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

Les bursites septiques, relativement fréquentes, représentent un tiers des bursites inflammatoires et sont souvent liées aux activités professionnelles. Leur prise en charge est hétérogène, ambulatoire ou hospitalière, et aucune recommandation n'est disponible à ce jour. Cet article propose des recommandations de prise en charge des bursites septiques élaborées par 18 rhumatologues du groupe de travail de la Société française de rhumatologie sur les infections ostéoarticulaires, un infectiologue, deux chirurgiens orthopédistes, un médecin généraliste et un médecin urgentiste. En s'appuyant sur une revue de la littérature et les avis d'expert, le groupe de travail a élaboré trois principes généraux et 11 recommandations de prise en charge des bursites septiques olécraniennes et prépatellaires, selon la méthodologie de la Haute Autorité de santé. Destinées aux médecins rhumatologues, généralistes, urgentistes et orthopédistes, ces recommandations mettent l'accent sur la place des examens d'imagerie et la ponction de bourse dans les deux modalités de prise en charge ambulatoire et hospitalière. Des options d'antibiothérapie (molécules et durées) sont proposées pour les deux contextes de prise en charge. Enfin, des recommandations spécifiques sont consacrées aux indications chirurgicales, aux thérapies non pharmacologiques et à la prévention. Septic bursitis (SB) is a common condition accounting for one third of all cases of inflammatory bursitis. It is often related to professional activities. Management is heterogeneous and either ambulatory or hospital-based, with no recommendations available. This article presents recommendations for managing patients with septic bursitis gathered by 18 rheumatologists from the French Society for Rheumatology work group on bone and joint infections, 1 infectious diseases specialist, 2 orthopedic surgeons, 1 general practitioner and 1 emergency physician. This group used a literature review and expert opinions to establish 3 general principles and 11 recommendations for managing olecranon and prepatellar SB. The French Health authority (Haute Autorité de santé [HAS]) methodology was used for these recommendations. Designed for rheumatologists, general practitioners, emergency physicians and orthopedic surgeons, they focus on the use of biological tests and imaging in both outpatient and inpatient management. Antibiotic treatment options (drugs and duration) are proposed for both treatment modalities. Finally, surgical indications, non-drug treatments and prevention are covered by specific recommendations. [ABSTRACT FROM AUTHOR]

Background: Evidence is lacking for the efficacy of shockwave therapy (SWT) in the treatment of greater trochanteric pain syndrome (GTPS). Aim: To investigate the efficacy of SWT on pain and function in the management of GTPS. Methods: A systematic search of electronic databases and grey literature was conducted up to May 2023. Studies utilising SWT on adults for GTPS, providing measures of pain and/or function at baseline and at follow‐up were considered for inclusion. Meta‐analysis was undertaken using converted pain and functional outcomes. Studies were assessed for quality and risk of bias, and assigned a level of evidence as per the Grading of Recommendations, Assessment, Development and Evaluations criteria. Results: Twelve articles (n = 1121 subjects) were included, including five randomised controlled trials (RCTs) and seven non‐RCTs. No statistical differences were observed for pain over time f(1,5) = 1.349 (p = 0.298) or between SWT and control f(1,5) = 1.782 (p = 0.238). No significant differences in functional outcomes in short‐ (H = 2.591, p = 0.181) and medium‐term follow‐up (H = 0.189, p = 0.664) were identified between SWT and control. Moderate magnitude treatment effects for pain (Hedges‐G [HG] 0.71) favouring SWT groups over control was identified, decreasing to low for function (HG 0.20). Further pain and functional treatment effects were identified at higher magnitudes across follow‐up time‐points in SWT groups compared to control. Conclusion: Moderate‐quality evidence demonstrated no statistically significant improvements in pain and function post‐SWT compared to control. Low‐quality evidence established clinical improvements throughout all included studies favouring SWT over control. Consequently, owing to relatively low incidence of side effects, SWT should be considered a viable option for the management of GTPS. Issues with both clinical and statistical heterogeneity of studies and during meta‐analysis require consideration, and more robust RCTs are recommended if the efficacy of SWT for the management of GTPS is to be comprehensively determined. [ABSTRACT FROM AUTHOR]

This document provides a summary of a study that examined the relationship between balance and various factors in patients with adhesive capsulitis (AC), also known as frozen shoulder. The study used questionnaires and tests to assess pain levels, functional capacity, depression levels, and upper extremity function in the participants. The results showed that balance was negatively affected by increases in pain and depression levels. Additionally, resting pain intensity and functional capacity were found to be predictors of balance. The study suggests that these factors should be considered when developing evaluation and rehabilitation programs for individuals with AC. [Extracted from the article]

Introduction: The anatomy of the forefoot is complex, and the sonographic assessment to image the plantar digital nerves and exclude, diagnose or discriminate between a Morton's neuroma and intermetatarsal bursitis can be challenging. Topic description and discussion: A good appreciation of the sonographic anatomy, technique, normal and abnormal appearances is required to undertake a sonographic assessment of the forefoot and its interspaces, particularly the plantar digital nerves. This is unpacked in this paper with associated pictorial aids. Muscles, tendons, and ligaments of the interspaces and the nearby metatarsophalangeal joints and their associated soft-tissue structures are helpful sonographic landmarks to guide imaging and assessment of the common and proper plantar digital nerves and the intermetatarsal bursa. These need to be appreciated from both dorsal and plantar sonographic approaches, in both short- and long-axis imaging planes. Conclusion: Improved understanding of the anatomy and sonographic appearances of the interspace structures can enhance the sonographic assessment of the forefoot and improve diagnosis of a Morton's neuroma and/or intermetatarsal bursitis when present to guide patient management. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is one of the fastest-growing health challenges of the twenty-first century with multifactorial impact including high rates of morbidity and mortality as well as increased healthcare costs. It is associated with musculoskeletal complications, with frozen shoulder being commonly reported. While low-level laser therapy (LLLT) and muscle energy technique (MET) are commonly used to manage this condition, there remains a lack of agreement on the most effective approach, with limited research available on their comparative efficacy. Objectives: To evaluate the comparative effectiveness of LLLT versus MET among diabetic patients with frozen shoulder. Methods: This is a single-centre, prospective, single-blind, randomised controlled trial with three parallel groups to be conducted at Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria. Sixty diabetic patients with frozen shoulder will be randomly assigned into LLLT group, MET group, or control group in a 1:1:1 ratio. All the groups will receive treatment three times weekly for 8 weeks. The primary outcome will be shoulder function and the secondary outcomes will include pain intensity, shoulder ROM, interleukin-6 (IL-6), depression, anxiety, and quality of life (QoL). All outcomes will be assessed at baseline, at post 8-week intervention, and at 3 months follow-up. Discussion: This will be the first randomised controlled trial to evaluate the comparative effectiveness of LLLT versus MET on both clinical and psychological parameters among diabetic patients with frozen shoulder. The findings of the study may provide evidence on the efficacy of these interventions and most likely, the optimal treatment approach for frozen shoulder related to diabetes, which may guide clinical practice. Trial Registration: Pan African Clinical Trials Registry (PACTR202208562111554). Registered on August 10, 2022. [ABSTRACT FROM AUTHOR]

