resulted in significant improvements in shoulder range of motion, as measured by forward flexion, abduction, external rotation, and hand-behind-back, as well as in patient-reported outcomes, including disabilities of the arm, shoulder, and hand and Shoulder 36 scores. These improvements were observed 1 week, 3 months, and 1 year after silent manipulation, indicating the short-term efficacy of the procedure. Furthermore, this study revealed that the practitioners' level of experience played a significant role in the outcomes. The experienced doctor achieved better 1st external rotation and belt tying outcomes, as well as Shoulder 36 pain, muscle strength, and activities of daily living domain scores. This suggests that technical expertise in silent manipulation is crucial to achieve optimal outcomes. Silent manipulation offers an effective therapeutic approach for frozen shoulder, leading to significant improvements in range of motion and patient satisfaction. Practitioner expertise is a vital factor in treatment success, emphasizing the importance of skilled professionals in the performance of this procedure.

Study of Functional Outcome of Intra-articular Steroid Injection and Manipulation of Shoulder Joints in Frozen Shoulder.

INTRODUCTION: Frozen shoulder, also known as adhesive capsulitis, is characterized by the insidious onset of pain and progressive loss of global active and passive mobility of the glenohumeral joint, which can be treated by non-surgical or surgical methods. This study was done to evaluate the functional outcome of intra-articular (I/A) steroid injection and manipulation of the shoulder joint manipulation under anesthesia (MUA) in frozen shoulder. METHODS: A cross-sectional study was done in a tertiary care hospital in Pokhara, Nepal. A total of 35 patients over 40 years were included in the study. All the patients underwent I/A steroid injection and MUA. The functional outcome was evaluated using a Constant-Murley shoulder score (CSS) and a visual analogue scale (VAS) scoring system. RESULT: The mean age was 53.46±7.524 years. Twenty-two were female, while 13 were male. Twelve patients were associated with diabetes. Minor complications were noted in 15 patients (14 with transient pain and one with facial flushing). At 12 weeks, the mean VAS score was 2.16±1.33 cm, and the mean CSS score was 82.66±7.008. At 24 weeks, the mean VAS was 1.534±1.195 cm, and the mean CSS score was 85.77±6.998. CONCLUSION: This study shows that patients with frozen shoulder treated with I/A steroid injection and MUA give excellent functional outcomes in most patients.

Fibro-adhesive Bursitis: A Novel Sonographic Finding in Adhesive Capsulitis Patients and a Proposal of Management.

INTRODUCTION: Adhesive capsulitis, also known as "frozen shoulder," is a debilitating shoulder condition increasingly linked to fibroadhesive bursitis, particularly after COVID-19 and related vaccinations. There is no definitive gold standard for its treatment, the primary therapeutic objectives of which are the reduction of pain and the restoration of shoulder range of motion. The aim of our study was to analyze treatment outcomes based on quantitative measures of shoulder function and symptom relief. METHOD: Conducted between January 2022 and April 2023, the research involved 45 patients initially diagnosed with adhesive capsulitis and associated fibroadhesive bursitis. After excluding nine patients for other concomitant pathologies (five for calcific tendinopathy and four for rotator cuff injury), 36 patients were randomized into two groups: one group was treated with glenohumeral hydrodistension, the other with glenohumeral hydrodistension combined with bursal injection. Assessments were conducted at baseline and then 2, 4, and 6 months after treatment, focusing on changes in pain levels, functional scores, and range of motion in all planes. Each group followed a home-based rehabilitation protocol. RESULTS: Significant improvements were observed in both treatment groups, with the combined hydrodistension and bursal injection group showing notably superior outcomes. Specifically, the range of motion in flexion improved from an initial median of 80° to 155° in the combined treatment group, compared to an increase from 75.5° to 129° in the group treated with hydrodistension alone. This enhancement was statistically significant (p < 0.001). Regarding pain reduction, the combined treatment group demonstrated a dramatic decrease in visual analogue scale (VAS) scores, from a baseline median of 7 to 1 at the 6-month follow-up. In contrast, the hydrodistension-only group showed a reduction from 7 to 3, with these differences also proving statistically significant (p < 0.001). CONCLUSIONS: Ultrasound-guided hydrodistension of the glenohumeral joint, if combined with bursal injection and specific exercises, effectively reduces pain, decreases disability, and improves range of motion in patients with second-stage adhesive capsulitis. This study highlights the importance of a combined approach in the management of this complex condition, especially after the histological changes that occurred after COVID-19 and related vaccinations. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT06062654.

