How to Treat Musicians with Frozen Shoulder: A Narrative Review

2021 ◽  
Vol 36 (2) ◽  
pp. 129-138
Author(s):  
LM Kok ◽  
T Kraal ◽  
A van Noort
Keyword(s):  
Glenohumeral Joint ◽  
Adhesive Capsulitis ◽  
Healthcare Providers ◽  
Frozen Shoulder ◽  
Narrative Review ◽  
Loss Of Function ◽  
Treatment Principles ◽  
Early Return ◽  
Wide Range ◽  
Limiting Condition

Musicians comprise a specific occupational group with high musculoskeletal loads as well as demands. A frozen shoulder, or adhesive capsulitis, is a common musculoskeletal condition characterized by pain and loss of function of the glenohumeral joint. Despite being described as a generally self-limiting condition, the clinical course of the disease is unclear. A frozen shoulder can be a career-threatening diagnosis for musicians who need a wide range of motion of the shoulder to play their instruments. The aim of this narrative review is to provide healthcare providers and musicians with an overview of treatment principles for instrumental musicians with frozen shoulder. In this review, both general treatment principles as well as instrument-specific ergonomic tools are discussed. The aim is to provide an overview of the available tools to preserve a musician's playing capabilities and to enable early return to playing the instrument.

scholarly journals ‘Frozen shoulder’ is ill-defined. How can it be described better?

2020 ◽  
Vol 5 (5) ◽  
pp. 273-279 ◽  
Author(s):  
Sophie Abrassart ◽  
Franck Kolo ◽  
Sébastian Piotton ◽  
Joe Chih-Hao Chiu ◽  
Patrick Stirling ◽  
...  
Keyword(s):  
Natural History ◽  
Systematic Reviews ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
The Past ◽  
Three Phase ◽  
Pubmed Search ◽  
History Of ◽  
Definition Of ◽  
Limiting Condition

Frozen shoulder, a common and debilitating shoulder complaint, has been the subject of uncertainty within the scientific literature and clinical practice. We performed an electronic PubMed search on all (1559) articles mentioning ‘frozen shoulder’ or ‘adhesive capsulitis’ to understand and qualify the range of naming, classification and natural history of the disease. We identified and reviewed six key thought leadership papers published in the past 10 years and all (24) systematic reviews published on frozen shoulder or adhesive capsulitis in the past five years. This revealed that, while key thought leaders such as the ISAKOS Upper Extremity Council are unequivocal that ‘adhesive capsulitis’ is an inappropriate term, the long-term and short-term trends showed the literature (63% of systematic reviews assessed) preferred ‘adhesive capsulitis’. The literature was divided as to whether or not to classify the complaint as primary only (9 of 24) or primary and secondary (9 of 24); six did not touch on classification. Furthermore, despite a systematic review in 2016 showing no evidence to support a three-phase self-limiting progression of frozen shoulder, 11 of 12 (92%) systematic reviews that mentioned phasing described a three-phase progression. Eight (33%) described it as ‘self-limiting’, three (13%) described it as self-limiting in ‘nearly all’ or ‘most’ cases, and six (25%) stated that it was not self-limiting; seven (29%) did not touch on disease resolution. We call for a data and patient-oriented approach to the classification and description of the natural history of the disease, and recommend authors and clinicians (1) use the term ‘frozen shoulder’ over ‘adhesive capsulitis’, (2) use an updated definition of the disease which recognizes the often severe pain suffered, and (3) avoid the confusing and potentially harmful repetition of the natural history of the disease as a three-phase, self-limiting condition. Cite this article: EFORT Open Rev 2020;5:273-279.DOI: 10.1302/2058-5241.5.190032

scholarly journals Intraarticular injection of relaxin-2 alleviates shoulder arthrofibrosis

2019 ◽  
Vol 116 (25) ◽  
pp. 12183-12192 ◽  
Author(s):  
William A. Blessing ◽  
Stephen M. Okajima ◽  
M. Belen Cubria ◽  
Juan C. Villa-Camacho ◽  
Miguel Perez-Viloria ◽  
...  
Keyword(s):  
Type I Collagen ◽  
Glenohumeral Joint ◽  
Smooth Muscle Actin ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Joint Space ◽  
Intracellular Camp ◽  
Bolus Administration ◽  
Type I ◽  
Relaxin 2

