scholarly journals Single intra-articular steroid injection of the glenohumeral joint in management of adhesive capsulitis: a comparison between approaches

2018 ◽  
Vol 4 (3) ◽  
pp. 410
Author(s):  
Surykanth Kalluraya ◽  
Anand Varma ◽  
Jayaram P. H.
Keyword(s):  
Range Of Motion ◽  
Outcome Measures ◽  
Glenohumeral Joint ◽  
Steroid Injection ◽  
Adhesive Capsulitis ◽  
Exercise Program ◽  
Steroid Injections ◽  
Vas Score ◽  
Shoulder Range Of Motion ◽  
Therapeutic Exercises

<p class="abstract"><strong>Background:</strong> Adhesive capsulitis is a common, painful musculoskeletal condition of the shoulder associated with loss of range of motion in the glenohumeral joint resulting from contraction of the glenohumeral joint capsule and adherence to the humeral head. Earlier stages of adhesive capsulitis can be treated by intra-articular steroid injections into the glenohumeral joint. This study was designed to study the role of long acting intra-articular corticosteroid injections in combination with simple therapeutic exercises while comparing the outcome of blinded anterior and posterior injection approaches in the management of adhesive capsulitis.</p><p class="abstract"><strong>Methods:</strong> The study comprised of 60 subjects aged 18 years and above who were diagnosed with primary adhesive capsulitis. They were randomly divided into 2 groups i.e., Group A who received blind intra-articular steroid injections via standard anterior approach and group B who received blind intra-articular steroid injection via standard posterior approach. Both groups followed up with a simple home based exercise program. Outcome measures assessed were visual analog scale (VAS) score, shoulder pain assessment disability index (SPADI) and passive shoulder range of motion (ROM).<strong></strong></p><p class="abstract"><strong>Results:</strong> At last follow up, both groups showed statistically significant improvements in all outcome measures i.e., VAS score, SPADI, shoulder ROM. However, comparison between groups did not reveal any statistically significant differences between the two groups.</p><p class="abstract"><strong>Conclusions:</strong> Intra-articular steroid injections into the glenohumeral joint in conjunction with simple physiotherapy are effective in improving pain, function and shoulder ROM in adhesive capsulitis. Both the anterior and posterior injection approaches provide good results.</p>

scholarly journals A Comparative Study of Steroid Injection With or Without Lignocaine in Treating Frozen Shoulder

2018 ◽  
Vol 5 (1) ◽  
pp. 22-28 ◽  
Author(s):  
Alok Pandey ◽  
B Shrestha ◽  
K M Shrestha
Keyword(s):  
Range Of Motion ◽  
Steroid Injection ◽  
Frozen Shoulder ◽  
Equal Frequency ◽  
Steroid Injections ◽  
Shoulder Range Of Motion ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Dominant Side

BACKGROUND: Treatment of Frozen shoulder (Adhesive Capsulitis) is mainly nonoperative. Intra-articular steroid injections and physiotherapy are one of the most effective and useful treatment. Even though intra-articular steroid injections are very effective in inflammatory phase of the disease; patients are reluctant to move their affected shoulder for fear of pain. Thus, they do not follow exercise program properly resulting in poor outcomes.OBJECTIVE: If pain could be reduced, outcome of treatment can improve. Lignocaine, when combined with steroid injection, plays an important role in immediate improvement of pain and active range of motion thereby increasing the overall result. MATERIALS & METHODS: 100 patients with frozen shoulder were selected according to predetermined inclusion and exclusion criteria. After randomization by sealed envelope technique, patients were divided into Group A and Group B. Group A patients were injected with 2 ml (80 mg) of methylprednisolone and 3 ml of 1% Lignocaine, and Group B patients were injected with 2 ml (80 mg) of methylprednisolone and 3 ml of Distilled water in the affected shoulder via standard posterior approach. Then half an hour of standard shoulder range of motion (ROM) exercise regimen was performed under supervision. Pre injection and post injection pain level was scored by Visual Analogue Score (VAS) and Subjective satisfaction score (SSS). Shoulder exercises were taught and home based physiotherapy was carried out by patients themselves. They were also prescribed oral analgesics for 5 days and were followed at 1, 3, and 6 weeks. At every follow up visit, they were assessed for improvement via Constant-Murley Score (CMS).RESULTS: The mean age of this study in group A and group B was 56.46 years (SD 10.05) and 57.18 years (SD 8.87) respectively (P0.70). There were 31 male and 19 female in group A as compared to group B where there was 26 males and 24 females (P0.41). In both the groups, maximum number of patients presented at around 10 weeks. In both the groups left side dominated right side with equal frequency (33 left sides and 17 right sides) (P 1.00) and non dominant side outnumbered dominant side with near equal frequency (P 1.00). After the intervention, excellent result in SSS was observed only in group A whereas maximum patients of Group B had only fair result (42 patients). There was statistically significant difference between two groups in terms of pain; Activity of daily living (ADL) and Range of motion (ROM). Patients in group A were able to carry more weight than group B.   In CMS 1 and 6 week total, there was statistically highly significant difference between two groups. CONCLUSION: Even though steroid and physical exercises play important role in managing frozen shoulder, addition of lignocaine to steroid injection seems to be helpful. It relieves immediate pain on movement and improves exercise compliance thereby improving early outcomes. Evaluation of long term benefits of lignocaine injection needs further studies. Journal of Universal College of Medical Sciences (2017) Vol.05 No.01 Issue 15, Page: 22-28 

