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Objective. Primary adhesive capsulitis (AC), or frozen shoulder, is an insidious and idiopathic disease. Severe pain is predominant in the first two of the three stages of the condition,which can last up to 21 months. Design, Setting, and Subjects. Sixty volunteers with primary AC were randomly assigned to acupuncture with press tack needles compared with press tack placebos in a patient- and observer-blinded placebo-controlled study. The participants were subsequently offered classical needle acupuncture in an open follow-up clinical application. Thirty-four volunteers received conservative therapy, including 10 classical needle acupuncture treatments over 10 weeks, 13 volunteers received conservative therapy without classical needle acupuncture. All subjects agreed to follow-up after one year. Methods. Acupuncture treatment was performed using a specific distal needling concept, using reflex areas on distant extremities avoiding local treatment. Results. An immediate improvement of 3.3 ± 3.2 points in Constant-Murley Shoulder Score (CMS) pain subscore was seen in the press tack needles group and of 1.6 ± 2.8 points in the press tack placebos group (P < 0.02). Conservative therapy including classical needle acupuncture significantly improved the pain subscore within 14.9 ± 15.9 weeks compared with 30.9 ± 15.8 weeks with only conservative therapy (P < 0.001). Conclusion. The efficiency of distal needling acupuncture on immediate pain reduction was demonstrated in patients with AC and confirmed the applicability of press tack needles and press tack placebos for double-blind studies in acupuncture. Subsequent clinical application observation proved that results obtained with press tack needles/press tack placebos can be transferred to classical needle acupuncture. Integrating acupuncture with conservative therapy showed superior effectiveness with respect to the time course of the recovery process in AC compared with conservative therapy alone. [ABSTRACT FROM AUTHOR]

Background: There is no consensus about the optimal treatment strategy for frozen shoulders (FS). Conservative treatment consisting of intra-articular corticosteroid infiltrations and physiotherapy are considered appropriate for most patients. However, with a conservative strategy, patients experience a prolonged rehabilitation period with a considerable amount of pain and disabilities in daily life. Also, at long term, a residual amount of pain and restriction of range of motion is frequently reported. Manipulation under anesthesia is a short and relative simple procedure with the potential to rapidly reduce symptoms and restore the range of motion. The objective of this trial is to evaluate the effectiveness of MUA followed by a PT program compared to a PT program alone, in the treatment of patients with a stage two FS. We hypothesize that the course of the disease can be shortened with MUA with a quicker functional recovery.Methods: This is a prospective, single center, randomized controlled trial. Eligible patients will be allocated to either the manipulation (MUA) group or the physiotherapy alone (PT) group. In the MUA group manipulation will be performed under interscalene block, directly followed by an intensive physiotherapy treatment protocol, with the goal to maintain the obtained range of motion. Patients allocated to the PT group are given advice and education and receive a written protocol to hand out to their physical therapist based on the recent guideline of the Dutch Shoulder Network for the treatment of frozen shoulders. Descriptive statistics will be used to describe the sample size, patients demographics, presence of diabetes mellitus, range of motion, duration of symptoms till randomization and will be presented for each treatment group. The SPADI is used as primary functional outcome parameter. Secondary outcome parameters are; OSS, NPRS, EQ-5D 3-L, passive range of motion, WORQ-UP, duration of symptoms, usage of analgesics and adverse events. A sample size of 41 subjects in each group was calculated. Follow up is planned after 1,3 and 12 months. The length of physiotherapy treatment in both groups is variable, depending on individual progression. Differences between groups in outcome parameters will be analysed using the linear mixed modelling and the restricted maximum likelihood ratio technique for estimating the model parameters.Discussion: Successful completion of this trial will provide evidence on the best treatment strategy for patients with a stage two frozen shoulder. The results of this study can lead to a better understanding for the role of manipulation in the treatment of frozen shoulders.Trial Registration: This trial is registered in the Dutch Trial Register under the number NTR6182 on the 20th of February 2017. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of mobilization with movement and end range mobilization along with conventional therapy for the treatment of frozen shoulder. Study Design: Experimental study design. Subjects: 30 patients between the age group 40 yrs to 60 yrs were selected as per the inclusion and exclusion criterion. Procedure: By random sampling method the 30 subjects were divided into 2 equal groups with 15 patients each.Experimental group A received Hot Pack,Exercises,MWM .Experimental group B received Hot Pack,Exercises,ERM. The study was performed for 4 months.The treatment was given 6 days per week.once in a day for 12 weeks .Evaluation was done before starting the treatment and then after 4 months. Outcomes scores were evaluated using SPADI & ROM . Result: Experimental group A showed improvement in SPADI score 62.9 % and ROM improved by 81.87 degree. The ERM group showed improvement in SPADI scores by 47.9 % and 76.8 degree Conclusion: The study found that both the treatment that is MWM and ERM are effective in the management of frozen shoulder but MWM is found to be slightly more effective. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to examine the effects of reminders, encouragement, and educational messages delivered by mobile phone on shoulder exercise compliance and improvements in shoulder function among patients with a frozen shoulder. Design and Methods A randomized controlled trial design was used. A convenience sample of patients with a frozen shoulder in an orthopedic outpatient clinic was recruited. All participants were instructed on how to do shoulder exercises and were provided with a printed pamphlet about shoulder exercises. Then, the intervention group received reminders, encouragement, and educational messages by mobile phone daily for the next 2 weeks, while the comparison group did not. Findings The intervention group had higher compliance with shoulder exercises than did the comparison group ( t = 2.263, p = .03) and had significant improvements in shoulder forward flexion ( F = 12.067, p = .001), external rotation ( F = 13.61, p = .001), and internal rotation ( F = 5.903, p = .018) compared to those in the comparison group after the 2-week intervention. Conclusions The text messages significantly increased patient compliance with shoulder exercises and thus improved patients' shoulder range of motion. Clinical Relevance Hospital or clinics can send appropriate messages to patients via text message platforms in order to remind and encourage them to do shoulder exercises. [ABSTRACT FROM AUTHOR]

Purpose of Study - To compare the effect of Maitland technique and muscle energy technique in adhesive capsulitis. It is common in the age group of 35 to 60 years. In this the maximum disability has been measured by SPADI scale Methodology- 30 subjects were selected with adhesive capsulitis. Result- There is significant effect of muscle energy technique seen in group A. Conclusion - There is a statistically significant difference between both the group in improvement in group receiving muscle energy technique and Maitland technique. But there is a marked improvement seen in group A subjects with adhesive capsulitis. [ABSTRACT FROM AUTHOR]

