Manipulation under anaesthesia for frozen shoulders: outdated technique or well-established quick fix?

Manipulation under anaesthesia (MUA) for frozen shoulder (FS) leads to a considerable increase in range of motion and Oxford shoulder score, a significant reduction in pain and around 85% satisfaction. A clearly defined indication for MUA in FS patients cannot be extracted from this review or the available literature. The associating criteria before proceeding to MUA vary widely. All but one study in this review lacked a control group without intervention. Therefore, firm conclusions about the role of MUA in the treatment of FS cannot be drawn from the current literature. An overall complication rate of 0.4% was found and a re-intervention rate of 14%, although most of the included papers were not designed to monitor complications. The following criteria before proceeding to MUA are proposed: a patient unable to cope with a stiff and painful shoulder; clinical signs of a stage 2 idiopathic FS; lessening pain in relation to stage 1; external rotation < 50% compared to contralateral shoulder joint; a minimal duration of symptoms of three months; and failure to respond to an intra-articular corticosteroid infiltration. Cite this article: EFORT Open Rev 2019;4:98-109. DOI: 10.1302/2058-5241.4.180044

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Clinical Significance of ROMs, OXY, SHp and HMGB-1 in Canine Leishmaniosis

Animals ◽

10.3390/ani11030754 ◽

2021 ◽

Vol 11 (3) ◽

pp. 754

Author(s):

Michela Pugliese ◽

Alessandra Sfacteria ◽

Gaetano Oliva ◽

Annastella Falcone ◽

Manuela Gizzarelli ◽

...

Keyword(s):

Oxidative Stress ◽

Lymph Nodes ◽

Clinical Signs ◽

Biological Tissues ◽

Stress Index ◽

Control Group ◽

Canine Leishmaniosis ◽

Oxidative Stress Parameters ◽

Stress Parameters

This study aimed to investigate the role of oxidative stress parameters (ROMs, OXY, SHp), the Oxidative Stress index (OSi), and High Mobility Group Box-1 protein (HMGB-1) in canine leishmaniosis (CanL). For this study, thirty dogs, naturally infected with Leishmania spp. (Leishmania Group, LEISH) and ten healthy adult dogs (control group, CTR) were included. The diagnosis of CanL was performed by a cytological examination of lymph nodes, real time polymerase chain reaction on biological tissues (lymph nodes and whole blood), and an immunofluorescence antibody test (IFAT) for the detection of anti-Leishmania antibodies associated with clinical signs such as dermatitis, lymphadenopathy, onychogryphosis, weight loss, cachexia, lameness, conjunctivitis, epistaxis, and hepatosplenomegaly. The HMGB-1 and oxidative stress parameters of the LEISH Group were compared with the values recorded in the CTR group (Mann Whitney Test, p < 0.05). Spearman rank correlation was applied to evaluate the correlation between the HMGB-1, oxidative stress biomarkers, hematological and biochemical parameters in the LEISH Group. Results showed statistically significant higher values of SHp in the LEISH Group. Specific correlation between the ROMs and the number of red blood cells, and between HGMB-1 and SHp were recorded. These preliminary data may suggest the potential role of oxidative stress in the pathogenesis of CanL. Further studies are undoubtedly required to evaluate the direct correlation between inflammation parameters with the different stages of CanL. Similarly, further research should investigate the role of ROMs in the onset of anemia.