Introduction: Pes anserine bursitis (PAB) is a painful status inside the knee that may interfere with functional activities. Extracorporeal shockwave therapy (ESWT) may treat this disorder. Objective: Comparing the effects of low- versus middle-energy ESWT on pain and functional activity in patients with sub-acute PAB. Materials and Methods The study was a single-blind randomized trial. Twenty-eight patients with sub-acute PAB were randomly divided into two groups and received either low or middle-energy ESWT for three weeks. The numeric pain rating scale (NPRS), short-form McGill pain questionnaire (SF-MPQ), timed up and go (TUG) test, and Western Ontario and McMaster universities index (WOMAC) were evaluated before and 2 and 3 weeks after the intervention. Results: A significant improvement was observed for low-energy ESWT in terms of NPRS (P=0.001), SF-MPQ (P<0.001), WOMAC (P<0.001), and TUG (P<0.001) 3 weeks after the intervention. Also, a significant improvement was observed following middle-energy ESWT application on NPRS (P=0.003), SF-MPQ (P<0.001), WOMAC (P<0.001), and TUG (P<0.001) 3 weeks after the intervention. A similar trend was observed between study time points and for all variables in each group. The only exception was the TUG, which showed no improvement between 2 and 3 weeks after the intervention for each study group. A significant improvement was observed in the NPRS between the two groups after 2 weeks (P=0.001) and 3 weeks (P=0.006), both favoring the middle-energy ESWT application. Conclusion: Low- and middle-energy ESWT can effectively improve pain, functional activity, and mobility in patients with PAB. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness of extracorporeal shockwave therapy (ESWT) on pain, range of motion (ROM) and disability on adhesive capsulitis (AC) in patients with type 2 diabetes mellitus (DM). Method: Clinical trials assessing the effectiveness of extracorporeal shockwave therapy on adhesive capsulitis in diabetes mellitus patients were included. Academic databases of Pubmed, Scopus, Web of Science, Cochrane Library, Science Direct, PEDro and grey literature sources such as Clinical trials.gov and Google Scholar were searched from the year 2000 to 2021.Physiotherapy Evidence Database (PEDro) scale was used to determine overall quality of each included article. Result: The search yielded eight studies evaluating the effectiveness of ESWT plus shoulder exercises and mobilization on AC in type 2 DM patient population. Compared to control treatment groups in majority of included studies ESWT appeared to be effective in managing pain, ROM and disability and showed large to very large treatment effects. Two of included studies reported positive effects of ESWT on inflammatory markers and blood glucose levels. Conclusion: Findings from this review suggested that ESWT combined with shoulder exercises and mobilization may be a useful treatment modality in shoulder AC for type 2 DM patients for pain reduction, disability and ROM improvement. There was insufficient data to confirm the findings of ESWT on blood glucose and inflammatory markers in diabetic patients. Therefore, future studies are needed to evaluate its effectiveness on these outcomes. Trial registration number: #CRD4202127949. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the therapeutic effect of combining ultrasound-guided hydrodilatation with hyaluronic acid and physical therapy compared with physical therapy alone in patients with adhesive capsulitis. Design: A prospective, single-blinded, randomised controlled trial. Setting: Single medical centre. Participants: Patients with adhesive capsulitis (N = 62) were divided into group A: ultrasound-guided hydrodilatation with hyaluronic acid + physical therapy (N = 31) and group B: physical therapy alone (N = 31). Interventions: Group A received three doses of ultrasound-guided hydrodilatation with hyaluronic acid-based injectates (20 mL in total). Both groups underwent structured physical therapy. Outcome measures: The primary outcome measure was Constant score, while secondary outcomes included Shoulder Pain and Disability Index score, numerical rating scale (at rest, night, and during motion), 36-item Short Form Health Survey, and range of motion of the shoulder. All measurements were collected at baseline, 6 weeks, and 12 weeks post-injection. Results: At week 12, the Constant scores were 68.29 ± 14.55 and 62.77 ± 14.44 for groups A and B, respectively. There was a greater reduction in the Constant score, Shoulder Pain and Disability Index, and numerical rating scale between the baseline and 6 weeks and between the baseline and 12 weeks in group A (Constant score: p < 0.05, Shoulder Pain and Disability Index: p < 0.01, and numerical rating scale: p < 0.05). Conclusion: The combination of ultrasound-guided hydrodilatation with hyaluronic acid in conjunction with physical therapy provides additional benefits compared to physical therapy alone for the treatment of adhesive capsulitis at up to 12 weeks. Trial registration: ClinicalTrials.gov: NCT02708706. [ABSTRACT FROM AUTHOR]

Platelet rich plasma (PRP) injections have been utilized in an attempt to provide improved pain and functional outcomes to patients with a variety of orthopaedic ailments. Adhesive capsulitis, also known as frozen shoulder is a common debilitating condition that carries significant morbidity due to the painful and prolonged course. Various studies have investigated intra-articular PRP administration with different methodologies and outcomes. We sought to perform a meta-analysis on outcomes of adhesive capsulitis after PRP injection, determine effectiveness compared to corticosteroid, and compare adverse events. Meta analysis. EMBASE, EBSCO, Pubmed and Google Scholar were used to extract titles and abstracts using keywords "adhesive capsulitis", "frozen shoulder", "PRP", "platelet rich plasma". 41 articles were found and after duplicates removed and full-text review, 7 studies investigating 385 patients undergoing PRP or corticosteroid injections were found. Age, gender, body mass index (BMI), and ASA scores were obtained. Patient reported outcomes (PROs) were obtained and all reported range of motion (ROM) were recorded and compared after PRP and steroid injections using random effects meta-regression pre-injection and post-injection. Both intra-articular PRP and steroid injections resulted in improved outcomes for treatment of adhesive capsulitis at 3 months. PRP injections had significantly better range of motion in passive forward flexion (151° vs 144.1°, p = 0.024) and had improved Shoulder Pain and Disability Index (SPADI) scores (14.6° vs 18.6°, p = 0.009) compared to steroid, however these may not reach minimum clinical thresholds. PRP had significantly better active (60° vs 43. 5°, p = 0.038) and passive internal rotation (69.6° vs 52.7°, p = 0.017) compared to steroid which did reach minimum clinical thresholds. There were no differences detected between VAS pain, active forward flexion, extension, abduction, external rotation nor difference in adverse events. Both injections decreased pain and improved range of motion in patients. Intra-articular PRP injections may result in improved internal rotation compared to corticosteroid. Improvement in SPADI and passive forward flexion may be statistically significantly but may not be clinically relevant. 3, Therapeutic. [ABSTRACT FROM AUTHOR]

Introduction: Adhesive Capsulitis is a common condition of the shoulder with significant morbidity and protracted disease. It is usually characterized by sudden onset with progressive symptoms of pain and loss of function. This systematic review compares platelet rich plasma (PRP) intra-articular injections with corticosteroids (CS) injections and physiotherapy. Material and methods: A literature search was performed using online databases (Pubmed, Cochrane, EMBASE, Medline and CINAHL) including all the studies performed on humans through April 2023. Prospective comparative studies were included in this review of patients with adhesive capsulitis assessing the use of PRP injections versus corticosteroid injections or physiotherapy. The standardized mean difference (SMD) with 95 % confidence interval in VAS/DASH/SPADI and ROM scores was calculated using a random effects model, comparing PRP to corticosteroids injections and physiotherapy across studies. Results: A total of 11 studies and 971 patients, with a mean age of 52.1, were included in this analysis with 7 being randomised trials and four cohort studies. The control group was corticosteroid injections in 8 studies and physiotherapy in the other three studies. Overall PRP lead to a statistically significant improved outcome at 3 and 6 months follow up for all outcome parameters. The outcome measures at three months includes VAS 0.73 (0.31, 1.16) SMD, DASH 0.66 (0.36, 0.96) SMD, SPADI 1.50 (0.43, 2.57) SMD, ER 1.47 (0.27, 2.66) SMD and Abduction 1.10 (0.21, 1.98) SMD. Six months assessment similarly favoured PRP with VAS 3.17 (1.26, 5.08) SMD and DASH 2.10 (1.66, 2.55) SMD scores. Furthermore, a subgroup analysis demonstrated that PRP was favourable to corticosteroids as control with significant improvement in pain (VAS) at 3 months 0.65 (0.29, 1.00) and 6 months 3.17 (1.26, 5.08) SMD. Conclusion: This review demonstrated that intra-articular PRP injections for adhesive capsulitis produces favourable outcomes when compared to corticosteroid injections and physiotherapy. PRP produces improved pain and functional scores as well as range of motion, which is statistically significant from 3 to 6 months post intervention. PRP seems to be a safe and effective alternative non-invasive treatment modality for patients with adhesive capsulitis. [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis is an inflammatory condition that causes discomfort and stiffness in the shoulder which has a prevalence of 2% to 5%. Hence this research work is done to check the efficacy of Maitland mobilization technique versus Exercise with therapeutic ultrasound in adhesive capsulitis. Purpose: To find out the effects of Maitland mobilization technique & exercise with therapeutic ultrasound in adhesive capsulitis. Materials and Methods: Total of 28 participants were selected from Vijay physiotherapy clinic and divided into two groups. Group A was allocated with 14 participants and managed with Maitland mobilization technique and ultrasound. Group B 14 participants were managed with exercises and ultrasound for 4 weeks. The participant's intervention effects were assessed using VAS, SPADI Scale and Range of motion Study Period: November 2022 to July 2023. Result: This study results showed a significant (p value 0.0001) reduction in pain and improvement in shoulder disability values and ROM of adhesive capsulitis participants in group A (Maitland mobilization technique and Ultrasound) compared with group B (Exercise and Ultrasound). Conclusion: This study found that the Maitland Mobilization technique as well as Exercise both seems to be effective in treating adhesive capsulitis. But the patients in Maitland Group show greater improvement than the exercise group. [ABSTRACT FROM AUTHOR]

