Comparison of Effectiveness of Intraarticular Hyaluronate and Corticosteroid injections in Adhesive Capsulitis: A Systematic Review and Meta-analysis.

BACKGROUND: Adhesive capsulitis of the shoulder causes inflammation and adhesions in the shoulder joint capsule, leading to pain and limited range of motion (ROM). Intraarticular corticosteroid (CS) and hyaluronic acid (HA) injections are common therapeutic options for adhesive capsulitis, but their comparative effectiveness remains unclear. OBJECTIVES: To provide a robust comparison of the outcomes of HA and CS, we conducted a meta-analysis of relevant previous studies that examined the therapeutic effects of intraarticular HA and CS injections in patients with adhesive capsulitis. STUDY DESIGN: Systematic review and meta-analysis. METHODS: This meta-analysis of randomized controlled trials compared the effectiveness of intraarticular HA and CS injections. Of the 10,205 articles, 7 met our predetermined criteria and were included in the analysis. RESULTS: Patients who received CS injections demonstrated superior pain reduction and functional improvement at 2-4 weeks after injection to those who received HA injections. Nevertheless, comparable outcomes were observed between the 2 groups at 6 and 12 weeks. The active or passive range of motion of the shoulder joint was not significantly different between patients who received HA injections and those who received CS injections. LIMITATIONS: The meta-analysis included only a small number of studies, and the number of HA injections examined in those studies varied from one to 3 at a time, whereas an CS injection was performed only once in most of the included studies. CONCLUSIONS: The administration of intraarticular HA injection emerges as a commendable therapeutic option for patients with adhesive capsulitis, particularly for those requiring repetitive injections or at risk of developing side effects from injections of CS. Although intraarticular CS injections offer accelerated short-term (2-4 weeks) pain relief and functional improvement, comparable effects were observed within 6 and 12 weeks after intraarticular HA and CS injections.

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.

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.

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.

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.

Clinical efficacy of endoscopic debridement combined with compression suture in the treatment of recalcitrant aseptic olecranon bursitis.

PURPOSE: To investigate the clinical efficacy of endoscopic debridement combined with compression suture in the treatment of aseptic olecranon bursitis. METHODS: A retrospective analysis was conducted on 28 patients, including 25 males and 3 females, who underwent endoscopic debridement combined with compression suture for the treatment of aseptic olecranon bursitis at Huzhou Central Hospital from February 2017 to January 2024. Visual analogue scale (VAS) scores, Mayo elbow function scores, complications, recurrence rates and wound scars were evaluated to assess the treatment efficacy. RESULTS: The average follow-up time was 12 ± 5 months (range: 5-22 months). The VAS score was slightly greater on postoperative day 1 than preoperatively, but this difference was not statistically significant. Compared with the preoperative level, the VAS score was significantly lower at 2 weeks post-surgery, and the patients were generally free of pain. The patients' Mayo elbow function score was significantly improved at 2 weeks after the operation, and their elbow function was generally normal at 1 month after the operation. At the final follow-up, no recurrence or obvious scarring was found in any of the patients, and all of them exhibited normal elbow function without any reported pain. CONCLUSION: Endoscopic debridement combined with compression suture for the treatment of aseptic olecranon bursitis has several advantages: simple operation, minimal invasiveness, minimal postoperative pain, rapid recovery, a low recurrence rate, and satisfactory overall efficacy. Level of evidence Level IV.

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.

Efficacy of hydrodistension for frozen shoulder: A systematic review and meta-analysis.