Background: Traumatic lesions of the olecranon bursa (OB) and prepatellar bursa (PB) are injuries commonly seen in orthopaedic trauma units. These injuries are associated with a high rate of complications. At present, only little is known about the incidence, complication rate, and treatment approaches in patients with acute open bursae.Materials and Methods: A total of 552 patients who had been treated for acute traumatic lesions of either the olecranon bursa or the prepatellar bursa, or both at our department were retrospective identified in the years between 2009 and 2014. An analysis of the medical history of these patients was carried out to investigate the incidence of bursa injuries, circumstances, concomitant injuries, complication rate, and treatment approaches. In addition, a systematic literature search on PubMed was conducted.Results: The incidence of traumatic lesions of the OB or PB in trauma patients was 0.2% (198/100,000; 62% OB, 38% PB). Bursectomy was performed in 83.7%. Concomitant injuries were present in 41% of the cases, with no significant influence on the complication rate (P = 0.367). The overall complication rate was 19.7%. Revision surgery was necessary in 4.5% of the patients. No significant differences between OB and PB injuries were noted with regard to the complication rate (P = 0.221). There were also no significant differences in the complication rate between patients who received bursectomy and those with conservative treatment (P = 0.364). Regression analyses showed that prophylactic antibiotic administration significantly reduced the risk of infection (P = 0.04).Conclusions: Traumatic lesions of the OB and PB are associated with a high risk of complications. Prophylactic antibiotic therapy can potentially reduce the risk of infection and the need for revision surgery. [ABSTRACT FROM AUTHOR]

Objective The purpose of this review was to evaluate the effectiveness of conservative nondrug, nonsurgical interventions, either alone or in combination, for conditions of the shoulder. Methods The review was conducted from March 2016 to November 2016 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and was registered with PROSPERO. Eligibility criteria included randomized controlled trials (RCTs), systematic reviews, or meta-analyses studying adult patients with a shoulder diagnosis. Interventions qualified if they did not involve prescription medication or surgical procedures, although these could be used in the comparison group or groups. At least 2 independent reviewers assessed the quality of each study using the Scottish Intercollegiate Guidelines Network checklists. Shoulder conditions addressed were shoulder impingement syndrome (SIS), rotator cuff-associated disorders (RCs), adhesive capsulitis (AC), and nonspecific shoulder pain. Results Twenty-five systematic reviews and 44 RCTs met inclusion criteria. Low- to moderate-quality evidence supported the use of manual therapies for all 4 shoulder conditions. Exercise, particularly combined with physical therapy protocols, was beneficial for SIS and AC. For SIS, moderate evidence supported several passive modalities. For RC, physical therapy protocols were found beneficial but not superior to surgery in the long term. Moderate evidence supported extracorporeal shockwave therapy for calcific tendinitis RC. Low-level laser was the only modality for which there was moderate evidence supporting its use for all 4 conditions. Conclusion The findings of this literature review may help inform practitioners who use conservative methods (eg, doctors of chiropractic, physical therapists, and other manual therapists) regarding the levels of evidence for modalities used for common shoulder conditions. [ABSTRACT FROM AUTHOR]

This article is the eighth from our Manual Therap/ Student Handbook (see the 'Contents panef for further details) and it describes how to assess and treat common shoulder complaints. As well as listing a comprehensive assessment procedure, the treatments are described in full and have accompanying videos, which provides a great practical resource for the clinician. [ABSTRACT FROM AUTHOR]

A 30-year-old woman presented to our outpatient department with complaints of pain and swelling in bilateral infrapatellar regions and a discharging sinus in the right knee over the duration of one year. Radiographs showed lytic regions in bilateral patellae. Samples sent from material curetted from sinus yielded no organism but histopathology reported granulomatous inflammation. Following a fresh magnetic resonance imaging (MRI) scan that revealed the infrapatellar pad of fat communicating with the patellar lesions, an exploration and evacuation was done. Material sent revealed epithelioid cell granulomas with caseous necrosis consistent with tuberculosis (TB). The patient was put on first line anti-tubercular treatment (ATT) and has responded favourably with healing of sinus and patellar lesions. Bilateral infrapatellar bursitis is not rare. However patellar TB as a cause for OMIT is not a common diagnosis. A bilateral patellar involvement has not been reported in literature to the best of our knowledge. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Prospective, randomized, partially blinded. BACKGROUND: Greater trochanteric pain syndrome (GTPS) is the current terminology for what was once called greater trochanteric or subgluteal bursitis. Cortisone (corticosteroid) injection into the lateral hip has traditionally been the accepted treatment for this condition; however, the effectiveness of injecting the bursa with steroids is increasingly being questioned. An equally effective treatment with fewer adverse side effects would be beneficial. OBJECTIVE: To investigate whether administration of dry needling (DN) is noninferior to cortisone injection in reducing lateral hip pain and improving function in patients with GTPS. METHODS: Forty-three participants (50 hips observed), all with GTPS, were randomly assigned to a group receiving cortisone injection or DN. Treatments were administered over 5 weeks, and clinical outcomes were collected at baseline and at 1,3, and 6 weeks. The primary outcome measure was the numeric pain-rating scale (0-10). The secondary outcome measure was the Patient-Specific Functional Scale (0-10). Medication intake for pain was collected as a tertiary outcome. RESULTS: Baseline characteristics were similar between groups. A noninferiority test for a repeated-measures design for pain and averaged function scores at 6 weeks (with a noninferiority margin of 1.5 for both outcomes) indicated noninferiority of DN versus cortisone injection (both, P<,01). Medication usage (P = .74) was not different between groups at the same time point. No adverse side effects were reported. CONCLUSION: Cortisone injections for GTPS did not provide greater pain relief or reduction in functional limitations than DN. Our data suggest that DN is a noninferior treatment alternative to cortisone injections in this patient population. LEVEL OF EVIDENCE: Therapy, level lb. Registered December 2, 2015 at www.clinicaltrials. gov (NCT02539039). [ABSTRACT FROM AUTHOR]

