Adhesive Capsulitis Patients Research Articles

"Comparative Effects of Active Release Technique and Muscle Energy Technique on Pain, Range of Motion and Functional Disability in Adhesive Capsulitis Patients with Trigger Points"

Shahzadi Sumbal Naz*, Fareeha Amjad, Sarah khawar, Syed Asadullah Arslan and Ashfaq Ahmed Author Affiliations University Institute of Physical Therapy, Faculty of Allied Health Sciences, The University of Lahore, Pakistan Received: May 25, 2022 | Published: June 20, 2022 Corresponding author: Shahzadi Sumbal Naz, University Institute of Physical Therapy, Faculty of Allied Health Sciences, The University of Lahore, Pakistan DOI: 10.26717/BJSTR.2022.44.007083

Evaluation of Coraco-Humeral Ligament Thickness in Adhesive Capsulitis – A Case Control Study

Background: Coracohumeral ligament thickness plays an important role in maintaining shoulder range of motion and stability. It is essential to evaluate its thickness and also to find out its role in limiting shoulder range of motion in adhesive capsulitis. Aim of the study is to evaluate the coracohumeral thickness in adhesive capsulitis by ultrasonic scan and also to find out the relationship of its thickness with shoulder abduction and external rotation range of motion. Study design: Case – control study. Sixty-seven adhesive capsulitis patients and age and BMI matched controls were selected. The coracohumeral thickness was evaluated by ultrasound scanning. Shoulder abduction and external rotation range of motion was also recorded. The coracohumeral ligament thickness was compared between groups by independent sample ‘t’ test. The relationship between coracohumeral ligament thickness and shoulder abduction and external rotation was studied by Pearson’s correlation coefficient. Result: The mean coracohumeral thickness was 2.940.14 mm in adhesive capsulitis and it was significantly higher than in controls, mean = 1.92 0.19 mm

The effect of mirror therapy in patients with frozen shoulder.

This study was designed to compare mirror therapy and visual feedback with the control group in adhesive capsulitis patients. Thirty-six patients, divided into three groups as mirror therapy, visual feedback and control for 15 sessions of treatment. Evaluations were made before treatment, at 6th and 10th weeks. Bilateral glenohumeral exercise was performed at the end of each session with the affected extremity behind the mirror in the mirror group, with both upper extremities in front of the mirror in the visual feedback group, and without the mirror in the control group. There were statistically significant differences between the mirror therapy and visual feedback in terms of pain severity change, and the visual feedback was superior to the change in pain severity compared to the control. Visual feedback showed significant improvement in mean change from baseline to week 10 in shoulder pain and disability index scores compared to control (p = 0.012). There was no significant difference between the groups in terms of modified constant score, proprioception and shoulder range of motion. It was determined that the exercises performed by seeing the affected extremity in the mirror were more effective than mirror therapy and control group.

Urdu translation of Shoulder Pain and Disability Index (SPADI) and its validity and reliability on adhesive capsulitis patients

BackgroundExcessive scar tissues around the shoulder are the results of shoulder pathologies that lead to pain and disability. The Shoulder pain and disability index (SPADI) is used to measure the level of pain and disability in patients with shoulder pathology. SPADI is translated into Urdu and its validity and reliability are measured on patients with adhesive capsulitis.ObjectiveThe study was aimed to translate the SPADI in Urdu and to evaluate its reliability and validity in patients with shoulder adhesive capsulitis.MethodsTranslation of SPADI in Urdu was conducted by applying the standardized process. Two forward translations in Urdu were made T1 and T2 by bilingual translators. Urdu version of SPADI was drafted after experts’ opinion. Two Backward English translations of Urdu SPADI were made BT1 and BT2 and the back translation was finalized by the consensus of all experts. After this process of reviewing by the professional experts, 3rd version of Urdu SPADI was drafted. The Final version was drafted after its application on 10 patients. Its reliability and validity were tested on 150 patients with shoulder adhesive capsulitis.ResultsContent Validity Index was good with values of each item > 0.85. For Test–retest reliability, the Intraclass correlation coefficient (ICC2,1) was measured with a value of 0.89 which showed good Test–retest reliability. The internal consistency and reliability of SPADI were calculated by Cronbach’s alpha for a total score with a value of 0.94. Construct validity and Concurrent validity were determined. In Construct validity, factor analysis of Urdu SPADI showed two factors and a cumulative variance of 75.443%.ConclusionIt was concluded that the Urdu version of SPADI is a valuable translation that is a valid assessment tool for patients with shoulder adhesive capsulitis. It has good validity and test–retest reliability.

Evaluating whole-genome expression differences in idiopathic and diabetic adhesive capsulitis.

Diabetic patients have a greater incidence of adhesive capsulitis (AC) and a more protracted disease course than patients with idiopathic AC. The purpose of this study was to compare gene expression differences between AC with diabetes mellitus and AC without diabetes mellitus. Shoulder capsule samples were prospectively obtained from diabetic or nondiabetic patients who presented with shoulder dysfunction and underwent arthroscopy (N = 16). Shoulder samples of AC with and without diabetes (n = 8) were compared with normal shoulder samples with and without diabetes as the control group (n = 8). Shoulder capsule samples were subjected to whole-transcriptome RNA sequencing, and differential expression was analyzed with EdgeR. Only genes with a false discovery rate < 5% were included for further functional enrichment analysis. The sample population had a mean age of 47 years (range, 24-62 years), and the mean hemoglobin A1c level for nondiabetic and diabetic patients was 5.18% and 8.71%, respectively. RNA-sequencing analysis revealed that 66 genes were differentially expressed between diabetic patients and nondiabetic patients with AC whereas only 3 genes were differentially expressed when control patients with and without diabetes were compared. Furthermore, 286 genes were differentially expressed in idiopathic AC patients, and 61 genes were differentially expressed in diabetic AC patients. On gene clustering analysis, idiopathic AC was enriched with multiple structural and muscle-related pathways, such as muscle filament sliding, whereas diabetic AC included a greater number of hormonal and inflammatory signaling pathways, such as cellular response to corticotropin-releasing factor. Whole-transcriptome expression profiles demonstrate a fundamentally different underlying pathophysiology when comparing diabetic AC with idiopathic AC, suggesting that these conditions are distinct clinical entities. The new genes expressed explain the differences in the disease course and suggest new therapeutic targets that may lead to different treatment paradigms in these 2 subsets.