BACKGROUND: The aim of this study was to provide comprehensive and reliable evidence for the treatment of pain and motor function in patients with frozen shoulder (FS) with hydrodistension. METHODS: The research including randomized controlled trials (RCTs) for FS that compared hydrodistension with routine treatments to controls was searched and screened in the PubMed, Library of congress, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, China Science and Technology Journal Database. Constant-Murley score (CMS) for shoulder function and visual analog scale (VAS) for pain must be assessed. RevMan 5.3 software was used to evaluate the bias and quality of the included studies. RESULTS: We found that analgesic effects (MD: -1.07; 95% CI: -1.94 to -0.20; P < .00001; I2 = 99%) and function (MD: 8.54; 95% CI: 3.35 to 13.71; P < .00001; I2 = 97%) were better in the groups where hydrodistension plus routine treatments were used to treat FS compared to other interventions. CONCLUSION: The result suggests that hydrodistension is of great clinical significance in alleviating pain and improving function to patients with FS.

Similar short-term outcomes of ultrasound guided posterior intra-articular and anterior extra-articular corticosteroid injection in the treatment of primary frozen shoulder. A randomized controlled, single-blind study.

Frozen shoulder, a condition characterized by the limitation of active and passive shoulder movements, is predominantly managed conservatively. Corticosteroid injection stands as a widely utilized and effective method for treatment. Nevertheless, the optimal approach for administering the injection remains a subject of controversy. We hypothesized that the injection of corticosteroid through anterior into the extra-articular area would yield superior results than the posterior intra-articular injection. This prospective, randomized, single-blind, and single-center clinical study aimed to compare the therapeutic effectiveness of ultrasound (USG)-guided injection techniques in patients with primary frozen shoulder. We continued the study with 54 patients who met the inclusion criteria. We evaluated patients pre-injection and at the first, third, and sixth weeks after injection. Two distinct approaches were employed: (1) Injection through the anterior extra-articular area around the coracohumeral ligament (CHL), and (2) injection through the posterior route into the glenohumeral joint. Evaluation parameters, including Visual Analog Scale (VAS) scores, active range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) scores, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, were assessed pre-injection and at the first, third, and sixth weeks post injection. No significant differences in the demographic and clinical characteristics, laboratory, or radiological findings were observed between the groups. It was observed that both groups exhibited similar and significant improvement in all measured parameters within their respective groups. Regarding pain scores, a notable decrease in VAS scores was observed in both groups (P = .000). There was no difference between the groups in terms of pre-injection VAS, QuickDASH, and ASES scores and active ROM measurements. The study concluded that there was no significant difference between ultrasound-guided injection of posterior intra-articular injection and anterior extra-articular injection concerning pain, ROM, and functional scores. Both techniques can be considered as viable options in the early stage of the disease. Level I, Therapeutic study.

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.

Bioinformatics analysis of ferroptosis in frozen shoulder.

OBJECTIVES: Frozen shoulder is a common shoulder disease that significantly affects the patient's life and work. Ferroptosis is a new type of programmed cell death, which is involved in many diseases. However, there have been no studies reporting the relationship between frozen shoulders and ferroptosis. This study identified potential molecular markers of ferroptosis in frozen shoulders to provide more effective strategies for the treatment of frozen shoulders. METHODS: GSE238053 was downloaded from the Gene Expression Omnibus (GEO) dataset and intersected with ferroptosis genes to obtain differentially expressed genes (DEGs). The signaling pathways and biological functions of DEGs were performed by WebGestalt and Metascape. The interactions related to these DEGs and the key genes between frozen shoulders and ferroptosis was performed by STRING and Cytoscape. A frozen shoulders rat model was used to validate our predicted genes, Western Blot and qRT-PCR was used to assess the expression levels of our genes of interest. RESULTS: A total of 34 DEGs between GSE238053 and Ferroptosis Database were obtained, most of which were involved in the HIF-1 signaling pathway and inflammatory response. A protein-protein interaction network was obtained by Cytoscape and the key genes (IL-6, HMOX1 and TLR4) were screened by MCODE. Our results of Western Blot showed that the protein expression level of TLR4 and HMOX1 were elevated, and the protein level of IL-6 decreased in frozen shoulders rat model. The mRNA level after frozen shoulders showed that IL-6 was upregulated, whereas TLR4 and HMOX1were downregulated. CONCLUSIONS: The results demonstrated that ferroptosis may affect the pathological process of frozen shoulders through these signaling pathways and genes. The identification of IL-6, HMOX1 and TLR4 genes can provide new therapeutic targets for frozen shoulders.