Background: We evaluated the short-term clinical outcomes of frozen shoulder treatment via shoulder manipulation under ultrasound-guided cervical nerve root block (MUC).Methods: This study included frozen shoulder patients who were unresponsive to conservative therapy for at least 6 months and were then treated with MUC. Patients with a rotator cuff tear, calcifying tendinitis, osteoarthritis, or any other shoulder disorder were excluded following X-ray, ultrasound, and magnetic resonance imaging evaluation. Although 25 patients were initially included, three patients were not followed-up for at least 1 year. We investigated a final total of 22 patients; the average age was 58 years and 59% were female. We measured shoulder pain, shoulder range of motion, and American Shoulder and Elbow Surgeons shoulder scores immediately prior to MUC, 1 week after MUC, and 1 year after MUC. A Short-Form 36-Item Health Survey was administered before MUC and 1 year after MUC. We used the Friedman and Wilcoxon signed-rank tests to identify statistical differences. Significance was defined as p < 0.05.Results: MUC significantly improved shoulder pain during motion, range of motion, and American Shoulder and Elbow Surgeons scores 1 week after MUC. This improvement persisted at the 1-year follow-up. Seven of the eight Short-Form 36-Item Health Survey measures were significantly improved 1 year after MUC. One patient (4.5%) developed Horner's syndrome, although symptoms resolved within several hours without treatment.Conclusion: MUC for frozen shoulder was safe and resulted in a significant improvement in shoulder pain and range of motion 1 week after the procedure. This improvement persisted at the 1-year follow-up. [ABSTRACT FROM AUTHOR]

Superficial bursitis most often occurs in the olecranon and prepatellar bursae. Less common locations are the superficial infrapatellar and subcutaneous (superficial) calcaneal bursae. Chronic microtrauma (e.g., kneeling on the prepatellar bursa) is the most common cause of superficial bursitis. Other causes include acute trauma/hemorrhage, inflammatory disorders such as gout or rheumatoid arthritis, and infection (septic bursitis). Diagnosis is usually based on clinical presentation, with a particular focus on signs of septic bursitis. Ultrasonography can help distinguish bursitis from cellulitis. Blood testing (white blood cell count, inflammatory markers) and magnetic resonance imaging can help distinguish infectious from noninfectious causes. If infection is suspected, bursal aspiration should be performed and fluid examined using Gram stain, crystal analysis, glucose measurement, blood cell count, and culture. Management depends on the type of bursitis. Acute traumatic/hemorrhagic bursitis is treated conservatively with ice, elevation, rest, and analgesics; aspiration may shorten the duration of symptoms. Chronic microtraumatic bursitis should be treated conservatively, and the underlying cause addressed. Bursal aspiration of microtraumatic bursitis is generally not recommended because of the risk of iatrogenic septic bursitis. Although intrabursal corticosteroid injections are sometimes used to treat microtraumatic bursitis, high-quality evidence demonstrating any benefit is unavailable. Chronic inflammatory bursitis (e.g., gout, rheumatoid arthritis) is treated by addressing the underlying condition, and intrabursal corticosteroid injections are often used. For septic bursitis, antibiotics effective against Staphylococcus aureus are generally the initial treatment, with surgery reserved for bursitis not responsive to antibiotics or for recurrent cases. Outpatient antibiotics may be considered in those who are not acutely ill; patients who are acutely ill should be hospitalized and treated with intravenous antibiotics. [ABSTRACT FROM AUTHOR]

The article presents a case study about the management of neurodynamic irritability in a 47-year-old woman with adhesive capsulitis.

Background: Greater trochanteric pain syndrome (GTPS) can have a significant effect on quality of life.Aim: To evaluate the conservative treatments for GTPS.Design: This systematic review assessed risk of bias using the Cochrane Risk of Bias Tool and Cochrane Risk of Bias Tool for non-randomised studies of interventions.Data Sources: On 13 January 2016, a comprehensive search was conducted, with no limit on year of publication for relevant studies in the MEDLINE, CINAHL, AMED and EMBASE databases.Eligibility Criteria For Selecting Studies: English language randomised controlled trials, case-control or cohort studies reporting outcome data for conservative treatments for adults having a diagnosis of GTPS, or trochanteric bursitis, were included.Results: 8 studies (n=696) were eligible for inclusion in the review; corticosteroid injections (CSI) (n=6), shockwave therapy (n=2), home training (n=1) and orthotics (n=1). Based on pain, CSI demonstrated superior outcomes for up to 3 months compared with home training, radial shockwave therapy (RSWT) and usual care, in 4 studies demonstrating either a low or moderate risk of bias. Fluoroscopy-guided injections failed to show additional benefit. RSWT and home training had limited evidence. No conclusions can be drawn regarding the use of orthotics due to the serious risk of bias and methodological flaws within that study.Conclusions: This review demonstrates a paucity of high-quality research for the conservative treatments of GTPS. The risk of bias was low in only one study, demonstrating no additional benefit with fluoroscopically guided injections. Risk of bias in all remaining studies was varied. Standardisation of diagnostic criteria and outcome measures is essential to enable more powerful analysis. [ABSTRACT FROM AUTHOR]

Purpose Review the MRI appearance of different bursae located throughout the pelvis, including the pertinent osseous and musculotendinous anatomy. Materials and methods Bursae are potential spaces that reduce friction between opposed moving components which can become inflamed, clinically mimicking internal derangement. Results This series illustrates the most common as well as lesser-known pelvic bursae. Common causes of bursitis including overuse, trauma, and infection are presented. Conclusion Multiple bursae are located throughout the pelvis. It is important for radiologists to recognize bursitis as a potential etiology of pain and be familiar with their anatomical locations in order to guide appropriate management. [ABSTRACT FROM AUTHOR]

Adhesive capsulitis is a common cause of shoulder pain and limited movement. The objectives of this review were to assess the efficacy and safety of corticosteroid injections for adhesive capsulitis and to evaluate the optimum dose and anatomical site of injections. PubMed and CENTRAL databases were searched for randomised trials and a total of ten trials were included. Results revealed that corticosteroid injection is superior to placebo and physiotherapy in the short-term (up to 12 weeks). There was no difference in outcomes between corticosteroid injection and oral nonsteroidal anti-inflammatory drugs at 24 weeks. Dosages of intra-articular triamcinolone 20 mg and 40 mg showed identical outcomes, while subacromial and glenohumeral corticosteroid injections had similar efficacy. The use of corticosteroid injections is also generally safe, with infrequent and minor side effects. Physicians may consider corticosteroid injection to treat adhesive capsulitis, especially in the early stages when pain is the predominant presentation. [ABSTRACT FROM AUTHOR]

