scholarly journals A Novel Approach to New-Onset Hemiplegic Shoulder Pain With Decreased Range of Motion Using Targeted Diagnostic Nerve Blocks: The ViVe Algorithm

2021 ◽  
Vol 12 ◽  
Author(s):  
John W. Fitterer ◽  
Alessandro Picelli ◽  
Paul Winston
Keyword(s):  
Range Of Motion ◽  
Shoulder Pain ◽  
Adhesive Capsulitis ◽  
Treatment Algorithm ◽  
Diagnostic Algorithm ◽  
Nerve Blocks ◽  
Treatment Pathway ◽  
Painful Shoulder ◽  
Subacromial Injection ◽  
Budapest Criteria

Introduction: Hemiplegic shoulder pain (HSP) is the most common pain disorder after stroke with incidence estimates of 30–70% and associated with reductions in function, interference with rehabilitation, and a reduced quality of life. Onset may occur as soon as a week after stroke in 17% of patients. Management of HSP represents a complex treatment pathway with a lack of evidence to support one treatment. The pain has heterogeneous causes. In the acute setting, decreased range of motion in the shoulder can be due to early-onset spasticity, capsular pattern stiffness, glenohumeral pathology, or complex regional pain syndrome (CRPS). As contracture can form in up to 50% of patients after stroke, effective management of the painful shoulder and upper limb with decreased range of motion requires assessment of each possible contributor for effective treatment. The anesthetic diagnostic nerve block (DNB) is known to differentiate spasticity from contracture and other disorders of immobility and can be useful in determining an appropriate treatment pathway.Objective: To create a diagnostic algorithm to differentiate between the causes of HSP in the stiff, painful shoulder in the subacute setting using diagnostic techniques including the Budapest Criteria for CRPS and DNB for spasticity and pain generators.Results: Examination of each joint in the upper extremity with HSP may differentiate each diagnosis with the use of an algorithm. Pain and stiffness isolated to the shoulder may be differentiated as primary shoulder pathology; sensory suprascapular DNB or intra-articular/subacromial injection can assist in differentiating adhesive capsulitis, arthritis, or rotator cuff injury. CRPS may affect the shoulder, elbow, wrist, and hand and can be evaluated with the Budapest Criteria. Spasticity can be differentiated with the use of motor DNB. A combination of these disorders may cause HSP, and the proposed treatment algorithm may offer assistance in selecting a systematic treatment pathway.

scholarly journals Ultrasound-Guided Hydrodilatation With Triamcinolone Acetonide for Adhesive Capsulitis: A Randomized Controlled Trial Comparing the Posterior Glenohumeral Recess and the Rotator Cuff Interval Approaches

2021 ◽  
Vol 12 ◽  
Author(s):  
Jia-Chi Wang ◽  
Po-Yi Tsai ◽  
Po-Cheng Hsu ◽  
Jian-Ru Huang ◽  
Kevin A. Wang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Rotator Cuff ◽  
Range Of Motion ◽  
Triamcinolone Acetonide ◽  
Shoulder Pain ◽  
Visual Analog Scale ◽  
Controlled Trial ◽  
Adhesive Capsulitis ◽  
Analog Scale ◽  
Randomized Controlled

For patients with adhesive capsulitis, hydrodilatation is typically performed using corticosteroids with ultrasound guidance via the posterior glenohumeral recess. Recently, a new intervention technique via the rotator cuff interval has been described. This study aimed to compare the efficacy of hydrodilatation with triamcinolone acetonide via the posterior glenohumeral recess and the rotator cuff interval in patients with adhesive capsulitis. This prospective randomized controlled trial was conducted in a tertiary care center with a follow-up period of 12 weeks. We enrolled 64 patients diagnosed with shoulder adhesive capsulitis. The subjects were randomly assigned to two groups that received hydrodilatation with corticosteroids either through the posterior glenohumeral recess or though the rotator cuff interval. The injection contained 4 ml of triamcinolone acetonide (40 mg) mixed with 4 ml of 2% lidocaine hydrochloride and 12 ml of normal saline. The shoulder pain and disability index, visual analog scale for pain, and range of motion were analyzed before and at 6 and 12 weeks after the treatment. Both groups experienced improvements in the visual analog scale scores, shoulder pain and disability index scores, and range of motion throughout the study period. A significant group-time interaction was observed in terms of the visual analog scale for pain during motion (p = 0.019), favoring hydrodilatation through the rotator cuff interval. Thus, hydrodilatation through the rotator cuff interval might be a better treatment option than that through the posterior glenohumeral recess for patients with adhesive capsulitis, considering its superior effect in alleviating pain during shoulder movement.