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Factors Affecting the Outcomes of Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119867621 ◽

2019 ◽

Vol 7 (9) ◽

pp. 232596711986762 ◽

Cited By ~ 3

Author(s):

Syed M. Rizvi ◽

Ahmed J. Harisha ◽

Patrick H. Lam ◽

George A.C. Murrell

Keyword(s):

Range Of Motion ◽

Internal Rotation ◽

External Rotation ◽

Adhesive Capsulitis ◽

Linear Regression Analysis ◽

Frozen Shoulder ◽

Level Of Evidence ◽

Duration Of Symptoms ◽

Capsular Release ◽

Arthroscopic Capsular Release

Background: Arthroscopic capsular release has been shown to provide excellent short- and long-term outcomes in patients with idiopathic frozen shoulder. Some surgeons delay surgery in the belief that operating in the early stages of adhesive capsulitis results in a poorer prognosis. However, it is unclear which factors, particularly the stage of the disorder, affect the surgical outcome of this procedure. Hypothesis: Patients who undergo capsular release during the early symptomatic stage of idiopathic adhesive capsulitis would have less improvement in range of motion compared with those who undergo surgery at a later stage. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 189 shoulders with idiopathic adhesive capsulitis that underwent arthroscopic capsular release were evaluated. All patients completed a L’Insalata questionnaire and had their range of motion and strength tested prior to surgery and at 1, 6, and 12 weeks and 6 months post–capsular release. Post hoc, patients were grouped by whether they had symptoms lasting <10 months (shorter symptoms group; n = 131) or ≥10 months (longer symptoms group; n = 38). Multiple linear regression analysis was performed to determine which preoperative factors were independently associated with a favorable outcome. Results: Patients in the shorter symptoms group were more restricted prior to surgery than were those in the longer symptoms group (mean ± SEM: external rotation, 17° ± 2° vs 27° ± 4° [ P = .04]; abduction, 78° ± 3° vs 92° ± 6° [ P = .04]; internal rotation, S3 ± 1 vs S1 ± 1 [ P = .03]). The shorter symptoms group had greater postoperative improvement in internal rotation (from S3 ± 1 preoperatively to T12 ± 1 vertebral levels) compared with the longer symptoms cohort (from S1 ± 1 to L2 ± 1) ( P = .02). Conclusion: Patients with a frozen shoulder and a duration of symptoms <10 months made greater improvements in internal rotation and had similar final results for flexion, abduction, and external rotation following arthroscopic capsular release when compared with patients who had a longer duration of symptoms, so there is no reason to delay surgery.

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A randomised controlled trial to examine the role of manipulation under anaesthesia for treatment of frozen shoulder

http://isrctn.org/> ◽

10.1186/isrctn11428748 ◽

2013 ◽

Author(s):

David Woods

Keyword(s):

Randomised Controlled Trial ◽

Controlled Trial ◽

Frozen Shoulder ◽

Manipulation Under Anaesthesia ◽

Randomised Controlled

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A preliminary study of manipulation under anaesthesia for secondary frozen shoulder following breast cancer treatment

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13824511649652 ◽

2014 ◽

Vol 96 (2) ◽

pp. 111-115 ◽

Cited By ~ 4

Author(s):

A Leonidou ◽

DA Woods

Keyword(s):

Breast Cancer ◽

Cancer Treatment ◽

Corticosteroid Injection ◽

Frozen Shoulder ◽

Breast Cancer Treatment ◽

Control Group ◽

Study Group ◽

Breast Cancer Patients ◽

Manipulation Under Anaesthesia ◽

Preliminary Study

Introduction The aim of this paper is to present the results of manipulation under anaesthesia (MUA) and injection of local anaesthetic and corticosteroid followed by a physiotherapy regime for secondary frozen shoulder after breast cancer treatment (surgery, radiotherapy), and to compare them with a control group. Methods Patients referred to the senior author for secondary frozen shoulder following breast cancer treatment over a ten-year period were investigated. Recorded data included age, treatment for breast cancer, length of symptoms, Oxford shoulder score (OSS) and range of motion before and after shoulder MUA. These data were compared with a control group of patients with frozen shoulder. Results A total of 263 patients were referred with 281 frozen shoulders. Of these, 7 patients (7 shoulders) had undergone previous breast cancer treatment and the remaining 256 patients (274 shoulders) formed the control group. None of the patients were diabetic. The mean preoperative OSS was 31 for the study group and 27 for the control group, improving to 43 for both groups following MUA. Forty-two per cent of the study group and fifteen per cent of the control group had a second MUA subsequently. At the long-term follow-up appointment, 71% of the study group patients were satisfied with their result. Conclusions The results of this preliminary study suggest that MUA, corticosteroid injection and subsequent physiotherapy have achieved good final results in a series of patients with frozen shoulder secondary to breast cancer treatment. Members of the multidisciplinary team looking after breast cancer patients should be aware of this management option and, on manifestation of this pathology, should refer the patient to an orthopaedic surgeon.