Isolated tuberculosis of the patella mimicking as prepatellar bursitis.

Patellar tuberculosis (TB) is a rare manifestation of musculoskeletal tuberculosis, accounting for a small proportion of cases. This case report presents a detailed analysis of a female patient in her early 30s who presented with isolated TB of the patella without concurrent pulmonary involvement. The patient received antitubercular chemotherapy, consisting of a 4-month intensive phase followed by an 8-month continuation phase. This case report underscores the rarity and diagnostic complexities associated with patellar TB. The condition often presents with non-specific symptoms, often mimicking prepatellar bursitis, necessitating a high level of clinical suspicion, particularly in patients from the endemic areas. Radiographic imaging and histopathological examination play crucial roles in establishing an accurate diagnosis. Antitubercular chemotherapy forms the cornerstone of treatment while surgical intervention is reserved for cases of extensive bone destruction or treatment failure.

The immune pathology of bursitis in rheumatic inflammatory diseases, degenerative conditions and mechanical stress: A systematic review.

OBJECTIVE: To summarize current insights on the immune pathology of bursitis caused by rheumatic inflammatory diseases, degenerative conditions, or mechanical stress and identify knowledge gaps in this field. Data on tenosynovitis pathology was included for comparison. METHODS: We performed a systematic review encompassing an electronic database search of all published literatures in PubMed/MEDLINE from inception to February 13, 2023, investigating the immunological changes occurring in the bursa of patients with inflammatory rheumatic diseases, degenerative conditions or mechanical stress (e.g., impingement syndrome). RESULTS: Thirty-two articles provided data on the immune pathology of bursal tissue inflammation were identified. Histological and immunological perturbations included alterations of tissue morphology, infiltration of macrophages and some T cells, and enhanced expression of proinflammatory cytokines, such as interleukin (IL)-6, IL-1ß and tumor necrosis factor alpha (TNF-α). These changes were described for all three underlying causes, although studies on bursitis associated with rheumatic inflammatory diseases were rare. Fibrosis was only reported in subacromial bursitis caused by mechanical stress within our included studies. CONCLUSION: Current insights on bursitis were outdated and studies on bursitis associated with rheumatic inflammatory diseases are particularly lacking. Substantial overlap of enhanced expression of IL-6, IL-1ß, TNF-α and infiltrating macrophages were found in bursitis irrespective of the underlying cause. In depth investigation on bursitis such as high throughput multi-omics are urgently needed to guide disease-specific therapeutic management.

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.

An approach leveraging radiomics and model checking for the automatic early diagnosis of adhesive capsulitis.

Adhesive Capsulitis of the shoulder is a painful pathology limiting shoulder movements, commonly known as "Frozen Shoulder". Since this pathology limits movement, it is important to make an early diagnosis. Diagnosing capsulitis relies on clinical assessment, although diagnostic imaging, such as Magnetic Resonance Imaging, can provide predictive or supportive information for specific characteristic signs. However, its diagnosis is not so simple nor so immediate, indeed it remains a difficult topic for many general radiologists and expert musculoskeletal radiologists. This study aims to investigate whether it is possible to use disease signs within a medical image to automatically diagnose Adhesive Capsulitis. To this purpose, we propose an automatic Model Checking-based approach to quickly diagnose the Adhesive Capsulitis taking as input the radiomic feature values from the medical images. Furthermore, we compare the performance achieved by our method with diagnostic results obtained by professional radiologists with different levels of experience. To the best of our knowledge, this is the first method for the automatic diagnosis of Adhesive Capsulitis of the Shoulder.

Percutaneous Coracohumeral Release for Patients with Adhesive Capsulitis: Two-Year Results from a Randomized Control Crossover Study.

