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Among all the prevalent painful conditions of the shoulder, frozen shoulder remains one of the most debated and ill-understood conditions. It is a condition often associated with diabetes and thyroid dysfunction, and which should always be investigated in patients with a primary stiff shoulder. Though the duration of 'traditional clinicopathological staging' of frozen shoulder is not constant and varies with the intervention(s), the classification certainly helps the clinician in planning the treatment of frozen shoulder at various stages. Most patients respond very well to combination of conservative treatment resulting in gradual resolution of symptoms in 12–18 months. However, the most effective treatment in isolation is uncertain. Currently, resistant cases that do not respond to conservative treatment for 6–9 months could be offered surgical treatment as either arthroscopic capsular release or manipulation under anaesthesia. Though both invasive options are not clinically superior to another, but manipulation could result in unwarranted complications like fractures of humerus or rotator cuff tear. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effects of three modalities of pain management i.e. SSNB (suprascapular nerve block) with NIR (non invasive rehabilitation), IAI (intra articular injection) with NIR and, NIR alone in idiopathic frozen shoulder patients. Methods: A double blinded randomized clinical trial was conducted. 60 cases of idiopathic frozen shoulder were selected and randomly divided into three treatment groups; group 1: NIR, group 2: NIR + SSNB, group 3: NIR +IAI. Range of motion, pain score and disability (SPADI: shoulder pain and disability index) score were evaluated pre-treatment and at 12 weeks follow up. Results: All three groups were homogenous and comparable regarding their age, sex ratio, pretreatment pain score, disability score and range of motion. There was significant improvement (p < 0.05) post treatment in all three groups with respect to pain score, disability score and range of motion. SSNB with NIR group patients demonstrated better improvement in all parameters examined, which was statistically significant in pain score, disability score and internal rotation but was statistically equivalent for total range of motion and external rotation as compared to shoulder injection group. Conclusion: SSNB in combination with non invasive rehabilitation is an effective and safe mode of treatment for idiopathic frozen shoulder. Present study also proves that SSNB with NIR is a more effective mode of treatment for idiopathic frozen shoulder as compared to NIR alone or in combination with IAI. Level of evidence: Level 1. [ABSTRACT FROM AUTHOR]

The article offers insights on frozen shoulder diagnosis and individual treatment based on biomedical and psychosocial factors. Topics discussed include the unclear aetiology of the painful and stiff glenohumeral joint, the condition's pathophysiology and clinical presentation, its conservative management, and mobilisation techniques for it. Also noted the biopsychosocial component to shoulder pain.

Background: Adhesive Capsulitis idiopathic painful restriction of Shoulder movement results in global restriction of the glenohumeral joint. It is affecting 2% to 3% of the general population and affects many functional activities like combing, lifting, pushing and pulling. Although Physiotherapy is often the first line of management, there are various treatments has found its effectiveness but yet to date its protocol of treatment has not been established. So, it is necessary to find effectiveness of specific Physiotherapy treatment protocol for Adhesive Capsulitis. The aim of this study was to find effectiveness of Therapeutic Protocol for Physiotherapy management of Adhesive Capsulitis. Materials and Method: Experimental trial of 30 patients, diagnosed with primary Adhesive Capsulitis selected and divided into two groups. One group was given a Therapeutic Protocol based on review of literature and the other group was treated with Conventional Physiotherapy treatment for 4 Weeks. Pre and post treatment measurement of ROM, and SPADI Index were taken and statistical analysis was done. The two treatment strategies were compared, Group A showed better improvement in Abduction, IR ROM and Functional Score (SPADI) as compare to Group B which was treated with Conventional regular Physiotherapy Treatment. Improvement in Flexion, Extension and ER ROM was relatively less. Conclusion: Therapeutic Protocol proved effective for management of Adhesive Capsulitis. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the clinical results of a repeat manipulation under ultrasound-guided cervical nerve root block (MUC) with corticosteroid and local anaesthetic injection for recurrence of idiopathic frozen shoulder after MUC. Methods: A consecutive series of 42 shoulders in 39 patients with idiopathic frozen shoulder underwent MUC. All patients were assessed according to the American Shoulder Elbow Surgeon (ASES) score and shoulder range of motion (ROM) both before MUC and at 1 year thereafter. If patients continued to have pain and limited ROM at 3 months after the procedure, they were offered a repeat MUC. Such patients were also assessed before the procedure and at 3 months and 1 year thereafter. Results: The initial MUC was successful in 31 shoulders (single group). Repeat MUC was required in 11 shoulders (repeat group). Patients in the single group showed significant improvement in ROM and ASES score at 1 year after the procedure (p < 0.001); similarly, patients in the repeat group had significant improvement in ROM and ASES score at 3 months and 1 year after the procedure (p < 0.001). Patients in the repeat group had had significantly more severely limited ROM (p < 0.01) and decreased ASES score (p < 0.001) before the procedure compared with those in the single group. Conclusions: A repeat MUC with corticosteroid and local anaesthetic injection is a valuable option before proceeding to surgery for recurrence of idiopathic frozen shoulder. When there is severely limited ROM and decreased ASES score before the MUC, a repeat MUC may be necessary, which would require the patient's informed consent. Trial registration: Retrospectively registered [ABSTRACT FROM AUTHOR]

Introduction Treatment options are limited for nonsurgical chronic refractory cases of adhesive capsulitis. We describe a novel percutaneous tenotomy technique for coracohumeral ligament interruption with cadaveric validation. Objective The objective of this study was to describe and validate a novel technique for percutaneous interruption of the coracohumeral ligament. Design Cadaveric study. Setting Academic tertiary care center. Methods Eight cadavers underwent ultrasound (US)-guided percutaneous incision of the coracohumeral (CHL) ligament. Performance of the procedure requires that the practitioner make oscillatory motions with a needle that uses ultrasound energy to cut through tissue. Each pass removes a pinhead-sized amount of tissue. The number of passes and the cutting time are recorded during the procedure. As a standard for this procedure does not exist, the authors created their own based on the preclinical information presented here. Postprocedure dissection was performed to assess the extent of CHL interruption and injury to surrounding tissue. Results The average resection time was seven minutes, requiring 500 passes. The technique described in this paper completely interrupted the CHL in all subjects. Cadaveric analysis demonstrated interruption of the CHL with respect to control shoulders requiring an average of seven minutes of cutting time and ∼500 micro-perforations. Conclusion US-guided percutaneous CHL ligament sectioning is possible with a commercially available ultrasonic probe. [ABSTRACT FROM AUTHOR]

