The Effect of Glenohumeral Joint Injection Prior to Physical Therapy on Treatment Outcomes in Adhesive Capsulitis

A 68-year-old woman presented for left shoulder pain, decreased range of motion (ROM) and fever 7 days following COVID-19 vaccination. Investigations showed a tender left deltoid mass, decreased shoulder ROM and elevated inflammatory markers. MRI demonstrated a large glenohumeral effusion with synovitis, and arthrocentesis confirmed septic arthritis (SA). She required subtotal bursectomy. Intraoperative joint cultures grew Streptococcus gordonii. She completed 6 weeks of antibiotics and is undergoing physical therapy for post-infectious adhesive capsulitis. SA is most commonly due to Staphylococcus aureus and β-haemolytic streptococci, and rarely due to viridans group streptococci including S. gordonii. To avoid inadvertent injection into the glenohumeral joint, vaccination should be performed posteriorly and inferiorly into the deltoid musculature. Progressive pain, fever or decreased passive ROM following vaccination should raise concern for SA. Given its rarity, however, concern for secondary SA should not affect the general population’s consideration for vaccination.

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The benefit of platelet-rich plasma injection over institution-based physical therapy program in adhesive capsulitis patients with diabetes mellitus: prospective observational cohort study

Clinics in Shoulder and Elbow ◽

10.5397/cise.2021.00381 ◽

2021 ◽

Author(s):

Apurba Barman ◽

Somanth Mukherjee ◽

Mithilesh K Sinha ◽

Jagannatha Sahoo ◽

Amrutha Viswanath

Keyword(s):

Diabetes Mellitus ◽

Physical Therapy ◽

Range Of Motion ◽

Shoulder Pain ◽

Glenohumeral Joint ◽

Platelet Rich Plasma ◽

Adhesive Capsulitis ◽

Diabetic Patients ◽

Single Shot ◽

Patients With Diabetes

Background: The objective of this study was to compare the efficacy of platelet-rich plasma (PRP) injection with an institution-based physical therapy (PT) program for adhesive capsulitis (AC) of the shoulder in patients with diabetes mellitus (DM).Methods: A total of seventy diabetic patients with AC of the shoulder for <6 months were assigned to two groups: PRP group and PT group. In the PRP group, 35 patients were administered a single shot of PRP (4 mL) into the glenohumeral joint. In the PT group, 35 patients were given institution-based PT that included 10 30-minute sessions of planned PT over a 2-week period. After the interventions, all patients were prospectively followed for 12 weeks. Intensity of shoulder pain, function, and range of motion were assessed at baseline and then at 3, 6, and 12 weeks. Results: Thirty-three patients in the PRP group and 32 in the PT group completed the 12-week study. At 12 weeks, patients who received PRP injections showed greater improvement in shoulder pain (p<0.001) than those recruited to the PT group. In the range of motion and shoulder function activities, patients in the PRP group showed significant improvement compared with the institution-based PT group (p<0.001). No significant complications were reported from any groups.Conclusions: In a diabetic population, PRP injections significantly improved shoulder pain and function compared with an institution-based PT program for shoulder AC. Additionally, it is a safe and well-tolerated method for AC management for diabetic patients.

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Effectiveness of interactive augmented reality-based telerehabilitation in patients with adhesive capsulitis: protocol for a multi-center randomized controlled trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04261-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Seung Mi Yeo ◽

Ji Young Lim ◽

Jong Geol Do ◽

Jae-Young Lim ◽

Jong In Lee ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Physical Therapy ◽

Augmented Reality ◽

Controlled Trial ◽

Adhesive Capsulitis ◽

Performance Measure ◽

Home Exercise ◽

Randomized Controlled ◽

Link Type ◽

Home Based

Abstract Background As the primary treatment for adhesive capsulitis, intensive and accurate home exercise is as important as physical therapy in hospitals. Augmented reality (AR)-based telerehabilitation has been implemented recently in various musculoskeletal conditions to increase patient compliance and enable patients to exercise with the correct posture. The objective of this study is to present a protocol for investigating the additive effect of interactive AR-based telerehabilitation in comparison with the usual care for patients with adhesive capsulitis. Methods This study presents the protocol of a prospective, multi-center, single-blinded, two-armed randomized controlled trial (RCT). One hundred patients with stage I or II adhesive capsulitis will be recruited at the physical medicine and rehabilitation clinic. Patients will be randomly divided into two groups with 1:1 allocation. The intervention group will receive 3 months of hospital-based physical therapy in conjunction with home-based telerehabilitation. The control group will receive 3 months of hospital-based physical therapy in conjunction with a home-based exercise described in a brochure provided by the hospital. The primary outcome will be the change in passive range of motion (ROM) of the affected shoulder joint from baseline to 12 weeks after baseline assessment. The secondary outcomes will be active ROM, pain measured with the numeric rating scale, shoulder pain and disability index, 36-Item Short Form Survey, EuroQoL-5D-5L, and Canadian Occupational Performance Measure. Discussion This will be the first RCT study protocol to investigate the effect of telerehabilitation in patients with adhesive capsulitis. The result of this RCT will determine whether AR-based telerehabilitation is more effective than a brochure-based home exercise program and will provide evidence of the usefulness of “telerehabilitation” using hardware (IoT) and software (monitoring platform) technologies to develop “digital therapeutics” for the future. Trial registration This trial was retrospectively registered at the Clinicaltrials.gov website on 20 March 2020, with the identifier NCT04316130.