Background: Adhesive Capsulitis in the shoulder characterized as a self-limiting situation that lasts only while it has also been described as a 24 week long-term impairment caused by a chronic condition. SMET is a widely used method to restore normal ROM and reduce pain. PNF aims to improve joint synchronization, movement control, and mobility. Purpose: This study focuses on the effect of Spencer Muscle Energy Technique and Proprioceptive Neuromuscular Facilitation for reducing pain and disability in Adhesive Capsulitis. Materials and Methods: A total of 40 participants were selected based on inclusion and exclusion criteria from Eyan Healthcare Foundation during the period of November 2022 to July 2023. They were split into two groups, with 20 Participants receiving Spencer Muscle Energy Technique and 20 Participants receiving Proprioceptive Neuromuscular Facilitation. Subjects with age of 40-70 years, with or without diabetes and pain or stiffness on shoulder were included and Subjects with recent trauma, injury around the shoulder were excluded in the study. All the subjects underwent pre-test measurement with Shoulder Pain and Disability Index (SPADI) and the same repeated for post-test measurement at the end of 4 weeks. Results: By statistical analysis there is a significant difference between the two groups. The Spencer group displays a greater difference than the PNF group when comparing mean differences of the two groups using SPADI. Conclusion: The study concluded that subjects who underwent Spencer Muscle Energy Technique are found to be more effective in reducing pain and disability than Proprioceptive Neuromuscular Facilitation in Adhesive Capsulitis. [ABSTRACT FROM AUTHOR]

Adhesive capsulitis (AC) affects approximately 1% of the general population. Current research lacks clear guidance on the dosage of manual therapy and exercise interventions. The purpose of this systematic review was to assess the effectiveness of manual therapy and exercise in the management of AC, with a secondary aim of describing the available literature present on the dosage of interventions. Eligible studies were randomized clinical/quasi-experimental trials with complete data analysis and no limits on date of publication, published in English, recruited participants >18 years of age with primary adhesive capsulitis, that had at least two groups with one group receiving manual therapy (MT) alone, exercise alone, or MT and exercise, that included at least one outcome measure of pain, disability, or external rotation range of motion, and that had dosage of visits clearly defined. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias 2 Tool. The Grading of Recommendations Assessment, Development, and Evaluation was used to provide an overall assessment of the quality of evidence. Meta-analyses were conducted when possible, and dosage was discussed in narrative form. Sixteen studies were included. All meta-analyses revealed non-significant effects of pain, disability, and external rotation range of motion at short- and long-term follow-up, with an overall level of evidence ranging from very low to low. Non-significant findings with low-to-very-low-quality of evidence were found across meta-analyses, preventing seamless transition of research evidence to clinical practice. Lack of consistency in study designs, manual therapy techniques, dosing parameters, and duration of care impedes the ability to make strong recommendations regarding optimal dosage of physical therapy for individuals with AC. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether combination of corticosteroid subdeltoid injections and physiotherapy was more effective than either treatment alone in chronic subacromial bursitis. Design: Prospective, three-arm randomised controlled trial. Setting: Rehabilitation department of an academic hospital. Subjects: Patients with chronic subacromial bursitis. Interventions: Patients were divided into corticosteroid injection (N = 36), physiotherapy (N = 40) and combined (N = 35) groups. Two corticosteroid subdeltoid injections in corticosteroid group, 8-week physical therapy emphasising on therapeutic exercise in physiotherapy group, and combined both treatments in combined group. Main outcome measures: The primary outcome measures were pain visual analogue scale and Shoulder Pain and Disability Index at 8 weeks after finishing treatment. The secondary outcome measures were active range of motion, Shoulder Disability Questionnaire, Western Ontario Rotator Cuff Index, patient's evaluation of treatment effect, and symptom recurrence. Results: Group comparison showed significant statistical difference in shoulder flexion (P < 0.003) and patient's evaluation of treatment effect (P < 0.001). The time and group interactions comparison revealed significant statistical differences in pain score (P < 0.024), external rotation (P < 0.044) and patient's evaluation of treatment effect (P < 0.001). The above statistics were in favour of the corticosteroid and combined groups rather than physiotherapy group. The percentage of recurrence was 36.1, 7.5 and 17.1 in the corticosteroid, physiotherapy and combined groups, respectively (P < 0.001). Conclusion: Corticosteroid subdeltoid injection, or combined with physiotherapy, was superior to physiotherapy alone, but the recurrence rate was least in the physiotherapy group. [ABSTRACT FROM AUTHOR]

Introduction: Hydrodistension, where a relatively high volume of local anaesthetic, corticosteroid, and sterile saline are injected into the shoulder joint, is a treatment of interest for frozen shoulder. In the UK National Health Service this is typically provided in the hospital setting. In 2017 we introduced hydrodistension into our physiotherapy led musculoskeletal service. This report describes the findings from our audit of onward referral for orthopaedic assessment following the introduction of hydrodistension to our frozen shoulder treatment pathway. Methods: A retrospective audit of data from 102 patients who followed our hydrodistension treatment pathway for frozen shoulder since 2017 was conducted. All 102 patients received at least one hydrodistension procedure performed by a physiotherapist. This involved injecting the glenohumeral joint with a combination of local anaesthetic, corticosteroid, and saline under ultrasound guidance with a total volume of 25–35 mls. This data was compared to the outcomes of 102 patients who presented with frozen shoulder prior to 2017 who did not receive hydrodistension. Results: Of 102 patients who received hydrodistension within the musculoskeletal service, six patients required onward referral to orthopaedics. Of the 102 patients who did not receive hydrodistension prior to 2017, 58 required onward referral to orthopaedics. Conclusion: We report a reduction in onward referral to orthopaedics following the introduction of hydrodistension to our physiotherapist‐led treatment pathway for patients with frozen shoulder. This preliminary data identifies the need to further evaluate the clinical and cost‐effectiveness of hydrodistension performed by physiotherapists for patients with frozen shoulder. [ABSTRACT FROM AUTHOR]

The subacromial/subdeltoid bursa can develop inflammation and effusion related to autoimmune, infectious, and musculoskeletal disorders. Rice bodies, or loose bodies within bursa, have been described as an uncommon complication of bursitis and have been the subject of case studies over a number of years. However, they have not been described in anatomical or physical therapy-related literature. A donor body dissected for a physical therapy anatomy course was found to have an enlarged subacromial/subdeltoid bursa. This bursa, along with the biceps brachii tendon sheath, and the subscapularis muscle bursa, were filled with numerous rice-like bodies. The bursal wall was well developed and thickened. Tissue specimens were obtained of the suspected rice bodies, the subacromial/subdeltoid bursal wall, and the biceps brachii tendon sheath. The tissue was embedded, sectioned, and processed with hematoxylin and eosin or Masson's Trichrome staining for blinded histologic assessment. The tissue samples from within the bursa were identified as tissue similar to that in prior descriptions of rice bodies. Tissue samples from the bursal wall and tendon sheath were identified as similar to synovial membranes. Rice bodies found within the cadaveric body were similar histologically to those described in rheumatology, radiology, and orthopedic literature. Anatomists teaching future health-care providers and practicing physical therapists should be familiar with rice bodies as a potential finding in cadavers, and patients. [ABSTRACT FROM AUTHOR]

Autism spectrum disorder (ASD) is an increasingly common neurodevelopmental disorder associated with impairments in postural control and repetitive patterns of behavior. Here, we describe two cases of adventitial bursitis of the dorsolateral feet in patients with ASD presenting as mass-like lesions. Both patients habitually sat in the W-position and were treated with ultrasound-guided aspirations with immediate relief of symptoms. [ABSTRACT FROM AUTHOR]