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Hypervetilation syndrome as a risk factor of diastolic dysfunction among hypertension patients

Eastern Ukrainian Medical Journal ◽

10.21272/eumj.2021;9(1):29-38 ◽

2021 ◽

Vol 9 (1) ◽

pp. 29-38

Author(s):

I.V. Zarivna ◽

V.A. Levchenko ◽

I.P. Vakalyuk ◽

M.V. Maksymyak ◽

O.S. Moroz

Keyword(s):

Left Ventricle ◽

Control Group ◽

Hypertensive Disease ◽

Hypertensive Patients ◽

Concentric Hypertrophy ◽

Eccentric Hypertrophy ◽

Heart Disorders ◽

The Right ◽

Stage 1

Hypertensive disease is one of the urgent problems in the modern cardiology. It is known that a huge variety of comorbid states influence the development of hypertensive disease, i. e. neurogenic hyperventilating syndrome. It is the sign and the marker of suprasegmental vegetative structures disorders that destabilize homeostasis, initiate the development of specific pathological processes, which are the base of somatization of hyperventilating disorders, including heart disorders. It led to research of structural and functional characteristics of the ventricles with the help of echocardiology among hypertensive patients with neurogenic hyperventilating syndrome. Ventricular dilation of cavities, mostly of the right one without thickening of the walls, was found in the patients with stage 1 hypertension disease (43.59 %). Dilation of the ventricular cavities was also revealed in hypertensive patients with stage 2 hypertension disease in 37.88% of cases. The next variations of remodeling were registered: concentric – in 10.61% of cases; concentric hypertrophy – in 22.73%; asymmetric hypertrophy – in 12.12%; eccentric remodeling and eccentric hypertrophy of the left ventricle – in 4.55% and 9.09% of patients, respectively. Thickening of the right ventricle wall was observed in 13.64% of patients. In the control group of patients without hypertonic syndrome, the signs of concentric and asymmetric hypertrophy were noticed in 10% of patients, eccentric – in 20%; extension of the left ventricle – in 20%. The assessment of the condition of transmitral and tricuspid flows revealed a significant increase in the number of cases, disorders, relaxation of the heart ventricles among hypertensive patients with neurogenic hyperventilating syndrome. It can be a sign of specific role of permanent hyperventilation in ventricle remodeling and mandatory systematic echocardiological control of these patients.

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ROLE OF CYTOKINE ACTIVATION IN THE DEVELOPMENT OF CARDIOVASCULARDISORDERS IN PATIENT WITH GRAVES DISEASE AND CHRONIC HEART FAILURE

HERALD of North-Western State Medical University named after I I Mechnikov ◽

10.17816/mechnikov20157274-77 ◽

2015 ◽

Vol 7 (2) ◽

pp. 74-77

Author(s):

