Abstract:Background:Idiopathic adhesive capsulitis is a condition of uncertain etiology characterized by pain and decreased shoulder range of motion (ROM) that occurs without a known intrinsic disorder. Many treatments have been advocated, yet the best option remains unclear. The purpose of this study was to determine if arthrographic injection of the shoulder joint with steroid and local anesthetic results in decreased pain and increased shoulder function in a cohort of patients with idiopathic adhesive capsulitis.Met… Show more
“…First, the skin was anesthetized with lidocaine, and then a 21-gauge spinal needle, 2.5–3 inches long, was directed into the shoulder joint space via an anterior approach under fluoroscopic guidance. Approximately 1 cc of contrast was injected to confirm the proper location of the needle inside the joint, followed by an injection of 40 mg triamcinolone (1 cc) and 0.5% lidocaine (5 cc) [ 9 ] (Fig. 1 ).…”
Section: Methodsmentioning
confidence: 99%
“…1 ). The repeated intraarticular injections were administered at 1 to 2-week intervals under C-arm fluoroscopy until a conceivable pain reduction was achieved [ 9 , 10 ]. Fig.…”
Introduction
We evaluated the factors influencing the duration of significant pain reduction after conservative management for adhesive capsulitis (AC).
Methods
Follow-up for 6–8 months was performed with 141 patients with AC who experienced significant pain reduction after treatment. Clinical and demographic factors, numeric rating scale (NRS) scores, and shoulder range of motion (ROM) were collected and assessed pretreatment (T0), at 5 weeks post-treatment (T1), and at 6–8 months post-treatment (T2). Patients were divided into successful (
n
= 96) and unsuccessful (
n
= 45) NRS groups according to the degree of pain reduction at T2. We assessed post-treatment NRS and ROM improvement scores within each group and compared these parameters between the two groups.
Results
Significant NRS and ROM improvements were achieved in all patients who participated in our study. The unsuccessful NRS group demonstrated a lack of significant improvement in abduction at T1 and T2. All T1 and shoulder ROM measurements among the unsuccessful NRS group were significantly smaller than those among the successful NRS group.
Conclusions
Failure to achieve a significant improvement in abduction angle after conservative management of AC was significantly associated with pain recurrence.
“…First, the skin was anesthetized with lidocaine, and then a 21-gauge spinal needle, 2.5–3 inches long, was directed into the shoulder joint space via an anterior approach under fluoroscopic guidance. Approximately 1 cc of contrast was injected to confirm the proper location of the needle inside the joint, followed by an injection of 40 mg triamcinolone (1 cc) and 0.5% lidocaine (5 cc) [ 9 ] (Fig. 1 ).…”
Section: Methodsmentioning
confidence: 99%
“…1 ). The repeated intraarticular injections were administered at 1 to 2-week intervals under C-arm fluoroscopy until a conceivable pain reduction was achieved [ 9 , 10 ]. Fig.…”
Introduction
We evaluated the factors influencing the duration of significant pain reduction after conservative management for adhesive capsulitis (AC).
Methods
Follow-up for 6–8 months was performed with 141 patients with AC who experienced significant pain reduction after treatment. Clinical and demographic factors, numeric rating scale (NRS) scores, and shoulder range of motion (ROM) were collected and assessed pretreatment (T0), at 5 weeks post-treatment (T1), and at 6–8 months post-treatment (T2). Patients were divided into successful (
n
= 96) and unsuccessful (
n
= 45) NRS groups according to the degree of pain reduction at T2. We assessed post-treatment NRS and ROM improvement scores within each group and compared these parameters between the two groups.
Results
Significant NRS and ROM improvements were achieved in all patients who participated in our study. The unsuccessful NRS group demonstrated a lack of significant improvement in abduction at T1 and T2. All T1 and shoulder ROM measurements among the unsuccessful NRS group were significantly smaller than those among the successful NRS group.
Conclusions
Failure to achieve a significant improvement in abduction angle after conservative management of AC was significantly associated with pain recurrence.
“…Physical therapy, combined with other modalities or alone, is the method of choice particularly for patients who experience mild forms in the early stages of the disease 2. As an adjuvant to physiotherapy, medications for relieving pain such as nonsteroidal anti-inflammatory drugs and oral or intra-articular corticosteroids are prescribed to help patients in bearing exercises 2,9–11. Intra-articular injection of sodium hyaluronate, suprascapular nerve block, hydrodilation with or without steroid, and whole-body cryotherapy are other suggested therapeutic measures 2,12–14.…”
mentioning
confidence: 99%
“…2 As an adjuvant to physiotherapy, medications for relieving pain such as nonsteroidal anti-inflammatory drugs and oral or intra-articular corticosteroids are prescribed to help patients in bearing exercises. 2,[9][10][11] Intraarticular injection of sodium hyaluronate, suprascapular nerve block, hydrodilation with or without steroid, and whole-body cryotherapy are other suggested therapeutic measures. 2,[12][13][14] There are a variety of invasive or surgical treatments for patients with long-lasting symptoms or with resistance to conservative therapy.…”
Purpose:
To compare local acupuncture and auricular acupuncture with physiotherapy in the treatment of frozen shoulder.
Methods:
A randomized clinical trial with 3 parallel groups in an outpatient clinic was conducted at a university hospital. In total, 116 participants with frozen shoulder were randomly allocated to 3 groups and underwent physiotherapy or local acupuncture or auricular acupuncture. Shoulder active and passive ranges of motion were assessed, and the Shoulder Pain and Disability Index questionnaire was used to assess pain and disability before and after the treatments.
Results:
Active and passive ranges of motion were best improved by physiotherapy in abduction and flexion (all P < .001). Passive external rotation was best increased after physiotherapy (P = .030). For active external and internal rotation, and also for passive internal rotation, there were no significant differences among the treatments. Pain reduction was more successful with acupuncture, especially with auricular acupuncture (P < .001). Auricular acupuncture was more effective in improving patients' functional abilities (P < .001). None of the participants reported any side effects resulting from the treatments.
Conclusion:
Acupuncture, particularly auricular acupuncture, is more effective in relieving pain and decreasing disability than physiotherapy. All the interventions were beneficial in improving range of motion.
“…37,41 Among them, a corticosteroid injection is the most common treatment in clinical practice. 37,58 Although the effect of corticosteroids in pain relief is fast and apparent, this effect does not last long, and adverse events may arise in adjacent body structures, such as tendon and bone. 38,39 With the use of triamcinolone acetonide, tendon properties become weaker, consequently increasing the rupture rate.…”
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.
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