Adhesive Capsulitis
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Patients with adhesive capsulitis (AC) demonstrate limited shoulder movement, often accompanied by pain. Common treatment methods include pain medication, and continuous passive movement (CPM). However, it is sometimes difficult to improve the reduction of pain and movement using a CPM intervention because the patient’s interest is diminished. In this study, we developed an innovative deep learning-based smartphone application (Funrehab exercise game (FEG)) to provide accurate kinematics movement and motivation as well as high-intensity and repetitive movements using deep learning. We compared the effects of CPM and FEG on brain activity and shoulder range of motion in patients with AC. Sixteen patients (males, [Formula: see text]; females, [Formula: see text]; mean age, [Formula: see text] years) with acute AC were randomized into either CPM group or FEG group 4 days/week for 2 weeks. The outcome measures were shoulder abduction kinematics movement and electroencephalography (EEG) brain activity (bilateral prefrontal, bilateral sensorimotor cortex, and somatosensory association cortex) during the intervention. The analysis of variance (ANOVA) test was performed at [Formula: see text], and the analysis demonstrated that FEG showed superior effects on shoulder abduction kinematics and brain [Formula: see text] and [Formula: see text]-wave activations compared to CPM. Our results provide a novel and promising clinical evidence that FEG can more effectively improve neurophysiological EEG data and shoulder abduction movements than CPM in patients with AC.

2021 ◽  
Vol 85 (1) ◽  
pp. 3166-3172
Elias Emhemed Yousef Alazabi ◽  
Adel Mohammad Salama ◽  
Mohmed A. Abdel Salam ◽  
Hany Mohamed Abd Elfattah Bakr

2021 ◽  
Vol 22 (1) ◽  
Sara M. Sarasua ◽  
Sarah Floyd ◽  
William C. Bridges ◽  
Stephan G. Pill

Abstract Background Adhesive capsulitis (AC) of the shoulder, also known as frozen shoulder, causes substantial pain and disability. In cases of secondary AC, the inflammation and fibrosis of the synovial joint can be triggered by trauma or surgery to the joint followed by extended immobility. However, for primary AC the inciting trigger is unknown. The burden of the disorder among the elderly is also unknown leading to this age group being left out of therapeutic research studies, potentially receiving delayed diagnoses, and unknown financial costs to the Medicare system. The purpose of this analysis was to describe the epidemiology of AC in individuals over the age of 65, an age group little studied for this disorder. The second purpose was to investigate whether specific medications, co-morbidities, infections, and traumas are risk factors or triggers for primary AC in this population. Methods We used Medicare claims data from 2010–2012 to investigate the prevalence of AC and assess comorbid risk factors and seasonality. Selected medications, distal trauma, and classes of infections as potential inflammatory triggers for primary AC were investigated using a case–control study design with patients with rotator cuff tears as the comparison group. Medications were identified from National Drug codes and translated to World Health Organization ATC codes for analysis. Health conditions were identified using ICD9-CM codes. Results We found a one-year prevalence rate of AC of approximately 0.35% among adults aged 65 years and older which translates to approximately 142,000 older adults in the United States having frozen shoulder syndrome. Diabetes and Parkinson’s disease were significantly associated with the diagnosis of AC in the elderly. Cases were somewhat more common from August through December, although a clear seasonal trend was not observed. Medications, traumas, and infections were similar for cases and controls. Conclusions This investigation identified the burden of AC in the US elderly population and applied case–control methodology to identify triggers for its onset in this population. Efforts to reduce chronic health conditions such as diabetes may reduce seemingly unrelated conditions such as AC. The inciting trigger for this idiopathic condition remains elusive.

2021 ◽  
Vol 8 (09) ◽  
pp. 5657-5665
Sajeda Islam ◽  
A.F.M Mahbubul Alam ◽  
Mohammed Emran ◽  
Mohammad Ibrahim Hossain

