Frozen shoulder (FS) is a common name for shoulder movement limitation with different degrees of shoulder rigidity and pain. It is characterized by varying developmental courses, different levels of shoulder movement limitation, and background ambiguity due to the multiplicity of its causative factors. Systemic inflammatory cytokines monitoring and restraining is easy to apply, fast to conduct, and needs lower costs compared to invasive methods for frozen shoulder stage evaluation and early controlling of its progress to the stage that necessitates surgical intervention. The aim of this review was to assess the recent findings concerning the role of cytokines in FS pathogenesis and the possibility of preventing or controlling their progress through targeting these cytokines by the new drugs candidates, such as hyaluronan (HA), botulinum toxin type A (BoNT A), Tetrandrine, tumor necrosis factor-stimulated gene-6 (TSG-6), and cannabidiol. Searching the PubMed site, we encountered out of 1608 records, from which 16 original studies were included for the quantitative construction of this systematic review screening of the recent studies to investigate the different FS pathogenic pathways. Most of the scenarios are centered around the inflammatory and fibrotic process triggered by synovial and capsular fibroblast stimulation. This mechanism depends mainly on alarmins cytokines, including thymic stromal lymphopoietin (TSLP), interleukin-33 (IL-33), and interleukin-25 (IL-25), with the stimulation of interleukin-1 α (IL-1α), interleukin-1 β (IL-1β), tumor necrosis alpha (TNF-α), cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) in a joint capsule. Different pathways of transforming growth factor- β (TGF-β) stimulation, resulting in overexpression of the fibrotic factors as tenascin C (TNC), fibronectin 1, collagen I (COL 1) and collagen III (COL III), and matrix metalloproteinases (MMPs) in the capsular or synovial/capsular fibroblasts. The overall investigation of these studies led us to conclude that the new drug candidates proved their efficiency in controlling the common pathogenesis of the inflammatory and fibrotic pathways of frozen shoulder and therefore represent a prospect for easy and early controlling and efficiently treating this serious disease.

IntroductionLong head biceps (LHB) tendon pathology results in anterior shoulder pain, affecting activities requiring overhead movement and forward flexion. Current surgical options for those in whom conservative management failed include tenotomy and tenodesis, and both have considerable success rates and various complications. Herein, we present a novel technique using tenotomy with autotenodesis of the LHB. MethodsPatients with isolated LHB tendinopathy and for whom the six-month conservative treatment failed were included in our study. Our semitenodesis technique was performed from May 2015 to May 2021. All patients underwent postoperative rehabilitation and were followed in the clinic to document the visual analog scale (VAS) score, constant functional score, supination and flexion power, and postoperative satisfaction score. We used IBM SPSS Statistics for Windows version 20.0 (IBM Corp., Armonk, NY) to analyze our data. ResultsThe study included 26 patients with a mean age of 50 ± 4.3 years and a male predominance. Following our technique, the postoperative VAS score improved significantly from 8.8 to 3 within three months and decreased to 0.4 during the final follow-up. The shoulder average constant score improved significantly from 45 ± 4 to 79 ± 5, in addition to a high postoperative mean satisfaction score. Only one patient had a Popeye sign deformity, making an incidence percentage of 3.8% with our technique. ConclusionsWe conducted this study to assess the outcomes of our novel technique using tenotomy with autotenodesis of the LHB compared to traditional techniques such as tenotomy and tenodesis. Our novel technique showed an improvement in pain score superior to patients who underwent tenodesis and tenotomy three months postoperatively. Furthermore, our technique yielded lower postoperative complications than traditional techniques. Our patients also scored a high mean of postoperative satisfaction. Therefore, our technique is a promising treatment option, proving its superiority over tenotomy and tenodesis in treating isolated LHB tendonitis.