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Introduction: Adhesive capsulitis of shoulder due to uncertain etiology of glenohumeral joint characterized by spontaneous onset of pain and reduction in the arc of active and passive movements at glenohumeral joint and essentially normal radiograph. It is considered a self-limiting condition with a natural history of 1–3 years while some have refractory course. Most of adhesive capsulitis patients are successfully treated with nonsurgical treatment such as non-steroidal anti-inflammatory drugs (NSAIDS), oral/intra-articular corticosteroids, and hydrodialtation, among nonsurgical modalities, ozone and laser are newer, safe, and show promising results in adhesive capsulitis management. A current study was done to compare between ozone therapy and laser therapy in terms of efficacy and utility in periarthritis shoulder. Materials and Methods: All patients who presented with shoulder pain and stiffness at the orthopedics outpatient department of tertiary care center of rural North India, on the basis of clinical history and examination, those who were diagnosed with adhesive capsulitis and fulfilling the inclusion criteria and exclusion criteria were included in the study, after obtaining proper informed and written consent, cases were randomized into two groups for laser and ozone therapy. Results: A total of 55 patients were included in the study, among them, 42 patients (20 patients in the laser and 22 in the ozone group) were followed up to a final follow-up of 6 months and 13 patients lost their follow-up. Disabilities of the arm, shoulder, and hand questionnaire (DASH) score ozone group showed a gradual decline from the preinjection score of 55.68–17.78 at 6 months. In the laser group, there is also a decline in DASH scores from the pretreatment score of 57.56–23.34 at 6 months. Difference in DASH score was insignificant up to 4 weeks across both groups. On follow-up after 4 weeks up to 6 months showed a significant difference in DASH score across both groups. Decline in the ozone group was more as compared to the laser group (P < 0.026). Conclusion: Both ozone and laser are safe and effective modalities of treatment of adhesive capsulitis but ozone is more effective in long term.

Introduction: "Periarthritis" and "adhesive capsulitis" have been used synonymously with frozen shoulder. The condition known as "frozen shoulder," which has an unknown cause, is characterized by a delayed, spontaneous restoration of all shoulder joint movements to some extent or entirely over several months to a year. Various treatment methods have been employed to manage periarthritis shoulder, with varying outcomes. The Aim: To evaluate the functional outcomes and pain relief of periarthritis shoulder treated with intra-articular steroid injection and manipulation under anesthesia. Material and Methods: A prospective study was conducted on adults with periarthritis shoulder admitted, evaluated, and followed up on 30 periarthritis shoulder cases using intra-articular steroid injection and manipulation over three months. Results: In our study, most of the patients were females and elderly, with diabetics being more prone to periarthritis of the shoulder. The range of movements improved, and pain was relieved in all 30 patients. Excellent results were found in 26 cases (86.6%) by DASH Score criteria. Conclusion: Intra-articular steroid injection and manipulation of the shoulder in periarthritis shoulder with follow-up for 12 weeks resulted in the study finding a significant improvement in the range of shoulder movement, pain, and function in patients with shoulder periarthritis. Keywords: Periarthritis shoulder; intra-articular steroid injection; Range of movement.

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]

Background: Periarthritis shoulder is a shoulder ailment with no recognised cause. It gradually causes the shoulder's range of motion to be restricted. Between 2% and 3% of the general population suffer from adhesive shoulder capsulitis, which most frequently develops between the ages of 40-65 years. The region gradually thickens, leading to shoulder stiffness and increase in pain. Purpose: To compare the effectiveness of Maitland mobilization and Muscle energy technique in patients with periarthritis shoulder using SPADI and NPRS. Materials and Methods: Subjects were randomly allocated into two groups. Maitland mobilization group (n = 33) and Muscle Energy Technique group (n = 33). The subjects were assessed using SPADI and NPRS for pre and post-test values. The one group treated with Maitland mobilization (grade 1 and 2) were given to the patients along with some exercises. The other group were treated with muscle energy technique along with some exercises. These interventions were given for 4 weeks.The entire process was conducted from November 2022 to April 2023. Result: There was a significant improvement from pre-treatment levels in pain and ROM in Maitland mobilization group compared to muscle energy group. Conclusion: Hence the study concludes that there is a more significant increase in ROM and SPADI score, and a significant decrease in pain on NPRS by Maitland mobilization as compared with Muscle energy technique. [ABSTRACT FROM AUTHOR]