Background: Adhesive capsulitis is common and can cause stiffness and pain. Diabetes and dyslipidemia are known to be associated with adhesive capsulitis. However, there is no report of any association between serum lipid levels accompanied by diabetes patients. Objective: To assess association between serum inflammatory lipoproteins and adhesive capsulitis accompanied by diabetes. Methods: This is a case-control study was conducted in Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. We investigated all the patients who visited our clinic because of their shoulder problems from January to June-2017.  Among those patients, 375 were diagnosed with adhesive capsulitis. Of these, we excluded 44 patients (11%) who had no laboratory results. Individuals with normal shoulder function (bilaterally pain-free, with full range of motion and no shoulder muscle weakness), no thyroid dysfunction, and no previously diagnosed systemic diseases. Individuals in the first control group had neither adhesive capsulitis nor diabetes. Individuals in the second control group had newly diagnosed diabetes without adhesive capsulitis. Results: Demographic data, serum lipid levels, and the prevalence of dyslipidemia for the 25 patients with adhesive capsulitis accompanied by diabetes and 75 individuals of two control groups were matched by age and sex. For the patients with adhesive capsulitis, the mean duration of symptoms was 5.8±2.7 months; the median interval between initial examination and blood sampling was 6.0 days (interquartile range [IQR], 1.0–8.0). Low-density lipoprotein and non HDL were associated with adhesive capsulitis accompanied by diabetes. Specifically, patients with adhesive capsulitis and diabetes had greater odds ratios of hyperlow-density lipoproteinemia when compared with individuals with neither adhesive capsulitis nor diabetes (OR, 3.19; 95% CI, 1.21–8.38; p =0.019) and when compared with individuals without adhesive capsulitis but with newly diagnosed diabetes (OR, 5.76; 95% CI, 1.67–19.83; p= 0.005). Similarly, patients with adhesive capsulitis accompanied by diabetes had greater odds ratios of hypernonhigh-density lipoproteinemia when compared with individuals with neither adhesive capsulitis nor diabetes (OR, 7.39; 95% CI, 2.72–20.09; p < 0.001) and when compared with individuals without adhesive capsulitis but with newly diagnosed diabetes (OR, 3.26; 95% CI, 1.40–7.61; p = 0.006). Conclusions: Inflammatory lipoproteinemias, particularly hyperlow-density lipoproteinemia and hypernonhighdensity lipoproteinemia, are associated with adhesive capsulitis accompanied by diabetes. Further research is needed to evaluate whether inflammatory lipoproteinemias are a cause, a related cofactor, or an aggravating factor in the development of adhesive capsulitis in people who have diabetes.

2021 ◽  
Vol 10 (1) ◽  
pp. 33-38
Rajeev Raj Manandhar ◽  
Krishna Raj Khanal ◽  
Himal Khanal ◽  
Saroj Gautam

Background: The pain and limitation of shoulder function can disrupt daily activities of patients for months to years. Adhesive capsulitis is considered a self-limiting disease but the duration remains uncertain. The brunt of the disease is focussed on the inflamed joint capsule. On this basis, use of corticosteroid injection is justified. However, injection method is not conclusive. Objectives: To compare clinical benefits of intra-articular injection alone versus combined intra-articular and subacromial injections in management of adhesive capsulitis. Methods: Fifty-nine patients with diagnostic criteria for adhesive capsulitis were included in the study from March 2019 to September 2020. Patients were divided into two groups; patients who underwent intra-articular (IA) injection alone (Group 1) and those who received both intra-articular and sub-acromial (IA+SA) injection (Group 2). The injections were landmark guided. Patients were followed up at three, six, and 12 weeks. Pain was recorded using visual analogue scale (VAS) and subjective function using Constant-Murley score. Results: Twenty-eight patients were included in Group 1 (IA) and 31 in Group 2 (IA+SA). Thirty-six patients were female (18 each in Group 1 and Group 2) and 23 patients were male (Group 1 = 13; Group 2 = 10). In the twelfth week, VAS score was reduced in both the groups. On comparing the mean value of Constant-Murley score between the two groups there is significant difference in value recorded at the sixth and twelfth week. Conclusion: The IA+SA injection provides significant reduction in pain and better function in the short term over the IA injection.

2021 ◽  
Vol 24 (3) ◽  
pp. 172-177
Mohsen Mardani-Kivi ◽  
Keyvan Hashemi-Motlagh ◽  
Zohre Darabipour

Background: This study aimed to evaluate the response rate to arthroscopic release treatment in adhesive capsulitis of the shoulder (ACS) for patients with refractory to conservative treatment. Methods: In this retrospective study, 51 patients (age mean, 49.1±5.6 years) with unilateral adherent capsule underwent arthroscopic releasing surgery for the shoulder capsule. Etiologies of the ACS in 30 patients were idiopathic: 10 patients were affected after surgery and 11 patients following trauma. The patients were evaluated in terms of shoulder function, satisfaction rate, pain intensity, and joint range of motion (ROM) based on a Constant score, a simple shoulder test, the visual analog scale, and four movements, respectively.Results: The mean Constant score before surgery was 48.2±3.5 and reached 74.4±6 and 77.0±6.3 at 6 months and the final follow-up, respectively (p<0.001). The mean scores of pain intensity, a simple shoulder test, and ROM showed significant improvement at all follow-ups (p<0.001). Sex, age, and diabetes did not have any significant effect on patient recovery. However, patients who experienced ACS after surgery had poorer results than others at all follow-up points. Conclusions: Arthroscopic releasing surgery of the shoulder in patients with ACS refractory to conservative treatment produces rare complications and an effective injury response. It seems that patients suffering ACS following surgery have a weaker response to the treatment.

