Citations
To evaluate the efficacy of intra-articular hyaluronic acid (IAHA) injection for hemiplegic shoulder pain (HSP) after stroke.
Thirty-one patients with HSP and limited range of motion (ROM) without spasticity of upper extremity were recruited. All subjects were randomly allocated to group A (n=15) for three weekly IAHA injection or group B (n=16) for a single intra-articular steroid (IAS) injection. All injections were administered by an expert physician until the 8th week using a posterior ultrasonography-guided approach. Shoulder joint pain was measured using the Wong-Baker Scale (WBS), while passive ROM was measured in the supine position by an expert physician.
There were no significant intergroup differences in WBS or ROM at the 8th week. Improvements in forward flexion and external rotation were observed from the 4th week in the IAHA group and the 8th week in the IAS group. Subjects experienced a statistically significant improvement in pain from the 1st week in the IAS and from the 8th week in IAHA group, respectively.
IAHA seems to have a less potent ability to reduce movement pain compared to steroid in the early period. However, there was no statistically significant intergroup difference in WBS and ROM improvements at the 8th week. IAHA might be a good alternative to steroid for managing HSP when the use of steroid is limited.
Citations
To evaluate the feasibility of a new position (internal rotation in hanging) in ultrasonography, we compared the length of the glenohumeral joint space and the effectiveness of steroid injection with the hanging position and with the commonly used abdomen or cross position.
A prospective, randomized controlled trial was performed in 42 patients with adhesive capsulitis of shoulder. We used three arm positions for the posterior approach as follows: the patient's palm on thigh, other hand on abdomen (abdomen position); hand on patient's opposite shoulder (cross position); arm in hanging position with internal rotation of shoulder (hanging position). The order of shoulder position was randomized and blinded. Real-time ultrasonography-guided intra-articular steroid injection was performed by posterior approach at the first position in each patient. The Brief Pain Inventory (BPI), the Shoulder Pain and Disability Index (SPADI), and range of motion (ROM) were measured before steroid injection and 2 weeks after injection.
The lengths of the joint space were 2.88±0.75, 2.93±0.89, and 2.82±0.79 mm in abdomen, cross, and hanging position respectively, with no significant difference among the three positions (p=0.429). Treatment efficacy was significantly improved in ROM, total BPI, and SPADI in all three positions (p<0.001). The changes in ROM for shoulder abduction were 23.6°±19.7°, 22.2°±20.9°, and 10.0°±7.8° in abdomen, cross, and hanging position, respectively. Changes in total BPI scores were 25.1±15.7, 23.6.±18.0, 11.6±6.1, and changes in total SPADI score were 35.0±14.2, 30.9±28.9, and 16.5±10.3 in abdomen, cross, and hanging position, respectively. There were no significant difference among the three positions for all parameters (p=0.194, p=0.121, and p=0.108, respectively.
For patients with adhesive capsulitis who cannot achieve or maintain abdomen or cross position, scanning and injection with the shoulder in internal rotation with hanging position may be a useful alternative.
Citations
To investigate whether an audible cracking sound during shoulder manipulation following distention arthrography is clinically significant in patients with adhesive capsulitis of the shoulder.
A total of 48 patients (31 women, 17 men) with primary adhesive capsulitis of the shoulder completed the study. All participants underwent C-arm-guided arthrographic distention of the glenohumeral joint with injections of a corticosteroid and normal saline. After distention, we performed flexion and abduction manipulation of the shoulder. The patients were grouped into sound and non-sound groups based on the presence or absence, respectively, of an audible cracking sound during manipulation. We assessed shoulder pain and disability based on a Numeric Rating Scale (NRS), the Shoulder Pain and Disability Index (SPADI), and passive range of motion (ROM) measurements (flexion, abduction, internal and external rotation) before the procedure and again at 3 weeks and at 6 weeks after the intervention.
The patients were divided into two groups: 21 were included in the sound group and 27 in the non-sound group. In both groups, the results of the NRS, SPADI, and ROM assessments showed statistically significant improvements at both 3 and 6 weeks after the procedure. However, there were no significant differences between the two groups except with respect to external rotation at 6 weeks, at which time the sound group showed a significant improvement in external rotation when compared with the non-sound group (p<0.05).
These findings showed that manipulation following distention arthrography was effective in decreasing pain and increasing shoulder range of motion. In addition, the presence of an audible cracking sound during manipulation, especially on external rotation, was associated with better shoulder range of motion.
