scholarly journals IDIOPATHIC UNILATERAL FROZEN SHOULDER

2018 ◽  
Vol 25 (02) ◽  
Author(s):  
Kanwal Arshad ◽  
Farooq Islam ◽  
Sunaina Muneer

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.

Author(s):  
Shakeel Khan Ghauri ◽  
Muhammad Aftab Anwar ◽  
Asif Hanif ◽  
Muhammad Akram

Objective:  To evaluate the result of treatment of frozen shoulder by Hydraulic Distention under local anesthesia with steroid and intra-articular steroid alone. Study Design:  It was a prospective and comparative study. Samples size:  60 patients were taken in this study and were divided into two groups. Duration and Setting:  The study was conducted in 2000 - 2001  treated in the department of Orthopaedic, Mayo Hospital Lahore. Methodology:  The patients were divided into two groups. Group-I were treated by hydraulic distension of glenohumeral joint with 50 ml normal saline under local anesthesia with steroid followed by medicines (oral analgesics and muscle relaxants) and exercises. Patients in group-II were treated by intra-articular steroid followed by medicines (oral analgesics and muscle relaxants) and exercises. Results:  The average age of patients in group I was 52 ± 2.16 years and 50 ± 2.03 in group II. There were 37 (63%) females and 22 (37%) males in our study. Female to male ratio was 1.7:1. All patients in group-I noted immediate pain relief with excellent return of range of motion (ROM) and resumption of normal sleep. At the end of 45 days of follow up all patients had returned to their normal daily activities. Most of them got excellent ROM and pain relief. All patients in group-II noted immediate pain relief and resumption of almost normal sleep. At the end of 45 days of follow up most of the patient presented with good relief of pain but could not return to most of their normal activities because of less improvement in ROM. Conclusions:  Hydraulic distension technique is a quick, safe and gives early results, so it should be considered first for the treatment of frozen shoulder. Key Words:  Frozen Shoulder, Hydrologic Distention, Intra articular steroid.


2020 ◽  
pp. 175857322097717
Author(s):  
Daoud Makki ◽  
Mustafa Al-Yaseen ◽  
Fayaz Almari ◽  
Puneet Monga ◽  
Lennard Funk ◽  
...  

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.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1945.2-1945
Author(s):  
E. Kaya Mutlu ◽  
T. Birinci ◽  
S. Kilic

Background:Frozen shoulder has a greater incidence, more severe course, and resistance to treatment in patients. Management is based on the underlying cause of pain and stiffness. Joint mobilization has been reported to improve joint range of motion in frozen shoulder. However, there is no information regarding the effect of instrument-assisted soft tissue mobilization (IASTM) in frozen shoulder. We proposed that there would be no significant difference between the two manual physical therapy techniques with relatively similar treatment effects in the frozen shoulder.Objectives:The aim of this randomized controlled study was to compare the effectiveness of IASTM and joint mobilization in the treatment of patients with frozen shoulder.Methods:Thirty patients with phase II frozen shoulder (mean age 50,9 years, age range 39–65 years) were randomly assigned to one of the two treatment groups: Group I received joint mobilization combined with manual stretching exercise and Group II received IASTM with manual stretching exercise (two days per week for six weeks) (Figure 1). The pain level was evaluated with a visual analogue scale (VAS) and the active range of motion (ROM) was measured with a universal goniometer. The Disabilities of the Arm, Shoulder and Hand score and the Constant-Murley score were used for functional assessment. The assessments were performed at baseline and after the 6-week intervention.Figure 1.Instrument-Assisted Soft Tissue MobilizationResults:Both groups had a significant decrease in pain according to VAS and a significant increase in ROM and function level (p<0.05). After the 6-week intervention, improvement of shoulder abduction ROM in Group I was found significantly higher than Group II (p=0.01), on the other hand, Constant-Murley score in Group II was found significantly higher compared to Group I (p=0,001).Conclusion:Our results supported the hypothesis that either joint mobilization or IASTM, performed in addition to stretching exercise, provided similar improvements in pain levels in patients with the frozen shoulder.References:[1]Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, Uhl TL, et al. Shoulder Pain and Mobility Deficits: Adhesive Capsulitis, J Orthop Sports Phys Ther, 2013:43:1-31.[2]Celik D, Kaya Mutlu E.Does AddingMobilization toStretchingImprove Outcomes for People with Frozen Shoulder? A Randomized Controlled Clinical Trial, Clin Rehab, 2016: 30(8): 786-794.[3]Iked N, Otsuka S, Kawanishi Y, Kawakami Y. Effects of Instrument-Assisted Soft Tissue Mobilization on Musculoskeletal Properties, Med Sci Sports Exerc, 2019:51(10): 2166-2172.Disclosure of Interests:None declared