BACKGROUND: Adhesive capsulitis (AC) causes a variety of symptoms, including but not limited to pain, stiffness, and a gradual restriction of active and passive range of motion (ROM). The coracohumeral ligament (CHL) plays an important role in this disease process, and percutaneous CHL release (PCHLR) has demonstrated efficacy in treating manifestations of this disorder that are refractory to pain medication, physical therapy, and local injections. Our previous study demonstrated one-year efficacy and durability, and this study examines 2-year data from our original randomized control crossover cohort. OBJECTIVE: To highlight the importance of extended follow-ups evaluating PCHLR's efficacy in AC management. STUDY DESIGN: A prospective, randomized, controlled, cross-over trial. SETTING: An academic medical center. METHODS: Patients with AC refractory to oral medication, physiotherapy, and at least one local injection were included in our original study. In all, there were initially 40 patients (46 shoulders), including 6 patients who underwent bilateral PCHLR using the Tenex® system. In this prospective study, 2 groups, the experiment group (scheduled to receive PCHLR) and the control group (scheduled to receive a local anesthetic in the coracohumeral ligament [LACHL]) were determined through 2-to-1 block randomization. Of these 46 shoulders initially treated, 39 remained in the study at one year. Twenty-six of the 39 shoulders were assigned to the PCHLR group whereas 13 were assigned to the LACHL group. Nine out of 13 shoulders in the LACHL group crossed over to the PCHLR group. Ultimately, 31 shoulders remained in the PCHLR group for 2-year analysis. The effectiveness of these interventions was assessed using a variety of parameters. Pain scores, ROM, and the Oxford Shoulder Score (OSS) were evaluated before the procedure and at one-year and 2-year follow-up visits. RESULTS: In this 2-year follow-up study, a total of 31 shoulders were sampled, comprising 22 women and 5 men, with 4 patients undergoing bilateral procedures. The mean age of the patients was 65 years (± 11.48). Patients' mean body mass index (BMI) was 36.33 (± 6.55), and the mean CHL thickness was 38.5 (± 3.45). Osteoarthritis was present in 11 cases. The mean follow-up period for the study was 29.7 months (± 6.39). The baseline mean external rotation was 30° (± 8), which increased to 62° (± 18) at one year and 53° (± 18) at 2 years. The baseline mean abduction was 60° (± 16), which improved to 77° (± 21) at one year and 68° (± 20) at 2 years. The median NRS decreased from 8 (IQR: 8, 9) at baseline to 3 (IQR: 2, 7) at one year and 5 (IQR: 2, 7) at 2 years. The baseline median OSS was 7 (IQR: 3, 10), which increased to 32 at one year and 22 (IQR: 15, 35) at 2 years. LIMITATIONS: The present investigation has a limited sample size of patients who have ROM impairment caused by CHL thickening. CONCLUSIONS: While the algorithm for AC care has seen little change for several decades, the authors suggest that PCHLR is a safe, durable, and effective option for cases of AC that are refractory to traditional management.

Combined MediaPipe and YOLOv5 range of motion assessment system for spinal diseases and frozen shoulder.

Spinal diseases and frozen shoulder are prevalent health problems in Asian populations. Early assessment and treatment are very important to prevent the disease from getting worse and reduce pain. In the field of computer vision, it is a challenging problem to assess the range of motion. In order to realize efficient, real-time and accurate assessment of the range of motion, an assessment system combining MediaPipe and YOLOv5 technologies was proposed in this study. On this basis, Convolutional Block Attention Module (CBAM) is introduced into the YOLOv5 target detection model, which can enhance the extraction of feature information, suppress background interference, and improve the generalization ability of the model. In order to meet the requirements of large-scale computing, a client/server (C/S) framework structure is adopted. The evaluation results can be obtained quickly after the client uploads the image data, providing a convenient and practical solution. In addition, a game of "Picking Bayberries" was developed as an auxiliary treatment method to provide patients with interesting rehabilitation training.