A Review on Frozen Shoulder: Pathophysiology and Its Associated Diagnosis

Background: Frozen shoulder is a commonly occurring disease of the population. It is also referred to as shoulder capsulitis. It causes pain and stiffness of the shoulder and dominant in left shoulder. Various things are still unclear regarding the treatment and causes of this disease. It is a painful and n quickly healed disease. Patients show recovery but are often unable to regain their full potential movements. Painful stiffness of the shoulder is an ill-described medical entity, this is hard to evaluate and sensitive to treat. The nomenclature sed and consists of phrinclude cluding frozen shoulder, adhesive capsulitis, focal dystrophy, stiff shoulder, shriveled shoulder, and following. Apart from its idiopathic form, the disease can be initiated with the resource of the usage of trauma, infection, tumor, radiation, systemic and neighborhood metabolic concerns. Patho- anatomically, the common place region denominates an inflammatory vascular proliferation found with the resource of the usage thickening, scarring, and retraction of the joint cover. Summary: The inflammatory technique frequently begins to evolved on the rotator language and can increase to the subacromial space. Clinical analysis is primarily based totally records and bodily examination. Generally, the onset of ache precedes the belief of a discounted variety of movement with the aid of using weeks or months. In early ranges of ailment, the inflammatory form of ache dominates, the patient's most important criticism is ache at night. In the later stage, variety of movement step by step decreases. Patients no longer frequently whine approximately decreased movement, likely due to its gradual onset. Conclusion: Treatment options are a mixture of mobilization carrying sports with intra-articular steroids, hydraulic distension of the joint capsule, manipulation below anaesthesia,arthroscopic and/or open arthrosis.The appropriate preference of protocol is really as critical as its correct timing. In the inflammatory phase, competitive invasive protocols are uncommon, but deleterious and therefore need to be taken into consideration. New anti- angiogenic outlets also can moreover enhance beneficial effects and shorten the rehabilitation phase.

The Role of Indian Hedgehog Signaling in Tendon Response to Subacromial Impingement: Evaluation Using a Mouse Model

Background: The underlying cellular and molecular mechanisms involved in the development of tendinopathy due to subacromial supraspinatus tendon (SST) impingement and the response to subsequent removal of impingement remain unknown. Purpose: To investigate the involvement of Indian hedgehog (IHH) signaling in the development of SST tendinopathy and the subsequent healing process after the relief of subacromial impingement in a novel mouse shoulder impingement model. Study Design: Controlled laboratory study. Methods: A total of 48 male wild-type C57BL/6 mice were used in this study. Supraspinatus tendinopathy was induced by inserting a microsurgical clip into the subacromial space bilaterally. Eleven mice were sacrificed at 4 weeks after surgery to establish impingement baseline; 24 mice underwent clip removal at 4 weeks after surgery and then were euthanized at 2 or 4 weeks after clip removal. Thirteen mice without surgical intervention were utilized as the control group. All SSTs were evaluated with biomechanical testing; quantitative histomorphometry after staining with hematoxylin and eosin, Alcian blue, and picrosirius red; and immunohistochemical staining (factor VIII, IHH, Patched1 [PTCH1], and glioma-associated oncogene homolog 1 [GLI1]). Results: The mean failure force and stiffness in the 4-week impingement group decreased significantly compared with the control group ( P < .001) and gradually increased at 2 and 4 weeks after clip removal. Histological analysis demonstrated increased cellularity and disorganized collagen fibers in the SST, with higher modified Bonar scores at 4 weeks, followed by gradual improvement after clip removal. The IHH-positive area and PTCH1- and GLI1-positive cell percentages significantly increased after 4 weeks of clip impingement (20.64% vs 2.06%, P < .001; 53.9% vs 28.03%, P = .016; and 30% vs 12.19%, P = .036, respectively) and continuously increased after clip removal. Conclusion: The authors’ findings suggest that the hedgehog signaling pathway and its downstream signaling mediator and target GLI1 may play a role in the development and healing process of rotator cuff tendinopathy due to extrinsic rotator cuff impingement. Clinical Relevance: This study suggests the potential for the hedgehog pathway, together with its downstream targets, as candidates for further study as potential therapeutic targets in the treatment of supraspinatus tendinopathy.