Citations
To find the most effective procedure to treat adhesive capsulitis of the shoulder, we evaluated the clinical effects of an ultrasonographic-guided anterior approach capsular distension and a fluoroscopy-guided posterolateral approach capsular distension. We expected the anterior approach to be better than the posterolateral approach because the rotator interval, a triangular anatomic area in the anterosuperior aspect of the shoulder, which is considered an important component of the pathology of adhesive capsulitis.
Participants were randomly assigned to two groups: 27 patients in group A were injected by an anterior approach with 2% lidocaine (5 mL), contrast dye (5 mL), triamcinolone (40 mg), and normal saline (9 mL) under fluoroscopic guidance in the operating room. Twenty-seven patients in group B were injected using a posterolateral approach with 2% lidocaine (5 mL), triamcinolone (40 mg), and normal saline (14 mL) under ultrasonographic guidance. After injection, all patients received physiotherapy four times in the first postoperative week and then two times each week for eight more weeks. Treatment effects were assessed using the shoulder pain and disability index (SPADI), visual numeric scale (VNS), passive range of motion (PROM), hand power (grip and pinch) at baseline and at one week, five and nine weeks after injection.
SPADI, VNS, PROM, and hand power improved in one week, five and nine weeks in both groups. Statistically significant differences were not observed in SPADI, VNS, PROM, or hand power between groups.
Ultrasonography-guided capsular distension by a posterolateral approach has similar effects to fluoroscopy-guided capsular distension by an anterior approach.
Citations
To evaluate the short-term clinical effects of the intra-articular injection of botulinum toxin type A (BoNT-A) for the treatment of adhesive capsulitis.
A prospective, controlled trial compared the effects of intra-articular BoNT-A (Dysport; 200 IU, n=15) with the steroid triamcinolone acetate (TA; 20 mg, n=13) in patients suffering from adhesive capsulitis of the shoulder. All patients were evaluated using a Numeric Rating Scale (NRS) of the pain intensity and a measurement of the range of motion (ROM) at baseline (before treatment) and at 2, 4, and 8 weeks post-treatment.
The NRS at 2 weeks (BoNT-A vs. TA; 5.0 vs. 5.2), 4 weeks (4.1 vs. 4.9) and 8 weeks (3.8 vs. 4.6) of both treatment groups were significantly lower than that measured at baseline (7.4 vs. 7.6). The ROM of patients' shoulders increased significantly from baseline in both treatment groups. There was no significant difference in the NRS of pain intensity or the ROM between the two groups. Reduction in the pain intensity score was maintained for 8 weeks post-injection in both groups. There were no significant adverse events in either treatment group.
The results suggest that there are no significant short-term differences between the intra-articular injections of BoNT-A and TA. Although BoNT-A has a high cost, it may be used as a safe alternative of TA to avoid the steroid-induced side effects or as a second-line agent, for patients who have failed to respond to the current treatments.
Citations
To investigate the short-term effects and advantages of sono-guided capsular distension, compared with fluoroscopically guided capsular distension in adhesive capsulitis of shoulder.
In this prospective, randomized, and controlled trial, 23 patients (group A) were given an intra-articular injection of a mixture of 0.5% lidocaine (9 ml), contrast dye (10 ml), and triamcinolone (20 mg); they received the injection once every 2 weeks, for a total of 6 weeks, under sono-guidance. Twenty-five patients (group B) were treated similarly, under fluoroscopic guidance. Instructions for the self-exercise program were given to all subjects, without physiotherapy and medication. Effects were then assessed using a visual numeric scale (VNS), and the shoulder pain and disability index (SPADI), as well as a range of shoulder motion examinations which took place at the beginning of the study and 2 and 6 weeks after the last injection. Incremental cost-effective ratio (ICER), effectiveness, preference, and procedure duration were evaluated 6 weeks post-injection.
The VNS, SPADI, and shoulder motion range improved 2 weeks after the last injection and continued to improve until 6 weeks, in both groups. However, no statistical differences in changes of VNS, SPADI, ROM, and effectiveness were found between these groups. Patients preferred sono-guided capsular distension to fluoroscopically guided capsular distension due to differences in radiation hazards and positional convenience. Procedure time was shorter for sono-guided capsular distension than for fluoroscopically guided capsular distension.
Sono-guided capsular distension has comparable effects with fluoroscopically guided capsular distension for treatment of adhesive capsulitis of the shoulder. Sono-guided capsular distension can be substituted for fluoroscopic capsular distension and can be advantageous from the viewpoint of radiation hazard mitigation, time, cost-effectiveness and convenience.
Citations
Method: A cross sectional study in 155 type II diabetic patients was done. The presence of LJM and shoulder adhesive capsulitis was sought. The diseases closely related to diabetes were recorded. The patients were assessed for retinopathy, nephropathy, and neuropathy.