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Hyperlipidemia Is a Risk Factor of Adhesive Capsulitis: Real-World Evidence Using the Taiwanese National Health Insurance Research Database

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120986808 ◽

2021 ◽

Vol 9 (4) ◽

pp. 232596712098680

Author(s):

Jr-Yi Wang ◽

Chen-Kun Liaw ◽

Chi-Chang Huang ◽

Tsan-Hon Liou ◽

Hui-Wen Lin ◽

...

Keyword(s):

Risk Factor ◽

Health Insurance ◽

Propensity Score ◽

National Health Insurance ◽

National Health ◽

Glenohumeral Joint ◽

Adhesive Capsulitis ◽

Small Sample ◽

Research Database ◽

Statin Use

Background: Patients with adhesive capsulitis are evaluated for pain and progressive contracture of the glenohumeral joint. Whether endocrine, immune, or inflammatory processes are involved in its definite pathogenesis is still under debate. Some cross-sectional studies with a small sample size have noted that hyperlipidemia is a possible risk factor for frozen shoulders. Purpose/Hypothesis: The purpose was to conduct a longitudinal population-based study to investigate the risk of adhesive capsulitis among patients with hyperlipidemia. It was hypothesized that patients with hyperlipidemia would have a higher risk of adhesive capsulitis and that the use of statin drugs could reduce the rate. Study Design: Cohort study; Level of evidence, 3. Methods: Using data from the National Health Insurance Research Database (NHIRD) of Taiwan, the authors obtained the records of patients with hyperlipidemia who received a diagnosis between 2004 and 2005 and were followed up until the end of 2010. The control cohort comprised age- and sex-matched patients without hyperlipidemia. Propensity score matching was performed for the other comorbidities. A Cox multivariate proportional hazards model was applied to analyze the risk factors of adhesive capsulitis. The hazard ratio (HR) and adjusted HR were estimated between the study and control cohorts after adjustment for confounders. The effects of statin use on adhesive capsulitis risk were also analyzed. Results: The NHIRD records of 28,748 patients and 114,992 propensity score–matched controls were evaluated. A higher incidence rate of adhesive capsulitis was revealed in the hyperlipidemia cohort, with a crude HR of 1.70 (95% CI, 1.61-1.79; P < .001) and adjusted HR of 1.50 (95% CI, 1.41-1.59; P < .001). Patients with hyperlipidemia who used a statin still had higher crude and adjusted HRs compared with controls. Statin use did not exert protective effects on patients with hyperlipidemia. Conclusion: Patients with hyperlipidemia had a 1.5-fold higher risk of adhesive capsulitis than did healthy controls. Statin use did not provide protection against adhesive capsulitis in patients with hyperlipidemia.

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Low Back Pain in Adolescents: A Comparison of Clinical Outcomes in Sports Participants and Nonparticipants

Journal of Athletic Training ◽

10.4085/1062-6050-45.1.61 ◽

2010 ◽

Vol 45 (1) ◽

pp. 61-66 ◽

Cited By ~ 15

Author(s):