Scapular Retraction under Adduction Load: An Alternative to Overhead Exercises to Activate Infraspinatus, Upper, and Lower Trapezius in Subjects with and without Shoulder Pain

Exercises for lower trapezius (LT) often use overhead positions, causing compressive forces to the subacromial space. Scapular retraction would be an alternative to activate LT muscle. The present study aimed to assess the excitation levels of infraspinatus, upper trapezius, and lower trapezius muscles during a scapular retraction exercise under progressive adduction loads in subjects with and without painful shoulder. Electromyography of infraspinatus (IS), upper trapezius (UT), and LT was recorded during scapular retraction under progressive adduction loads of 42 participants, divided into two groups: with (SP, n = 26) and without shoulder pain (nSP, n = 16). The adduction loads of 20%, 30%, 40%, and 50% of the maximal voluntary contraction (MVC) were applied using a load cell. Normalized electromyography and the ratio between UT and LT (UT:LT) were used for statistical analysis. No differences were observed between groups, but a condition effect occurred for all muscles: UT showed higher values at 50% vs. 20% of MVC (p = 0.004); LT showed higher values on 40% and 50% of MVC (p = 0.001; 0.006). Higher values for IS were noted at 40% of MVC (vs. 20% of MVC; p = 0.04) and at 50% of MVC (vs. 20% of MVC; p = 0.001, vs. 30% of MVC, p = 0.001; vs. 40% of MVC; p = 0.001). UT:LT showed lower values at 50% of MVC (vs. 20% of MVC; p = 0.001 and vs. 30% of MVC; p = 0.016). Scapular retraction with adduction loads at 40–50% is an alternative to overhead exercises aiming to activate the LT and the IS muscles. The exercise ensures higher levels of LT and IS excitation without increasing UT excitation.

How to Insert Acupuncture Needles into the Subacromial Space through LI15

LI15 is an important acupuncture point to treat shoulder pain. There are 4 needling methods for LI15 in the textbook; 1 method requires the insertion of the needle horizontally between the acromion and the great tuberosity of the humerus with the arm lowered for supraspinatus tendonitis. This method is also applicable for all conditions of rotator cuff disease, but it has not previously been described in detail. Providing X-ray scans and describing needle direction and depth of insertion will provide evidence for needling with the arm down as an effective stimulation of the subacromial space. Firstly, for this technique, with the arm raised, a concave point is located between the front edge of the acromion and the humerus, and the lower upper arm. Secondly, the acupuncture needle is inserted slightly posteriorly towards the supraspinous fossa, in the direction of the supraspinatus tendon and to a depth of 30-40 mm.

Scapular Retraction Under Adduction Load: an Alternative to Overhead Exercises to Activate Infraspinatus, Upper and Lower Trapezius in Subjects With and Without Shoulder Pain

Exercises for lower trapezius (LT) often use overhead positions, causing compressive forces to the subacromial space. Scapular retraction would be an alternative to activate LT muscle. Electromyography of infraspinatus (IS), upper (UT) and LT was recorded during scapular retraction under progressive adduction loads of 42 participants, divided in 2 groups: with (SP, n=26) and without shoulder pain (nSP, n=16). The adduction loads of 20, 30, 40 and 50% of the maximal voluntary contraction were applied using a load cell. Normalized electromyography and the ratio between UT and LT (UT:LT) were used for statistical analysis. No differences were observed between groups, but a condition effect occurred for all muscles: UT showed higher values at 50% vs. 20% (p=0.004); LT showed higher values on 40% and 50% (p=0.001; 0.006). Higher values for IS were noted at 40% (vs 20%; p=0.04), and at 50% (vs. 20%; p=0.001, vs. 30%, p=0.001; vs. 40%; p=0.001). UT:LT showed lower values at 50% (vs. 20%; p=0.001, and vs. 30%; p=0.016). Scapular retraction with adduction loads at 40-50% is an alternative to overhead exercises aiming to activate the LT and the IS muscles. The exercise ensures higher levels of LT and IS excitation, without increasing UT excitation.