BACKGROUND: The aim of this study was to clarify the effects of continuous passive motion (CPM) treatment on adhesive capsulitis (AC) in diabetes mellitus (DM) patients. METHODS: Forty-one DM patients with AC were randomized to two treatment groups. The first group (n = 20) (CPM group) received CPM treatments; the second group (n = 21) had conventional physical therapy (CPT group), including active stretching, range of motion (ROM) and pendulum exercises. All patients received electrotherapy. After a four-week-long physical therapy program, the patients were instructed to continue with an eight-week home exercise program. The patients rated the pain they felt at night, both while at rest and in motion, in the past week using the visual analogue scale (VAS). Functional outcome evaluations were performed using the Constant Shoulder Score (CSS) and Shoulder Pain and Disability Index (SPADI). All patients were evaluated at baseline, and during the fourth and twelfth weeks of the study. RESULTS: There were significant improvements in both groups' active and passive ROM for the shoulder, VAS measures, SPADI pain and disability scores and CSS, and excluding the active and passive internal and external rotation of shoulder increased with both treatment methods (CPM or CPT) over time (p < 0.001), however these differences were found to be prominent in patients receiving CPM therapy. CONCLUSIONS: Both the CPM and CPT therapies seemed to be beneficial for the treatment of AC in DM patients, however CPM revealed more distinctive improvements in the function and pain levels of the AC patients. [ABSTRACT FROM AUTHOR]

Objective: To describe a lateral fluoroscopically guided retrocalcaneal bursa injection technique, report patient outcomes at 1-4 weeks after steroid/anesthetic retrocalcaneal bursal therapeutic injection, and correlate pre-injection diagnostic heel ultrasound variables with improvement in patient pain scores.Materials and Methods: After IRB approval, fluoroscopically guided therapeutic retrocalcaneal bursa injections performed using a lateral approach were retrospectively reviewed. Pre-injection heel ultrasound results and pre- and post-injection patient VAS pain scores (scale 0-10) were recorded. The Wilcox matched-pair test compared pain scores, and Spearman's rho assessed for correlation between pain score changes and heel ultrasound results.Results: Thirty-two injections were performed in 30 patients (25 females, 5 males; mean 56.5 ± 9.3 years, range 39-75 years; 21 left heel, 11 right heel) with technical success in 32 of 32 cases (100 %). Insertional Achilles tendon pathology and retrocalcaneal bursitis were present in 31 of 32 cases (97 %) and 16 of 32 cases (50 %), respectively. Median pre- and post-procedure pain scores were 8 (IQR 7, 10) and 1.75 (IQR 0, 6). A statistically significant decrease in pain score was observed following injection, with a median change of 4.75 (IQR 3, 8; p < 0.001). Clinically significant response (>50 % reduction in pain score) was present in 69 % (95 % CI, 0.52-0.86; p < 0.001). No significant correlation was identified between a decrease in pain score and a sonographically abnormal Achilles tendon or retrocalcaneal bursa.Conclusion: Fluoroscopically guided retrocalcaneal bursal steroid/anesthetic using a lateral approach is an effective technique. This technique yielded 100 % technical success and a clinically significant decrease in patient pain scores (p < 0.001). [ABSTRACT FROM AUTHOR]

Background: Open excision of the olecranon bursa has been performed traditionally. However, surgical complications such as wound healing problems and recurrence may occur after the surgery. The purpose of this study was to report on the clinical outcomes of endoscopic olecranon bursal resection performed in both septic and aseptic olecranon bursitis. Methods: We retrospectively reviewed 30 patients who underwent endoscopic olecranon bursal resection from June 2007 to January 2012. There were 20 males and 10 females. The ages ranged from 22 to 80 years, with an average age of 57.4 years and the average follow-up was 21.1 months (6-61.5 months). There were 15 cases in the septic group. The treatment outcome was measured according to the following; the rate of recurrence, range of motion, complications associated with surgery, VAS and QuickDASH. Results: There were no complications such as postoperative infection or neurovascular injuries. In the septic group, the VAS and QuickDASH scores were significantly improved from 5.6 to 0.1 and from 28 to 1.3, respectively. In the aseptic group, the VAS and QuickDASH scores were improved from 0.6 to 0.1 and from 25.7 to 0.5, respectively. In all cases, there were no recurrences and no limitations of joint motion until the final follow-up. Conclusions: We were able to obtain excellent outcomes without recurrence by performing endoscopic olecranon bursal resection in both septic and aseptic olecranon bursitis. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this study was to compare axillary ultrasound, laser, and postisometric facilitation technique with standard care in the management of shoulder adhesive capsulitis. Methods This is a randomized clinical trial study. Fifty-nine participants with shoulder adhesive capsulitis were selected and randomly assigned for eligibility. Forty-five participants were assigned into 3 equal groups of 15, and 14 participants were excluded from the study. The participants were blinded to their group allocation. Standard care group (A) received traditional physical therapy treatment in the form of pulsed ultrasound, scanning laser, supervised exercise program, and home exercise program; group B received the same physical therapy program as group A, except that the ultrasound and scanning laser were applied to the axillary region of the painful shoulder; and group C received the same modified physical therapy program as group B plus postisometric facilitation technique to the painful shoulder. All dependent variables were measured by the second author, who was blinded to the participant's intervention group. The first author administered treatment to all 3 groups. All participants received 12 sessions (3 times/wk for 4 weeks). Pain level and shoulder range of motion (ROM; flexion, abduction, and external rotation) were recorded 3 times (pretreatment, immediately posttreatment, and 4 weeks of treatment). Results Mixed-design multivariate analysis of variance indicated significant pain reduction with significant ROM increase in all groups posttreatment and after 4 weeks. Post hoc analysis for within groups revealed that shoulder ROM and pain levels improved significantly posttreatment compared with pretreatment ROM in all groups, with the greatest improvement in group C. Between-group analysis revealed that pain-free shoulder flexion, abduction, external rotation, and pain level improved significantly in group C compared with groups A and B immediately after treatment and after 4 weeks of follow-up ( P < .05). Improvements reported in group B is more than in group A, and C is more than in groups A and B. Conclusions Combining axillary ultrasound and laser with postisometric facilitation had a greater effect in reducing pain and improving shoulder ROM in patients with shoulder adhesive capsulitis compared with axillary ultrasound and laser with traditional exercise. [ABSTRACT FROM AUTHOR]

Introduction: Patients with secondary frozen shoulder following anterior dislocation were treated with manipulation under anaesthesia (MUA) and injection. Methods: Ten patients included in study. Oxford Shoulder Scores (OSS), range of motion (ROM) and need for any further treatment measured. Results: Mean follow-up of 93 weeks. OSS and ROM improved in all patients. Three patients required repeat MUA. Two patients developed recurrent instability. Discussion: Secondary frozen shoulder may be more recalcitrant. Recurrent instability is a risk following anterior shoulder dislocation. It is feasible that by performing an MUA to maximise mobility, stability may be sacrificed. It should be performed with caution. [ABSTRACT FROM AUTHOR]