2021 ◽  
pp. 34-36
Aishwarya Mhetras ◽  
Poorva Devi

BACKGROUND AND PURPOSE Adhesive capsulitis is a condition where there is inammation of shoulder capsule (capsulitis) which in turn causes bands of sticky connective tissue (adhesions) between the joint's surfaces. Due to this (1) shoulder movement becomes painful and often completely restricted .The purpose of this case report is to highlight Importance of Shoulder Proprioceptive training and shoulder PNF techniques using theraband and inatable ball (30 cm) along with Conventional exercises in Functional Recovery of the patient with adhesive capsulitis secondary to rotator cuff tendinosis. CASE DESCRIPTION A 66-year-old female who presented with right shoulder pain and neck pain and limited range of motion (ROM) since 1 month with a past medical history of type II diabetes mellitus, hypertension and hypothyroidism on medication was diagnosed with adhesive capsulitis secondary to rotator cuff tendinosis based on clinical examination, ROM assessment, Radiographical investigations-MRI and past medical history. INTERVENTION The patient was treated for a total of 10 physical therapy sessions over the span of 2 weeks. Interventions included were incorporating shoulder proprioceptive exercises with a help of inatable ball and textured towel, shoulder PNF patterns using Red theraband along with cryotherapy(icepacks),mobilizations (Maitland grade 2) with oscillatory techniques, therapeutic exercises, Active assisted ROM exercises with the help of a wooden wand, capsular stretching, myofascial trigger point release, postural correction exercises, strengthening and home exercise program. Outcome measures included ROM goniometric measurements, pain rating scale, Angle reproduction test for proprioception, Manual muscle testing and the Disabilities of the Arm, Shoulder and Hand (DASH) Score. DISCUSSION AND CONCLUSION This case report conclude that appropriate combinations of interventions including shoulder proprioceptive exercises with an inatable ball, shoulder pnf patterns(D1-D2) , stretching, mobilisations, MFR and strengthening exercises resulted in an improvement in overall functional performance of the patient with adhesive capsulitis secondary to rotator cuff tendinosis .An improvement in post-test scores of Manual Muscle Testing (MMT) , ROM , DASH scores was observed after 10 sessions. Rationale for treatment was based on various research articles. The treatment was altered based on patient's need and response.

2021 ◽  
Vol 10 (17) ◽  
pp. 3882
Romain Gillet ◽  
François Zhu ◽  
Pierre Padoin ◽  
Aymeric Rauch ◽  
Gabriella Hossu ◽  

Background: MRI diagnostic criteria of shoulder adhesive capsulitis (AC) are nowadays widely used, but there is little information available on the association between MRI findings and clinical impairment. Purpose: To determine the correlation of MRI findings with the Constant–Murley Score (CMS), pain duration and symptoms at the one-year follow-up in AC patients. Materials and methods: This monocentric prospective study included 132 patients with a clinical diagnosis of shoulder AC who underwent shoulder MRI. Mean patient age was 54.1 ± 9.3 years, and there were 55 men and 77 women. A radiologist examined all patients and completed the CMS just prior to MRI. Pain duration was assessed along with the signal intensity and measured the maximal thickness of the inferior glenohumeral ligament (IGHL) by two radiologists. Medical record analysis was performed in a sub-group of 49 patients to assess prognosis approximately one year after the MRI examination. Linear regression analysis with the Pearson test and the Fisher exact test were used to determine the association between MRI findings and clinical impairment. Results: There was a significant difference in mean pain duration score (3.8 ± 1.2 versus 3.2 ± 0.9 and 3.8 ± 1.2 versus 3.2 ± 0.9, respectively, for readers 1 and 2) and in mean mobility scores (15.7 ± 8 points versus 19.6 ± 10.1 points and 15.8 ± 8.2 points versus 19.4 ± 10 points, respectively, for readers 1 and 2) in patients with a high IGHL signal compared to those with a low IGHL signal (p < 0.05). IGHL was thicker in patients with clinical improvement at one-year follow-up compared to those presenting clinical stability or worsening (p < 0.05). Conclusions: In patients with shoulder AC, the degree of signal intensity at the IGHL was inversely related to shoulder pain duration and range of motion, and a thickened IGHL indicated a favorable outcome at one-year follow-up.

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