Background: Manipulation under anaesthesia and arthroscopic capsular release are costly and invasive treatments for frozen shoulder, but their effectiveness remains uncertain. We compared these two surgical interventions with early structured physiotherapy plus steroid injection.Methods: In this multicentre, pragmatic, three-arm, superiority randomised trial, patients referred to secondary care for treatment of primary frozen shoulder were recruited from 35 hospital sites in the UK. Participants were adults (≥18 years) with unilateral frozen shoulder, characterised by restriction of passive external rotation (≥50%) in the affected shoulder. Participants were randomly assigned (2:2:1) to receive manipulation under anaesthesia, arthroscopic capsular release, or early structured physiotherapy. In manipulation under anaesthesia, the surgeon manipulated the affected shoulder to stretch and tear the tight capsule while the participant was under general anaesthesia, supplemented by a steroid injection. Arthroscopic capsular release, also done under general anaesthesia, involved surgically dividing the contracted anterior capsule in the rotator interval, followed by manipulation, with optional steroid injection. Both forms of surgery were followed by postprocedural physiotherapy. Early structured physiotherapy involved mobilisation techniques and a graduated home exercise programme supplemented by a steroid injection. Both early structured physiotherapy and postprocedural physiotherapy involved 12 sessions during up to 12 weeks. The primary outcome was the Oxford Shoulder Score (OSS; 0-48) at 12 months after randomisation, analysed by initial randomisation group. We sought a target difference of 5 OSS points between physiotherapy and either form of surgery, or 4 points between manipulation and capsular release. The trial registration is ISRCTN48804508.Findings: Between April 1, 2015, and Dec 31, 2017, we screened 914 patients, of whom 503 (55%) were randomly assigned. At 12 months, OSS data were available for 189 (94%) of 201 participants assigned to manipulation (mean estimate 38·3 points, 95% CI 36·9 to 39·7), 191 (94%) of 203 participants assigned to capsular release (40·3 points, 38·9 to 41·7), and 93 (94%) of 99 participants assigned to physiotherapy (37·2 points, 35·3 to 39·2). The mean group differences were 2·01 points (0·10 to 3·91) between the capsular release and manipulation groups, 3·06 points (0·71 to 5·41) between capsular release and physiotherapy, and 1·05 points (-1·28 to 3·39) between manipulation and physiotherapy. Eight serious adverse events were reported with capsular release and two with manipulation. At a willingness-to-pay threshold of £20 000 per quality-adjusted life-year, manipulation under anaesthesia had the highest probability of being cost-effective (0·8632, compared with 0·1366 for physiotherapy and 0·0002 for capsular release).Interpretation: All mean differences on the assessment of shoulder pain and function (OSS) at the primary endpoint of 12 months were less than the target differences. Therefore, none of the three interventions were clinically superior. Arthoscopic capsular release carried higher risks, and manipulation under anaesthesia was the most cost-effective.Funding: The National Institute for Health Research Health Technology Assessment programme. [ABSTRACT FROM AUTHOR]

BACKGROUND: The pathological changes in adhesive capsulitis occurs surrounding the intrinsic structure tightness. Movement with mobilization mostly works on intracapsular & sleeper's stretch mainly acts on capsule. There are some studies which supports that M.W.M. is more effective in patients with adhesive capsulitis. At the same time, some studies have been done which proves sleeper's stretch to be beneficial in capsular tightness. As a result, present study thought to determine the combined effects of M.W.M.& Sleeper's Stretch on adhesive capsulitis. OBJECTIVES: To find the effects of M.W.M. on R.O.M., pain and functional disability in populations with adhesive capsulitis. To find the effects of M.W.M. and sleeper's stretch on R.O.M., pain and functional disability in populations with adhesive capsulitis. To compare the effects of M.W.M. and M.W.M. with sleeper's stretch on R.O.M., pain and functional disability in populations with adhesive capsulitis. METHODOLOGY: A Randomized, controlled, single blinded study, 50 patients with adhesive capsulitis were selected based on the inclusion and exclusion criteria. Pre -assessment of pain, R.O.M. and disability index had been taken. The patients are randomly allocated into two groups. 25 patients in Group 'A' with adhesive capsulitis was treated with M.W.M. alone where as another 25 patients in Group 'B' with adhesive capsulitis was treated with M.W.M. plus, sleeper's stretch. Both the groups were given the conventional therapy which includes hot packs, pendular exercises, finger ladder exercises and active range of motion exercises. Post assessment was done. RESULTS: In total, 50 patients were randomized to the study interventions. The flexion R.O.M. in pre and post mean values of Groups 'A' and 'B' are 18.41 and 29.16, P value is 0.04. The internal rotation R.O.M. in pre and post mean values of Groups 'A' and 'B' are 7.72 and 14.44, P value is 0.09. The external rotation R.O.M. in pre and post mean values of Groups 'A' and 'B' are 13.72 and 16.85, P value is 0.39. In SPADI, Pre & Post mean values of Group 'A' & Group 'B' are 16.83 and 24.41 respectively, P value is 0.28. In NPRS, Pre and post mean values of Groups 'A' and 'B' are 2.72 & 2.88 respectively, P value is 0.02. CONCLUSIONS: Adding sleeper's stretch with M.W.M. to standard therapy for adhesive capsulitis may offer significant advantages. [ABSTRACT FROM AUTHOR]

Sciatica as a clinical diagnosis is nonspecific. A diagnosis of sciatica is typically used as a synonym for lumbosacral radiculopathy. However, the differential for combined low back and leg pain is broad, and the etiology can be one several different conditions. The lifetime prevalence of sciatica ranges from 12.2% to 43%, and nonsuccessful outcomes of treatment are prevalent. Nurse practitioners and other primary care clinicians often have minimal training in differential diagnosis of the complex causes of lower back and leg pain, and many lack adequate time per patient encounter to work up these conditions. Differentiating causes of low back and leg pain proves challenging, and inadequate or incomplete diagnoses result in suboptimal outcomes. Chiropractic care availability may lessen demands of primary care with respect to spinal complaints, while simultaneously improving patient outcomes. The authors describe three patients referred from primary care with a clinical diagnosis of sciatica despite differing underlying pathologies. More precise clinical terminology should be used when diagnosing patients with combined low back and leg pain. Nurse practitioners and other clinicians' triage, treat, and determine appropriate referrals for low back and leg pain. Multidisciplinary care including chiropractic may add value in settings where patients with lower back and leg pain are treated. [ABSTRACT FROM AUTHOR]

Background and Objectives: Adhesive capsulitis(AC) is a condition commonly affecting the shoulder with 2% prevalence, causing insidious pain and restriction of active as well as passive gleno-humeral movement. This study compares the effectiveness of Kaltenborn mobilization versus Mulligan's MWM technique for AC of the shoulder. Method: 56 participants were randomly allocated in Group M and Group K for the shoulder. SPADI and shoulder ROM were used as outcome measures. These were recorded at baseline and at the end of 2 weeks post treatment. Results: Statistically significant (p<0.05) improvements were found in Group K with respect to SPADI scores, while the same was observed in ROM although not statistically significant. Conclusion: Pain and disability along with ROM improved in both groups. [ABSTRACT FROM AUTHOR]