Objective: The objective is to determine whether corticosteroid injection into the subacromial space was not inferior to intra-articular injection in patients with idiopathic frozen shoulder (FS), and whether combined injections had an additive effect.Methods: Patients with idiopathic FS (n=126) were randomly assigned to receive ultrasound-guided intra-articular (IA group), subacromial (SA group), or combined IA and subacromial injections (IA+SA group). All groups received a total dose of 40mg triamcinolone acetonide. The outcome measures included the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeon (ASES) shoulder score, subjective shoulder value (SSV), and passive range of motion before and at 3, 6, and 12 weeks after treatment.Results: There was significant effect of time on all measurements such that all measures improved in all groups (P<0.001) during the 12 weeks after treatment. Group-by-time interactions were significant for ASES (P=0.006), VAS (P<0.001), SSV (P=0.03), and internal rotation (P=0.014). Between-group comparisons revealed a significant improvement in the IA (P<0.001) and IA+SA (P<0.001) groups as compared to the SA group. The IA+SA group demonstrated significant improvement in internal rotation as compared to the IA group (P=0.046).Conclusion: The efficacy of corticosteroid injection into the SA space in idiopathic FS was inferior to IA injection up to 12 weeks; however, combination injections had an additive effect on increasing the internal rotation angle. These results indicate that although the glenohumeral joint is a major site in the pathogenesis of idiopathic FS, the SA space may be a contributing site. [ABSTRACT FROM AUTHOR]

Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. A systematic review of the literature was conducted using PubMed through April 2015, and a multidisciplinary expert workgroup with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech-language pathology, physical medicine and rehabilitation, the patient perspective, and nursing was assembled. While the guideline is based on a systematic review of the current literature, most evidence is not sufficient to warrant a strong recommendation. Therefore, recommendations should be viewed as consensus-based management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment. CA Cancer J Clin 2016;66:203-239. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain, most commonly affecting female patients aged 40–60, and which can have a significant impact on patients' quality of life. Extra-corporeal shockwave therapy (ESWT) alongside a structured rehabilitation programme has been shown in previous research studies to have a significant improvement in patient's levels of pain, although it is unclear if this then leads to improved level of global functioning or activity. This case series examines the change in a range of patient reported outcome measures following shockwave therapy as well as the frequency of self-reported side-effects. Methods: Patients undergoing ESWT for GTPS were identified from case logs from a single NHS clinic. Patients completed a range of validated patient-rated outcome measures at baseline and at subsequent follow-up appointments. These include measures of pain, and measures of local hip functioning (Oxford Hip Score – OHS, Non-Arthritic Hip Score – NAHS), global functioning (EQ-5D-5L), sleep quality (Pittsburgh Sleep Quality Index – PSQI), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale – HADS), and activity levels (International Physical Activity Questionnaire – IPAQ). Results: Forty-five patients who completed ESWT for GTPS were identified; with a median follow-up duration of 189 days. Side-effect incidence was low, with <10% reporting bruising, and no patients withdrew due to side-effects. 'Average' and 'worst' self-reported pain values improved significantly from baseline at all time-periods studied; 6.3/10 and 8.2/10 to 3.8/10 and 5.4/10 at 3 months, respectively, correlating to an improvement of about a third. At 3 months 63% of patients were either satisfied or very satisfied, and 70% would recommend the procedure, these figures increased at 6 months. Sleep quality, measures of local hip functioning, and depressive symptoms all improved consistently across different time-points; however, activity levels and global health markers showed less evidence of improvement. Conclusions: ESWT is known to be effective in patients with greater trochanteric pain alongside a structured rehabilitation programme, and this case series is in keeping with the available evidence. This series demonstrates benefits across different areas of functioning. In this series, even though pain decreased, physical activity levels did not increase. As staying active has numerous health benefits further targeted intervention to address this alongside the reduction of pain may be required for optimal health outcomes. [ABSTRACT FROM AUTHOR]

Although shoulder adhesive capsulitis is a common condition, its treatment remains controversial. No previous radial extracorporeal shockwave therapy (rESWT) use has been reported for this condition. The objective of this study was to determine the effects of rESWT compared with placebo in patients with shoulder adhesive capsulitis. This prospective, randomised, double-blind, placebo-controlled, clinical trial took place in four physical therapy departments in New York. The study included 106 patients with primary shoulder adhesive capsulitis, who were randomly assigned to either the experimental (n = 53) or control group (n = 53). All patients received instructions in a home-based exercise program before their allocated intervention. Both groups received four applications of rESWT, 1 week apart; a clasp blocked transmission of the shockwave impulses in the control group. Function was measured by the Disabilities of the Arm, Shoulder and Hand questionnaire, pain by a visual analog scale, and shoulder active and passive abduction, and passive external rotation degrees by a goniometer, at baseline, and at 4 and 24 weeks from baseline. Compared to the control group, significant clinical and statistical (p < 0.001) improvements in all outcome measures were seen in the experimental group at the two follow-up intervals. In conclusion, the rESWT is a safe and effective treatment in shoulder adhesive capsulitis. [ABSTRACT FROM PUBLISHER]

Objective: To evaluate the feasibility and effect of ultrasound-guided ethyl alcohol injection on malleolar and olecranon synovial proliferative bursitis. Methods: Twenty-four patients received ultrasound-guided 50% diluted ethyl alcohol injection at the site of synovial proliferative bursitis after aspiration of the free fluid. Results: Swelling and symptoms significantly decreased in 13 of the 24 patients without any complications. Eleven patients had partial improvement in swelling and symptoms. Conclusion: Ultrasound-guided alcohol injection could be an alternative therapeutic option before surgery in patients with chronic intractable malleolar and olecranon synovial proliferative bursitis. [ABSTRACT FROM AUTHOR]