The Clinical Significance of Mulligan's Mobilization with Movement in Shoulder Pathologies: A Systematic Review and Meta-Analysis.

Background: Mulligan's mobilization with movement (MWM) is a manual therapy technique designed to address musculoskeletal pain and joint mobility. Despite immediate reported improvements by patients, the clinical significance of MWM compared with other interventions remains uncertain. Objective: To assess the clinical effectiveness of MWM for shoulder pathologies compared with other treatment methods. Methods: The databases PubMed, Web of Science, Cochrane Library, Scopus, and the Physiotherapy Evidence Database (PEDro) were searched up to June 2024. Inclusion criteria were limited to randomized controlled trials published in English and Turkish languages, focusing on the MWM technique for shoulder pathologies. Two independent reviewers evaluated methodological quality based on the PEDro scale. Outcome data were analyzed for pain, function, and range of motion (ROM) using SPSS Statistics 29.0. Results: Twenty-seven studies (1157 participants) were included. MWM demonstrated statistical superiority in function (MD = -11.24, 95% CI: [-18.33, -4.16], p = 001) and shoulder flexion and abduction ROM compared with other mobilization techniques. There was a significant MD in pain intensity, which was -1.55 cm (95% CI: [-2.60, -0.51], p = 0.00), with high heterogeneity (I2 = 93%), favoring MWM in comparison with control group. MWM was significantly better for shoulder abduction ROM in comparison with physical therapy interventions (MD = -14.44, 95% CI: [1.98, 26.90], p = 0.02) with high heterogeneity (I2 = 90%) and control group (SMD = 56.67, 95% CI: [7.71, 111.63], p = 0.02) with high heterogeneity (I2 = 96%). However, clinical significance was not consistently achieved. Conclusions: Although some statistical significance was found when comparing MWM with other her treatment methods, it was observed that most of the statistically significant data did not reach clinical significance. Upon closer examination, outcome measures that showed clinical significance, either the interventions in the comparison group were inadequate, not evidence-based, or the improvements within the group were not logical.

Ultrasonography-guided corticosteroid injection in the coracohumeral ligament in patients with adhesive capsulitis of the shoulder: a double-blinded, sham-controlled randomized study.

BACKGROUND: Contracture and thickening of the coracohumeral ligament (CHL) occur in patients with adhesive capsulitis. This adversely affects the movement and function of the shoulder joint. There is limited evidence that explores the effectiveness of an isolated steroid injection into the CHL in combination with physical therapy. This prospective randomized control trial aimed to evaluate the clinical effects of ultrasonography-guided corticosteroid injection compared to a sham injection into the CHL in subjects with adhesive capsulitis. METHODS: Forty patients (23 males, 52.2 ± 8 years of age) with unilateral adhesive capsulitis (with 5.4 ± 2 months' mean duration of symptoms) were randomly assigned to either the experimental or control group. Both groups received ultrasonography-guided injections into the CHL. The experimental group (n = 20) received corticosteroids and the control group (n = 20) received a sham lidocaine injection. All subjects underwent supervised conventional physical therapy 3 times a week for 3 months. Subjects were evaluated for improvements in pain, range of motion, and disability at 6 and 12 weeks compared with preinjection baseline measurements. Data were compared statistically across groups and times at P < .05. The CHL thickness was compared at baseline across sides using paired t tests. RESULTS: The experimental group showed statistically greater improvements in pain, functional scores, flexion, abduction, and internal and external rotation range of motion at 12 weeks compared with the control group. Pain reduction was observed in both groups at 6 and 12 weeks, but the experimental group exhibited significantly greater reductions. The CHL was significantly thicker on the affected side than on the unaffected side (P < .001). DISCUSSION AND CONCLUSION: This study partially supported the hypothesis. Notably, significant improvements in pain, range of motion, and functional scores were observed at 12 weeks in the experimental group. The greater improvements in pain and external rotation may have resulted in lower disability scores in the experimental group. The results emphasize the importance of targeted intervention into the CHL.