BACKGROUND: Intra-articular distension is a validated treatment in adhesive capsulitis of the shoulder and is commonly followed by intensive in-patient physical therapy. A recent meta-analysis found that physical therapy is as effective as intra-articular distension (IAD) and that an early distension could be the primary choice for treating frozen shoulder. The question of the additional contribution of physical therapy prior to IAD compared with IAD followed by physical therapy has not been raised. OBJECTIVES: We compared IAD preceded by physical therapy to that followed by physical therapy in terms of pain relief and functional outcome. METHODS: We enrolled patients with primitive adhesive capsulitis of the shoulder. The eligible patients were randomized into three groups: A, B and C. Group A received intra-articular distension followed by physical therapy, group B received intra-articular distension in the middle of physical therapy and group C received physical therapy alone. Patients were assessed at the beginning of the protocol (T0), after 6 weeks (T1) and after 12 weeks (T2). The main outcome measures were pain using a Visual Analog Scale and the Disabilities of Arm, Shoulder and Hand Questionnaire. RESULTS: Out of the 179 enrolled patients, only 122 completed the follow up: group A (n = 34), group B (n = 46) and group C (n = 42). Compared to intra-articular distension preceded by physical therapy, IAD followed by physical therapy did not improve significantly the outcome in terms of pain relief (p = 0.123) but it enhanced the upper extremity function (p = 0.002). Upper extremity pain and function were found to improve with time regardless of the protocol (p < 0.001). CONCLUSIONS: IAD followed by physical therapy is more beneficial than IAD preceded by physical therapy in terms of upper extremity function. IAD, whether or not preceded by physical therapy, does not significantly improve pain compared to physical therapy alone. Time is a crucial factor to take into consideration while treating adhesive capsulitis of the shoulder. [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis is the very common in people with diabetes and people between the age group of 40 - 65 years of age. It is essential to design a treatment protocol which reduces pain and improve ROM and functional activity of the shoulder in least possible. As this condition is very painful and hampers the functional activity of the shoulder. Objectives: Objectives of the study were to determine the effect of posterior glide with MET for subscapularis muscle on adhesive capsulitis in reducing pain, improving ROM and functional activity of the shoulder. Material and Method: In this experimental study, the subject with adhesive capsulitis were assessed with VAS, ROM and SPADI, the subjects were given Maitland Technique (posterior glide) along with MET for subscapularis with conventional treatment. Results: Statistical analysis was done of VAS, ROM and SPADI in 40 subjects in which it was seen that post treatment showed extremely significant results in all the outcome measures. Conclusion: The current study concluded that Maitland technique (posterior glide) along with MET for subscapularis is effective in the management of Frozen Shoulder. Maitland technique (posterior glide) along with MET for subscapularis given with Conventional Treatment is significantly effective in reducing pain, increasing range of motion and functional status of Shoulder and thus Alternate Hypothesis accepted. [ABSTRACT FROM AUTHOR]

Background: There is a lack of evidence on the clinical effectiveness of hydrodistension for frozen shoulder following failed conservative management. Methods: A total of 90 patients opted for hydrodistension following failed initial treatment which included physiotherapy and at least one corticosteroid injection. Shoulder pain and function were assessed at baseline, and 6, 12 and 24 weeks using the Shoulder Pain Disability Index (SPADI), The Upper Extremity Functional Index (UEFI) and a visual analogue scale (VAS) for pain. Active ranges of motion were assessed at baseline, post‐24 hr and discharge. Results: We observed clinically important improvements in pain (VAS −5.5; 90% confidence interval [CI] −6.0 to −5.0; SPADI pain, −20; 90% CI−23 to −17) and function (UEFI 23; 90% CI 19 to 26; SPADI disability, −32; 90% CI −36 to −28) at 6 weeks. These improvements remained clearly substantial at 24 weeks. Active range of motion improved substantially post‐24 hr (flexion 20, 90% CI 18 to 23; lateral rotation 14, 90% CI 12 to 16; abduction 22, 90% CI 19 to 25) and at discharge (flexion 37, 90% CI 33 to 41; lateral rotation 24, 90% CI 21 to 27; abduction 44, 90% CI 38 to 50). Discussion: This single‐arm observational study suggests that hydrodistension is an effective treatment of frozen shoulder within a UK primary care setting when standard treatment has failed. [ABSTRACT FROM AUTHOR]

Background: Although numerous studies have suggested that frozen shoulder (FS) is a self-limiting disease with most patients recovering within 2 years, its long-term outcome is still controversial. The aims of this study were to evaluate the clinical outcomes after conservative treatment for FS and to determine the predictors of its clinical outcome.Methods: This study included 234 shoulders of 215 patients who received conservative treatment for FS. The mean follow-up period was 41.8 months (range 27-117 months). Initial evaluation included demographics, detailed medical history, and clinical assessments of shoulder status. Questionnaires, which included the Visual Analogue Scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV) and satisfaction grading for the current shoulder status were assessed at the final follow-up.Results: The mean VAS pain score, ASES score, and SSV significantly improved from 6.7, 37.0, and 40.1% at the time of initial evaluation to 1.5, 87.6, and 85.0% at the final follow-up evaluation (all p < 0.001). According to satisfaction grading, the shoulder status at the final follow-up was very satisfied in 101 shoulders (43.2%), satisfied in 68 (29.1%), fair in 37 (15.8%), unsatisfied in 20 (8.5%), and very unsatisfied in 8 (3.4%). Univariate analysis revealed that gender, diabetes, simultaneous bilateral involvement, overall bilateral involvement and duration of symptoms were associated with clinical outcomes at the final follow-up. Multivariate analysis revealed that duration of symptoms (p = 0.002) was an independent risk factor for unsuccessful outcome.Conclusions: At the mean follow-up period of 41.8 months, 72.3% of patients revealed subjective satisfaction for the current shoulder status. Duration of symptoms was an independent risk factor for poor prognosis. [ABSTRACT FROM AUTHOR]

The article describes a case of idiopathic adhesive capsulitis (IAC) or frozen shoulder in a healthy 54-year-old male patient who was familiar with the condition and decided to self-manage the condition without medical consultation. The patient is familiar with IAC because he had experienced its symptoms after a skiing accident 10 years earlier. It provides an overview of the medical history and quality of life of the patient. It discusses the outcomes of the whole-body vibration exercise (WBV) adopted by the patient.

Adhesive capsulitis, a common primary care and orthopedic diagnosis often referred to as frozen shoulder, is a painful inflammatory process that leads to a mechanical block in active and passive range of shoulder motion. Risk factors include diabetes and thyroid dysfunction. Diagnosis is made based on physical examination, but can be augmented by diagnostic imaging. Nonsurgical management is the mainstay of treatment because the disease is self-limiting. However, some patients may need surgical intervention. [ABSTRACT FROM AUTHOR]

Chen et al. [[3]] showed intraarticular injections had improved outcome for pain relief compared to subacromial injection but no difference in function. Treatment management for Stage 1 often consists of NSAIDs, supervised physical therapy, and intraarticular corticosteroid injections, though several studies recommend early intervention with intra-articular corticosteroid injections in the early inflammatory or frozen stages of adhesive capsulitis [[2], [10]], and this may be more efficacious than other approaches [[10], [14], [16]]. Finally, a randomized control trial that used three different locations (rotator interval, intraarticular, and subacromial) showed that injections in the rotator interval yielded the best results followed by intraarticular injections for pain and passive ROM. CORR Insights®: Is the Anterior Injection Approach Without Ultrasound Guidance Superior to the Posterior Approach for Adhesive Capsulitis of the Shoulder?. [Extracted from the article]