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

scholarly journals General Health Status in Patients of Adhesive Capsulitis visiting Rehabilitation Department of Fauji Foundation Hospital Rawalpindi, Pakistan

2020 ◽  
Vol 4 (2) ◽  
pp. 65-68
Author(s):  
Akhtar Hussain ◽  
Naureen Tassadaq
Keyword(s):  
Health Status ◽  
Activities Of Daily Living ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
General Health ◽  
Daily Living ◽  
Adhesive Capsulitis ◽  
Sleep Cycle ◽  
General Health Status ◽  
Recreational Activities

Objective: To investigate the general health status in patients of Adhesive Capsulitis Study Design: Prospective study Place and duration: Occupational Therapy Unit of Rehabilitation Department of Fauji Foundation Hospital Rawalpindi from July 1, 2019 to September 30, 2019. Methodology: There were many patients suffering from shoulder pain. Among them, 52 patients who were suffering from adhesive capsulitis included. After the history of subjects, assessed for pain and restriction of range of motion in their affected shoulder. Lateral rotation, abduction, and medial rotation (LAM) test was performed. The inclusion criteria for subjects was symptomatic shoulder problems with restricted active and passive range of motion along with positive (LAM) test in ages between 30 to 80 years. The exclusion criteria was: (1) any neurological conditions affecting shoulder (2) any pathology other than adhesive capsulitis (3) any surgery of head, neck or upper limb. Data was analyzed using SPSS 25. Results: Our study showed that all 52 patients were suffering from a very acute state of pain, sleep cycle disturbance, difficulty in activities of daily living (ADLs) and recreational activities. Some patients were jobless due to acute shoulder pain of adhesive capsulitis. Conclusion: Adhesive capsulitis disturbs the daily life, sleep cycle, activities of daily living and difficulty in recreational activities. it is advocated that further researches must be conducted to point out the difficulties of such patients.

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

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.

Additional effects of Thoracic manipulation on pain, shoulder disability and range of motion in Adhesive Capsulitis

2021 ◽  
Vol 15 (12) ◽  
pp. 3333-3336
Author(s):  
Ubaidullah Bilal ◽  
Maria Khalid ◽  
Kinza Anwar ◽  
Hafsah Arshad ◽  
Uzair Ahmed
Keyword(s):  
Clinical Trial ◽  
Physical Therapy ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
Adhesive Capsulitis ◽  
P Value ◽  
Dash Score ◽  
Shoulder Range Of Motion ◽  
Intergroup Comparison ◽  
Shoulder Range

Aim: To determine the additional effects of thoracic manipulation on shoulder pain, shoulder range of motion (ROM) and disability in combination with conventional physical therapy exercises for individuals with adhesive capsulitis. Materials: A parallel, randomized controlled clinical trial was conducted. 32 patients (16 in each group), aged between 40‑60 years from both genders having shoulder pain, clinically diagnosed with adhesive capsulitis (Stage II and III), along with thoracic spine hypo mobility were included. Patients were randomized into conventional physiotherapy group (A) and thoracic manipulation group (B). Clinical trial was continued for two weeks with three sessions per week and a follow up was done at the end of 3rd week. Visual analogue scale (VAS), shoulder range of motion (ROM) and Disabilities of Arm Shoulder and Hand (DASH) score were used for outcomes measurement. Results: Intragroup comparison for shoulder ROM, DASH and VAS scores shows a significant (p value=≤0.001) for both groups. Intergroup comparison for shoulder ROM was improved significantly on post-intervention (p value=≤0.001). While intergroup comparison of baseline to end value for VAS showed insignificant result (p value=0.373). Conclusion: Additional effects of thoracic manipulation to conventional physical therapy underwent a greater improvement regarding shoulder range of motions and disability. Conventional physical therapy exercises and a combination of thoracic manipulation to conventional physical therapy exercises are equally effective for decreasing shoulder pain. Keywords: Adhesive Capsulitis, Pain, Frozen shoulder, Physical Therapy, Rehabilitation

scholarly journals Effect of Spencer Muscle Energy Technique Versus Maitland’s Mobilization Technique on Pain, ROM and Disability in Patients with Frozen Shoulder: A Comparative Study

2021 ◽  
Vol 9 (4) ◽  
pp. 3928-3936
Author(s):  
Raksha R. Jivani ◽  
◽  
Dharti N Hingarajia ◽  
Keyword(s):  
Range Of Motion ◽  
Shoulder Pain ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Group Comparison ◽  
Post Intervention ◽  
Muscle Energy Technique ◽  
Significant Difference ◽  
Muscle Energy ◽  
Conventional Physiotherapy