A V Frolova ◽

T I Rodionova

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Clinical Signs ◽

Cardiovascular Complications ◽

Control Group ◽

Graves Disease ◽

Necrosis Factor Alpha ◽

Cytokine Activation ◽

Thyrotropin Receptor Antibodies ◽

Stage 1

The aim of the study is to assess the ability to influence immunological changes on the formation of cardiovascular complications of hyperthyroidism by determining the level of thyrotropin-receptor antibodies (TRAb), 6,8,10 interleukins (IL-6,8,10) and tumor necrosis factor-alpha (TNF-) in patients with Graves’ disease (Gd) and chronic heart failure (CHF) and without it. 68 patients were investigated with Gd, CHF diagnosed in 38 patients (55.9%), stage 1- in 12 patients (31.6%), stage 2A - in 19 (50%) patients, stage 2B - in 7 (18,4%) patients. For the analysis, patients were divided into 3 groups: 1 - with no signs of heart failure, 2 with CHF 1 stage (because the clinical signs characteristic of heart failure stage 1 can also be symptoms of hyperthyroidism, these patients were in separate group), 3 - CHF 2A and step 2B. In all three patients groups showed a significant increase in the levels of cytokines and TRAb compared with the control group. The development of CHF in patients with Graves’ disease is associated with increasing of IL-6, IL-8 and IL-10 concentration. direct correlation between the level of TRAb, TNF- and development of the cardiovascular complications in patients with Gd have not been identified.

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A Thickened Coracohumeral Ligament and Superomedial Capsule Limit Internal Rotation of the Shoulder Joint: Report of Three Cases

Case Reports in Orthopedics ◽

10.1155/2016/9384974 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Masashi Koide ◽

Junichiro Hamada ◽

Yoshihiro Hagiwara ◽

Kenji Kanazawa ◽

Kazuaki Suzuki

Keyword(s):

Internal Rotation ◽

External Rotation ◽

Adhesive Capsulitis ◽

Arthroscopic Surgery ◽

Frozen Shoulder ◽

Severe Restriction ◽

Manipulation Under Anesthesia ◽

Coracohumeral Ligament ◽

Joint Report

Adhesive capsulitis of the shoulder (also known as frozen shoulder) is a painful and disabling disorder with an estimated prevalence ranging from 2% to 5% in the general population. Although the precise pathogenesis of frozen shoulder is unclear, thickened capsule and coracohumeral ligament (CHL) have been documented to be one of the most specific manifestations. The thickened CHL has been understood to limit external rotation of the shoulder, and restriction of internal rotation of the shoulder has been believed to be related to posterior capsular tightness. In this paper, three cases of refractory frozen shoulder treated through arthroscopic release of a contracted capsule including CHL were reported. Two cases in which there is recalcitrant severe restriction of internal rotation after manipulation under anesthesia (MUA) were finally treated with arthroscopic surgery. Although MUA could release the posterior capsule, internal rotation did not improve in our cases. After release of the thickened CHL, range of motion of internal rotation was significantly improved. This report demonstrates the role of the thickened CHL in limiting the internal rotation of the shoulder. We highlight the importance of release of thickened CHL in addition to the pancapsular release, in case of severe limitation of internal rotation of shoulder.

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Functional outcome of manipulation under anaesthesia for the treatment of frozen shoulder

Journal of Fatima Jinnah Medical University ◽

10.37018/krcw7511 ◽

2020 ◽

Vol 14 (1) ◽

pp. 34-40

Author(s):

Yasir Arfat ◽

Muhammad Umer Anwer ◽

Maria Imdad ◽

Faheem Ahmad Usmani ◽

Sana Imdad ◽

...