2021 ◽  
Vol 1 (1) ◽  
pp. 163-167
Author(s):  
Siti Sarah Bintang Sarah Bintang ◽  
Sabirin Berampu ◽  
Mawaddah Saleha ◽  
Miftahul Zannah ◽  
Simson Sinuhaji ◽  
...  

Frozen shoulder or another name for adhesive capsulitis is pain that results in limited Range of Motion (ROM). Frozen shoulder or another name for adhesive capsulitis is pain that results in limited Range of Motion (ROM). Codman pendular exercises are interventions or techniques often used by physiotherapists to increase Range of Motion (ROM). This service activity is carried out through seminars using lecture, question and answer methods and demonstrations. The samples taken were patients with frozen shoulder with a total of 14 people. The statistical test results obtained p-value <0.05, it can be concluded that the hypothesis in the study was accepted, namely: "There is an Effect of Giving Codman Pendular Exercises and Mulligan Mobilization With Movement on Increasing Range Of Motion in Frozen Shoulder Patients"


Author(s):  
Ramamurthy Raja ◽  
Mitali Shekadar ◽  
VN Ravish

Introduction: Adhesive capsulitis is a self-limiting regional skeletal condition of uncertain aetiology characterised by a progressive loss of both active and passive mobility of the glenohumeral joint in the shoulder complex. It begins insidiously with shoulder pain and dysfunction in middle aged and elderly population. Adhesive capsulitis predominantly affects the older population, affecting both the sexes; however, female patients are affected more. Aim: To find the effect on pain, Range of Motion (ROM) and disability in subjects with adhesive capsulitis treated with hot pack along with caudal glide versus hot pack along with antero-posterior glide mobilisation. Materials and Methods: The study, quasi experimental, was conducted on 80 subjects which were further divided into two groups with 40 subjects in each groups. Subjects were evaluated for pain, ROM and disability index. Group A received antero-posterior glide mobilisation with the hot pack, where as Group B received caudal glide mobilisation with hot pack for thrice a week for three weeks completing a total of nine sessions. The statistical analysis was done using one-way ANOVA and post-hoc t-test for calculating within and between group differences. The parameters that were measured were Visual Analogue Scale (VAS), ROM, Shoulder Pain and Disability Index (SPADI). Results: The p-value after three weeks between the groups was 0.02, 0.0001, and 0.014 for VAS, ROM and disability. There was significant difference in the pre and post values in both Group A and Group B. Post-treatment values of VAS (p=0.0001), ROM (p=0.0001), and SPADI (p=0.0001) in Group B were showed more improvement than the post-treatment values of VAS, ROM and SPADI in Group A. Conclusion: Caudal glide mobilisation is more effective in improving pain, abduction ROM and SPADI index in patients with adhesive capsulitis.


2014 ◽  
Vol 17 (2) ◽  
pp. 57-63 ◽  
Author(s):  
Young Woong Back ◽  
Suk Kee Tae ◽  
Min Kyu Kim ◽  
Oh Jin Kwon