Purpose Greater trochanteric pain syndrome (GTPS) is a debilitating condition causing lateral hip pain. A recent randomized controlled trial (LEAP) demonstrated that exercise interventions for GTPS provided superior outcomes, compared with corticosteroid injection and wait‐and‐see approaches. However, participants were not patients seeking care and therefore may not have represented the typical patient seen within the National Health Service (NHS). The present service evaluation aimed to provide data on the characteristics of patients with GTPS presenting to NHS physiotherapy services, to enable consideration of the applicability of the findings of the LEAP trial to patients seeking care within the NHS. Methods: Four NHS sites provided anonymized data on patients presenting to their service with a primary complaint of GTPS. Results: The data from 162 patients suggested that the typical patients presenting to the NHS with GTPS are female (73%), overweight (body mass index 28.5) and experiencing a 12‐month or longer history of lateral hip pain (56.8%). Patients reported high levels of pain (visual analogue score 6.5), low health‐related quality of life (EuroQol five‐dimensions – 5‐level score 0.6), coexisting medical conditions (79.0%) and high medication use (82.7%). Conclusions: Patients presenting to the NHS with GTPS appear to have multifactorial issues, with high levels of pain and disability, and are often medicated for multiple coexisting conditions. These characteristics differentiate them from patients recruited to the LEAP trial. Hence, it is unclear whether the findings of the LEAP trial are applicable to patients with GTPS who consult physiotherapy services in the NHS. Further research is warranted to evaluate this. [ABSTRACT FROM AUTHOR]

The shoulder is the third most common region in which musculoskeletal pain occurs, involving symptoms that cause a decrease in quality of life and a reduced ability to perform activities of daily life if untreated. Many lesions cause shoulder pain; therefore, we included those commonly encountered in primary care clinics. We aimed to describe the diagnosis and non-operative or conservative treatment modalities of rotator cuff tendinopathy, impingement syndrome, rotator cuff tear, adhesive capsulitis, biceps tendonitis, and acromioclavicular arthritis. Exercise has been reported to be effective for the treatment of impingement syndrome, and the effect of exercise has been shown to reduce pain. Both home-based self-exercise and exercise supervised by professionals are equally effective. Types of exercise should include stretching, active, active-assistive, and resistive exercise. Ten repetitions per set for 3 sets of each exercise should be prescribed initially post-injury. Repetition and resistance should be increased as strength grows. The use of ultrasonography for the diagnosis of shoulder pain has increased recently. Corticosteroid injection under ultrasonographic guidance is effective in reducing pain. [ABSTRACT FROM AUTHOR]

Study Design: Nonrandomized controlled trial. Objective: To determine whether translational manipulation under anesthesia/local block (TMUA) adds to the benefit of mobilization and range of motion exercise for improving pain and functional status among patients with adhesive capsulitis of the shoulder (AC). Background: TMUA has been shown to improve pain and dysfunction in patients with AC. This intervention has not been directly compared to physical therapy treatment without TMUA in a prospective trial. Methods: Sixteen consecutive patients with a primary diagnosis of AC were divided into two groups. Patients in the first (TMUA) group received a session of translational manipulation under interscalene block, followed by six sessions of manipulation and exercise. Patients in the comparison group received seven sessions of manipulation and exercise. Outcome measures taken at baseline and 3, 6, 12 months and 4 years included Shoulder Pain and Disability Index (SPADI) scores. Four-year outcomes included percent of normal ratings, medication use, and activity limitations. Results: Both groups showed improved SPADI scores across all follow-up times compared to baseline. The TMUA group showed a greater improvement in SPADI scores than the comparison group at 3 weeks, with no significant differences in SPADI scores at other time points. However, at 4 years, significantly more subjects in the comparison group (5 of 8) had activity limitations versus subjects in the TMUA group (1 of 8). No subject experienced a complication from either intervention protocol. Conclusion: Physical therapy consisting of manual therapy and exercise provides benefit for patients with AC. Translational manipulation under local block may be a useful adjunct to manual therapy and exercise for patients with AC. [ABSTRACT FROM AUTHOR]

It has been well recognized that student-athletes (SAs) are a hard-to-reach population for university counselling services. However, after this present author started implementing Dohsa Therapy (DT), a body psychotherapy originally developed in Japan, the total number of therapy sessions increased remarkably. There has been as many as nine times the number of sessions than before DT was implemented. Once SAs started DT and noticed changes in their bodies, movements, and postures, which improved their sport performance as well as mental wellness, they became willing participants for extended periods. This paper describes how DT was implemented through university counselling services and contributed to the connectivity between the services and the SAs by overcoming the barriers to psychological assistance. [ABSTRACT FROM AUTHOR]

Objectives: To investigate if focused extracorporeal shock wave therapy (f-ESWT) is an effective treatment in a population affected by greater trochanteric pain syndrome (GTPS). Design: Randomized controlled trial, with blind outcome assessors. Setting: Outpatients, University Hospital. Subjects: A total of 50 patients affected by GTPS with gluteal tendinopathy. Interventions: The study group was assigned to receive f-ESWT, the control group received ultrasound therapy (UST). Main measures: We assessed hip pain and lower limb function by means of a numeric rating scale (p-NRS) and the Lower Extremity Functional Scale (LEFS scale), respectively. The first follow-up evaluation (2M-FUP) was performed two months after the first treatment session, the second (6M-FUP) was carried out six months later. Results: The mean age of the population was 61.24 (9.26) years. A marked prevalence of the female sex was recorded (44 subjects, 86%). The statistical analysis showed a significant pain reduction over time for the study group and the control group, the f-ESWT proving to be significantly more effective than UST (P < 0.05) at the 2M-FUP (2.08 vs 3.36) and at the 6M-FUP (0.79 vs 2.03). A marked improvement of the LEFS total score was observed in both groups as well, but we found no statistical differences in the comparisons between groups. Conclusion: Our findings support the hypothesis that f-ESWT is effective in reducing pain, both in the short-term and in the mid-term perspective. We also observed a functional improvement in the affected lower limb, but, in this case, f-ESWT showed not to be superior to UST. [ABSTRACT FROM AUTHOR]

Background: Frozen shoulder is a painful and debilitating condition with an incidence of 3% to 5% in the general population and up to 20% in those with diabetes. Physiotherapy has been found to be very effective in treatment of frozen shoulder. Cryoflow IR is a new advanced modality, which is the first cryotherapy device to cool down free surrounding air with a biofeedback system, thereby ensuring a constant temperature on a treated spot. Hence this study was conducted to compare the effect of moist hot pack and Cryoflow (IR Guided). Aims and Objectives: To study and compare the effect of Cryoflow (IR guided) and moist hot pack on pain and function in frozen shoulder. Methodology: 15 patients of frozen shoulder were included by simple random sampling after taking ethical approval for the present study. The patients were then divided in two groups. Along with the conventional physiotherapy, patients in Group A were given moist hot pack; while in Group B Cryoflow (IR Guided) was given for 6 days/week for 4 weeks. Pre and post interventional outcome measures in terms of VAS score at rest, ROM and SPADI score were evaluated. Results: Both groups showed significant improvement when pre and post data were analyzed for all outcome measures (p< 0.05).Whereas between group comparison showed no significant difference. Conclusion: It can be concluded that Conventional physiotherapy along with moist hot pack and conventional physiotherapy along with Cryoflow (IR guided), both are individually effective in relieving pain, improving range of motion and functional ability in patients with frozen shoulder. [ABSTRACT FROM AUTHOR]