Background: Olecranon bursitis might be a minor problem in the outpatient clinic but relatively be common to occur. However, there are few well-designed studies comparing approaches to treatment.Questions/purposes: (1) Which treatment (compression bandaging with nonsteroidal antiinflammatory drugs [NSAIDs], aspiration, or aspiration with steroid injections) is associated with the highest likelihood of resolution of nonseptic olecranon bursitis? (2) Which treatment is associated with earliest resolution of symptoms? (3) What factors are associated with treatment failure by 4 weeks?Methods: We enrolled 133 patients from two centers; after applying prespecified exclusions (septic bursitis or concomitant inflammatory arthritis, intraarticular elbow pathology, recent aspiration or steroid injection done elsewhere, and refusal to participate), 90 patients were randomly allocated to receive compression bandaging with NSAIDs (C), aspiration (A), or aspiration with steroid injection (AS) groups (30 patients in each). The groups were similar at baseline in terms of age and gender. Seven patients (four from Group A and three from Group AS) were lost to followup. All patients were followed up weekly for 4 weeks, and the same treatment procedure was repeated if the bursitis recurred with any substantial fluid collection. At 4 weeks, the state of resolution and pain visual analog scale (VAS) were evaluated. Failed resolution was defined as presence of persistent olecranon bursal fluid collection at Week 4 after the initiation of the treatment; on the contrary, if bursal fluid collection was clinically reduced or completely disappeared by the end of Week 4, the treatment was considered successful. We compared the proportion of resolution by Week 4 and the median times to resolution among the treatment groups. In addition, we evaluated whether the resolution affected pain VAS and what factors were associated with the resolution.Results: There were no differences in the proportion of patients whose bursitis resolved by Week 4 among the three treatment groups (Group C: 25 of 30 [83%], relative risk of resolution failure: 0.68 [95% confidence interval {CI}, 0.27-1.72], p = 0.580; Group A: 17 of 26 [65%], relative risk of resolution failure: 2.19 [95% CI, 0.98-4.87], p = 0.083; Group AS: 23 of 27 [85%], relative risk of resolution failure: 0.59 [95% CI, 0.22-1.63], p = 0.398) (p = 0.073). Steroid injection after aspiration (Group AS) was associated with the earliest resolution (2.3 weeks [range, 1-4 weeks]) when compared with aspiration alone (Group A; 3.1 weeks [range, 2-4 weeks]) and compression bandaging with NSAIDs (Group C; 3.2 weeks [range, 2-4 weeks]), p = 0.015). Longer duration of symptoms before treatment was the only factor associated with treatment failure by 4 weeks (failed resolution: 6 weeks [range, 2-9 weeks]; successful resolution: 4 weeks [range, 0.4-6 weeks]; p = 0.008).Conclusions: With the numbers available, there were no differences in efficacy when compression bandaging with NSAIDs, aspiration, and aspiration with steroid injection were compared. However, we were powered only to detect a 30% difference, meaning that if there were a smaller difference in efficacy among the groups, we might not have detected it in a study of this size. Our data can be used as pilot data to power future prospective (and likely multicenter) trials. Because olecranon bursitis can recur, and because treatments like aspiration and aspiration with steroid injection can cause complications, unless future trials demonstrate clear efficacy advantages of aspiration and/or injection both at short and longer terms, we suggest that compression bandaging and a short course of NSAIDs may offer the most appropriate balance of safety and efficacy.Level Of Evidence: Level II, therapeutic study. [ABSTRACT FROM AUTHOR]

A 31-yr-old soldier presented with an 8-mo history of right prepatellar bursitis with 1-mo history of pain and loss of range of motion. His symptoms did not respond to activity modification, compression, nonsteroidal anti-inflammatory agents, or repeated aspirations with fenestration. After thorough discussion, the soldier and his provider reviewed the literature and found a single case report of intrabursal sclerotherapy in two patients with recalcitrant prepatellar bursitis. After informed consent, the patient wished to proceed with the scelerotherapy. Utilizing ultrasound guidance, the bursal sac was aspirated then injected with the scerlosing agent polidocanol. The patient had a much slower reaccumulation of swelling and at the two week follow-up the procedure was repeated. The patient has had no reaccumulation of the fluid as of 10 mo post-procedure and has resumed all his normal activities with no symptom limitation. This case demonstrates that sclerotherapy has utility in the management of recurrent non-septic prepatellar bursitis. [ABSTRACT FROM AUTHOR]

Calcific bursitis most commonly affects the subacromial and trochanteric bursae. Patients most often present at the hospital because of increased pain at night and when performing overhead activities. A physical examination of the shoulder typically reveals restriction in abduction and internal rotation. Pain is usually observed during the resorption phase of the deposit. Chronic pain is also related to the inflammatory process caused by calcification. Calcified lesions in a bursa or tendon are not always visible on an X-ray, and may not be apparent among physical examination findings. Small and scattered deposits can often be detected on an X-ray; however, a calcific slurry mass in the subacromial-subdeltoid bursa can be found more reliably with ultrasonography (US) than with plain film. Pain is often resistant to steroid injections. In symptomatic patients, US-guided fragmentation of the lesion with a needle, using a local anesthetic, saline lavage, and a steroid injection, can often achieve complete healing in a very short period of time. Presently described is successful treatment of a calcified lesion located in the subdeltoid bursa achieved by performing lavage, splitting the calcified lesion, and administering a steroid injection. [ABSTRACT FROM AUTHOR]

Over the years, a wide range of image-guided interventional therapies have been used in treating different elbow pathologies, many of which are predominantly based on anecdotal and low-level study findings. This article critically assesses the existing literature and discusses the efficacy of the most commonly utilized interventional procedures for elbow pathology. [ABSTRACT FROM AUTHOR]