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Treatment Modalities ◽

Unknown Etiology ◽

Early Recovery ◽

Duration Of Symptoms ◽

Manipulation Under Anaesthesia

Background: Frozen shoulder is defined as painful progressive loss of shoulder movements with unknown etiology. It is a self-limiting disease with the natural history of 18-30 months but with residual pain and restriction of shoulder movement. Its incidence is 2-5%. Various treatment modalities include benign neglect, physical therapy, non-steroidal anti-inflammatory medications, oral glucocorticoids, distention arthrography, intra articular steroid injections, closed manipulation under anaesthesia (MUA) and arthroscopic release of joint capsule. MUA regarding pain control and range of motion is safe, yields immediate results and is very cost effective. The purpose of this study was to ascertain the functional outcome of manipulation under anaesthesia and physiotherapy for the treatment of frozen shoulder in term of safety, cost effectiveness and immediate results. Patients and Methods: In the 6 months study period, 50 patients with adhesive capsulitis were included by non-probability purposive sampling. Manipulation of shoulders was done under general anaesthesia and after the MUA intra articular injection of a mixture of corticosteroid and local anaesthetic was injected. Postoperatively, all patients underwent physiotherapy. Functional outcome was measured using Shoulder Pain and Disability Index (SPADI) preoperatively and postoperatively at 1st, 2nd and 3rd week follow up. Results: Out of 50 patients, 32 (64%) were females and 18 (36%) were males having female to male ratio of 1.8:1. Average age was 51 years and average duration of symptoms preceding to MUA was 4 months and 27 days. The average pain score decreased from 92.52% to 18.08% and the average disability score reduced from 95% to 17.10%, both at 3rd week postoperative follow up. There were no procedure-related complications. Conclusion: Manipulation under anaesthesia along with physiotherapy diminishes pain and disability, improves range of motion and expedites early recovery of function in patients having frozen shoulder.

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Tryptophan-Niacin Metabolism in Rat with Puromycin Aminonucleoside-Induced Nephrosis

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831.76.1.28 ◽

2006 ◽

Vol 76 (1) ◽

pp. 28-33 ◽

Cited By ~ 7

Author(s):

Yukari Egashira ◽

Shin Nagaki ◽

Hiroo Sanada

Keyword(s):

Body Weight ◽

Urinary Excretion ◽

Enzyme Activities ◽

Treated Group ◽

Control Group ◽

Puromycin Aminonucleoside ◽

Low Level ◽

Key Enzyme

We investigated the change of tryptophan-niacin metabolism in rats with puromycin aminonucleoside PAN-induced nephrosis, the mechanisms responsible for their change of urinary excretion of nicotinamide and its metabolites, and the role of the kidney in tryptophan-niacin conversion. PAN-treated rats were intraperitoneally injected once with a 1.0% (w/v) solution of PAN at a dose of 100 mg/kg body weight. The collection of 24-hour urine was conducted 8 days after PAN injection. Daily urinary excretion of nicotinamide and its metabolites, liver and blood NAD, and key enzyme activities of tryptophan-niacin metabolism were determined. In PAN-treated rats, the sum of urinary excretion of nicotinamide and its metabolites was significantly lower compared with controls. The kidneyα-amino-β-carboxymuconate-ε-semialdehyde decarboxylase (ACMSD) activity in the PAN-treated group was significantly decreased by 50%, compared with the control group. Although kidney ACMSD activity was reduced, the conversion of tryptophan to niacin tended to be lower in the PAN-treated rats. A decrease in urinary excretion of niacin and the conversion of tryptophan to niacin in nephrotic rats may contribute to a low level of blood tryptophan. The role of kidney ACMSD activity may be minimal concerning tryptophan-niacin conversion under this experimental condition.

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The Use of Posterior Pericardiotomy Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery

The Heart Surgery Forum ◽

10.1532/hsf98.20111128 ◽

2012 ◽

Vol 15 (2) ◽

pp. 84 ◽

Cited By ~ 4

Author(s):

Canturk Cakalagaoglu ◽

Cengiz Koksal ◽

Ayse Baysal ◽

Gokhan Alici ◽

Birol Ozkan ◽

...

Keyword(s):

Cardiac Surgery ◽

Heart Surgery ◽

Artery Bypass ◽

Pericardial Tamponade ◽

Anxiety Level ◽

Control Group ◽

Echocardiographic Study ◽

Number Of Patients ◽

Hospital Stays

Aim: The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT).Materials and Methods: We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patient's anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded.Results: The 2 groups were not significantly different with respect to demographic and operative data (P > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (P < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (P < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (P = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups.Conclusion: Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.

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