Effectiveness and Safety of Hyaluronic Acid for Chronic Shoulder Pain

Objective: To elucidate the functional outcomes of Hyaluronic acid for chronic painful shoulder with improvement of pain and functional scores Study Design: Descriptive study Place and Duration: Study was conducted in Dr.Sulaimanal HabibHospital, Riyadh, KSAfor period of one year June, 2019 to June, 2020. Methodology: Ninety patients with Tendinitis and Rotator cuff syndrome were included in this study. Patients demographics including age, sex, body mass index and complete medical profile were recorded after taking written consent. Injection was given in an aseptic technique in subacromial space in controlled setting with 1 ml of lignocaine 1 percent, 2 ml 0.5 percentmarcaine and 4 ml of hyaluronic acid. The functional outcomes were assessed by Constant Murley scoring. Follow-up was taken at 6 weeks and at 12 weeks and patients satisfaction was recorded. Results: Out of 90 patients 54 (60%) were males while 40% were females with mean age 49.8±10.283 years. Constant Murley score at baseline was 55.18±9.70 and at 6 weeks it was increased to 63.48±7.86 and at final follow-up it was 81.9±12.46. A significant improvement was found at 6 and 12 weeks with p-value <0.05. 5 (5.56%) patients showed complications. None of the patients had severe complication. 75 (83.33%) patients were satisfied. Conclusion: It is concluded that Hyaluronic acid action replaces the traditional form of corticosteroid treatment of chronic shoulders pain associated with Rotator cuff tear and tendinitis. Keyword: Tendinitis, Rotator cuff syndrome, Hyaluronic acid, Range of motion

AB0512 CLINICAL AND RADIOLOGICAL FEATURES OF SHOULDER INVOLVEMENT IN SPONDYLARTHRITIS

Background:Peripheral joint involvement is frequent among patients with peripheral spondylarthritis (SA). However, the root joint involvement, such as hip involvement, has been described as being associated with axial spondylarthritis, while data for shoulder involvement are scarce. Cuff tendonitis and enthesitis are common features in the shoulder in patients with SA.Objectives:This study aimed to identify the prevalence of shoulder involvement in SA patients and describe its clinical and radiological features.Methods:We conducted a retrospective study including SA patients, all fulfilling the assessment of Spondyloarthritis International Society (ASAS) criteria.For all patients, we collected the following data: Age, the clinical presentation of SA, the inflammatory biomarkers C-reactive protein (CRP), and the disease activity assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).Regarding shoulder involvement, we assessed the following items: tenderness, mobility, rotator cuff tests, as well as the results of X-ray and Ultrasound examination (US).Results:We included one hundred and thirty-one SA patients (mean age 39,77 years). Among them, sixty-two percent were male. Ten percent of patients were smokers, 46,6% had the peripheral beginning of the disease. Fourteen patients complained of shoulder pain. The majority of them were male.X-rays showed no abnormalities (n=2), while a destructive form was noted in (n=7).Rotator cuff rupture or enthesopathy was also revealed by the reduction of subacromial space (n=5), condensation of the greater tuberosity (n=3), crooked aspect of the acromion (n=2), and Moloney’s line disruption(n=1).US showed no abnormalities (n=1), supraspinatus tendinopathy (n=5), supraspinatus transfixing tear (n=1), infraspinatus tendinopathy (n=2), supraspinatus enthesopathy (n=2), infraspinatus enthesopathy (n=1), moderate synovitis (n=1), subacromiodeltoid bursitis (n=1).Shoulder involvement was correlated significantly with the peripheral beginning of SA (P < 0.05). There were no significant differences in gender, tobacco use, CRP value, and the disease activity between the two groups (P > 0.05).Conclusion:The shoulder involvement was rare in our study. It is characterized by cuff tendonitis and enthesitis, especially in supraspinatus insertion. However, the glenohumeral synovitis was uncommon in our series, even in the peripheral form of the disease.References:[1]Hip and Shoulder Involvement and Their Management in Axial Spondyloarthritis: a Current Review Clementina López-Medina1,2,3,4 & M. Carmen Castro-Villegas1,2,3 & Eduardo Collantes-Estévez1,2,3, 23 July 2020.Acknowledgements:I would like to thank all the authors listed above, for they helped me make writing my first abstract less harder.Disclosure of Interests:None declared.