Arthrofibrosis is a prevalent condition affecting greater than 5% of the general population and leads to a painful decrease in joint range of motion (ROM) and loss of independence due to pathologic accumulation of periarticular scar tissue. Current treatment options are limited in effectiveness and do not address the underlying cause of the condition: accumulation of fibrotic collagenous tissue. Herein, the naturally occurring peptide hormone relaxin-2 is administered for the treatment of adhesive capsulitis (frozen shoulder) and to restore glenohumeral ROM in shoulder arthrofibrosis. Recombinant human relaxin-2 down-regulates type I collagen and α smooth muscle actin production and increases intracellular cAMP concentration in human fibroblast-like synoviocytes, consistent with a mechanism of extracellular matrix degradation and remodeling. Pharmacokinetic profiling of a bolus administration into the glenohumeral joint space reveals the brief systemic and intraarticular (IA) half-lives of relaxin-2: 0.96 h and 0.62 h, respectively. Furthermore, using an established, immobilization murine model of shoulder arthrofibrosis, multiple IA injections of human relaxin-2 significantly improve ROM, returning it to baseline measurements collected before limb immobilization. This is in contrast to single IA (sIA) or multiple i.v. (mIV) injections of relaxin-2 with which the ROM remains constrained. The histological hallmarks of contracture (e.g., fibrotic adhesions and reduced joint space) are absent in the animals treated with multiple IA injections of relaxin-2 compared with the untreated control and the sIA- and mIV-treated animals. As these findings show, local delivery of relaxin-2 is an innovative treatment of shoulder arthrofibrosis.

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.

scholarly journals THE EFFICACY OF PLATELET RICH PLASMA IN THE TREATMENT OF PERIARTHRITIS OF SHOULDER JOINT IN DIABETICS VS NON-DIABETICS

2020 ◽  
pp. 1-3
Author(s):  
T. Venugopal ◽  
M.E. Luther ◽  
Y. Bhanurekha
Keyword(s):  
Shoulder Joint ◽  
Glenohumeral Joint ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Population Based ◽  
Increased Risk ◽  
Patients With Diabetes

Periarthritis of shoulder joint / adhesive capsulitis also commonly known as Frozen shoulder, occurs due to adhesion at the glenohumeral joint 1. The term “Frozen Shoulder” was first described in 1934 by Codman.2 The incidence of periarthritis of shoulder joint is around 3-5% in the general population3. It is more common in females4 and develops between the ages of 40 to 70 years3. The main cause of painful restriction of movement in frozen shoulder is an inflammatory contracture of the joint capsule5. A meta-analysis showed that patients with diabetes were 5 times more likely than non-diabetics to have adhesive capsulitis. Also, the overall prevalence of adhesive capsulitis in diabetics was estimated at 13.4%6. According to a population-based followup study, patients with diabetes had an increased risk of developing adhesive capsulitis of shoulder joint as compared to non-diabetics7. The increased incidence of adhesive capsulitis in diabetics might be due to the glycosylation of the collagen within the shoulder joint triggered by the presence of high blood sugar8.

scholarly journals IDIOPATHIC UNILATERAL FROZEN SHOULDER

2018 ◽  
Vol 25 (02) ◽  
Author(s):  
Kanwal Arshad ◽  
Farooq Islam ◽  
Sunaina Muneer
Keyword(s):  
Range Of Motion ◽  
Glenohumeral Joint ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Systematic Sampling ◽  
Shoulder Abduction ◽  
P Value ◽  
Surgical Interventions ◽  
Group I ◽  
Group Ii

Introduction: Frozen shoulder or adhesive capsulitis is a condition affectingthe glenohumeral joint and leads to restricted painful shoulder. It is very debilitating. This notonly affects the activities of daily living of a person but job related chores too. The inflammationof the capsule of the glenohumeral joint causes pain and restriction of the motion. Adhesivecapsulitis can be characterized as primary or secondary. It can be secondary due to anyunderlying disease such as cervical spondylosis or diabetes mellitus. People affected seekdifferent treatment options for this debilitating condition such as taking non-steroidal antiinflammatorydrugs (NSAIDS), steroid injections, taking physical therapy and some even gofor surgical interventions. Objective: the objective of this research was to find out whetherKaltenborn mobilization technique alone improved the restricted shoulder abduction range ofmotion in better way or a combination of Kaltenborn mobilization and range of motion exerciseswas a better option. Study Design: randomized clinical trial (RCT). Setting: Fatima MemorialHospital (FMH) Shadman Lahore. Period: a period of 6 months. Material and Methods:Group I: Thirty patients participated in this group and were treated with Kaltenborn mobilizationtechnique along with range of motion exercises. Group II: The second group also consisted ofthirty patients and were treated with Kaltenborn mobilization technique without range of motionexercises. Sample Size: Sixty patients were included in the research by taking 30 patients ineach group. Systematic sampling was used in which all the odd ordered patients (1st, 3rd, 5th etc.)were included in group I while all the even ordered patients (2nd, 4th, 6th etc.) in group II. Results:For abduction the mean change was 29.33±10.65 in combination while for kaltenborn alone themean change was 12.30±4.06. The values obtained for shoulder abduction were significantlyhigher in Kaltenborn + ROM group, p-value < 0.05. Conclusion: A combination of Kaltenbornmobilization along with range of motion exercises showed better results in improving shoulderabduction range of motion.