Frozen Shoulder (FS) is a painful debilitating condition that is a significant burden to those experiencing it and healthcare systems. Despite research investigating the pathogenesis and effective treatment for the condition, there is a paucity of research exploring how having frozen shoulder is lived through and meaningful to persons experiencing it. To explore how living with Frozen Shoulder is experienced and meaningful. A qualitative research study design using hermeneutic phenomenology methodology was used. In-depth unstructured interviews were conducted with six purposively recruited participants. Interpretive Phenomenological methods were used to analyze the data forming emergent, superordinate and master themes to qualitatively expose the meaningful aspects of living through FS. Five Master themes were identified: 1) "Dropping me to my knees," an incredible pain experience; 2) The struggle for normality; 3) An emotional change of self; 4) The challenges of the healthcare journey; and 5) Coping and adapting. The overarching 'binding theme' was Frozen Shoulder: Living with uncertainty and being in "no-man's land." This study illuminated the struggle to maintain a normal life while living with the significant pain, physical restriction, sleep loss and disability experienced by persons with Frozen Shoulder. Attempts to cope and adapt were impeded by the challenges of the healthcare journey. The uncertainty of these experiences was conveyed as being in "no man's land" an expression that reflected the existential crisis and impact on persons' sense of self. [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis is a progressive, idiopathic disorder that significantly impacts individuals? daily lives and increases their medical burden. Pharmacopuncture therapy, which combines acupuncture techniques with herbal medicine, involves injecting herbal extracts into specific acupoints. This study aims to determine the effectiveness and safety of pharmacopuncture therapy in comparison to physiotherapy (PT) for treating adhesive capsulitis Methods: This research protocol outlines a two-arm, parallel, multi-center, pragmatic randomized controlled trial. Fifty participants will be randomly allocated to either the pharmacopuncture therapy or PT group, and they will receive 12 sessions of their respective therapies over a 6-week period. The primary outcome measure is the numeric rating scale for shoulder pain. Secondary outcomes include the visual analog scale score for shoulder pain, Shoulder Pain and Disability Index, Patients? Global Impression of Change score, Short Form-12 Health Survey Version 2 score, and EuroQol-5 Dimension. Statistical analysis will be conducted based on the intention-to-treat principle. Discussion: This trial may offer high-quality and reliable clinical evidence for evaluating the effectiveness and safety of pharmacopuncture therapy compared to PT in the treatment of adhesive capsulitis. Furthermore, this study will serve as a valuable guideline for practitioners when making clinical decisions and managing adhesive capsulitis. [ABSTRACT FROM AUTHOR]

Introduction: Adhesive capsulitis is clinically characterized by the gradual progressive painful loss of active and passive motion caused by the formation of adhesions of the joint capsule. Adhesive Capsulitis of the Hip (ACH) is not a well-explored clinical condition when compared to adhesive capsulitis of shoulder because of the underdiagnosis and rarity of this condition. Materials and Methods: Cochrane, Scopus, Pubmed, Embase, and Web of Science databases were searched for original studies on ACH till December 2021 following Cochrane and PRISMA guidelines. Year of publication, authors, number of cases, baseline characteristics of the studies, causes described, presentation, associated conditions, method of diagnosis, treatment to be given, functional outcomes, and complications was extracted from each study. Results: 16 articles were included in this review. 3 of the included studies were retrospective case–control studies, 6 were case series and the remaining 7 were case reports. A total of 224 ACH cases were recorded. Pain and stiffness of the hips were the most common clinical features. Investigations like serology, radiograph, and MRI have been used to rule out other conditions. Arthrography has been used to confirm the diagnosis in 7 studies. Spontaneous recovery is expected in one to two years. Management has been in the form of physiotherapy, intra-articular injection, and arthroscopy. Conclusion: Literature on ACH is limited because of the rarity of the condition. The disease has a favorable prognosis with the possibility of spontaneous recovery. Physiotherapy has been the first line of management. Intractable cases require surgical intervention. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adhesive capsulitis (AC) is a common musculoskeletal disease characterized with shoulder pain, limitation of range of motion (ROM) and disability. Although physical therapy is used in the treatment of AC, studies on its effectiveness are continuing. OBJECTIVE: This study aimed to assess the effectiveness of ultrasound (US) and high-intensity laser therapy (HILT) in the treatment of AC. METHODS: Sixty patients were randomized into two groups. Group I received US (15 sessions) and Group II received HILT (9 sessions) for 3 weeks. In addition, all patients received physical therapy program (hot pack, TENS and exercises). Assessments were made using VAS-pain, Shoulder Pain and Disability Index (SPADI), range of motion (ROM) at baseline and in post-treatment 3 rd , 8 th and 24 th weeks. RESULTS: There was no statistically significant difference between the groups in terms of all pre-treatment values. In intragroup assessment, statistically significant difference was identified in all the values of Groups 1 and 2 in all assessment periods compared with the pre-treatment values (p < 0.05). There was no significant difference between groups in all assessment periods. CONCLUSION: According to results, US therapy and HILT were effective on the improvement of pain, ROM and functional conditions of patients in the treatment of AC. [ABSTRACT FROM AUTHOR]

Background: The best treatment of degenerative hip abductor tendon lesions remains largely unknown, as the natural course of the disease has not yet been reported. The aim of the present study was to investigate the natural history of symptomatic degenerative hip abductor lesions. Hypothesis: Nonoperatively treated hip abductor lesions progress over time, resulting in refractory hip pain and low functional outcomes. Study Design: Case series (prognosis); Level of evidence, 4. Methods: Consecutive patients with greater trochanteric pain syndrome and degenerative changes on magnetic resonance imaging (MRI) of the symptomatic hip were included. Bilateral hip MRI scans and a clinical examination were performed at a minimum follow-up of 36 months to study the type and location of hip abductor lesion. Progression of a lesion was defined as a more severe lesion as compared with the initial MRI results or if the lesion extended to another, initially not involved, trochanteric facet. The muscle's fatty infiltration (FI) was also described. Results: From 106 patients identified, 58 patients (64 hips) aged 66 ± 14 years (mean ± SD) agreed to return to the clinic for follow-up MRI and met the inclusion criteria. At a mean 71-month follow-up, an overall 34% (22/64) of lesions had progressed over time: from trochanteric bursitis to tendinopathy (9/64, 14%) or partial tear (5/64, 8%), from tendinopathy to partial tear (4/64, 6%), from a partial to complete tear (3/64, 4.5%), and with 1 complete tear (1/64, 1.5%) extending to another trochanteric facet. Interestingly, 90% of partial tears remained stable or transformed into a scar. Although patients with a progressive lesion experienced more trochanteric pain (visual analog scale, 4.6 vs 2.8; P =.001), the functional outcomes were comparable with patients with a stable lesion. The majority of hips with a partial tear (64%) demonstrated a progression of gluteus minimus FI from a median grade of 1 to 2, whereas only 1 hip (3%) progressed from grade 2 to 3. Only 3 hips (9%) with a partial tear had a progression of gluteus medius FI, which did not differ significantly from the contralateral unaffected side. Conclusion: Nonoperative treatment might be a valid long-term option for degenerative hip abductor lesions, especially for partial tears, which demonstrated a low risk of clinically relevant progression or muscle FI and similar clinical outcomes to those reported in the literature for operatively treated hip abductor tendon lesions. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis (OA) is a common problem in elderly patients. They are often troubled with altered knee function, such as pain and weakness. However, not all these patients are able to receive autologous platelet-rich plasma (PRP) injections as they may be taking antiplatelet or anticoagulant medications. Their physical condition may not allow them to receive total knee replacement surgery as well. Long-term oral intake of nonsteroidal anti-inflammatory drugs may be detrimental to the gastrointestinal tract. As a result, it is crucial to discover new treatment options that can alleviate painful knee symptoms in elderly knee OA patients. In this study, 19 elderly patients diagnosed with moderate degree of knee OA as well as suprapatellar bursitis were recruited. They received low-level laser therapy (LLLT) to their affected knees. Under ultrasound guidance, flexible fiber optic wire was inserted intra-articularly into the knee joint. Red laser followed by infrared irradiation was performed once every 2 weeks for a total of 3 times. The Lequesne index for knee OA and the volume of suprapatellar synovial fluid (SF) were measured. SF proteomic analyses were also performed up to a period of 6 months. The results revealed that after 3 LLLT, the Lequesne index significantly decreased, signifying improvement in the knee joint functional status. The volume of suprapatellar SF and SF proteins associated with inflammation also decreased significantly in the SF. These findings lasted up to a period of at least 3 months. Therefore, LLLT may be considered as a feasible option in treating elderly patients with knee OA who are not suitable for surgical interventions or intra-articular PRP injections. [ABSTRACT FROM AUTHOR]