Results: The prevalence of LJM and shoulder adhesive capsulitis in type II diabetic patients was 32.3% and 29.7%, respectively. Development of LJM and shoulder adhesive capsulitis was correlated with age and duration of diabetes. Higher blood HbA1c level was noticed in mild and moderate degree of LJM. The prevalence of shoulder adhesive capsulitis was shown association with LJM. The prevalence of LJM was associated with a history of myocardial infarction and chronic diabetic compli cations. The prevalence of shoulder adhesive capsulitis was associated with retinopathy, carpal tunnel syndrome, and autonomic neuropathy.
Conclusion: According to the results, around 30% of type II DM patients could have hand LJM and should adhesive capsulitis, which suggested more attention and effort to prevent the LJM and shoulder adhesive capsulitis were needed.
Objective: To examine the relation of shoulder adhesive capsulitis and local bone loss to affected limb.
Method: Twenty-nine patients with the adhesive capsulitis of the shoulder were studied. For reference, 29 patients, without history of injury or disease in the upper limbs, were randomly selected. Areal bone mineral density (BMD) was measured from the proximal humerus, distal humerus and forearm of upper limbs using a ProdigyⰒ (Lunar, USA). The BMD of the affected side versus the unaffected were compared.
Results: The reference group: no significant difference between the mean BMDs in the right and left upper limb. The adhesive capsulitis group: 1) The mean BMD in the proxi-mal humerus of the affected upper limb was significantly lower than the unaffected limb (0.85 g/cm2 vs 0.88 g/cm2; p＜0.05). 2) No significant difference between the mean BMDs in the distal humerus of the affected and unaffected limb (1.10 g/cm2 vs 1.10 g/cm2). 3) No significant difference between the mean BMDs in the forearm of the affected and unaffected limb (0.82 g/cm2 vs 0.82 g/cm2).
Conclusion: In patients with adhesive capsulitis of the shoulder, the mean BMD of the affected limb, compared with the unaffected side, was significantly lower in the proximal humerus. But distal humerus and forearm showed no significant side-to-side differences. (J Korean Acad Rehab Med 2002; 26: 327-331)
Objective: MRI findings of adhesive capsulitis (AC) have been rarely documented even though the disease is a rather common disorder. To find reliable MRI parameters, we studied MRI findings of the patients with arthrographically-proven AC.
Method: Eighteen patients with AC (patient group) and eight subjects without AC (control group) were enrolled. Mean age of the former was 55.1 years and that of the latter was 41.4 years. Mean duration of the diseases in patient group was 5.9 months. Oblique coronal and axial MRI images of the shoulder were measured for the thickness of capsule and synovium around the axillary fold (TAF), volume of axillary recess (VAR), and volume of biceps tendon sheath (VBTS), which were com-
pared in both groups using unpaired t-test.
Results: TAF was significantly increased in patient group (p＜0.0001), and the thickened axillary fold greater than 5.1 mm was a useful MRI criterion for the diagnosis of AC with sensitivity of 93% and with specificity of 100%. VBTS was also significantly diminished in patient group (p＜0.05), whereas there was no significant difference in VAR between two groups.
Conclusion: TAF, especially greater than 5.1 mm, and decreased VBTS are useful MRI parameters for the diagnosis of AC of shoulder. (J Korean Acad Rehab Med 2002; 26: 177-181)
Objective: The goal of this study is to investigate the effect of subacromial bursa injection of hyaluronate in patients with adhesive capsulitis of shoulder.
Method: Fifty nine patients with adhesive capsulitis of shoulder were injected with hyaluronate (HyruanⰒ, LG chemical) 2.5 ml to subacromial bursa once a week for 5 weeks and randomly selected twenty eight patients among them were injected with DepomedrolⰒ 20 mg only at first week. The effect of hyaluronate injection was evaluated by pain (Visaul analogue scale), night pain, range of motion of shoulder, functional activities of daily living and patient's self satisfaction at preinjection, every week after first injection until 5th week, 8th and 12th week.
Results: Visual analogue scale and night pain were signi-
ficantly decreased at 5th and 12th week compared with preinjection status. The range of motion of shoulder and functional activities of daily living significantly improved at 5th week and 12th week. Eighty eight percent (N=52) of patients reported as a little improved, improved or much improved at 5th week. No significant serious side effect of injection was found until 12th week.
Conclusion: Hyaluronate injection into subacromial bursa decreased pain and improved shoulder range of motion. It also improved functional activities of daily living of patients with adhesive capsulitis. So it is effective and safe for those patients, especially who cannot receive corticosteroid intraarticular injection. (J Korean Acad Rehab Med 2002; 26: 73-80)
Objective: To define arthrographic findings in patients with frozen shoulder and to evaluate the therapeutic effect of arthrographic capsular distension and rupture.
