Long-Term Outcomes Following Manipulation Under Anaesthetic for Patients with Primary and Secondary Frozen ShoulderShoulder

Background Frozen Shoulder (FS) is a common, debilitating condition for which manipulation under anaesthetic (MUA) is a non-invasive and effective treatment option. Current literature evaluates short to medium-term outcomes, but there is a paucity of long-term (>10 years) studies. Knowledge of long-term outcomes is also needed to evaluate whether FS or its treatment pre-disposes to other shoulder pathology in the long-term. Methods A retrospective analysis of 398 shoulders undergoing MUA for FS between Jan 1999 and Jan 2010; 240 complete datasets were obtained. Outcomes were Oxford Shoulder Score (OSS), recurrence and development of other shoulder pathology (arthritis or rotator cuff tear). Results At long-term follow-up (mean 13.2 years), 71.3% had no symptoms (OSS 48), 16.6% had minor symptoms (OSS 42–47) and 12.1% had significant symptoms (OSS < 42). There were 4/240 (1.7%) self-reported recurrences > 5 years after initial MUA and 2/240 (0.8%) repeat MUAs. In the long-term 6.7% developed rotator cuff pathology and 3.8% shoulder OA. Discussion This study suggests that long-term outcome after MUA for FS is favourable. Late recurrence of FS is uncommon and the development of OA or rotator cuff pathology is no greater than that of the general population.

Effectiveness of acromioclavicular joint mobilization and physical therapy vs physical therapy alone in patients with frozen shoulder: A randomized clinical trial

Objectives The objective of this trial was to compare the efficacy of acromioclavicular joint mobilization and standard physical-therapy versus physical-therapy alone in the treatment of the frozen shoulder. Design Single-blind randomized clinical trial. Setting Outpatient setting. Subjects Patients with frozen shoulder. Intervention Participants were randomly allocated into mobilization + physical-therapy (n = 28), and physical-therapy alone (n = 28) groups for one month. Main Measures The primary outcomes were the shoulder pain and disability index and the shoulder range of motion. The secondary outcome was the visual analogue scale. Measures were performed at the baseline, immediately and one month after the beginning of the treatment. Results Visual analogue scale and the shoulder pain and disability index improved more significantly in the mobilization group compared to the physical-therapy group immediately [−4.63 (−5.58–−3.67) vs. −2.22 (−2.96–−1.47), P < 0.001 and −23.08 (−28.63–−17.53) vs. −13.04 (−17.93–−8.16), P = 0.008, respectively] and one month after the beginning of the treatment [−5.58 (−6.45–−4.72) vs. −3.61 (−4.60–−2.62), P < 0.001 and −33.43 (−40.85–−26.01) vs. −20.03 (−26.00–−14.07), P = 0.001, respectively]. Active abduction range of motion was also improved more significantly immediately after the treatment in the mobilization group compared to the physical-therapy group [25.83 (11.45–40.13) vs. 10.17 (1.02–19.15), P = 0.025], however there were no significant differences between two groups concerning other measured range of motions. Conclusions Adding acromioclavicular mobilization to standard physical-therapy was more efficient in decreasing pain and disability and improving active abduction range of motion compared to standard physical-therapy in frozen shoulder patients.

The Spatial Extent of Pain Is Associated with Pain Intensity, Catastrophizing and Some Measures of Central Sensitization in People with Frozen Shoulder

The aim of this cross-sectional study was to explore the spatial extent of pain and its association with clinical symptoms, psychological features, and pain sensitization in people with frozen shoulder (FS). Forty-eight individuals with FS completed pain drawings (PDs) and reported their clinical symptoms including pain intensity (Visual Analogue Scale) and shoulder disability (Shoulder Pain and Disability Index). Moreover, pain sensitization measurements (pressure pain thresholds, temporal summation, conditioned pain modulation, and Central Sensitization Inventory (CSI)) were assessed. Psychological features were assessed by Pain Catastrophizing Scale (PCS) and Pain Vigilance and Awareness Questionnaire. Pain frequency maps were generated, Margolis rating scale was used for pain location, and Spearman correlation coefficients were computed. The mean (SD) pain extent was 12.5% (6.7%) and the most common painful area was the anterolateral shoulder region (100%). Women presented a more widespread pain distribution compared with men. Significant positive associations were obtained between pain extent and current pain intensity (rs = 0.421, p < 0.01), PCS (rs = 0.307, p < 0.05) and CSI (rs = 0.358, p < 0.05). The anterolateral region of the shoulder was the most common painful area in people with FS. Women with FS presented more extended areas of pain; and a more widespread distribution of pain was correlated with higher levels of pain, pain catastrophizing and pain sensitization.

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.