Background: The management of frozen shoulder (FS) differs depending on experience level and variation between scientific guidelines and actual practice. Purpose: To determine the current trends and practices in the management of FS among shoulder specialists and compare them with senior shoulder specialists. Study Design: Consensus statement. Methods: A team of 15 senior shoulder specialists (faculty group) prepared a questionnaire comprising 26 questions regarding the definition, terminology, clinical signs, investigations, management, and prognosis of FS. The questionnaire was mailed to all the registered shoulder specialists of Shoulder and Elbow Society, India (SESI) (specialist group; n = 230), as well as to the faculty group (n = 15). The responses of the 2 groups were compared, and levels of consensus were determined: strong (>75%), broad (60%-74.9%), inconclusive (40%-59.9%), or disagreement (<40%). Result: Overall, 142 of the 230 participants in the specialist group and all 15 participants in the faculty group responded to the survey. Both groups strongly agreed that plain radiographs are required to rule out a secondary cause of FS, routine magnetic resonance imaging is not indicated to confirm FS, nonsteroidal anti-inflammatory drugs should be administered at bedtime, steroid injection (triamcinolone or methylprednisolone) is the next best option if analgesics fail to provide pain relief, passive physical therapy should be avoided in the freezing phase, <10% of patients would require any surgical intervention, and patients with diabetes and thyroid dysfunction tend to fare poorly. There was broad agreement that routine thyroid dysfunction screening is unnecessary for women, a single 40-mg steroid injection via intra-articular route is preferred, and arthroscopic capsular release (ACR) results in a better outcome than manipulation under anesthesia (MUA). Agreement was inconclusive regarding the use of combined random blood sugar (RBS) and glycosylated hemoglobin versus lone RBS to screen for diabetes in patients with FS, preference of ACR versus MUA to treat resistant FS, and the timing of surgical intervention. There was disagreement over the most appropriate term for FS, the preferred physical therapy modality for pain relief, the most important movement restriction for early diagnosis of FS, and complications seen after MUA. Conclusion: This survey summarized the trend in prevalent practices regarding FS among the shoulder specialists and senior shoulder surgeons of SESI. [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis is a clinical diagnosis made from a history of the gradual onset of severe shoulder pain with the progressive limitation of active and passive glenohumeral movements. The most significant loss of movement is in the external rotation of the joint. Traditionally physical therapists have used an anterior glide of the humeral head on the glenoid technique to improve external rotation range of motion a choice based on 'convex on concave' concept of joint surface motion. Aim & objective of the study: To compare the effect of IFT with anterior glide versus posterior glide joint mobilization technique on shoulder external rotation ROM in patients with adhesive capsulitis. Data Analysis and Results: This study results shows that there is statistically significant improvement in the variables of shoulder pain and disability index (SPADI) and Shoulder External Rotation ROM between pre and post mean values in both control and experimental group with p<0.05. The Post mean values of SPADI and Shoulder External Rotation ROM in degrees with p values p<0.05 in Control group when compared to Experimental Group. Conclusion: This study concluded that both anterior glide and posterior glide with Interferential therapy reduce the pain and improve the external rotation range of motion in adhesive capsulitis. Meanwhile, interferential therapy with anterior glide is more effective than the interferential therapy with posterior glide in reducing the pain and improving the external rotation range of motion in adhesive capsulitis. [ABSTRACT FROM AUTHOR]

Background: Diabetes is associated with microvascular and macrovascular complications. Although it is less recognized, diabetes also has an important role in the development of musculoskeletal disorders. Our objective was to evaluate the effect of type 2 diabetes (T2D) on the severity of adhesive capsulitis of the shoulder (AC) and on the efficacy of ultrasound guided hydrodistension treatment. Methods: We conducted a retrospective longitudinal observational study, of patients with AC who underwent ultrasound guided hydrodistension at our Centre. Severity was measured with DASH (Disabilities of Arm, Shoulder and Hand) score and pain was evaluated with a score between 0 and 10. The association of T2D with baseline characteristics of AC, and with outcomes at 6–12 months was analyzed using linear and logistic regression models. Results: We evaluated 120 ultrasound guided hydrodistension treatments of AC, 85 in patients without diabetes and 35 in patients with T2D. Patients with diabetes had a higher prevalence of dyslipidemia, hypertension and higher HbA1c values. The average duration of diabetes was 4.8 years (2.0, 7.9). The baseline characteristics of AC were not significantly different between patients with and without diabetes. Patients with T2D relapsed more frequently and required more reinterventions than patients without diabetes (20.0% vs 4.7%, p = 0.008), had higher post-intervention pain scale values [4.0 (0.0–5.0) vs 0.0 (0.0–5.0), p = 0.022] and higher post-intervention DASH score [0.8 (0.0–1.8) vs 0.0 (0.0–0.8), p = 0.038]. Conclusion: Although baseline characteristics of AC in patients with diabetes were similar to those without diabetes, patients with diabetes had a worse response to treatment, more frequent relapses and a greater need for new interventions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Frozen shoulder (FS), also known as shoulder adhesive capsulitis, is a musculoskeletal disorder associated with pain and functional disability. There is a lack of evidence on the optimal treatment strategy for FS. OBJECTIVE: The present study aimed to evaluate the effectiveness and safety of ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy for treatment of FS. METHODS: In this prospective randomized, double-blind, controlled study, 63 FS patients were recruited, and equally allocated to treatment group and control group. The treatment group was treated with ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy, while the control group was only treated with ultrasound-guided hydrodilatation of glenohumeral joint. The pain and mobility of shoulder, overall efficacy and adverse reactions were evaluated 3 months after treatment. RESULTS: At baseline, no significant difference in all characteristic value was found between the treatment group (n = 33) and control group (n = 30). Three months after operation, the joint's Active Range of Motion (AROM) and Constant-Murley Scale (CMS) scores in the experimental group were higher than those in the control group, and the coracohumeral ligament (CHL) thickness and the rate of hypoechoic thickening in rotator cuff space in the experimental group were lower than those in the control group (all P < 0.05). The amount of injection volume at the third hydrodilatation was significantly higher in the experimental group than that in the control group (15.8 ± 4.7 vs 12.2 ± 5.2, P = 0.03). After 2 times of treatment, the volume increment of glenohumeral joint Δ 2 in the experimental group was greater than that in the control group (3.5 ± 1.8 vs 1.2 ± 1.6, P < 0.001). There were significant differences in the effective rate between the two groups (93.94% vs. 76.67%, P = 0.04). CONCLUSION: The ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy may benefit FS patients. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Objective: An evolved understanding of the pathophysiology of greater trochanteric pain syndrome has led to a number of proposed nonoperative management strategies. The objective of this review was to compare the efficacy of the various nonoperative treatments for greater trochanteric pain syndrome (GTPS). Design: Systematic review and network meta-analysis. Setting: PubMed, Embase, CENTRAL, SCOPUS, and Web of Science were searched to January 2020. Patients: Patients undergoing nonoperative treatment for GTPS. Interventions: Nonoperative treatment strategies for GTPS including injections of corticosteroids, platelet-rich plasma, hyaluronic acid, dry needling, and structured exercise programs and extracorporeal shockwave therapy. Main Outcome Measures: Pain and functional outcomes. Bayesian random-effects model was performed to assess the direct and indirect comparison of all treatment options. Results: Thirteen randomized controlled trials and 1034 patients were included. For pain scores at 1 to 3 months follow-up, both platelet-rich plasma (PRP) and shockwave therapy demonstrated significantly better pain scores compared with the no treatment control group with PRP having the highest probability of being the best treatment at both 1 to 3 months and 6 to 12 months. No proposed therapies significantly outperformed the no treatment control group for pain scores at 6 to 12 months. Structured exercise had the highest probability of being the best treatment for improvements in functional outcomes and was the only treatment that significantly improved functional outcome scores compared with the no treatment arm at 1 to 3 months. Conclusion: Current evidence suggests that PRP and shockwave therapy may provide short-term (1-3 months) pain relief, and structured exercise leads to short-term (1-3 months) improvements in functional outcomes. [ABSTRACT FROM AUTHOR]