Method: Thirty patients who were clinically diagnosed as frozen shoulder were enrolled. During a trial of intra-articular injection of 35 mL of fluid which contained 8 mL of 1% lidocaine, 2 mL of prednisolone (80 mg) and 25 mL of radiocontrast material, arthrographic findings and the occurrence of iatrogenic capsular tear were observed. Passive range of shoulder motion (percent of normal, %) at flexion, abduction, internal rotation, and external rotation was measured at pre- and 1 week post-injection. The therapeutic effect of the procedure was statistically analyzed by paired Student's t-test.
Results: Mean age of the subjects was 57-years-old (range: 40∼76 years) and mean duration of the symptom was 6 months (2∼42 months). A decreased joint volume of less than 10 mL (100%), poor or absent filling of the axillary recess or subscapular bursa (75.9%), nonfill of the biceps tendon sheath (37.9%), and irregularity of capsular insertion (31.0%) were typical abnormal arthrographic findings. In one week after arthrographic distension and rupture, the passive range of shoulder motion was significantly (p＜0.05) increased at flexion, abduction and external rotation, of which the range of external rotation was the most remarkably increased (mean, 23.9%).
Conclusion: Distension arthrography was useful for increasing shoulder motion in frozen shoulder, especially at flexion, abduction and external rotation.
Objective: To compare intraarticular steroid injection with and without capsular distension in the treatment of adhesive capsulitis of the shoulder
Method: Fifty-five cases those were clinically diagnosed as adhesive capsulitis of the shoulder were randomly assigned to one of two treatment groups. 28 cases were treated by intraarticular steroid injection with capsular distension (group 1) and 27 cases by steroid injection alone (group 2). They were evaluated by visual analogue scales, Cyriax stages of arthritis, and active shoulder range of motion (flexion, abduction, external rotation and internal rotation). Follow up assessments were made one week and one month after injection.
Results: There were no statistically significant differences in Cyriax stages and VAS between two groups. But in the group 1, shoulder range of motion showed significant improvement in flexion and internal rotation at one week, and flexion at one month.
Conclusion: Intraarticular steroid injection with cspsular distension had no advantage over steroid injection alone in pain reduction, but can help the patients to achieve better range of motion, especially flexion and internal rotation, in treatment of adhesive capsulitis of the shoulder.
Objective: The purpose of this study was to determine the usefulness of manual medicine therapy in adhesive capsulitis of shoulder.
Method: Twelve patients with adhesive capsulitis of shoulder were treated with the muscle energy technique of Greenman in manual medicine therapy. The muscle energy technique of Greenman was repeated 6 times for each subject. The therapeutic effect of manual medicine therapy was assessed by the shoulder range of motion (ROM) and visual analogue scale (VAS) before and after the treatment. Two patients took the fluoroscopic examination before and after the treatment.
Results: After the manual medicine therapy, active range of shoulder motion were increased by 30.0o in forward flexion, by 21.2o in abduction, by 11.2o in external rotation, and by 18.7o in internal rotation, respectively. The visual analogue scale was decreased after treatment. None of the subjects complained pain during treatment. The mobility of shoulder joint was improved and the rhythm of scapulohumeral joint was restored.
Conclusion: The manual medicine therapy is an effective, tolerable and noninvasive treatment method for the painful adhesive capsulitis of shoulder.
Objective: In adhesive capsulitis, assessment of the mobility of the shoulder are likely to have intrinsic error because of the altering scapulohumeral rhythm and extrinsic error. For more objective and the precise assessment of shoulder mobility in adhesive capsulitis, we observed proper glenohumeral movement, the change of scapulohumeral angle, the scapulohumeral rhythm were evaluated with radiography and compared with clinical measurement of shoulder range of motion (ROM).
Method: The subjects were 19 patients (21 shoulder) with adhesive capsulitis of the shoulder and undertook combination treatment of distention arthrography, per os medication of non-steroid anti- inflammatory drug, stellate ganglion block, physical therapy including exercise. We assessed change in visual analogue scale (VAS), joint space capacity, shoulder mobility by measurement of ROM, and scapulohumeral angle in active shoulder abduction under the fluroscopy.
Results: All the subjects experienced pain relief, increased shoulder mobility and restoration of scapulohumeral rhythm. The improvement of the shoulder extension and scapulohumeral angle is well correlated with the change of VAS and joint capacity. However, the improvement of the shoulder flexion, abduction, external rotation and internal rotation were poor correlated with them.