Ultrasound is an established modality for shoulder evaluation, being accurate, low cost and radiation free. Different pathological conditions can be diagnosed using ultrasound and can be treated using ultrasound guidance, such as degenerative, traumatic or inflammatory diseases. Subacromial-subdeltoid bursitis is the most common finding on ultrasound evaluation for painful shoulder. Therapeutic injections of corticosteroids are helpful to reduce inflammation and pain. Calcific tendinopathy of rotator cuff affects up to 20% of painful shoulders. Ultrasound-guided treatment may be performed with both single- and double-needle approach. Calcific enthesopathy, a peculiar form of degenerative tendinopathy, is a common and mostly asymptomatic ultrasound finding; dry needling has been proposed in symptomatic patients. An alternative is represented by autologous platelet-rich plasma injections. Intra-articular injections of the shoulder can be performed in the treatment of a variety of inflammatory and degenerative diseases with corticosteroids or hyaluronic acid respectively. Steroid injections around the long head of the biceps brachii tendon are indicated in patients with biceps tendinopathy, reducing pain and humeral tenderness. The most common indication for acromion-clavicular joint injection is degenerative osteoarthritis, with ultrasound representing a useful tool in localizing the joint space and properly injecting various types of drugs (steroids, lidocaine or hyaluronic acid). Suprascapular nerve block is an approved treatment for chronic shoulder pain non-responsive to conventional treatments as well as candidate patients for shoulder arthroscopy. This review provides an overview of these different ultrasonography-guided procedures that can be performed around the shoulder. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the current status of scientific research on the natural history of frozen shoulder as published in the literature.Materials and Methods: This systematic review was carried out on PubMed data and was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Articles had to meet inclusion criteria. The quality of the papers was assessed using a newly developed tool, AMQPP (Assessing the Methodological Quality of Published Papers). The AMQPP score was correlated with the level of evidence rating according to the Oxford Centre for Evidence-Based Medicine. Suitable papers were divided into groups according to the shoulder condition on which they reported. This article focuses on the frozen shoulder.Results: Seven articles on frozen shoulder met the inclusion criteria. One article was considered to have level 1 of evidence. Three articles had level 3 and the remaining 3 had level 4. Three papers assessed the natural history and the natural course of different forms of stiff shoulder. The others indirectly assessed the natural history by evaluating therapy trends. None of the articles clearly referred to the role of regression to the mean of frozen shoulder specifically.Conclusion: Spontaneous recovery to normal levels of function is possible and standardised non-operative treatment programmes are an effective alternative to surgery in most cases. However, patients with high risk factors such as diabetes mellitus, and those who suffer chronic symptoms or bilaterally affected, would benefit from early surgery. We also concluded that AMQPP score is simple and straight forward. It works as a quick quality-checking tool which helps researchers to identify the key points in each paper and reach a decision regarding the eligibility of the paper more easily. The AMQPP score is still open for further development. [ABSTRACT FROM AUTHOR]

The article presents case studies of noniatrogenic septic bursitis. A 32-year-old male basketball player presented with left elbow swelling and redness, who was diagnosed with septic olecranon bursitis and cellulitis, and was given intravenous (IV) ceftriaxone and IV vancomycin. A 43-year-old man presented with right posterior elbow pain, where plain radiography showed only soft tissue swelling on the elbow's posterior aspect without bony abnormality.

Introduction: Adhesive capsulitis, also called frozen shoulder, affects about 3-5% of the population, especially in the age group 40 to 60 years, affecting more women and having an insidious onset. Objective: Analyze the isolated effect of joint manipulation by Maitland method in treating patients with adhesive capsulitis of the shoulder, the level of pain, range of motions of the shoulder and functional capacity. Method: It is about a cases studies in which four volunteers underwent protocol Maitland to shoulder for 15 sessions. The evaluation instruments used were the Visual Analog Scale, Goniometer and Shoulder Pain and Disability Index to measure the level of disability of the shoulder. Results: There was decreased pain from 55.5 to 80.0%, increased all range of motions, especially flexion of the shoulder, with more than 100% gains in the four cases investigated and improved functional capacity between 27.9 -- 91.9%. Conclusion: These results suggest that the therapy had improved outcomes assessed, as clinically relevant contribution, but indicate the need to develop more studies to prove the effectiveness of the method isolated. [ABSTRACT FROM AUTHOR]

Introduction: Subacromial bursitis is caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon from the overlying coraco-acromial ligament and acromion. While multiple cytokines are implicated, interleukin-1 beta appears to play a prominent role. Rilonacept, an interleukin-1 trap, may be an alternative to corticosteroid injection for the management of this condition.Methods: This single center, randomized, non-inferiority, unblinded study recruited 33 subjects over 9 months. Twenty subjects received 160mg intrabursal injection of rilonacept and 13 received a 6mL mixture of lidocaine, bupivacaine, and 80mg triamcinolone acetonide. QuickDASH, subject reported pain, and adverse events were recorded at time of injection, 2 days later, 2 weeks later, and 4 weeks later. Primary outcome was improvement in QuickDASH 4 weeks post-injection. Secondary outcomes were improvement in subject reported pain and occurrence of adverse events at 4 weeks.Results: Both study groups were equally matched for age, gender, ethnicity, and site of bursa injection. Both medications demonstrated a statistically significant improvement in QuickDASH 4 weeks post-injection, but triamcinolone acetonide injection offered greater improvement (P=0.004). Both medications demonstrated improvement in subject reported pain but between group comparison at 4 weeks showed that triamcinolone was superior (P=0.044). No statistically significant differences in adverse events were noted between groups, but subjects who received rilonacept experienced more episodes of diarrhea and headache.Conclusions: While improvement in QuickDASH and pain was noted with a single intrabursal injection of rilonacept at 4 weeks, injection with triamcinolone acetonide was more efficacious. This trial was registered with www.clinicaltrials.gov (NCT01830699). [ABSTRACT FROM AUTHOR]

Revaxis ® is a vaccine against diphtheria, tetanus and poliomyelitis (dT-IPV). This vaccine should not be administered by the intradermal or intravenous route. Poor injection techniques and related consequences are rare. We report a case of bursitis associated with reactive glenohumeral effusion complicated by bone erosion occurring after injection of the dT-IPV vaccine. A 26 year old patient was admitted for painful left shoulder causing functional impairment. Control magnetic resonance imaging showed bone oedema on the upper outer part of the humeral head, with a slight cortical irregularity, indicating that the vaccine was injected in contact with the bone at this location, causing erosion. Outcome was favourable after intra-articular corticosteroids. Reports of articular or periarticular injury after vaccination are extremely rare, in view of the substantial number of vaccines administered every year. The potential complications of vaccination are well known to general practitioners but under-reported in the literature. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to show that endoscopic surgery is a simple and acceptable method for various problems associated with wounds, range of motion and that such surgery ensures an early return to work after treatment of nonresponding nonseptic bursitis. Methods: Thirty-two patients with nonseptic bursitis caused by repeated minor trauma that did not respond to medical treatment from 2008 to 2012 were included in this study. Radiographic [anteroposterior and lateral], ultrasound, macro and microscopic analyses of drainage liquid and aerobic and anaerobic cultures were obtained from the patients for the diagnosis. Results: The mean age was 40.8 years. Fifteen patients had prepatellar bursitis, 13 had olecranon bursitis and 4 had ankle bursitis. Two patients had a history of falling on their knee. The other patients had a history of repetitive stimulation. The mean follow up period was 2.6 years [range. 2-5 years] and no medical complications occurred after the endoscopic surgery; such as scarring, loss of sensation and infection. One recurrence in response to medical treatment was observed. Conclusion: Endoscopic bursectomy is a short and acceptable procedure with excellent results in terms of returning to work early and minimal wound related problems. [ABSTRACT FROM AUTHOR]