Background: Claims of shoulder injury now account for half of all claims to the Vaccine Injury Compensation Program. Reports from databases of claims or potential adverse events note a relatively high mean age and high prevalences of rotator cuff tendinopathy and adhesive capsulitis-common shoulder problems that might be incidental to vaccination. Published case reports provide much more detail about individual patients than is available in databases. A review of published cases provides an opportunity for more detailed review of symptoms, diagnoses, pathology, treatment, and prognosis. Such a review can better assess the relative likelihood that pathologies associated with new persistent shoulder symptoms after vaccination are coincidental or unique to and caused by vaccine.Questions/purposes: Regarding published case reports addressing persistent shoulder pain after vaccination: (1) In what proportion of patients was a specific diagnosis made? (2) What diagnoses were most common? (3) Among patients treated nonsurgically, what proportion resolved, and over what time span did they resolve?Methods: In August 2020, we searched PubMed and Embase between 2006 and 2020 using the following search strategy: Search 1: (shoulder dysfunction OR shoulder pain OR shoulder bursitis OR rotator cuff tendonitis OR adhesive capsulitis OR glenohumeral arthritis AND [vaccine OR vaccination OR immunization]); Search 2: (shoulder injury related to vaccine administration or SIRVA). The search was supplemented by reviewing reference lists of identified studies. Inclusion criteria were any detailed report of three or fewer cases involving shoulder pain after vaccine administration. Twenty published reports of 29 patients were identified and assessed by two reviewers independently. One reported glenohumeral joint infection was excluded because the relationship between this type of relatively uncommon, discrete diagnosis and vaccination raises different considerations. We assumed a high risk of bias, although we are not aware of bias assessment tool for case reports. We recorded and summarized patient demographics, symptoms, examination and imaging findings, surgery findings, diagnoses, treatments, and outcomes. Seventy-five percent (21 of 28) of patients were women, with a mean age of 54 ± 19 years. In search of an underlying pathology, at least one diagnostic study was performed in 82% (23 of 28) of patients including radiographs in seven, ultrasound in seven, and MRI in 16 patients (some patients underwent more than one type of imaging). We distinguished specific pathophysiological diagnosis from shoulder pain and stiffness, counted the most common diagnoses among patients a specific diagnosis, and tracked symptom resolution among patients treated nonoperatively.Results: A specific diagnosis was made in 57% (16 of 28) of patients. Twelve patients had pain and limitation of motion due to pain but no specific pathological diagnosis. The most common specific diagnoses were rotator cuff tendinopathy (9 of 16) and adhesive capsulitis (4 of 16). Less common specific diagnoses included rotator cuff arthropathy (and rheumatoid arthritis) and suspected septic arthritis with nonspecific synovitis on arthroscopy. One patient had transient MRI signal change in the humeral head, which was interpreted as osteonecrosis that resolved in a manner not typical for that diagnosis. Of the 17 patients treated nonsurgically, 15 reported resolution, and two had incomplete symptom resolution with the mean 6-month evaluation period.Conclusion: The observation that persistent shoulder pain after vaccination overlaps with common shoulder pathology-both in large databases as well as in more detailed reports of specific patients as analyzed in this review-establishes a high probability of a coincidental rather than a causal association. In the absence of high-quality experimental evidence of vaccine-specific shoulder pathology, in our opinion, it seems safest and healthiest to assume that perceived shoulder injury related to vaccine administration (SIRVA) is due to misinterpretation of new symptoms from established pathology rather than a new, vaccine-specific pathology.Level Of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Background: Shoulder injury related to vaccine administration (SIRVA) is postulated to be an immune-mediated inflammatory response to a vaccine antigen injected into or near the subacromial bursae or synovium, leading to shoulder pain and dysfunction. The number of studies on this topic is rapidly increasing. Recent comparative studies have reported conflicting conclusions, which suggests that a systematic review of the best-available evidence may be helpful.Questions/purposes: In this systematic review, we asked: What are the (1) clinical characteristics, (2) diagnoses, and (3) management approaches and outcomes reported in association with SIRVA?Methods: A search was performed on October 4, 2021, of the PubMed and Medline databases for studies related to SIRVA. Inclusion criteria were English-language comparative studies, case series, and case reports that involved shoulder pain occurring after vaccination. Studies of exclusively neurologic conditions after vaccination were excluded. Forty-two studies met the eligibility criteria, including three retrospective comparative studies (72 patients and 105 controls), five database case series (2273 patients), and 34 case reports (49 patients). Study quality was assessed for the database case series and retrospective comparative studies using the Methodological Index for Non-randomized Studies tool.Results: Among patients in the case reports, the median age was 51 years (range 15-90 years), and 73% (36 of 49) were women. BMI was reported for 24% of patients (12 of 49) in case reports, with a median of 23.5 kg/m2 (range 21-37.2 kg/m2). The most common symptoms were shoulder pain and reduced ROM. The most common diagnoses were shoulder bursitis, adhesive capsulitis, and rotator cuff tears. The most frequent management modalities included physical or occupational therapy, NSAIDs, and steroid injections, followed by surgery, which was generally used for patients whose symptoms persisted despite nonsurgical management. Full resolution of symptoms was reported in 2.9% to 56% of patients.Conclusion: The association between inflammatory conditions of the shoulder (such as bursitis) and vaccination appears to be exceedingly rare, occurring after approximately 1:130,000 vaccination events according to the best-available comparative study. Currently, there is no confirmatory experimental evidence supporting the theory of an immune-mediated inflammatory response to vaccine antigens. Although the clinical evidence is limited, similar to any bursitis, typical treatments appear effective, and surgery should rarely be performed. Additional research is needed to determine the best injection technique or evaluate alternate injection sites such as the anterolateral thigh that do not involve positioning a needle close to the shoulder. [ABSTRACT FROM AUTHOR]

To summarise factors that might influence treatment outcomes of physical therapy in patients with frozen shoulder. A systematic literature study was performed by searching electronic bibliographies PubMed and Web of Science. Original full text research articles about human adults with frozen shoulder, assessing influencing factors of treatment outcome of physical therapy were included in the review. Sixteen studies were included in this systematic review. Methodological quality of the included studies was low to moderate and most studies had level of evidence B. Duration of symptoms and affected shoulder were found not to influence range of motion. Preliminary evidence was found for shoulder kinematics, pain, functionality, therapy compliance, and interactive rehabilitation as possible influencing factors. Conflicting evidence was found for co-morbidities, gender, and age. Most frequent used interventions were exercises, stretching, and mobilisation. Level of conclusion 2 was found for duration of symptoms and affected shoulder for not influencing range of motion. Some limitations are that only few studies specifically investigated influencing factors and there is a difference in research and physical therapy protocols and outcome measures used. Therefore, more high-quality research with standardised protocols is needed to confirm preliminary evidence and elucidate conflicting results. [ABSTRACT FROM AUTHOR]

Objective: Patients with shoulder disorders show altered periscapular muscle activity (e.g., decreased serratus anterior and increased upper trapezius activities). We herein devised a novel method for strengthening serratus anterior without excessive upper trapezius activation, named squeezing ball exercise in which patients squeezed a ball between both elbows with maximum voluntary isometric contraction in the horizontal adduction direction with the arms elevated at a 45-degree angle. The present study aimed to investigate whether the squeezing ball exercise could produce high muscle activity in the serratus anterior in patients with frozen shoulder and subacromial impingement syndrome before the rehabilitation intervention. Design: This is a proof-of-concept study. Serratus anterior and upper trapezius activities during squeezing ball exercise were evaluated using electromyography in 16 patients with frozen shoulders and subacromial impingement syndrome. Electromyography signals were normalized using maximal voluntary isometric contraction, and the muscle balance ratios (upper trapezius/serratus anterior) were calculated. Results: The average serratus anterior and upper trapezius activity was 69.9% ± 30.8% and 10.2% ± 6.3% maximal voluntary isometric contraction during the squeezing ball exercise, respectively, whereas the upper trapezius–serratus anterior ratio of the affected side was 0.15 ± 0.07. Conclusions: The high serratus anterior activation and low upper trapezius–serratus anterior ratio during squeezing ball exercise could be attributed to the limb position where shortened serratus anterior exerts itself without painful subacromial impingement. Squeezing ball exercise could be a novel rehabilitation tool for patients with frozen shoulders and subacromial impingement syndrome. [ABSTRACT FROM AUTHOR]

A 10-yr-old nationally competitive female in-line rollerblade speed skater presented to a sports medicine clinic with bilateral lateral ankle pain and swelling over 2 mos. Patient had tenderness to palpation and focal swelling at the lateral malleoli. Ultrasound examination confirmed a diagnosis of lateral adventitial malleolar bursitis, potentially owing to repetitive shear forces across the lateral malleoli. Inspection of the patient's carbon-fiber boots revealed millimeters of discrepancy in fit around the patient's lateral malleoli. After a brief relative rest from sport, the patient had custom-molded boots made and was able to return to high-level competition and shortly thereafter was pain free. This case is the first known report of lateral malleolar bursitis in an athlete and highlights the role of equipment evaluation, which may be necessary in these athletes. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this trial was to compare the efficacy of acromioclavicular joint mobilization and standard physical-therapy versus physical-therapy alone in the treatment of the frozen shoulder. Design: Single-blind randomized clinical trial. Setting: Outpatient setting. Subjects: Patients with frozen shoulder. Intervention: Participants were randomly allocated into mobilization + physical-therapy (n = 28), and physical-therapy alone (n = 28) groups for one month. Main Measures: The primary outcomes were the shoulder pain and disability index and the shoulder range of motion. The secondary outcome was the visual analogue scale. Measures were performed at the baseline, immediately and one month after the beginning of the treatment. Results: Visual analogue scale and the shoulder pain and disability index improved more significantly in the mobilization group compared to the physical-therapy group immediately [−4.63 (−5.58–−3.67) vs. −2.22 (−2.96–−1.47), P < 0.001 and −23.08 (−28.63–−17.53) vs. −13.04 (−17.93–−8.16), P = 0.008, respectively] and one month after the beginning of the treatment [−5.58 (−6.45–−4.72) vs. −3.61 (−4.60–−2.62), P < 0.001 and −33.43 (−40.85–−26.01) vs. −20.03 (−26.00–−14.07), P = 0.001, respectively]. Active abduction range of motion was also improved more significantly immediately after the treatment in the mobilization group compared to the physical-therapy group [25.83 (11.45–40.13) vs. 10.17 (1.02–19.15), P = 0.025], however there were no significant differences between two groups concerning other measured range of motions. Conclusions: Adding acromioclavicular mobilization to standard physical-therapy was more efficient in decreasing pain and disability and improving active abduction range of motion compared to standard physical-therapy in frozen shoulder patients. [ABSTRACT FROM AUTHOR]