Background: The background of the study is the incidence of Movement restriction among Periarthritis subjects which affects the Pressure pain threshold and Functional activity of the shoulder. Purpose: To compare the effectiveness of shoulder strengthening exercises in patients with Periarthritis Shoulder. To evaluate the effect of pain and functional activity by pressure algometer and SPADI. Materials and methods: The two groups; Group-A (Mulligan Mobilisation with Movement) and Group-B (Shoulder strengthening exercises) were randomly assigned. The pre-test assesses Pressure Pain Threshold by utilising a pressure algometer and Shoulder Pain and Disability Index (SPADI) Questionnaires to assess Shoulder Functional Activity among periarthritis shoulder in both the groups. The Group-A(MWM) has received Mulligan Mobilisation with Movement for a period of 4 weeks. In contrast to Group-B,which has received shoulder strengthening exercises for periarthritis shoulder.The same tests were measured after 4 weeks of treatment as post-test values. Results: The pretest and post test values significant difference (p<0.0001)between groups A(MWM) and B(Shoulder strengthening exercises).The study showed that MWM has a major impact on recovery of PPT and Functional activity affected in Periarthritis shoulder participants. Conclusion: The Mulligan mobilisation with movement was effective on improving the Functional activity and reduction in pressure pain threshold. [ABSTRACT FROM AUTHOR]

Background: Painless and early aggressive mobilization of the shoulder can give good outcomes in a frozen shoulder (FS).Objectives: Our objective is to compare the early and late clinical and functional outcomes of mobilization under continuous interscalene block (CISB) and mobilization and intraarticular steroid injection (IASI) and to determine the effect of the addition of IASI on mobilization and CISB in adults with FS.Methods: We conducted a prospective comparative study. Participants were divided into 3 groups of 20 patients. The allocation was performed by simple randomization. The primary outcomes of pain and patient satisfaction were assessed using VAS scores. Outcome measures such as pain, patient satisfaction, range of motion, and UCLA scores within the groups were assessed.Results: The majority of patients were females. There was a significant improvement in early pain relief and range of motion in patients treated using mobilization under CISB. The late functional outcomes were similar in all groups irrespective of the method of treatment. The IASI had no significant effect on the early or late outcomes of mobilization under CISB.Conclusion: Mobilization under CISB provides early pain relief, improvement in the range of movements, and good long-term functional outcomes in frozen shoulders. IASI does not affect early pain relief or improvement in the range of movements.

Adhesive capsulitis shoulder is a common problem of patients presenting with shoulder pain and disability. The approach to such patients includes a variety of modalities. This systematic review evaluates the efficacy of intra-articular injections of platelet-rich plasma (PRP) in the treatment. A literature search was performed between January 2010 and 30 May 2022. MeSH terms used were 'Platelet-rich plasma' OR 'PRP' AND 'Frozen shoulder' OR 'Adhesive capsulitis shoulder' OR 'Periarthritis shoulder'. The search included published articles in the English language involving human subjects. Studies evaluating other types of shoulder disorders, in vitro studies, review articles, animal-model studies, and pre-clinical trials were excluded. The data regarding study characteristics, efficacy, and safety outcomes were analyzed. A total of 11 studies with 347 patients over 10 years were finally included in this review. Most publications were in 2019 and 2020, mostly from India. This review included seven comparative studies, three case series, and one case report. In seven studies, a single intra-articular PRP injection was administered, whereas in the rest of the studies two or multiple injections were given. Only one study demonstrated an equivocal efficacy of PRP and steroid intra-articular injection. The rest all depicted better clinical and functional outcomes with the PRP injection. Only one study compared the outcomes of hydro-dissection treatment in adhesive capsulitis with the intra-articular PRP injection. The rest all either examined PRP alone or compared it with the steroid intra-articular injection. None of the studies showed any major side effects. The intra-articular injections of PRP in the management of adhesive capsulitis of the shoulder provide a new treatment approach. Further studies are required to ascertain the efficacy and safety of the PRP intraarticular injection as a management alternative in adhesive capsulitis. [ABSTRACT FROM AUTHOR]