scholarly journals Frozen shoulder: overview of clinical presentation and review of the current evidence base for management strategies

2020 ◽  
Vol 6 (10) ◽  
pp. FSO647
Author(s):  
Akshay Date ◽  
Luthfur Rahman
Keyword(s):  
Clinical Presentation ◽  
Glenohumeral Joint ◽  
Adhesive Capsulitis ◽  
Management Strategies ◽  
Frozen Shoulder ◽  
Scar Tissue ◽  
Evidence Base ◽  
Current Evidence ◽  
Economic Implications ◽  
Current Evidence Base

Adhesive capsulitis of the shoulder (ACS) is a condition with significant clinical and economic implications. The etiology of adhesive capsulitis is not clearly understood and there remains lack of consensus in clinical management for this condition. It can occur as a primary idiopathic condition or secondary to medical conditions or trauma. The hallmarks of ACS are pain and stiffness, caused by formation of adhesive or scar tissue in the glenohumeral joint. Management strategies vary depending on stage of presentation, patient factors and clinician preferences, and can range from conservative options to surgical intervention. The aim of this review is to summarize the pathophysiology and clinical presentation of ACS and to discuss the evidence base for various management strategies employed today.

scholarly journals Does Single Blind Anterior Glenohumeral Steroid Injection Performed by Short Experienced Clinicians Could Provide Clinical Efficacy in Patients with Frozen Shoulder?

2014 ◽  
Vol 17 (3) ◽  
pp. 102-106
Author(s):  
Jin Ho Hong ◽  
Ho Young Ryu ◽  
Yong Bok Park ◽  
Sang Jun Jeon ◽  
Won Ha Park ◽  
...  
Keyword(s):  
Visual Analog Scale ◽  
Glenohumeral Joint ◽  
Steroid Injection ◽  
External Rotation ◽  
Corticosteroid Injection ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Analog Scale ◽  
The Mean ◽  
Frozen State

BACKGROUND: The purpose of this study was to evaluate the effect of single blinded anterior intra-articular corticosteroid injection to the glenohumeral joint performed by short experienced clinicians in frozen state adhesive capsulitis patients.METHODS: From March to June of 2013, among the patients who visited the shoulder outpatient clinic due to shoulder pain for 5-6 months and those patient diagnosed as frozen state adhesive capsulitis was selected. The diagnosis were based on base, first the global limitation of range of motion, defined as forward elevation <100, external rotation at side <10, internal rotation less than buttock, and abduction <70. Second, the patients had additional radiologic evaluations showing no major pathologies for such stiffness. Clinical outcome, were performed with pain visual analog scale (PVAS) and functional visual analog scale (FVAS), American Shoulder and Elbow Surgeons Shoulder score (ASES), preinjection and postinjection after 2-4 weeks. Finally 82-patients were enrolled. Mean age of the patients was 55.1 years and mean follow-up duration was 25.17 days.RESULTS: The mean preinjection PVAS was 6.91 and postinjection was 3.11, there was 3.8 decreases from preinjection status (p < 0.001). The mean FVAS score showed 4.26 at preinjection and 6.63 afterwards (p < 0.001). The ASES score showed 27.89 increases after injection (p < 0.001). There were 64-patients (78.04%) who reported more than 3 points of decrease of PVAS, who could be judged as effective treatment.CONCLUSIONS: Single anterior glenohumeral steroid injection by short experienced clinicians to the patients with frozen state adhesive capsulitis has shown relatively high efficacy in clinical result evaluated by means of PVAS.

scholarly journals A prospective study on causes and functional outcome of frozen shoulder