BACKGROUND: To compare the effect of different starting periods of rehabilitative exercise (early or delayed passive exercise) on the rate of retear and other clinical outcomes after the arthroscopic repair of the rotator cuff.METHODS: In total, 103 patients who underwent arthroscopic repair of the rotator cuff were included in the study. Determined at 2 weeks post-operation, patients who were incapable of passive forward elevation greater than 90degrees were allotted to the early exercise group (group I: 79 patients; 42 males, 37 females), whilst those capable were allotted to the delayed exercise group (group II: 24 patients; 14 males, 10 females). The group I started passive exercise, i.e. stretching, within 2 weeks of operation, whilst group II started within 6 weeks. The results were compared on average 15.8 months (11-49 months) post-operation using the passive range of motion, the Visual Analog Scale (VAS) pain score, and the University of California at Los Angeles (UCLA) and Constant scores. Stiffness was defined as passive forward elevation or external rotation of less than 30degrees compared to the contralateral side. Follow-up magnetic resonance imaging (MRI) was carried out on average 1 year post-operation and the rate of retear was compared with Sugaya's criteria.RESULTS: There were no differences between the two groups in gender, age, smoking, presence of diabetes, arm dominance, period of tear unattended, pre-operative range of motion, shape and size of tear, degree of tendon retraction, and tendon quality. There were no significant differences in clinical outcomes. Whilst stiffness was more frequent in group II (p-value 0.03), retear was more frequent in group I (p-value 0.028) according to the MRI follow-up.CONCLUSIONS: During rehabilitation after the arthroscopic repair of the rotator cuff, the delay of passive exercise seems to decrease the rate of retear but increase the risk of stiffness.


2021 ◽  
Vol 15 (9) ◽  
pp. 2873-2875
Author(s):  
Mudassar Nazzar ◽  
Muhammad Adeel-Ur- Rehman ◽  
Rizwan Anwar ◽  
Omer Farooq Tanveer ◽  
Muhammad Abdul Hanan ◽  
...  

Objectives: To compare the complications and outcomes of lateral entry pin fixation with medial and lateral pin fixation for Gartland type III supracondylar fractures of humerus. Methodology: This prospective comparative study involving 190 patients of Gartland type III close supracondylar fractures were included. from March-2019 to Dec-2020. In all patients, initially the elbow was mobilized using the splint placed above the elbow joint at 30 to 45 degrees’ flexion. After closed reduction, lateral pinning was applied in group I and in group II lateral and medial cross pinning was applied using the standard protocol. Patients were followed for iatrogenic ulnar nerve injury, radiologic and function outcomes in-terms of loss of reduction, elbow range of motion, loss in carrying angle and functional outcomes. Results: The two groups were comparable for loss of elbow range of motion, loss of carrying angle and loss of Bauman's angle. On clinical examination, immediate post-operative ulnar nerve injury was diagnosed in 4 (4.2%) cases in group II and in no patient in group I (p-value 0.12). Satisfactory functional outcomes were achieved in 85 (89.5%) patients in group I and in 88 (92.6%) patients in group II (p-value 0.44). Conclusion: Lateral pinning provided stable fixation clinically and radiologically as compared to lateral and medial cross pinning. Keywords: Supracondylar fracture of Humerus, Iatrogenic ulnar nerve injury, Lateral pin entry, lateral and medial cross pin entry.


2021 ◽  
Vol 15 (7) ◽  
pp. 2289-2291
Author(s):  
Jahangir Anjum ◽  
Talal Safdar ◽  
Muhammad Imran ◽  
Muazzam Fuaad ◽  
Waheed Iqbal ◽  
...  

Objective: The aim of this study is to determine the comparison of adverse outcomes in cirrhotic and non-cirrhotic patients presented with coronavirus disease. Study Design: Place and Duration: The department of Medicine of Divisional Headquarters Teaching Hospital Mirpur Azad Kashmir and Mohiuddin Teaching Hospital, Mirpur AJK for six months during the period from October 2020 to March 2021. Methodology: Total 80covid-19 patients of both genders with or without chronic liver disease were enrolled in this study. Patients were aged between 20-55 years. Patients were divided in to two groups. Group I (with cirrhosis 40 patients) and group II (without cirrhosis 40 patients). Outcomes in term of mortality between both groups were examined. All the data was analyzed by SPSS 26.0 version. Results: There were 24 (60%) males and 16 (40%) were females with mean age 44.19±7.65 years in group I while in group II 27 (67.5%) and 13 (32.5%) patients were males and females with mean age 43.62±5.34 years. We found that mortality rate among patients of group I (cirrhotic) had high mortality rate13 (32.5%) as compared to patients without cirrhosis 5 (12.5%) in group II with p-value 0.0003. Conclusion: We concluded in this that frequency of adverse outcomes was significantly high among cirrhotic patients with coronavirus disease as compared to non-cirrhotic patients. Keywords: Corvid-19, Mortality, Chronic Liver Disease


2018 ◽  
Vol 41 (3) ◽  
pp. 159-164 ◽  
Author(s):  
Madhabi Baidya ◽  
Mahfuza Shirin ◽  
Liton Chandra Saha