Shoulder hydrodilatation for primary, post-traumatic and post-operative adhesive capsulitis

2020 ◽  
pp. 175857322097717
Author(s):  
Daoud Makki ◽  
Mustafa Al-Yaseen ◽  
Fayaz Almari ◽  
Puneet Monga ◽  
Lennard Funk ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Outcome Measures ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Capsular Release ◽  
Arthroscopic Capsular Release ◽  
Number Of Patients ◽  
Post Traumatic

Background Adhesive capsulitis (frozen shoulder) is characterised by pain and loss of range of motion of the glenohumeral joint. It can be present as primary (idiopathic) or secondary to surgery, trauma or other conditions that restrict the use of the shoulder joint. Various treatment options have been adopted including physiotherapy, manipulation under anaesthetic, hydrodilatation and arthroscopic or open capsular release but the optimal form of management remains uncertain. Objectives The purpose of the study was to assess the clinical outcome of glenohumeral hydrodilatation in three cohorts of patients with different aetiologies with adhesive capsulitis. Study design & methods We carried out a retrospective study of patient who underwent hydrodilatation for adhesive capsulitis between 2013 and 2015. The procedure was performed by a specialist musculoskeletal radiologist under radiological guidance. The injection consisted of steroids, local anaesthetics and NaCl solution with a target volume around 35 mL. Our outcome measures were range of motion, and pre- and post-operative pain. Patients were divided into three groups based on the presumed cause of their stiffness: idiopathic, post-traumatic and post-surgical. Results Two hundred fifty patients were included, with a mean age of 59 years (range: 20–79). Of these, 180 had idiopathic primary adhesive capsulitis (27 were diabetic), 23 were post-traumatic, and 20 following surgical procedures. Thirty-four required further intervention following initial hydrodilatation with 8 undergoing repeat hydrodilatation, and 26 requiring arthroscopic capsular release. The diabetic group accounted for 16 capsular releases and 4 repeat procedures, while the idiopathic group accounted for 9 and 4, respectively. One patient required capsular release in the surgical group. An improvement was recorded in ROM in all groups with mean abduction improving from 59° to 110°, flexion from 50° to 120° and external rotation from 20° to 50°. With regards to pain, the majority showed an improvement from severe or moderate pain to no or mild pain. Conclusions Results show that hydrodilatation resulted in an improvement in all outcome measures, with only a small number of patients, especially those with diabetes, needing further procedures or showing no improvement in range of motion and pain. There was no difference between the post-traumatic and post-surgical groups.

Foot Mobilization and Exercise Program Combined with Toe Separator Improves Outcomes in Women with Moderate Hallux Valgus at 1-Year Follow-up

2018 ◽  
Vol 108 (6) ◽  
pp. 478-486 ◽  
Author(s):  
Sahar Ahmed Abdalbary
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Hallux Valgus ◽  
Outcome Measures ◽  
Mixed Model ◽  
Exercise Program ◽  
Angular Measurements ◽  
Foot Joint ◽  
Abduction Strength