*BACKGROUND: Manual therapy has been demonstrated to reduce pain and improve function in patients with frozen shoulder contracture syndrome (FSCS), but no evidence exists to support one form of manual therapy over another. This case series describes both short- and long-term outcomes after a manual therapy program and home stretching exercises based on specific impairments in shoulder mobility and level of tissue irritability in patients with FSCS. *CASE DESCRIPTION: Eleven patients with primary FSCS were treated with an individually tailored, multimodal manual therapy approach once weekly for 12 visits, coupled with home stretching exercises once a day, 5 days per week. Pain, disability, range of motion (ROM), and muscle strength of the affected shoulder were assessed at baseline, posttreatment, at 6 months, and at 9 months. *OUTCOMES: Significant improvements in self-reported pain, disability, shoulder ROM, and strength were reported following treatment. Additionally, 4 of 11 patients showed pain improvements that exceeded the minimal clinically important difference (MCID) on the visual analog scale postintervention, and 8 of 11 showed pain improvements at 6 and 9 months. Moreover, 7 of 11 patients showed improvements in Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores exceeding the MCID postintervention and at 6 months, and 8 of 11 exceeded the MCID at 9 months. *DISCUSSION: Clinically meaningful changes in shoulder pain and disability, ROM, or muscle strength were observed in 11 patients with primary FSCS treated with an individually tailored approach of both manual therapy techniques and stretching exercises, accounting for tissue irritability. [ABSTRACT FROM AUTHOR]

Greater trochanteric pain syndrome (GTPS) is a common clinical condition that can affect a wide range of patients. Historically, the condition has been associated with trochanteric bursitis. More recently, however, a growing body of literature has demonstrated gluteus medius tendinopathy and tearing is present in many cases of GTPS. Pathology of the gluteus medius can result in significant hip pain, loss of motion, and decreased function. Affected patients characteristically have symptoms including lateral hip pain and a Trendelenburg gait, which may be refractory to conservative management such as non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, and injections. In these cases, both open and arthroscopic repair techniques have been described, with recent literature demonstrating excellent patient-reported outcomes. We present a comprehensive review of gluteus medius tears including relevant anatomy, clinical evaluation, diagnosis, and treatment options. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the effect of mirror therapy (MT) in conjunction with a standard physical therapy program on shoulder range of motion (ROM), pain and quality of life in patients with adhesive capsulitis (AC). METHOD: This prospective, randomized, controlled, single blind study included 30 patients with AC who were scheduled to undergo 10 sessions of standard physical therapy. The participants were divided into two identical groups, namely, The MT group and the control group. After each session, the MT group underwent active ROM exercises with the reflective side of the mirror while the control group underwent active ROM exercises with the non-reflective side of the mirror. Pre-treatment and post-treatment shoulder pain (VAS), shoulder function (UCLA shoulder scale) and quality of life (SF-36) were assessed, and active and passive ROM were quantified with a goniometer. RESULTS: Both groups revealed a significant reduction of shoulder pain and significant improvement of shoulder function, active and passive ROM, and quality of life after the treatment. Post-treatment measurements showed that the MT group had a significantly lower amount of pain compared to the control group (p = 0.007). The UCLA scores were significantly higher in the MT group (p = 0.003). The MT group had significantly better post-treatment active flexion, active abduction, passive flexion, and passive abduction values (p = 0.001, p = 0.02, p = 0.002, and p = 0.02, respectively). The MT group had significant post-treatment improvement in physical function, physical role limitation and emotional role limitation, and pain parameters including SF-36 (p = 0.003, p = 0.01, p = 0.015, and p = 0.002, respectively). CONCLUSION: MT in conjunction with physical therapy appears to be an effective treatment modality that reduces shoulder pain and improves shoulder ROM, shoulder function, and quality of life among patients with AC. [ABSTRACT FROM AUTHOR]

Acupuncture has been a popular alternative medicine in the United States for several decades. Its therapeutic effects on pain have been validated by both basic and clinical researches, and it is currently emerging as a unique non-pharmaceutical choice for pain against opioid crisis. However, the full spectrum of acupuncture indications remains unexplored. In this study, we conducted a cross-sectional survey among 419 acupuncturists nation-wide to investigate the top 10 and top 99 acupuncture indications in private clinics in the United States. We found the top 10 indications to be: lower back pain, depression, anxiety, headache, arthritis, allergies, general pain, female infertility, insomnia, neck pain and frozen shoulder. Among the top 99 indications, pain represents the largest category; and mental health management, especially for mood disorders, is in greatest demand. The following popular groups are: immune system dysfunctions, gastrointestinal diseases, gynecology and neurology. In addition, specialty index, commonality index, and the potential to become medical specialties were estimated for each indication. Demographic analysis suggests that China trained acupuncturists tend to have broader indication spectrums, but the top conditions treated are primarily decided by local needs. Also, gender, resident states, age and clinical experience all affect indication distributions. Our data for the first time outlines the profile of acupuncture treatable conditions in the US and is valuable for strategic planning in acupuncture training, healthcare administration and public education. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of active release technique and capsular stretch along with conventional therapy in patients with frozen shoulder Study Design: Experimental study design. Subjects: 30 patients between the age group 40 yrs to 60 yrs having frozen shoulder were selected as per the inclusion and exclusion criterion. Procedure: Using random sampling method the 30 subjects were divided into 2 equal groups with 15 patients each and treated with active release technique and capsular stretch along with conventional therapy and capsular stretch with conventional therapy. 18 sessions over a period of 5 weks. Outcomes scores were evaluated using goniometer and VAS scale. Result: Subjects receiving active release technique and capsular stretch along with conventional therapy showed significant reductions in pain and other symptoms with an improvement in quality of life. Conclusion: Active release technique and capsular stretch with conventional therapy is more effective in increasing ROM and decreasing pain of frozen shoulder rather alone capsular stretch with conventional therapy. These changes are clinically significant. [ABSTRACT FROM AUTHOR]

BACKGROUND: In treatment of adhesive capsulitis, deep heating agents have been shown to have positive effects on pain and function. OBJECTIVE: To evaluate if addition of ultrasound used in treatment of adhesive capsulitis will provide additional benefits. METHODS: Thirty patients with adhesive capsulitis were included in a prospective, double-blind, randomized controlled trial. Hotpack, TENS (Transcutaneus Electrical Nerve Stimulation), exercise and active ultrasound therapies were applied to the first group (n = 15), whereas sham ultrasound was applied to the second group (n = 15) in addition to hotpack, TENS and exercise. The patients were evaluated using joint range of motion, UCLA shoulder scale and Shoulder Disability Questionnaire scales at baseline and at 6th and 24th weeks post-treatment. RESULTS: When pain and the clinical and functional parameters were compared in both groups, significant improvement was found compared to baseline (p < 0.001). At week 24, no difference was found in terms of pain at rest, but all other parameters were improved compared to week 6. When the groups were compared, no difference was found in any comparison between 6th and 24th week (p > 0.05). CONCLUSION: Adding ultrasound treatment to a combination of physical therapy modalities did not provide any additional benefits for the treatment of adhesive capsulitis. [ABSTRACT FROM AUTHOR]

