Association between fasting glucose levels and adhesive capsulitis in a normoglycemic population: a case-control study.

BACKGROUND: Hyperglycemia is the most commonly cited risk factor for adhesive capsulitis. However, no study has established whether fasting glucose levels within the normoglycemic range are associated with idiopathic adhesive capsulitis (IAC). This study hypothesized that increments of fasting glucose levels within the normoglycemic range would be linked to IAC. This study investigated any association between normoglycemic fasting glucose levels and IAC. METHODS: This case-control study comprised a group of 151 patients with IAC without intrinsic shoulder lesions, extrinsic causes, or known metabolic risk factors such as diabetes, dyslipidemia, and thyroid dysfunction. The control group comprised 453 age- and sex-matched persons seeking general check-ups at the authors' health promotion center during the same period as the case group. Control subjects had normal shoulder function, no previous diagnosis of adhesive capsulitis or of metabolic disease, and no history of trauma or of shoulder surgery. The studied variables were body mass index, serum lipid profiles, thyroid hormone levels, fasting glucose levels, glycosylated hemoglobin A1c, and high-sensitivity C-reactive protein. Fasting glucose levels were studied as scale data and categorical data (<85, 85-89, 90-94, and 95-99 mg/dL). Multivariable conditional logistic regression analysis evaluated the matched sets of subjects. Odds ratios and 95% confidence intervals were determined for various potentially associated factors. RESULTS: Fasting glucose level, hypercholesterolemia, and high-sensitivity C-reactive protein were significantly associated with IAC (P ≤ .030). Fasting glucose levels in the <85 mg/dL quartile were significantly negatively associated with IAC (P ≤ .001). In contrast, fasting glucose levels in the 90-94 mg/dL quartile or higher were significantly positively associated with IAC (P ≤ .034). CONCLUSION: IAC is positively associated with fasting glucose levels of 90-99 mg/dL, which are currently considered normoglycemic.

Association of steroid injection with soft-tissue calcification in lateral epicondylitis.

BACKGROUND: Steroid injections are among the most commonly used conservative treatments for lateral epicondylitis (LE). Although soft-tissue calcification has been reported as a steroid injection complication in certain tendons, such an association in LE has not been established. This study's purpose was to determine any association of both a history of steroid injection and the number of steroid injections with the types of calcification found in LE. METHODS: This study included 110 patients (110 elbows) with LE diagnosed from February 2016 to October 2017. We categorized calcifications seen on standard elbow radiographs as soft-tissue calcifications or enthesophytes using the classification of Shillito et al. Using logistic regression analyses, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) for various factors possibly affecting calcification in LE: age, sex, body mass index, dominant-side involvement, occupation, symptom duration, hand-grip power, pain score on a visual analog scale, and treatment methods. The evaluated treatments included stretching exercise, extracorporeal shockwave therapy, and steroid injections. RESULTS: In the univariate analysis, the visual analog scale pain score, a history of steroid injection, and the number of steroid injections were significantly associated with soft-tissue calcification (P ≤ .020). In the multivariable analysis, a history of steroid injection (OR, 7.63; 95% CI, 1.63-35.72) and the number of steroid injections (OR, 1.18; 95% CI, 1.06-1.32) were significantly associated with soft-tissue calcification (P ≤ .010). CONCLUSIONS: The significant association of steroid injections with soft-tissue calcification in LE suggests that this calcification is likely to be an iatrogenic complication of steroid injection.

Is the Frozen Shoulder Classification a Reliable Assessment?

BACKGROUND: Although a common shoulder disease, there are no accepted classification criteria for frozen shoulder (FS). This study therefore aimed to evaluate the accuracy of the conventionally used FS classification system. METHODS: Primary FS patients (n=168) who visited our clinic from January 2010 to July 2015 were included in the study. After confirming restrictions of the glenohumeral joint motion and absence of history of systemic disease, trauma, shoulder surgery, shoulder muscle weakness, or specific x-ray abnormalities, the Zuckerman and Rokito's classification was employed for diagnosing primary FS. Following clinical diagnosis, each patient underwent a shoulder magnetic resonance imaging (MRI) and blood tests (lipid profile, glucose, hemoglobin A1c, and thyroid function). Based on the results of the blood tests and MRIs, the patients were reclassified, using the criteria proposed by Zuckerman and Rokito. RESULTS: New diagnoses were ascertained including blood test results (16 patients with diabetes, 43 with thyroid abnormalities, and 149 with dyslipidemia), and MRI revealed intra-articular lesions in 81 patients (48.2%). After re-categorization based on the above findings, only 5 patients (3.0%) were classified having primary FS. The remaining 163 patients (97.0%) had either undiagnosed systemic or intrinsic abnormalities (89 patients), whereas 74 patients had both. CONCLUSIONS: These findings demonstrate that most patients clinically diagnosed with primary FS had undiagnosed systemic abnormalities and/or intra-articular pathologies. Therefore, a modification of the Zuckerman and Rokito's classification system for FS may be required to include the frequent combinations, rather than having a separate representation of systemic abnormalities and intrinsic causes.