Background. Frozen shoulder is a widespread concern having an unknown etiology. Management mainly aims at restoring function and treating symptoms. The choice of treatment may differ based on patient variables, stage of presentation, priorities of clinicians, and funding. No robust evidence exists to endorse one treatment modality over another in a conclusive way. Therefore, we performed a systematic review of the conservative therapeutic options for the frozen shoulder. Materials and methods. A wide range of electronic bibliographic databases such as PubMed, Embase, and ERIC was searched. Based on the eligibility criteria, all randomized controlled trials that compared the efficacy of any type of non-surgical or conservative management from 2010 to 2020 are incorporated in the review. Following screening and assessing the abstracts, we ended up reviewing 12 full-text articles and data extracted on essential parameters such as sample size, type of non-surgical treatment, time of follow-up, and primary outcomes. Results. Overall, the systematic review results seem promising for the efficacy of different non-surgical modalities. They improve multiple outcomes such a pain, range of motion, Constant-Murley score, simple Shoulder Test, Shoulder Pain, Disability Index, and patient satisfaction. Nonsurgical management is the preferred initial care option, with most patients typically improving within 6 to 18 months. Steroids, physiotherapies, hydrodilatation with hypertonic saline, suprascapular nerve block (SNB), Extracorporeal shockwave therapy, and intra-articular steroid or sodium hyaluronate injections are conservative treatment choices. Conclusions. Treatment of frozen shoulder remains a challenge, and high-level conclusive evidence is needed to recommend one treatment method over another. The results of this systematic review showed that nonsurgical management, regardless of the preferred treatment option, is beneficial and effective in the treatment of frozen shoulder, and that can guide clinicians in making evidence-based decisions when managing this condition conservatively. This will avoid unnecessary burdens on the healthcare system and patients, as they might be treated effectively without undergoing surgery. [ABSTRACT FROM AUTHOR]

Frozen shoulder syndrome, also called an adhesive capsule, is in many ways a mysterious disease; the exact causes of this complication are unknown. Pain and stiffness associated with frozen shoulders are caused by the shoulder joint capsule. This is a group of ligaments or connective tissues that attach the shoulder to the arm. When the capsule hardens or swells, the shoulder freezes. There are different types of exercise therapy useful to improve the range of motion and level of pain. This paper has tried to determine this issue based on the previously published papers, especially among retired athletes. For this purpose, various databases were used and papers published after 2016 were collected. The findings of this analysis emphasized doing regular exercise training and stretching among retired athletes to prevent frozen shoulders. [ABSTRACT FROM AUTHOR]

Background Hypervascularity of the rotator interval with increased expression of the vascular endothelial growth factor may be the causative factor of conventionally managed adhesive capsulitis. Hence, transcatheter arterial embolisation(TAE) has emerged as an alternative treatment option to occlude the target neovessels by infusing an embolic agent. The present study reviews the literature regarding the efficacy of the TAE for adhesive capsulitis. Material and methods The systematic review was performed following PRISMA guidelines. MEDLINE, Google Scholar, Scopus and Cochrane database of systemic reviews (CDSR) were searched for relevant publication (from 1960 to 2021). The search algorithm used was Transcatheter arterial embolisation and resistant adhesive capsulitis or refractory adhesive capsulitis or vascular adhesive capsulitis. The database search produced a total of 12026 publications. After exclusion of the non relevant titles, 113 abstracts were reviewed. From these abstracts, three full-text articles were obtained for final review. Results All the studies were analyzed in depth. Patients with no or minimal improvement with conservative treatment for at least 3 months underwent TAE. Pre and post embolisation visual analog score(VAS), shoulder range of motion(ROM) were noted. Any additional therapy was also taken into account. Significant improvement of the VAS score and shoulder ROM was noted immediately after surgery and maintained till final follow up at 24.5 months. Conclusion Resistant cases of adhesive capsulitis can be managed successfully with TAE. But ample evidence is lacking regarding the appropriate patient selection and efficacy of TAE as a sole management option of resistant AC. [ABSTRACT FROM AUTHOR]

Objective. To determine whether arthrographic distention combined with manipulation for frozen shoulder provides additional benefits. Methods. A total of 180 participants from five clinical centers with pain and stiffness in predominantly 1 shoulder for >3 months entered the study, and 165 completed the study. The control group was treated with arthrographic distention alone, and the treatment group underwent manipulation after resting for 5 minutes following arthrographic distention. Patients were followed up at the one and two weeks and at three and six months. For the clinical evaluation, shoulder-specific disability measure (SPADI) score, the visual analog scales (VASs) for pain, and range of active motion were used. Results. 83 patients out of 90 in the treatment group and 82 out of 90 in the control finished the entire study period. SPADI, VAS, Constant-Murley (CM), and range of motion (ROM) were improved after treatments in both groups. The statistical differences were not observed in the CM, adduction, internal rotation, and posterior extension function between groups (P >.05) after the first treatment. And the statistical differences were not observed in the internal rotation, the extorsion, and posterior extension function (P >.05) after the second treatment. Conclusion. Distention arthrography plus manual therapy provided faster pain relief, a higher level of patient satisfaction, and an earlier improvement in AROM of the shoulder than distention arthrography alone in patients with frozen shoulder. [ABSTRACT FROM AUTHOR]

Background: Although the clinical outcomes of manipulation under ultrasound-guided fifth and sixth cervical nerve root block for frozen shoulder have been reported, few studies have focused on the timing of manipulation. This study aimed to determine whether the timing of manipulation impacts the clinical outcomes.Methods: We retrospectively reviewed the outcomes of 103 frozen shoulder patients (mean age 51.5 years) who underwent manipulation in one shoulder (n = 103 shoulders) between January 2012 and April 2019. Stiff shoulder was defined as limited range of motion in at least three directions, i.e., passive forward flexion of ≤100°, passive external rotation at the side of ≤10°, and internal rotation of ≤L5. The patients were categorized into two groups: those mobilized within 6 months after symptom onset (early group, 44 shoulders) and those mobilized >6 months after symptom onset (late group, 59 shoulders). The range of motion (forward flexion, external rotation, and internal rotation), Japanese Orthopaedic Association shoulder scores, Constant Shoulder Score, and University of California, Los Angeles scores before and 3, 6, and 12 months after manipulation were compared between groups.Results: The late group exhibited significant improvement in forward flexion, external rotation, internal rotation, Japanese Orthopaedic Association scores, Constant Shoulder Score, and University of California, Los Angeles scores at 3 months; forward flexion at 6 months; and forward flexion and University of California, Los Angeles scores at 12 months after manipulation compared to the early group.Conclusions: Our results indicate that timing has a significant influence on the outcome of manipulation for frozen shoulders. The optimal time for manipulation may be >6 months after symptom onset. These findings can be applied in counselling for frozen shoulder patients and for improved outcomes after manipulation. [ABSTRACT FROM AUTHOR]