Background: Shoulder stiffness is a common complication after arthroscopic rotator cuff repair. However, there is no consensus on the treatment of stiffness after repair. Although one treatment option is an intra-articular steroid injection, it may negatively affect repair integrity, and there is a paucity of literature regarding the timing of intra-articular injections for stiffness after repair and its effect on repair integrity. Purpose: To compare repair integrity and clinical outcomes after an intra-articular steroid injection administered at 6 weeks and 12 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who developed stiffness after arthroscopic rotator cuff repair were given a series of 3 intra-articular steroid injections every 4 weeks from 6 (6-week group) and 12 weeks (12-week group) postoperatively. The control group had rotator cuff tears but neither stiffness nor injections. Shoulder range of motion (ROM), the Korean Shoulder Scoring System (KSS) score, and the University of California, Los Angeles (UCLA) shoulder score were assessed preoperatively with a minimum of 2-year follow-up. Repair integrity was assessed using magnetic resonance imaging at 6 months postoperatively. Results: Seventy-four of 209 patients (35.4%) who underwent arthroscopic rotator cuff repair developed stiffness. There were no significant differences in retear rates among the 6-week (5.7%, 2/35 patients), 12-week (10.3%, 4/39 patients), and control groups (14.1%, 19/135 patients) (P = .374). Both the 6- and 12-week groups showed significant improvement in ROM (both P < .001), KSS scores (both P < .001), and UCLA scores (both P < .001) at the final follow-up. The 6-week group showed significantly better ROM (P < .001), KSS scores (P < .001), and UCLA scores (P < .001) than the 12-week group at 3 months postoperatively. However, both the 6- and 12-week groups showed significantly lower KSS (81.3 ± 12.0 [P = .004] and 83.4 ± 8.6 [P = .035], respectively) and UCLA (29.3 ± 4.6 [P = .006] and 30.0 ± 3.3 [P = .042], respectively) scores than the control group (90.4 ± 13.6 and 32.3 ± 4.7, respectively) at the last follow-up. Conclusion: An intra-articular steroid injection administered at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair may be effective for reducing patients’ pain and improving shoulder ROM at 3 months postoperatively without compromising repair integrity. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to determinate the effectiveness of extracorporal shock wave therapy (ESWT) in the treatment of trochanteric bursitis (TB) in both the short and long term. Methods: The participants of this study were recruited by different clinicians of the National Health Service (NHS) and private sector centres in the United Kingdom. Data were collected in a web-based database [Assessment of the Effectiveness of Extracorporeal Shock Wave Therapy (ESWT) for Soft Tissue Injuries (ASSERT)]. The 40 participants (mean age 56.35 ± 13.90 y) were treated using a standardized ESWT protocol. At baseline and again at 3, 6, 12 and 24 months following ESWT treatment, the participants were evaluated with the Visual Analogue Scale (VAS) for pain perception, the Lower Extremity Functional Scale (LEFS) for functional limitation assessment, and the 6 scores of EuroQol-5D questionnaire (EQ-5D) for quality of life. Results: There was a significant improvement over time in 2 of the 8 analysed scores that were VAS (p=0.0006) and the Pain/Discomfort score of EQ-5D (p=0.0003). Conclusion: ESWT showed beneficial effects on the pain relief in TB over a 24-month follow-up period. [ABSTRACT FROM AUTHOR]

Frozen Shoulder remains one of the most misunderstood pathologies to affect the shoulder joint. Frozen Shoulder is characterised by pain, loss of active and passive range of motion especially in flexion and external rotation with normal radiological findings undergoing three stages of presentation: initial pain, stiffness and near full resolution with time. Current treatment options include manual physiotherapy techniques, injection therapy, manipulation under anaesthetic and surgical release of shoulder capsule. Presently there remains a paucity of significant research supporting the sole use of any of these techniques in the treatment of frozen shoulder. Future studies should incorporate larger subject populations with closely related symptoms and be multicentred across a larger geographical area. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the current study was to determine the effects of education with targeted or sham exercise on pain and function in postmenopausal women with greater trochanteric pain syndrome (GTPS). Background: Conservative management of GTPS is poorly described, and to date, there have been no studies on education with exercise as an intervention for GTPS. Ninety-four postmenopausal women with GTPS were recruited to participate in this study. Materials and Methods: Participants were randomized to receive one of two 12-week exercise programs (GLoBE vs. sham). Participants received education on avoiding tendon compression with appropriate activity modification. The Victorian Institute of Sport Assessment-Gluteal tendon (VISA-G) was examined at baseline, 12, and 52 weeks. Secondary outcomes included hip pain and function questionnaires (Hip dysfunction and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), and Lateral Hip Pain questionnaire), a global rating of change in symptom questionnaire, and a quality of life measure (Assessment of Quality of Life [AQoL]-8D). Differences between groups were analyzed using intention to treat with analysis of covariance, per-protocol analysis, and responder analysis. Results: Responders to the GLoBE intervention had significantly better VISA-G, HOOS, OHS, and lateral hip pain questionnaire scores compared to responders in the sham group. However, intention to treat analyses showed no between-group differences for the GLoBE intervention and sham exercise groups. Significant improvement in VISA-G score was found for both programs at 12- and 52-weeks time points (p < 0.001). Conclusion: Lack of treatment effect was found with the addition of an exercise program to a comprehensive education on GTPS management. The improved outcomes of the responders in the GLoBE group indicate that there may be a subgroup of patients with a GTPS diagnosis that benefit from a GLoBE intervention program. [ABSTRACT FROM AUTHOR]

It is fairly well understood that frozen shoulder involves several stages, which reflect the series of process from capsular inflammation and fibrosis to spontaneous resolution of this fibrosis. However, the underlying pathophysiologic process remains poorly determined. For this reason, management of frozen shoulder remains controversial. Determining the pathophysiological processes of frozen shoulder is a pivotal milestone in the development of novel treatment for patients with frozen shoulder. This article reviews what is known to date about the biological pathophysiology of frozen shoulder. Although articles for the pathophysiology of frozen shoulder provide inconsistent and inconclusive results, they have suggested both inflammation and fibrosis mediated by cytokines, growth factors, matrix metalloproteinases, and immune cells. Proinflammatory cytokines and growth factors released from immune cells control the action of fibroblast and matrix remodeling is regulated by the matrix metalloproteinases and their inhibitors. To improve our understanding of the disease continuum, better characterizing the biology of these processes at clearly defined stages will be needed. Further basic studies that use standardized protocols are required to more narrowly identify the role of cytokines, growth factors, matrix metalloproteinases, and immune cells. The results of these studies will provide needed clarity into the control mechanism of the pathogenesis of frozen shoulder and help identify new therapeutic targets for its treatment. [ABSTRACT FROM AUTHOR]