Background: This investigation assessed the effectiveness of muscle energy and joint mobilisation techniques on range of motion, pain and functional ability in adults with frozen shoulder., Methods: Relevant RCTs from a 10-year period, or from 2013 to September 28, 2023, were looked for in databases including PubMed, PEDro, and Google Scholar. Two reviewers independently screened the literature and a third reviewer intervened to resolve the conflict. Risk of Bias assessment was done by the PEDro scale and the certainty of evidence was checked using the Grading of Recommendations, Assessment, Development and Evaluation at three time points. The final articles were systematically summarised., Results: A total of 9 studies comprising 439 subjects were selected for data extraction. Overall joint mobilisation technique and muscle energy technique both tended to be more effective than conservative management but there was a low to very low level of certainty for the effectiveness of muscle energy technique and joint mobilisation technique for frozen shoulder at short term, medium term and long-term time points., Conclusion: This review indicates that current evidence for managing frozen shoulder with joint mobilisation and muscle energy techniques is limited and of low quality. However, positive outcomes in most studies suggest potential benefits in pain relief, range of motion, and function, suggesting they could be useful adjuncts to conventional treatment., (© 2024 John Wiley & Sons Ltd.)

Adhesive capsulitis shoulder is a common problem of patients presenting with shoulder pain and disability. The approach to such patients includes a variety of modalities. This systematic review evaluates the efficacy of intra-articular injections of platelet-rich plasma (PRP) in the treatment. A literature search was performed between January 2010 and 30 May 2022. MeSH terms used were ‘Platelet-rich plasma’ OR ‘PRP’ AND ‘Frozen shoulder’ OR ‘Adhesive capsulitis shoulder’ OR ‘Periarthritis shoulder’. The search included published articles in the English language involving human subjects. Studies evaluating other types of shoulder disorders, in vitro studies, review articles, animal-model studies, and pre-clinical trials were excluded. The data regarding study characteristics, efficacy, and safety outcomes were analyzed. A total of 11 studies with 347 patients over 10 years were finally included in this review. Most publications were in 2019 and 2020, mostly from India. This review included seven comparative studies, three case series, and one case report. In seven studies, a single intra-articular PRP injection was administered, whereas in the rest of the studies two or multiple injections were given. Only one study demonstrated an equivocal efficacy of PRP and steroid intra-articular injection. The rest all depicted better clinical and functional outcomes with the PRP injection. Only one study compared the outcomes of hydro-dissection treatment in adhesive capsulitis with the intra-articular PRP injection. The rest all either examined PRP alone or compared it with the steroid intra-articular injection. None of the studies showed any major side effects. The intra-articular injections of PRP in the management of adhesive capsulitis of the shoulder provide a new treatment approach. Further studies are required to ascertain the efficacy and safety of the PRP intraarticular injection as a management alternative in adhesive capsulitis.

Introduction Periarthritis of the shoulder, or frozen shoulder (FS), is a common, painful, and disabling condition with varied treatment strategies. Intra-articular (IA) corticosteroid (CS) injections are a popular treatment option, but their efficacy is often temporary. Platelet-rich plasma (PRP) has emerged as an alternative therapy for adhesive capsulitis, but the literature on its effectiveness is limited. This study aimed to compare the efficacy of IA PRP and CS injections in managing FS. Methods In this prospective, randomized study, 68 patients who met the inclusion criteria were enrolled and randomized using a computer-generated table into two groups: Group 1 (IA PRP) received 4 ml PRP, and Group 2 (IA CS) received 2 ml (80 mg) of methylprednisolone acetate mixed with 2 ml normal saline (for a total of 4 ml) as a CS injection in the IA area of the shoulder. Outcome measures included pain; shoulder range of motion (ROM); the condensed version of the disabling conditions of the arm, shoulder, and hand (QuickDASH) score; and the shoulder pain and disability index (SPADI) score. Participants were monitored via follow-up for 24 weeks, with pain and function assessed at each evaluation using the visual analog scale (VAS) score, the SPADI score, and the QuickDASH score. Results The IA PRP injections demonstrated better long-term outcomes than the IA CS injections, significantly improving pain, shoulder ROM, and daily activity performance. After 24 weeks, the mean VAS score in the PRP and methylprednisolone acetate groups was 1.00 (1.0 to 1.0) and 2.00 (2.0 to 2.0), respectively (P≤0.001). The mean QuickDASH score was 41.83 ± 6.33 in the PRP group and 48.76 ± 5.08 in the methylprednisolone acetate group (P≤0.001). The mean SPADI score was 53.32 ± 7.49 in the PRP group and 59.24 ± 5.80 in the methylprednisolone acetate group (P≤0.001), indicating a significant improvement in the PRP group's pain and disability scores after 24 weeks. The rate of complications was similar between the two groups. Conclusions Our findings suggest that IA PRP injections provide better long-term results than IA CS injections for managing FS. Platelet-rich plasma can be used as a treatment modality for better outcomes, particularly when the patient is contraindicated or refuses CS treatment. Further research is needed to evaluate the efficacy of these treatment modalities at different stages of FS and explore the potential benefits of ultrasound-guided injections., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Somisetty et al.)