Background: Adequate neonatal transport is a key component of care of the sick newborns who require referral to tertiary care center. Poor transportation is one of the iatrogenic factors associated with greater neonatal mortality. Neonatal transport is the greatest challenge faced today in our country. The purpose of this study was to find out characteristics of transport of referred neonates and to idention the factors that contribute to mortality.Methodology: This cross sectional study was conducted in Dhaka Shishu (Children) Hospital from June 2013 to November 2013. Both term and preterm neonates who were referred within first seven days of life were included and those with gross congenital abnormalities and left against medical advice were excluded from the study. After enrollment, data were collected using a structured questionnaire including birth details, interventions before transportation, reasons for referral, and details of transportation. Outcome & duration of hospital stay were also recorded. Neonates who were expired considered as group I and who were survived considered as group II. The study variables were analyzed for their association with immediate outcome by applying chi square test and t test. P value <0.05 was considered significant.Results: This study found that out of 332 neonates 181 were expired with 54.5% mortality rate. One eighty one neonates who were expired, considered as group I and one fifty one neonate were survived, considered as group II. The mortality was significantly high in male neonates [RR 0.80 (0.66-0.97)] and neonates those delivered at home [RR 1.34(1.10-1.64)] (p<0.05). Perinatal asphyxia, pre-term low birth weight, neonatal sepsis were the main causes of referral. It was found that transportation without any referral note [RR 1.40 (1.14- 1.71)], no advice regarding maintenance of airway[RR 1.50(1.17- 1.92)]and keeping warm [RR 1.51(1.17-1.950], resuscitation on admission [RR 1.63(1.23-2.17)] and transportation required > 3hours [RR 1.36(1.09-1.69)] were associated with significantly higher mortality among referred transported neonates(p<0.05).Conclusions: This study found that male neonates, home delivery, transportation without any referral note, no advice regarding maintenance of airway and keeping warm, resuscitation needed on admission and prolonged transportation time were significantly associated with mortality of referred transported neonates.Bangladesh J Child Health 2017; VOL 41 (3) :159-164


2021 ◽  
Author(s):  
Shivkumar Gopalakrishnan ◽  
sangeetha kandasamy ◽  
S.Malini ◽  
S.Peer Mohamed ◽  
k.velmurugan

Abstract Background. Approximately 5% of COVID-19 patients suffer near fatal disease. Clinical and radiologic features may predict severe disease albeit with limited specificity and radiation hazard. Laboratory biomarkers are eyed as simple, specific and point of care triage tools to optimize management decisions.This study aimed to study the role of inflammatory markers in prognosticating COVID-19 patients.Methodology. A hospital based retrospective study was conducted on COVID-19 adult inpatients classified into three groups as mild disease-recovered [Group I], severe disease-recovered [Group II] and dead [Group III]. Categorical outcomes were compared using Chi square test. Univariate binary logistic regression analysis was performed to test the association between the explanatory and outcome variables. Unadjusted OR along with 95% CI was calculated. The utility of lab parameters (Ferritin, LDH, D dimer, N/L ratio and PLT/L ratio) in predicting severity of COVID-19 was assessed by Receiver Operative Curve (ROC) analysis. P value < 0.05 was considered statistically significant.Results. The mean age was 49.32 +/- 17.1 years. Among study population, 378 were Group I, 66 Group II, and 56 Group III. Median levels of Ferritin among the 3 groups were 62ng/mL, 388.50 ng/mL and 1199.50 ng/mL. Median value of LDH were 95U/L, 720 and 982.50(p <0.001). D-dimer values of 3 groups were 23.20ng/mL, 104.30 ng/mL and 197.10 ng/mL (p <0.001). CRP done qualitatively was positive in 2 (0.53%), 30 (45.45%) and 53 (94.64%) of patients. The odds of patients suffering severe COVID-19 rose with rising values of ferritin, LDH and D-dimer [unadjusted OR 1.007, 1.004 &1.020]Conclusion. One time measurement of serum ferritin, LDH, D-dimer and CRP is promising to predict outcomes for COVID 19 inpatients. Single qualitative CRP was equally good but more cost effective than quantitative CRP. The most specific combination was NLR, Lymphocyte percentage and D-dimer levels done between 7th – 10th day of symptoms.


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