Objectives:: Although the shoulder is known to move together with the scapula and other upper quarter joints, the current frozen shoulder clinical practice guidelines describe only physical therapy study treatments directed to the shoulder. None received a strong recommendation, highlighting the need for alternate interventions. This retrospective case series describes a pragmatic regional interdependence approach to frozen shoulder with impairment and functional outcomes, noting whether final ROM approached normal. Methods:: Five consecutive patients referred with frozen shoulder diagnoses attended 11-21 sessions over 5-10 weeks with one physical therapist. Treatment addressed inter-related regions (shoulder, shoulder girdle, scapulothoracic/humerothoracic, and spine) following a pragmatic approach using impairment-based interventions (joint/soft tissue mobilization, muscle stretching/strengthening) as well as patient education, modalities and warm up that addressed individual presentations. Results:: All patients improved on all outcomes. Mean shoulder ROM at discharge, the impairment outcome, demonstrated large effect size increases: flexion (117 ± 10-179 ± 12, d = 5.9), abduction (74 ± 8-175 ± 9, d = 9.3), external rotation (23 ± 7-89 ± 2, d = 12.0). The Disability of Arm Shoulder Hand functional outcome score upon follow up demonstrated a large effect size improvement (d = 1.5) from 40.0 ± 19.4-6.2 ± 3.7. Final ROM approached normal. Discussion:: This case series utilized a regional interdependence approach to frozen shoulder that included manual therapy interventions directed to consistent upper quarter body segments. Shoulder ROM was returned to near normal with functional improvements evident months after discharge. A pragmatic regional interdependence approach addressing multiple joints related to shoulder function may benefit other people with frozen shoulder. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Frozen shoulder is a painful debilitating condition which can be diagnosed clinically. It is a condition of chronic inflammation and proliferative fibrosis resulting in painful limitation of shoulder movements with classical clinical signs. Diabetic patients are more likely to develop the disease and more likely to require operative management. Diabetic frozen shoulder is a difficult condition to manage, and the clinician must strike a balance between improving range of movement and treating pain, but not over-treating what is an essentially self-resolving condition. Treatment options principally include physiotherapy and intra-articular injections, and progression to hydrodilatation, manipulation under anaesthetic, or arthroscopic capsular release as required. In this article, we review the available literature to assess best management, and correlate with practice at our unit, proposing a management strategy for treating patients with diabetic frozen shoulder. Management decisions should be agreed upon jointly with the patient and be based upon comorbidities, severity and the natural history of the condition. [ABSTRACT FROM AUTHOR]

Clinical Question: In patients diagnosed with adhesive capsulitis, is scapular mobilization combined with end range glenohumeral mobilization more effective at improving shoulder range of motion when compared to glenohumeral mobilization alone? Clinical Bottom Line: There is moderate evidence to support the use of scapular mobilization combined with end range glenohumeral mobilization to improve shoulder range of motion in patients with adhesive capsulitis. [ABSTRACT FROM AUTHOR]

We hypothesized that ultrasound (US) guidance improves outcomes of corticosteroid injection of trochanteric bursitis. 40 patients with greater trochanteric pain syndrome defined by pain to palpation over the trochanteric bursa were randomized to injection with 5 ml of 1% lidocaine and 80 mg of methylprednisolone using (1) conventional anatomic landmark palpation guidance or (2) US guidance. Procedural pain (Visual Analogue Pain Scale), pain at outcome (2 weeks and 6 months), therapeutic duration, time-to-next intervention, and costs were determined. There were no complications in either group. Ultrasonography demonstrated that at least a 2-in (50.8 mm) needle was required to consistently reach the trochanteric bursa. Pain scores were similar at 2 weeks: US: 1.3 ± 1.9 cm; landmark: 2.2 ± 2.5 cm, 95% CI of difference: − 0.7 < 0.9 < 2.5, p = 0.14. At 6 months, US was superior: US: 3.9 ± 2.0 cm; landmark: 5.5 ± 2.6 cm, 95% CI of difference: 0.8 < 1.6 < 2.4, p = 0.036. However, therapeutic duration (US 4.7 ± 1.4 months; landmark 4.1 ± 2.9 months, 95% CI of difference − 2.2 < − 0.6 < 1.0, p = 0.48), and time-to-next intervention (US 8.7 ± 2.9 months; landmark 8.3 ± 3.8 months, 95% CI of difference − 2.8 < − 0.4 < 2.0, p = 0.62) were similar. Costs/patient/year was 43% greater with US (US $297 ± 99, landmark $207 ± 95; p = 0.017). US-guided and anatomic landmark injection of the trochanteric bursa have similar 2-week and 6-month outcomes; however, US guidance is considerably more expensive and less cost-effective. Anatomic landmark-guided injection remains the method of choice, but should be routinely performed using a sufficiently long needle [at least a 2 in (50.8 mm)]. US guidance should be reserved for extreme obesity or injection failure. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Case report. BACKGROUND: Aggressive physical therapy in the freezing stage of frozen shoulder may prolong the course of recovery. Central sensitization may play a role in the early stages of frozen shoulder. Pain neuroscience education, tactile discrimination, and graded motor imagery have been used in a number of conditions with central sensitization. The purpose of this case report was to describe the examination and treatment of a patient in the freezing stage of frozen shoulder using pain neuroscience education, tactile discrimination, and graded motor imagery. CASE DESCRIPTION: A 54-year-old woman with a diagnosis of frozen shoulder was referred by an orthopaedic surgeon following lack of progress after 4 weeks of intensive daily physical therapy. Pain at rest was 7/10, and her Shoulder Pain and Disability Index score was 64%. She had painful and limited active range of motion and elevated fear-avoidance beliefs. Tactile discrimination and limb laterality were impaired, with signs of central sensitization. A "top-down" approach using pain neuroscience education, tactile discrimination, and graded motor imagery was used for the first 6 weeks, followed by a "bottom-up" impairment-based approach. OUTCOMES: The patient was seen for 20 sessions over 12 weeks. At discharge, her Shoulder Pain and Disability Index score was 22%, resting pain was 0/10, and fear-avoidance beliefs improved. Improvements in active range of motion, laterality, and tactile discrimination were also noted. DISCUSSION: Intensive physical therapy in the freezing stage of frozen shoulder may be detrimental to long-term outcomes. This case report suggests that a top-down approach may allow a quicker transition through the freezing stage of frozen shoulder. LEVEL OF EVIDENCE: Therapy, level 5. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy of distention arthrography (DA) alone and in combination with translational mobilization (TM) for treatment of patients with frozen shoulder (FS). Methods Eighty-five patients diagnosed with unilateral FS (freezing or frozen stage) were included. Forty-one patients were treated with DA and TM (group 1) and 44 patients with DA alone (group 2). Clinical assessments including visual analogue scale (VAS), Cyriax stage, and shoulder passive range of motion (PROM) including forward flexion, abduction, external rotation, and internal rotation were measured at baseline, 1 month, and 3 months following treatment. Results There were no significant differences in gender, side affected, symptom duration, presence of diabetes mellitus, VAS score, Cyriax stage, or shoulder PROM between the two patient groups at baseline. Compared with baseline metrics, patients in both groups demonstrated significantly improved outcome parameters at two posttreatment time points. However, mean all shoulder PROMs were significantly greater, and mean VAS score and Cyriax stage were lower in patients treated with DA and TM than in those treated with DA alone group at two posttreatment time points. At these times, mean interval change of all outcome parameters was significantly greater with DA and TM than DA alone. No serious complications were observed following treatment in either patient group. Conclusion Compared with DA alone, DA combined with TM more effectively alleviates shoulder pain and increases PROM in patients with freezing or frozen stage FS. [ABSTRACT FROM AUTHOR]