Background: The best nonsurgical treatment for frozen shoulder is still unclear. Extracorporeal shockwave therapy (ESWT) is an innovative adjunctive treatment for frozen shoulder, but its effect is still unclear. Purpose: To evaluate the published literature regarding the potential of ESWT as an adjunctive therapy for frozen shoulder. Study Design: Systematic review; Level of evidence, 1. Methods: Searches were conducted in the PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), and VIP Information databases for relevant studies between inception and November 2020. Included were randomized controlled trials (RCTs) for frozen shoulder that compared ESWT with routine treatments to controls. There were no restrictions on the treatment period, type of ESWT, or severity of symptoms. At least 1 of the following outcome indices was assessed: visual analog scale (VAS) for pain, Constant-Murley score (CMS) for shoulder function assessment, or external rotation range of movement (ER ROM). RevMan 5.3 software was used to evaluate the bias and quality of the included studies. For continuous variables, the mean difference (MD) or standardized MD (SMD) with the 95% CI was extracted. For dichotomous data, event ratios and sample sizes were extracted. Results: Overall, 20 studies were included. The ESWT used as an adjunct to other interventions had better outcomes compared with control groups regarding immediate and short-term analgesic effects (immediate: MD, –1.10 [95% CI, –1.27 to –0.92], P <.00001; short-term: MD, –0.72 [95% CI, –0.94 to –0.50], P <.00001) as well as immediate function (SMD, 1.54 [95% CI, 1.19 to 1.89], P <.00001], I 2 = 0%). There was significant heterogeneity between studies for long-term analgesia (MD, –0.90 [95% CI, –1.40 to –0.41], P <.00001, I 2 = 89%) and ER ROM (MD, 10.31 [95% CI, 3.46 to 17.17], P <.003, I 2 = 93%). Conclusion: ESWT seems to be beneficial to patients with frozen shoulder by alleviating pain and improving function. ESWT could be used as an adjunct therapy to routine treatments, although the quality of the included RCTs was hampered by significant heterogeneity regarding long-term analgesia and joint ROM. [ABSTRACT FROM AUTHOR]

Background: While platelet-rich plasma (PRP) has been widely studied for musculoskeletal disorders, few studies to date have reported its use for adhesive capsulitis (AC). Fully characterized and standardized allogenic PRP may provide clues to solve the underlying mechanism of PRP with respect to synovial inflammation and thus may clarify its clinical indications. Purpose: To clinically evaluate the safety and efficacy of a fully characterized pure PRP injection in patients with AC and to assess the effects of pure PRP on synoviocytes with or without inflammation in vitro. Study Design: Controlled laboratory study and cohort study; Level of evidence, 3. Methods: For the clinical analysis, a total of 15 patients with AC received an ultrasonography-guided intra-articular PRP injection and were observed for 6 months. Pain, range of motion (ROM), muscle strength, shoulder function, and overall satisfaction in the patients were evaluated using questionnaires at 1 week as well as at 1, 3, and 6 months after the PRP injection and results were compared with the results of a propensity score−matched control group that received a corticosteroid injection (40 mg triamcinolone acetonide). For the in vitro analysis, synoviocytes were cultured with or without interleukin-1β (IL-1β) and PRP. The gene expression of proinflammatory and anti-inflammatory cytokines as well as matrix enzymes and their inhibitors was evaluated. Results: At 6-month follow-up, pure PRP significantly decreased pain and improved ROM, muscle strength, and shoulder function to levels comparable with those after a corticosteroid injection. All pain values, strength measurements, and functional scores significantly improved up to 6 months in the PRP group, but these measures improved up to 3 months and then were decreased at 6 months in the corticosteroid group. ROM was significantly improved in the 2 groups at 6 months compared with baseline. Allogenic PRP did not cause adverse events. For the in vitro findings, PRP induced inflammation but significantly improved the IL 1β−induced synovial inflammatory condition by decreasing proinflammatory cytokines such as IL-1β, tumor necrosis factor−α, IL-6, cyclooxygenase-2, and microsomal prostaglandin E synthase−1 and decreased matrix enzymes (matrix metalloproteinase−1, −3, and −13 as well as a disintegrin and metalloproteinase with thrombospondin motifs−4 and −5) and further increasing anti-inflammatory cytokines such as vasoactive intestinal peptide. Conclusion: This study showed that PRP decreased pain and improved shoulder ROM and function to an extent comparable with that of a corticosteroid in patients with AC. Allogenic pure PRP acted in a pleiotropic manner and decreased proinflammatory cytokines only in the inflammatory condition. Clinical Relevance: Allogenic PRP could be a treatment option for the inflammatory stage of AC. [ABSTRACT FROM AUTHOR]

Purpose: Adhesive capsulitis of the hip (ACH) is likely that this condition had been previously encountered, but easily unrecognised. We investigated the clinical features of patients with ACH, the efficacy of ultrasound-guided intra-articular hydrodilatation, and the patients' prognosis.Methods: We enrolled 84 patients (93 hips) who visited the outpatient clinic from August 2018 to November 2019. ACH was diagnosed by restricted range of motion and sharp pain when turning with the affected leg fixed on the ground. We evaluated patient demographics and associated intra-articular pathologies found on magnetic resonance angiography (MRA) images. Injections were performed twice at two week intervals with a mixture of 0.5% lidocaine (25 mL) and triamcinolone (40 mg; 1 mL) with capsular distension under ultrasound guidance. Patients were assessed before and after treatment using a visual analogue scale (VAS), hip disability and osteoarthritis outcome score (HOOS), hip range of motion (ROM), and distance from floor to knee (DFK) when sitting in the cross-legged position.Results: On MRA, 18 patients had abnormal findings (eight labral tears, seven abductor tendinosis, three primary arthrosis). The mean VAS decreased from 7.1 ± 1.1 to 0.8 ± 0.9 after the last injection, and the HOOS improved in all subsets. The mean DFK decreased from 17.9 ± 4.8 to 9.7 ± 2.8 cm, and passive ROM showed improvement, especially in flexion and rotation. In seven patients, symptom recurrence was reported a mean of 4.1 months after the latest injection, but no independent risk factor for recurrence was identified.Conclusion: Based on these current observations, patients with ACH may receive relief from hip joint pain and experience improved function with a timely diagnosis and effective treatment. [ABSTRACT FROM AUTHOR]

Adhesive capsulitis results in a multidimensional disability which demands a polygonal approach. Although physiotherapy proves an essential for a complete and comprehensive recovery in adhesive capsulitis, evidence also suggest the role of yoga in the management, hence this study investigate their effectiveness. This is a quasi-randomised control study. A pre-diagnosed subacute and chronic adhesive capsulitis of shoulder, between the age group of 35–60 years of both genders of total 40 participants were randomly divided into Group 'A' (yogasana) and Group 'B' (physiotherapy). The parameters of pain, joint mobility and functional disabilities were measured at the baseline and after four-weeks. The mean age of Group 'A' was 45.4 ± 7.78 years whereas 50.05 ± 5.98 years was in Group 'B'. Intragroup analysis for both the groups showed statistically significant improvement in all the study variables. Whereas in intergroup analysis yogasana was found to be statistically significant in improving shoulder abduction mobility, p=0.03, effect size r=0.35 and also in shoulder flexion (p=0.15, r=0.23) and shoulder internal rotation (p=0.07, r=0.3), though statistically not significant, in view of small effect size response. Both techniques improved the functional status in adhesive capsulitis, however additional effects on joint mobility was demonstrated by yogasana. [ABSTRACT FROM AUTHOR]

Background: Frozen shoulder is a common shoulder disorder characterized by pain and restriction. Various nonsurgical treatments have been reported, but there is no consensus about their comparative efficacy and the effects of moderators. Purpose: To compare the efficacy of different nonsurgical interventions and identify potential patient-specific moderating factors for frozen shoulder. Study Design: Systematic review and network meta-analysis. Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched from their inception to February 18, 2019. The search was supplemented by manual review of relevant reference lists. Randomized controlled trials of participants with frozen shoulder that compared nonsurgical interventions were selected. Measured outcomes included pain, shoulder function in daily activities, and range of motion. Results: Of 3136 records identified, 92 trials were eligible, evaluating 32 nonsurgical interventions in 5946 patients. Intra-articular injection improved pain (pooled standardized mean difference [95% CI]: steroid injection, 1.68 [1.03-2.34]; capsular distension, 2.68 [1.32-4.05]) and shoulder function (steroid injection, 2.16 [1.52-2.81]; distension, 2.89 [1.71-4.06]) to a greater extent than placebo. Capsular distension and extracorporeal shockwave therapy showed the highest ranking for pain relief and functional improvement, respectively. Laser therapy also showed benefits for pain relief (3.02 [1.84-4.20]) and functional improvement (3.66 [1.65-5.67]). Subgroup analyses by disease stages revealed that steroid injection combined with physical therapy provided more benefits during the freezing phase, whereas joint manipulation provided more benefits in the adhesive phase. Adjunctive therapies, female sex, and diabetes were also identified as moderators of effectiveness. Conclusion: Capsular distension is a highly recommended choice for treatment of frozen shoulder, contributing greatly to pain relief and functional improvement; steroid injection is also a prevailing effective intervention. Among new options, extracorporeal shockwave therapy and laser therapy show potential benefits for multiple outcomes. Individualized optimal intervention should be considered, given that treatment effect is moderated by factors including the disease stage, time of assessment, adjunctive therapies, female sex, and diabetes. [ABSTRACT FROM AUTHOR]