Background: Few studies have documented the outcome of conservative treatment of hallux valgus deformities on pain and muscle strength. We sought to determine the effects of foot mobilization and exercise, combined with a toe separator, on symptomatic moderate hallux valgus in female patients. Methods: As part of the randomized clinical trial, 56 women with moderate hallux valgus were randomly assigned to receive 36 sessions for 3 months or no intervention (waiting list). All patients in the treatment group had been treated with foot joint mobilization, strengthening exercises for hallux plantarflexion and abduction, toe grip strength, stretching for ankle dorsiflexion, plus use of a toe separator. Outcome measures were pain and American Orthopedic Foot and Ankle Society (AOFAS) scores. Objective measurements included ankle range of motion, plantarflexion and abduction strength, toe grip strength, and radiographic angular measurements. Outcome measures were assessed by comparing pretreatment, posttreatment, and 1-year follow-up after the intervention. Mixed-model analyses of variance were used for statistical assessment. Results: Patients who were treated with 3 months of foot mobilization and exercise combined with a toe separator experienced greater improvement in pain, AOFAS scores, ankle range of motion, hallux plantarflexion and abduction strength, toe grip strength, and radiographic angular measurements than those who did not receive an intervention 3 months and 1 year postintervention (P &lt; .001 for all comparisons). Conclusions: These results support the use of a multifaceted conservative intervention to treat moderate hallux valgus, although more research is needed to study which aspects of the intervention were most effective.

Shoulder Range of Motion and Strength Characteristics in Circus Acrobats

2020 ◽  
Vol 35 (3) ◽  
pp. 145-152
Author(s):  
Carlie Huberman ◽  
Melissa Scales ◽  
Srikant Vallabhajosula
Keyword(s):  
General Population ◽  
Range Of Motion ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Hand Dominance ◽  
Cross Sectional ◽  
Shoulder Range Of Motion ◽  
Shoulder Strength ◽  
Shoulder Complex ◽  
Shoulder Range

OBJECTIVES: To begin to establish normative data for shoulder range of motion (ROM) and strength in the circus acrobats and to compare these values based on age, sex, hand dominance, and acrobatic subgroup. METHODS: Active (AROM) and passive (PROM) of the full shoulder complex and PROM of the isolated glenohumeral joint were measured in 193 circus acrobats using standardized techniques for anterior elevation (flexion), posterior elevation (extension), lateral elevation (abduction), and external and internal rotation. Shoulder strength was measured using a hand-held dynamometer in all planes of motion. Measurements were taken twice and averaged. Mixed ANOVA were performed. One-sample t-tests were used to compare with general population. RESULTS: Several significant differences were noted between dominant and non-dominant sides, but not between the sex or age groups tested. Acrobats who did both aerial and ground acrobatics had significantly greater full shoulder complex flexion AROM than the aerial group, and AROM extension than the ground group. Circus acrobats had significantly greater AROM full shoulder complex extension, abduction, internal and external rotation, and shoulder strength than the general population. CONCLUSION: Overall, results from this cross-sectional study revealed that circus acrobats had greater shoulder strength and ROM than the general population, which could affect the way these patients should be treated in a clinical setting. Age and sex seemed to have minimal effects, but there was clearly an effect of hand dominance. Acrobats who train both aerial and ground acrobatics may have greater ROM in certain planes than those who train in only one type of discipline.

scholarly journals COMPARISON OF GLENOHUMERAL JOINT ROTATION RANGE OF MOTION IN YOUNG ATHLETES

2019 ◽  
Vol 25 (1) ◽  
pp. 53-57
Author(s):  
Felipe Ribeiro Pereira ◽  
Gabriela G. Pavan Gonçalves ◽  
Deborah Rocha Reis ◽  
Izabel C. P Rohlfs ◽  
Luciana De Michelis Mendonça ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Functional Performance ◽  
Glenohumeral Joint ◽  
Young Athletes ◽  
Level Of Evidence ◽  
Joint Rotation ◽  
Shoulder Range Of Motion ◽  
Medial Rotation ◽  
Lateral Rotation ◽  
Overhead Throwing

ABSTRACT Introduction: Overhead-throwing athletes undergo changes in shoulder range of motion (ROM) due to sports activities, such as excessive amplitude, lateral rotation (LR) increase and medial rotation (MR) restriction. Asymmetry greater than 20° may render athletes more prone to injuries. There are similarities among sports featuring overhead throwing due to the considerable amount of movements involving maximum lateral rotation. In these sports, medial rotation (MR) restriction, excess of lateral rotation (LR) and shoulder pain are common, particularly in overhead-throwing athletes. Objective: To assess shoulder MR and LR ROM in athletes participating in different sports, considering the influence of these variables on injuries and functional performance. Methods: The rotation ROM of the glenohumeral joint was assessed in 477 young athletes, who were categorized in three sports groups: swimming, overhead-throwing and non-overhead throwing, distributed by age group. Analyses of Variance (ANOVA) were performed to verify if there were differences in MR and LR between groups and paired Student t test was used to verify differences between sides (asymmetry). Results: Youngest athletes showed significant shorter LR than the oldest, in both sides. This study demonstrated that the right side has less MR and greater LR in all groups. Conclusion: The findings showed that overhead-throwing and swimming groups have similarities in shoulder rotation ROM. Level of evidence III; Diagnostic Studies - Investigating a Diagnostic Test.