Adhesive capsulitis shoulder is a common problem of patients presenting with shoulder pain and disability. The approach to such patients includes a variety of modalities. This systematic review evaluates the efficacy of intra-articular injections of platelet-rich plasma (PRP) in the treatment. A literature search was performed between January 2010 and 30 May 2022. MeSH terms used were 'Platelet-rich plasma' OR 'PRP' AND 'Frozen shoulder' OR 'Adhesive capsulitis shoulder' OR 'Periarthritis shoulder'. The search included published articles in the English language involving human subjects. Studies evaluating other types of shoulder disorders, in vitro studies, review articles, animal-model studies, and pre-clinical trials were excluded. The data regarding study characteristics, efficacy, and safety outcomes were analyzed. A total of 11 studies with 347 patients over 10 years were finally included in this review. Most publications were in 2019 and 2020, mostly from India. This review included seven comparative studies, three case series, and one case report. In seven studies, a single intra-articular PRP injection was administered, whereas in the rest of the studies two or multiple injections were given. Only one study demonstrated an equivocal efficacy of PRP and steroid intra-articular injection. The rest all depicted better clinical and functional outcomes with the PRP injection. Only one study compared the outcomes of hydro-dissection treatment in adhesive capsulitis with the intra-articular PRP injection. The rest all either examined PRP alone or compared it with the steroid intra-articular injection. None of the studies showed any major side effects. The intra-articular injections of PRP in the management of adhesive capsulitis of the shoulder provide a new treatment approach. Further studies are required to ascertain the efficacy and safety of the PRP intraarticular injection as a management alternative in adhesive capsulitis.

Introduction/Background Periarthritis shoulder (PA) characterized by gradual onset of pain with restriction of active and passive shoulder range of motion is one of the commonest musculoskeletal conditions of upper limb. Treatment options include rest, NSAID, active and passive mobilization, physical modalities, hydro-dilatation, manipulation under anaesthesia, arthroscopic capsular release, intra-articular injections and regional nerve blocks. Material and method Ninety patients of periarthrits shoulder were enrolled in the study and randomly allocated into two groups. Group A received methyl prednisolone 80 mg intra-articular injection and group B received suprascapular nerve block of 0.5% bupivacaine and methyl prednisolone. Each patient was assessed before intervention, at 1, 4 and 12 weeks after intervention. 0–10 Numeric Pain Intensity Scale, Active and passive range of motion, Quick Disability of Arm, Shoulder and Hand (DASH) score and Shoulder Pain and Disability Index (SPADI) were used for assessment. Results Group A showed statistically significant improvement ( P < 0.05) in pain, ROM and functional index on follow-up at 1, 4 and 12 weeks whereas, group B showed improvement ( P < 0.05) in all parameters except passive flexion and external rotation on first follow-up. However, this difference disappeared at subsequent follow-ups. Comparison between the groups revealed a better outcome in group A, in terms of Numerical Pain Intensity Scale Scores, SPADI Score, passive extension, active and passive internal and external rotations at 1, 4 and 12 weeks. Both the groups were comparable in terms of qDASH, active and passive abduction, flexion and active extension at first week with group A showing subsequent improvement. Conclusion Both intrarticular steroid injection and suprascapular nerve block showed improvement in patients with periarthritis shoulder, but intrarticular steroid injection was found to be more efficacious as compared to suprascapular nerve block. [ABSTRACT FROM AUTHOR]