Symptomatic scapulothoracic disorders, including scapulothoracic crepitus and scapulothoracic bursitis are uncommon disorders involving the scapulothoracic articulation that have the potential to cause significant patient morbidity. Scapulothoracic crepitus is the presence of a grinding or popping sound with movement of the scapula that may or may not be symptomatic, while scapulothoracic bursitis refers to inflammation of bursa within the scapulothoracic articulation. Both entities may occur either concomitantly or independently. Nonetheless, the constellation of symptoms manifested by both entities has been referred to as the snapping scapula syndrome. Various causes of scapulothoracic crepitus include bursitis, variable scapular morphology, post-surgical or post-traumatic changes, osseous and soft tissue masses, scapular dyskinesis, and postural defects. Imaging is an important adjunct to the physical examination for accurate diagnosis and appropriate treatment management. Non-operative management such as physical therapy and local injection can be effective for symptoms secondary to scapular dyskinesis or benign, non-osseous lesions. Surgical treatment is utilized for osseous lesions, or if non-operative management for bursitis has failed. Open, arthroscopic, or combined methods have been performed with good clinical outcomes. [ABSTRACT FROM AUTHOR]

Objectives. This study aims to explore whether extracorporeal shockwave treatment (ESWT) based on the theory of fascial manipulation (FM) at select treatment points is superior to traditional local ESWT for pain relief in adhesive capsulitis of the shoulder. Methods. Data from patients with adhesive capsulitis of the shoulder who received weekly ESWT according to fascial manipulation theory (ESWT-FM) or local extracorporeal shockwave treatment (L-ESWT) during a 5-week treatment period were evaluated. Pain-on-movement numeric rating scale (p-NRS) and range of motion (ROM) testing were performed before the treatment period, after the first treatment, and after the fifth treatment. Results. There were significant reductions in pain scores in the ESWT-FM group (p<0.05) after the first treatment, and after the fifth treatment, both groups had marked, significant improvement (p<0.05), with a significantly greater reduction in pain (p-NRS) in the ESWT-FM group compared to the L-ESWT group (p<0.05). There was no significant difference in terms of ROM in the L-ESWT group, while there was slight improvement of forward flexion in the ESWT-FM group after the fifth treatment. Conclusions. ESWT-FM provided faster pain relief and slightly more notable improvement of function compared with L-ESWT for the patients with adhesive capsulitis of shoulder. [ABSTRACT FROM AUTHOR]

Study Design: Case series study. Objectives: Although there have been no reported complications from translational manipulation under anesthesia (tMUA) for individuals with adhesive capsulitis (AC) there are no cases reporting surgical findings post tMUA. Also, there are no studies evaluating health care utilization following tMUA. The purpose of this study was to: (1) report clinical outcomes following tMUA, (2) describe relevant health care costs and utilization following tMUA, and (3) summarize findings from two cases receiving joint arthroscopy following tMUA. Methods: Fourteen Individuals with AC underwent tMUA. Range of motion (ROM) and Shoulder Pain and Disability Index (SPADI) values were collected at baseline and six weeks follow-up. Shoulder-related health care cost and utilization were analyzed for a five-year period following tMUA. Two additional patients with AC underwent tMUA followed by arthroscopic assessment for evidence of iatrogenic injury. Results: Thirteen patients completed the six-week follow-up. Mean change scores for ROM and SPADI values were flexion; +38.5°, abduction; +71.1°, external rotation (shoulder abducted); +49.8°, internal rotation (shoulder abducted); +26.6°, SPADI scores; +44.4. 13 patient records were analyzed for health care utilization. Ten of the 13 patients utilized no additional shoulderrelated health care. Surgical evaluation revealed no evidence of iatrogenic injury. Discussion: Clinical outcomes were similar to previous studies. Utilization data indicated that for the majority of patients, little shoulder-related health care was utilized. Surgical evaluation provided further evidence that tMUA performed by a physical therapist is safe. Future research will be required to establish a causal relationship between tMUA and the results observed in this study. Level of Evidence: Therapy, Level 4. [ABSTRACT FROM AUTHOR]

Frozen shoulder, also known as adhesive capsulitis, is a common presentation in the primary care setting and can be significantly painful and disabling. The condition progresses in three stages: freezing (painful), frozen (adhesive) and thawing, and is often self-limiting. Common conservative treatments include nonsteroidal anti-inflammatory drugs, oral glucocorticoids, intra-articular glucocorticoid injections and/or physical therapy. However, many physicians may find themselves limited to prescribing medications for treatment. This article elaborates on physical therapy exercises targeted at adhesive capsulitis, which can be used in combination with common analgesics. [ABSTRACT FROM AUTHOR]

Background: Contractile tissue plays an important role in mobility deficits in frozen shoulder (FS). However, no study has assessed the effect of the muscle release technique on the muscle activation and kinematics in individuals with FS. The purposes of this study were to assess the differences in shoulder muscle activity and kinematics between the FS and asymptomatic groups; and to determine the immediate effects of muscle release intervention in the FS group.Methods: Twenty patients with FS and 20 asymptomatic controls were recruited. The outcome measures included muscle activity of the upper and lower trapezius (UT and LT), infraspinatus (ISp), pectoralis major (PM), and teres major (TM), shoulder kinematics (humeral elevation, scapular posterior tilt (PT) and upward rotation (UR), shoulder mobility, and pain. Participants in the FS group received one-session of heat and manual muscle release. Measurements were obtained at baseline, and immediately after intervention. Multivariate analysis of variance was used for data analysis. The level of significance was set at α=0.05.Results: Compared to the controls, the FS group revealed significantly decreased LT (difference =55.89%, P=0.001) and ISp muscle activity (difference =26.32%, P =0.043) during the scaption task, and increased PM activity (difference =6.31%, P =0.014) during the thumb to waist task. The FS group showed decreased humeral elevation, scapular PT, and UR (difference = 35.36°, 10.18°, 6.73° respectively, P <0.05). Muscle release intervention immediately decreased pain (VAS drop 1.7, P <0.001); improved muscle activity during scaption (UT: 12.68% increase, LT: 35.46% increase, P <0.05) and hand to neck (UT: 12.14% increase, LT: 34.04% increase, P <0.05) task; and increased peak humeral elevation and scapular PT during scaption (95.18°±15.83° to 98.24°±15.57°, P=0.034; 11.06°±3.94° to 14.36°±4.65°, P=0.002), and increased scapular PT during the hand to neck (9.47°±3.86° to 12.80°±8.33°, P=0.025) task. No statistical significance was found for other group comparisons or intervention effect.Conclusion: Patients with FS presented with altered shoulder muscle activity and kinematics, and one-session of heat and manual muscle release showed beneficial effects on shoulder muscle performance, kinematics, mobility, and pain.Trial Registration: Retrospectively registered on Jan 18, 2016 (ACTRN 12616000031460 ). [ABSTRACT FROM AUTHOR]