2016 ◽  
Vol 4 (1) ◽  
pp. 23
Author(s):  
Sanjeev Mahajan ◽  
Daksh Gadi ◽  
Rahul Gupta ◽  
Saurav Singla ◽  
Piyush Setia ◽  
...  
Keyword(s):  
Prospective Study ◽  
Functional Outcome ◽  
Indian Population ◽  
Glenohumeral Joint ◽  
Early Stage ◽  
Adhesive Capsulitis ◽  
Treatment Options ◽  
Frozen Shoulder ◽  
Capsular Release ◽  
Arthroscopic Capsular Release

<p><strong>Backgroud:</strong> Frozen shoulder also called as adhesive capsulitis is a condition characterised by global limitation of humeroscapular motion resulting from contracture and loss of compliance of the glenohumeral joint capsule. Frozen shoulder is a common problem and results in frustrating debilitation for its sufferers. There can be many reasons for pain and stiffness of shoulder joint, so it is very important to differentiate between adhesive capsulitis and the other causes.</p><p><strong>Objective:</strong> The main objective of the study was to evaluate the various modes of treatment for frozen shoulder and to identify various causes and associations of frozen shoulder in Indian population. To the best of our knowledge no prospective study has been done which have compared different treatment options in patients of adhesive capsulitis in Indian population.</p><p><strong>Methods:</strong> The study was done on 75 patients which were divided into three groups, based on the mode of management i.e. conservatively with medication and physiotherapy, physiotherapy and intraarticular injection and arthroscopic capsular release. The range of movement and functional outcome was compared using Constant &amp; Murley score.</p><p><strong>Conclusion:</strong> We found that patients undergoing conservative management showed benefits of various treatment options if the condition is diagnosed at an early stage but the results convincingly prove the advantages of arthroscopic capsular release in patients with chronic painful stiff shoulder or in failed conservative treatment.</p>

scholarly journals Current concepts of natural course and in management of frozen shoulder: A clinical overview

2021 ◽  
Vol 12 (4) ◽  
Author(s):  
Wojciech Konarski ◽  
Tomasz Poboży ◽  
Martyna Hordowicz ◽  
Kamil Poboży ◽  
Julia Domańska
Keyword(s):  
Conservative Treatment ◽  
Frozen Shoulder ◽  
Natural Course ◽  
Loss Of Function ◽  
Normal Range ◽  
Progressive Return ◽  
Surgical Methods ◽  
Limiting Condition ◽  
And Function ◽  
Clinical Overview

Frozen Shoulder (FS) by many specialists is still considered a benign, self-limiting condition, which usually resolves without intervention. This concept originated in the 70’, stating that FS will proceed from “the freezing” phase, with the predominance of inflammation and pain to “the frozen” phase with marked stiffness in the joint and “the thawing” phase, with a progressive return to the normal Range Of Motion (ROM) and function. Nevertheless, numerous authors have recently challenged this concept, arguing that most patients with FS will never fully recover, and suffer from residual pain and loss of function. Lack of early intervention, when a patient does not improve with conservative treatment, might lead to disability. We have discussed the recent concepts in the natural course of the disease and discussed both noninvasive and surgical methods in the treatment of FS.

scholarly journals Mini-Review Regarding the Applicability of Genome Editing Techniques Developed for Studying Infertility

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 246
Author(s):  
Bogdan Doroftei ◽  
Ovidiu-Dumitru Ilie ◽  
Maria Puiu ◽  
Alin Ciobica ◽  
Ciprian Ilea
Keyword(s):  
Motor Activity ◽  
Experimental Model ◽  
Zinc Finger ◽  
Biomedical Research ◽  
Zinc Finger Nucleases ◽  
Loss Of Function ◽  
Transcription Activator ◽  
Phenotypic Changes ◽  
Wide Range ◽  
Short Palindromic Repeat

Infertility is a highly debated topic today. It has been long hypothesized that infertility has an idiopathic cause, but recent studies demonstrated the existence of a genetic substrate. Fortunately, the methods of editing the human genome proven to be revolutionary. Following research conducted, we identified a total of 21 relevant studies; 14 were performed on mice, 5 on zebrafish and 2 on rats. We concluded that over forty-four genes in total are dispensable for fertility in both sexes without affecting host homeostasis. However, there are genes whose loss-of-function induces moderate to severe phenotypic changes in both sexes. There were situations in which the authors reported infertility, exhibited by the experimental model, or other pathologies such as cryptorchidism, cataracts, or reduced motor activity. Overall, zinc-finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs), and clustered regularly interspaced short palindromic repeat (CRISPR)/Cas9 are techniques that offer a wide range of possibilities for studying infertility, even to create mutant variants. It can be concluded that ZFNs, TALENs, and CRISPR/Cas9 are crucial tools in biomedical research.

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