Julie M. Fritz ◽

Shannon N. Clifford

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Treatment Outcomes ◽

Clinical Outcomes ◽

Sports Participation ◽

Mean Difference ◽

Analysis Of Covariance ◽

Low Back ◽

Baseline Characteristics

Abstract Context: Back pain is common in adolescents. Participation in sports has been identified as a risk factor for the development of back pain in adolescents, but the influence of sports participation on treatment outcomes in adolescents has not been adequately examined. Objective: To examine the clinical outcomes of rehabilitation for adolescents with low back pain (LBP) and to evaluate the influence of sports participation on outcomes. Design: Observational study. Setting: Outpatient physical therapy clinics. Patients or Other Participants: Fifty-eight adolescents (age = 15.40 ± 1.44 years; 56.90% female) with LBP referred for treatment. Twenty-three patients (39.66%) had developed back pain from sports participation. Intervention(s): Patients completed the Modified Oswestry Disability Questionnaire and numeric pain rating before and after treatment. Treatment duration and content were at the clinician's discretion. Adolescents were categorized as sports participants if the onset of back pain was linked to organized sports. Additional data collected included diagnostic imaging before referral, clinical characteristics, and medical diagnosis. Main Outcome Measure(s): Baseline characteristics were compared based on sports participation. The influence of sports participation on outcomes was examined using a repeated-measures analysis of covariance with the Oswestry and pain scores as dependent variables. The number of sessions and duration of care were compared using t tests. Results: Many adolescents with LBP receiving outpatient physical therapy treatment were involved in sports and cited sports participation as a causative factor for their LBP. Some differences in baseline characteristics and clinical treatment outcomes were noted between sports participants and nonparticipants. Sports participants were more likely to undergo magnetic resonance imaging before referral (P = .013), attended more sessions (mean difference = 1.40, 95% confidence interval [CI] = 0.21, 2.59, P = .022) over a longer duration (mean difference = 12.44 days, 95% CI = 1.28, 23.10, P = .024), and experienced less improvement in disability (mean Oswestry difference = 6.66, 95% CI = 0.53, 12.78, P = .048) than nonparticipants. Overall, the pattern of clinical outcomes in this sample of adolescents with LBP was similar to that of adults with LBP. Conclusions: Adolescents with LBP due to sports participation received more treatment but experienced less improvement in disability than nonparticipants. This may indicate a worse prognosis for sports participants. Further research is required.

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Reliability of measuring the medial knee joint space using ultrasound imaging

10.36879/jcmi.18.000108 ◽

2018 ◽

pp. 1-4

Keyword(s):

Physical Therapy ◽

Knee Joint ◽

Ultrasound Imaging ◽

Mixed Model ◽

Glenohumeral Joint ◽

Joint Space ◽

Rater Reliability ◽

Medial Knee ◽

Operator Experience ◽

Bony Landmarks

Background: The use of ultrasound to perform quantitative musculoskeletal (MSK) measurements requires reliability among different providers with varied levels of experience and training. Recent studies have shown that physical therapists (PT) can reliably measure the glenohumeral joint space using ultrasound imaging (USI) and operator experience or well defined training protocols influences the reliability. Few studies have reported the reliability of medial knee gap measurements with USI. Objective: Evaluate inter- and intra-rater reliability of a novel approach to measuring knee gapping using experienced and trained novice clinicians. Design: Inter-rater and intra-rater reliability study Setting: Physical therapy program Participants: Novice researchers were three upper-year Doctor of Physical Therapy students. Experienced researchers were two PT certified in MSK USI with eight years of experience. Methods: A total of 166 images of two subject’s medial knee joint gaps were captured in resting by a single experience researcher. Three novice researchers, who underwent a three-hour training protocol and two experienced researchers measured the images individually. Measurements were taken using standardized bony landmarks and internal calipers. All researchers were blinded to the subjects and results. Main outcome measures: Data was analyzed using two-way ICC mixed-model single measurement, SEM run for all researchers compared with experienced researcher one. Results: An excellent degree of reliability was found for both intra-rater and inter-rater measurements for Novice One and a good degree of reliability was found between Experienced One and Novice Two and Three. Conclusion: Both experienced and novice researchers attained a clinically significant ICC when compared to Experienced One. An accurate and reliable measurement of the medial knee joint gap maybe useful for further studies and help with diagnosis of joint pathologies. Level of study: IIB

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Glenohumeral Joint Injection

Essential Orthopaedics ◽

10.1016/b978-1-4160-5473-3.00053-8 ◽

2010 ◽

pp. 221-224

Author(s):

Colin G. Crosby ◽

Brandon D. Bushnell ◽

Timothy N. Taft

Keyword(s):

Glenohumeral Joint ◽

Joint Injection

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Common upper limb musculoskeletal lesions

Oxford Handbook of Rheumatology ◽

10.1093/med/9780198728252.003.0020 ◽

2018 ◽

pp. 595-604

Author(s):

Gavin Clunie ◽

Nick Wilkinson ◽

Elena Nikiphorou ◽

Deepak R. Jadon

Keyword(s):

Rotator Cuff ◽

Upper Limb ◽

Glenohumeral Joint ◽

Tennis Elbow ◽

Adhesive Capsulitis ◽

Lateral Epicondylitis ◽

Glenohumeral Instability ◽

Suprascapular Notch ◽

Long Head ◽

Musculoskeletal Lesions

This chapter introduces readers to some common upper limb musculoskeletal lesions, including subacromial (shoulder) impingement syndrome, adhesive capsulitis, and lateral epicondylitis (tennis elbow). The epidemiology, aetiopathogenesis, clinical presentation, and management of these conditions are presented. Algorithms for their management are provided. Other disorders presenting with a subacromial impingement pattern of pain are detailed and optimal diagnostic imaging methods proposed. These include supraspinatus/cuff tendonitis, subacromial bursitis, rotator cuff tear, long head of biceps tendonitis, osteophyte impingement on the rotator cuff tendon, glenohumeral instability due to labral trauma (e.g. SLAP lesion), arthritis of the glenohumeral joint, enthesitis related to spondyloarthritis, and lesions at the suprascapular notch.

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