Genetic insights into the association between serum cytokines and frozen shoulder risk: A bidirectional mendelian randomization study.

BACKGROUND: Although existing studies have indicated a connection between chronic low-grade inflammation and the onset of frozen shoulder (FS), the precise causal relationship between distinct circulating inflammatory factors and FS has yet to be thoroughly evaluated. In this study, we employed a bidirectional two-sample Mendelian randomization (MR) analysis to investigate the potential causal relationship between systemic cytokines and FS. METHODS: A genome-wide association dataset comprising 41 serum cytokines from 8,293 individuals of Finnish descent was utilized, along with FS data from the UK Biobank included 10,104 FS cases and 451,099 controls. The primary MR method was the inverse variance weighted approach, and four additional MR techniques (MR-Egger, weighted median, simple mode, and weighted mode) were also employed to support and validate the findings. Heterogeneity and horizontal pleiotropy assessments were assessed using Cochrane's Q and MR-Egger intercept tests. Moreover, a series of sensitivity analyses were conducted to strengthen the accuracy and credibility of these findings. RESULTS: Based on the IVW method, genetically predicted increasing levels of growth regulated oncogene alpha (GROa) (OR=1.08, 95 % CI 1.02-1.13, P=0.005), interferon gamma-induced protein 10 (IP-10) (OR=1.09, 95 % CI 1.02-1.17, P=0.010), regulated on activation, C-C Motif Chemokine Ligand 5 (CCL5) (OR=1.11, 95 % CI 1.03-1.20, P=0.007) were suggestively associated with an increased risk of FS. Reverse MR analysis revealed no significant causal effect of FS on the 41 systemic inflammatory factors. No heterogeneity or horizontal pleiotropy was observed in our analysis. CONCLUSION: This study established a causal association between 41 systemic inflammatory factors and FS, indicating that elevated levels of GROa, IP-10 and CCL5 were associated with a higher risk of FS. Further research is warranted to explore the potential of these biomarkers as early predictors and therapeutic targets for FS.

Comparison between Intra-Articular Steroid Injection and Supra-Scapular Nerve Block in the Management of Frozen Shoulder.

Objective: To compare the efficacy of intra-articular steroid injection with ultrasound-guided supra-scapular nerve block in the management of frozen shoulder in terms of shoulder pain and disability index score and range of motion. Method: This randomized controlled trial was conducted in orthopedic department, PIMS, Islamabad from 1st January, 2020 to 30th June, 2020. A total of 72 patients were randomly equally (n=36 each) allocated to Group-A (intra-articular steroid injection) and Group-B (supra-scapular nerve block). Adults above 18 years of both genders having diffuse shoulder pain were included. Cases of shoulder pain localized because of bicipital tendinitis, rotator cuff tear, pain due to acute trauma and those with osteoarthritis were excluded. Data was analyzed in SPSS version 22.0. Results: Patients average age was 60.1 ± 6.29 in IASI and 58.0 ± 5.83 years in SSNB Group-And there were 19 (52.8%) males in IASI group compared to 15 (41.7%) in SSNB. At three weeks mean pain was significantly less in SSNB (57.1 ± 9.53 vs 49.4 ± 9.02) compared to IASI group (p-value, <0.001). The mean disability index was significantly low in SSNB (51.5 ± 5.10 vs 63.9 ± 5.14) versus IASI group (p-value, <0.001). At one week, three weeks and six weeks, mean external rotation was better in SSNB than IASI group (p-value, <0.001). The mean abduction was also better in SSNB group. Conclusion: Ultrasound guided supra-scapular nerve block is better than intra-articular steroid injection in managing frozen shoulder.