scholarly journals COMPARISON OF INTRA-ARTICULAR METHYLPREDNISOLONE AND KETOROLAC INJECTIONS IN IMPROVING RANGE OF MOTION FOR DIFFERENT SHOULDER JOINT DISORDERS

2021 ◽  
Vol 71 (3) ◽  
pp. 819-22
Author(s):  
Sumeera Matee ◽  
Wasif Anwar ◽  
Sami Wahid ◽  
Saeed Bin Ayaz ◽  
Rana Shahid ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Shoulder Joint ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Military Hospital ◽  
Prednisolone Acetate ◽  
Methyl Prednisolone ◽  
Shoulder Range Of Motion ◽  
Significant Difference ◽  
Flexion Extension

Objective: To compare the efficacy of intra-articular injection of methyl prednisolone with ketorolac for improvement in range of motion in various shoulder joint disorders. Study Design: Quasi-experimental study. Place and Duration of Study: Departments of Internal and Rehabilitation Medicine, Combined Military Hospital Mangla, from Nov 2018 to May 2019. Methodology: Through non-probability consecutive sampling, patients with shoulder disorders were enrolled in the study and divided into two groups. Group A received intra articular corticosteroid injection and group B received intra-articular Ketorolac injection. Outcome was measured in terms of improvement in shoulder range of motion. Results: A total of 60 patients were selected, 40 (66.7%) male and 20 (33.3%) female. 30 (50%) patients had adhesive capsulitis, 24 (40%) had rotator cuff syndrome and 6 (10%) had impingement syndrome. 24 patients received methyl prednisolone acetate injection while 36 received ketorolac injection. There was no significant difference in the mean gain in flexion, extension, abduction, internal or external rotation between both groups (p=0.224, p=0.261, p=0.884, p=0.238, and p=0.584 respectively). Conclusion: There was no significant difference in efficacy of corticosteroid and ketorolac when injected intra-articularly in shoulder joint disorders.

scholarly journals Neuromodulation of the Suprascapular Nerve

2014 ◽  
Vol 6;17 (6;12) ◽  
pp. E769-E773
Author(s):  
Foad Elahi
Keyword(s):  
Peripheral Nerve ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
Nerve Stimulation ◽  
Shoulder Joint ◽  
Adhesive Capsulitis ◽  
Suprascapular Nerve ◽  
Shoulder Range Of Motion ◽  
Shoulder Range ◽  
Chronic Shoulder Pain

The shoulder joint is an enarthrodial or ball-and-socket joint. A complex network of anatomic structures endows the human shoulder with tremendous mobility, greater than any other joint in the body. Many pathologies can been found in those patients with chronic shoulder pain. The painful limitation of shoulder motion affects hand and arm motion as well; therefore, it significantly influences work performance and everyday activities as well as the quality of life. Therefore, the treatment of patients with chronic shoulder pain has major social and health economic implications. In this article we present a patient with a complex history of shoulder pathology including 7 surgeries that left the patient with chronic debilitating shoulder pain. She was suffering from chronic pain and limited mobility of the shoulder joint due to adhesive shoulder capsulitis. She was treated with a multimodality approach with the goals of increasing shoulder range of motion and decreasing her pain. This did not provide significant improvement. The suprascapular nerve supplies motor and sensory innervation to the shoulder, and can be easily accessible in the supraspinatus fossa. A suprascapular nerve block dramatically decreased her pain. This clinical observation along with confirmatory nerve block play an important role during the decision-making process for a trial period of electrical neuromodulation. She was followed for 3 months after the permanent implantation of a suprascapular nerve stimulator. Her pain and shoulder range of motion in all planes improved dramatically. Peripheral nerve stimulation (PNS) of the suprascapular nerve, in addition to multimodality pain management, is one approach to the difficult task of treating adhesive capsulitis with accompanying pain and the inability to move the shoulder. We conducted a literature review on PubMed and found no case describing a similar patient to our knowledge. Key words: Suprascapular nerve, neuromodulation, peripheral nerve stimulation, adhesive capsulitis, chronic shoulder pain

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