Static progressive stretch (SPS) devices are used to restore shoulder functional mobility in patients with adhesive capsulitis. The purpose of this prospective, randomized, blinded, controlled, clinical study was to compare traditional physical therapy alone with a combination of traditional physical therapy and SPS device use in the treatment of shoulder adhesive capsulitis. Sixty patients diagnosed with shoulder adhesive capsulitis were randomly assigned to either the control group ( n = 30) or experimental group ( n = 30). Both groups received three physical therapy sessions per week for 4 weeks, while the experimental group used in addition a SPS device for 4 weeks. Shoulder active and passive abduction, and passive external rotation range of motion (ROM) degrees, Disabilities of the Arm, Shoulder and Hand (DASH) scores, and visual analog scale (VAS) pain scores were recorded for all patients at baseline, and at 4, 12, 24, 52 and 104 weeks later. At 104 weeks from baseline, statistical analysis demonstrated that traditional physical therapy and the SPS device resulted in significantly increased mean shoulder active and passive abduction, and passive external rotation ROM degrees, and reduced mean DASH scores compared to traditional physical therapy alone ( p < 0.001). Although the mean VAS scores were markedly reduced in both groups, the difference between the two was not significant ( p > 0.05). At 104 weeks, the mean shoulder active abduction remained increased by 111°, passive abduction by 79° and passive external rotation by 66°, the mean DASH scores remained decreased by 97% and VAS pain scores by 71% in the experimental group compared to 33°, 49° and 28°, 50% and 63%, respectively, in the control group. In conclusion, this study showed lasting favorable effects of the SPS device used with traditional physical therapy in treating subjects with shoulder adhesive capsulitis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether the imaging features of the retrocalcaneal recess normalize on a conventional radiograph after surgery for retrocalcaneal bursitis and evaluate whether it can be reused if complaints reoccur. Methods: Patients who underwent an endoscopic calcaneoplasty at least 2 years before were eligible for inclusion. A lateral conventional radiograph of the surgically treated hindfoot was made to assess the retrocalcaneal recess and pre-Achilles fat pad; images were analysed, clinical complaints were registered and evaluated. Radiographs were evaluated by two experienced observers (one orthopaedic surgeon one musculoskeletal specialized radiologist), these scored the images either as 'normal' (no obliteration of retrocalcaneal recess and pre-Achilles fat) or as 'abnormal'. Results: Thirty patients (34 heels: 28 asymptomatic and 6 recurrent complaints) were included in this study. Observer one rated 12 images as 'normal' (2 symptomatic heels and 10 asymptomatic), 22 'abnormal'. Observer two rated 9 'normal' (1 symptomatic heels and 8 asymptomatic), 25 'abnormal'. No correlation between the radiographic appearance and complaints (n.s.) was found. Cohen's kappa for interobserver agreement was low (0.11 n.s.). Conclusion: The appearance of the retrocalcaneal recess on a lateral radiograph cannot be used as a reliable diagnostic criterion for retrocalcaneal bursitis in patients who previously underwent endoscopic calcaneoplasty. This study clinical relevance is based upon the conclusion that a lateral radiograph cannot be used after endoscopic calcaneoplasty, whereas previous work reported the diagnostic value of a lateral radiograph for retrocalcaneal bursitis prior to surgery. Level of evidence: III. [ABSTRACT FROM AUTHOR]

This report describes the diagnosis and treatment of synovial sepsis of the infraspinatus and intertubercular (bicipital) bursae. The origin of infection was considered to be haematogenous spread from an ipsilateral foot abscess. The horse responded well to treatment and returned to full athletic function. [ABSTRACT FROM AUTHOR]

The article presents information on a study conducted to determine the effectiveness of a traditional Japanese herbal medicine, Nijutsuto, for the treatment of frozen shoulder in patients who did not respond to Western medical treatment. In the study, patients suffering from long-term frozen shoulder refractory to Western medical treatment were given Nijutsuto. The study concluded that Nijutsuto combined with an exercise program reduced pain in patients with long-term frozen shoulder.

Background: There is accumulating evidence for the effectiveness of extracorporeal shock wave therapy (ESWT) when treating lower limb tendinopathies including greater trochanteric pain syndrome (GTPS), patellar tendinopathy (PT), and Achilles tendinopathy (AT). Purpose: To evaluate the effectiveness of ESWT for lower limb tendinopathies. Study Design: Systematic review and meta-analysis. Methods: PubMed (Medline), Embase, Web of Knowledge, Cochrane, and CINAHL were searched from inception to February 2013 for studies of any design investigating the effectiveness of ESWT in GTPS, PT, and AT. Citation tracking was performed using PubMed and Google Scholar. Animal and non-English language studies were excluded. A quality assessment was performed by 2 independent reviewers, and effect size calculations were computed when sufficient data were provided. Results: A total of 20 studies were identified, with 13 providing sufficient data to compute effect size calculations. The energy level, number of impulses, number of sessions, and use of a local anesthetic varied between studies. Additionally, current evidence is limited by low participant numbers and a number of methodological weaknesses including inadequate randomization. Moderate evidence indicates that ESWT is more effective than home training and corticosteroid injection in the short (\12 months) and long (.12 months) term for GTPS. Limited evidence indicates that ESWT is more effective than alternative nonoperative treatments including nonsteroidal anti-inflammatory drugs, physical therapy, and an exercise program and equal to patellar tenotomy surgery in the long term for PT. Moderate evidence indicates that ESWT is more effective than eccentric loading for insertional AT and equal to eccentric loading for midportion AT in the short term. Additionally, there is moderate evidence that combining ESWT and eccentric loading in midportion AT may produce superior outcomes to eccentric loading alone. Conclusion: Extracorporeal shock wave therapy is an effective intervention and should be considered for GTPS, PT, and AT particularly when other nonoperative treatments have failed. [ABSTRACT FROM AUTHOR]

The article presents author's views regarding study conducted on using activity and structural-oriented treatment approach for frozen shoulder. Topics include frozen shoulder is pathological and morphological changes in the capsule of either inflammatory or fibrosing origin; freezing, frozen, and thawing of range of motion (ROM); and lack of differentiation between primary and secondary frozen shoulder in the inclusion and exclusion criteria.

The article presents a study on snapping scapula syndrome and scapulothoracic bursitis. Topics covered include superomedial angle resection, partial scapulectomy, and crepitus. Also mentioned are the anatomic characteristics of the periscapular musculature. Also mentioned are scapulothoracic articulation, the potential soft tissue causes of scapular snapping, and the use of magnetic resonance imaging (MRI).