Conclusion: We propose the measurement of scapulohumeral angle with active shoulder abduction in shoulder AP view as an assessment method for shoulder mobility in adhesive capsulitis.
Objective: The purpose of this study was to investigate the risk factors of adhesive capsulitis and the effect of intra-articular steroid injection in spinal cord injured patients.
Method: Fifty spinal cord injured patients participated in this study. The risk factors of adhesive capsulitis were compared between fourteen patients with adhesive capsulitis and thirty-six patients without one. Methylprednisolone acetate 40 mg mixed with 0.5% lidocaine 2 ml was given into glenohumeral joint space in adhesive capsulitis group and their pain and range of motion (ROM) were analyzed.
Results: 1) The incidence of adhesive capsulitis was higher in patients with higher injury level, older age and delayed start of rehabilitation therapy.
2) 10 cm visual analogue scale scores were significantly decreased after intra-articular steroid injection (p＜0.01).
3) The shoulder ROM was increased after intra-articular steroid injection.
The shoulder ROM at pre-injection was 126o in flexion, 113o in abduction, 64o in external rotation and 51o in internal rotation. The shoulder ROM at 4 weeks after injection was 138o in flexion, 131o in abduction, 74o in external rotation and 77o in internal rotation.
Conclusion: There was a trend that the incidence of adhesive capsulitis was higher in patients with higher injury level, older age and delayed start of rehabilitation therapy. Further, it was suggested that intra-articular steroid injection was effective for reducing pain and improving ROM.
Objective: To evaluate the efficacy of intraarticular injection of hyaluronic acid and steroid in adhesive capsulitis of shoulder.
Method: Thirty-nine patients with adhesive capsulitis of shoulder were assigned at random to receive intraarticular injection into the glenohumeral joint. The treatment groups were divided into three: group A, triamcinolone 1 ml and 1% lidocaine 3 ml and normal saline 25 ml; group B, hyaluronic acid 2 ml and 1% lidocaine 3 ml and normal saline 25 ml; group C, hyaluronic acid 2 ml and 1% lidocaine 3 ml. The same physical therapy program was carried out for all patients. Pain was assessed by visual analogue scale (VAS) and range of motion (flexion, abduction, internal rotation and external rotation) was measured before injection, and at 30 minutes, 1 week and 2 weeks after injection.
Results: The shoulder range of motion (ROM) and VAS of three groups were all improved at 30 minutes, 1 week and 2 weeks after injection compared with those of preinjection, but there was no significant difference in ROM and VAS among three groups.
Conclusion: We concluded that intraarticular injection of hyaluronic acid would be a good treatment method in adhesive capsulitis of shoulder, specially in patients with risk of steroid use.
Objective: To evaluate the effects of stellate ganglion block(SGB) in adhesive capsulitis of the shoulder which was not treated with other procedures and therapeutic exercise.
Method: Fifty patients with adhesive capsulitis of the shoulder were assessed by the shoulder range of motion(ROM) and visual analogue scale before and in 30 minutes after the SGB without other procedures and therapeutic exercise.
Results: In 30 minute after the SGB, the shoulder ROM increased 11o in flexion, 14o in abduction, 8o in internal rotation, and 6o in external rotation and visual analogue scale decreased (P＜0.05). The changes of shoulder ROM after the SGB were not significantly related to duration of the adhesive capsulitis of shoulder, except in flexion.
Conclusion: The stellate ganglion block can be another effective method for the patients with adhesive capsulitis of the shoulder.
Object: To find out the anatomical changes of adhesive capsulitis of the shoulder by the ultrasonography.
Method: We examined 20 patients with a adhesive capsulitis of the shoulder. Ultrasonographic findings were analysed by a radiologist who measured the synovium thickness of anterior, posterior and axillary plane and coracohumeral ligament length of the shoulder.
Results: Synovium thickness of the shoulder was measured with a mean value of 1.4⁑0.3 mm in the anterior plane, 1.4⁑0.4 mm in posterior plane and 1.8⁑0.5 mm in axillary plane of the unaffected sides and a mean value of 1.7⁑0.5 mm in the anterior, 1.8⁑0.4 mm in posterior and 3.2⁑1.0 mm in axillary planes of the affected sides. Coracohumeral ligament length was measured with a mean value of 27.8⁑7.9 mm in the unaffected side and 26.3⁑8.1 mm in the affected side.
Conclusion: The characteristic appearance of the adhesive capsulitis of the shoulder by ultrasonography was an increased synovium thickness in the axillary plane compared to the unaffected side. This study demonstrates that the ultrasonography is a valuable tool for the evaluation and follow up for the adhesive capsulitis of shoulder.
First
Prev