Background: Adhesive capsulitis is characterized by a painful, gradual loss of both active and passive glenohumeral motion resulting from progressive fibrosis and ultimate contracture of the glenohumeral joint capsule. Patients with Adhesive capsulitis have difficulties in everyday activities and shoulder pain also disturbs sleep at night on the affected side. Muscle energy technique helps in increasing shoulder range of motion. Maitland Mobilization is commonly used in the treatment of frozen shoulder. SPENCER Muscle Energy Technique (MET) is unique in its application as the client provides the initial effort while the practitioner facilitates the process. Objective: Objectives of the study was to compare the effect of Spencer MET Vs Maitland’s mobilization on pain, Range of Motion (ROM) and Disability in the patients with frozen shoulder. Methods: In the present experimental study, total 58 patients with frozen shoulder were included. Inclusion criteria were male and female with age of 40 to 60 year with unilateral frozen shoulder (at least 3-month duration). Patients were randomly allocated in two groups with 29 patients in each group: SPENCER MET and Conventional physiotherapy and MM and conventional physiotherapy for 5days a week with total duration of 4 weeks. Pre and post intervention assessment was carried out by using VAS, SPADI and ROM. Data was analysed by using SPSS 15 version. Results: Paired t test was applied within group comparison and result showed statistically significant difference in post intervention measurement compared to pre intervention for improving pain, reducing disability and increasing all ROM in both the groups. Independent t test was applied between group comparison and result showed statistically significant difference between groups mean pre-post differences in improving pain, reducing disability and increasing all ROM except extension and internal rotation. Conclusion: This study concludes that both the techniques used in the present study i.e., Spencer Muscle Energy Technique and Maitland Mobilization are effective for improving pain, reducing disability, and increasing ROM. However, SPENCER MET is the more effective for improving pain, reducing disability, and increasing ROM compared to Maitland Mobilization in patients with frozen shoulder. KEY WORDS: Frozen shoulder, SPENCER MET, Maitland mobilization, Shoulder Pain and Disability Index, Visual Analogue Scale.

scholarly journals Effect of Hijamah (Dry Cupping) on Frozen Shoulder: A Case Study

2021 ◽  
Vol 08 (1&2) ◽  
pp. 14-17
Author(s):  
Mohammad Abid ◽  
Keyword(s):  
General Population ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
Clinical Presentation ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Left Shoulder ◽  
Radiological Assessment ◽  
Common Causes

Frozen shoulder or adhesive capsulitis is one of the most common causes of shoulder pain and disability in the general population. Its prevalence is 2-5% in the general population and 10-20% among diabetics. It predominantly affects females and most commonly affects people between the ages of 40 and 60 years. The left shoulder is more likely to be affected, with both shoulders affected in 12% of cases. A case study is presented to illustrate the clinical presentation, aetiology, diagnosis, radiological assessment, and management of frozen shoulder through Hijamah bila shurt (dry cupping) in a 60-year-old diabetic male patient. The present case was studied for over 8 weeks; Hijamah (dry cupping) was done on prescribed points for the affected shoulder twice a week for 8 weeks, and assessment was done at baseline and every 2 weeks. This study concluded that regimental therapy Hijamah bila shurt (dry cupping) has a significant effect in reducing pain, stiffness of joints, and increasing range of motion in frozen shoulder.

Subluxed Shoulders Need TLC: Pilot Study of the T-L-C Taping Method to Address Hemiplegic Shoulder Pain, Passive Range of Motion, and Subluxation

2021 ◽  
Vol 75 (Supplement_2) ◽  
pp. 7512520390p1-7512520390p1
Author(s):  
Steven Frey ◽  
Mark Stumpf ◽  
Jacob Wright ◽  
Sara Stephenson ◽  
John Wong ◽  
...  
Keyword(s):  
Pilot Study ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
Intervention Studies ◽  
Muscle Tone ◽  
Neurological Rehabilitation ◽  
Assessment Approach ◽  
Uniform Assessment ◽  
Common Intervention ◽  
Primary Author

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Hemiplegic shoulder pain and subluxation are prevalent sequelae following stroke. A gap in the literature exists for shoulder assessments specifically for taping, a common intervention. Studies and tape methods primarily focus on mechanical corrections. However, muscle tone and management, which are prevalent topics in neurological rehabilitation, are rarely addressed. The T-L-C taping method consists of a uniform assessment approach of the shoulder specifically to guide Kinesio® Tape application Primary Author and Speaker: Steven Frey Additional Authors and Speakers: Mark Stumpf, Jacob Wright, and Sara Stephenson Contributing Authors: John Wong, Lauren Loges

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