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

BackgroundThe 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).MethodsA 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.ResultsThirty-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.ConclusionsIn 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.

Evaluation of magnetic resonance imaging findings in adhesive capsulitis: which quantitative findings are most valuable?

This study aims to investigate magnetic resonance imaging (MRI) findings in adhesive capsulitis (AC) and determine the most valuable MRI finding in diagnosis using easily applied quantitative methods. Shoulder MRI was performed on 193 patients who were diagnosed with AC by clinical examination and 116 controls. Axillary pouch thickness (APT), superior and inferior glenohumeral ligament (SGHL and IGHL) thickness, coracohumeral ligament (CHL) thickness, fluid increase and soft-tissue thickness in the rotator interval (RI), and increases in the fluid and signal in the localization of biceps tendon attachment were evaluated. MRI examinations were assessed by three radiologists blinded to the clinical findings of the patients, and the results were obtained based on consensus and records. There were 119 women and 74 men in the AC group and 80 women and 36 men in the control group. IGHL, SGHL, RI, and CHL thicknesses were measured thicker in AC patients than in the control group. When IGHL=4, RI=3.6, SGHL=2.0, CHL=4.6-mm cutoff, the area under the receiver operating characteristic (ROC) curve (AUC) values were 0.700, 0.922, 0.972, and 0.783, respectively. According to the results obtained in this study, IGHL=4 mm, RI=3.6 mm, SGHL=2.0 mm, and CHL=4.6 mm can support the diagnosis of AC. Using the quantitative values in diagnosis can provide objective criteria and prevent variability among interpreters.

MR Imaging Biomarkers for Clinical Impairment and Disease Progression in Patients with Shoulder Adhesive Capsulitis: A Prospective Study.

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.

유착성 관절낭염 환자의 복합 처치에 따른 통증 정도, 관절가동범위와 근 기능에 미치는 영향

본 연구는 유착성 관절낭염 환자의 도수치료와 능동적 자가 운동 프로그램의 복합 처치가 견관절 통증 및 기능장애 점수(Korean Shoulder Score for Instability, KSSI), 관절가동범위(Range of Motion), 근 기능(Myofunction)에 어떠한 영향을 미치는지 알아보고자 하였다. 연구 대상자들은 유착성 관절낭염 진단을 받은 40~60대 여성 환자 24명으로 선정하여 도수치료 집단(MG=8명), 능동적 운동 집단(AG=8명), 복합 처치 집단(CG=8명)으로 무선 배정하였으며, 모든 프로그램은 주 3회, 12주간, 1회 70분으로 구성하였다. 자료처리는 이원 반복 측정 분산분석(two-way repeated ANOVA)과 대응 표본 t-검정(paired t-test)을 실시하여 다음과 같은 결과를 도출하였다. 이원 반복 측정 분산분석 결과 굽힘 각도를 제외한 모든 변인(KSSI, 벌림 각, 바깥 돌림 각, 굽힘 근력, 바깥 돌림 근력)에서 시기, 집단, 상호작용의 유의차가 나타났다(p .05). 굽힘 각도의 경우 시기에서는 유의차가 나타났지만 상호작용과 집단의 유의차는 나타나지 않았다. paired t-test 결과 굽힘 근력을 제외한 모든 변인(KSSI, 굽힘 각, 벌림 각, 바깥 돌림 각, 바깥 돌림 근력)에서 세 집단 모두 유의하게 증가한 결과를 나타내었다(p .05). 굽힘 근력의 경우 AG와 CG에서는 유의하게 증가하였지만(p.05), MG에서는 유의차가 나타나지 않았다. 따라서 본 연구에서 시행한 복합 처치 프로그램은 유착성 관절낭염 환자의 증상 개선에 효과적인 처치방법으로 보이며, 향후 연구에서는 남성 환자를 추가하고, 더 많은 유착성 관절낭염 환자를 포함한 비교 연구가 필요할 것으로 사료된다.

EFFECTS OF END-RANGE MOBILIZATION TECHNIQUE ON PAIN AND DISABILITY IN PATIENTS WITH ADHESIVE CAPSULITIS-A QUASI-EXPERIMENTAL STUDY

BACKGROUND AND AIMS Studies have revealed that end-range mobilization techniques are found to be efficient in providing high and low-grade thrusts thereby enhance cellular elongation, decreases soft tissue edema and localized inflammatory changes in the affected individual. Therefore, this study is aimed to determine the effects of end-range mobilization on patients with Adhesive Capsulitis. METHODOLOGY This quasi-experimental study was conducted on 40 patients of 40-70 years of age with adhesive capsulitis. End-range mobilization was performed in 2-3 sets of 10-15 repetitions in Grade 3 or 4 in varying plane and degree of rotation for 2 days/week for 4 weeks for the duration of 30 minutes while the Shoulder Pain and Disability Index (SPADI ) was used to assess pre and post outcomes. RESULTS A total number of 40 adhesive capsulitis patients included in this study with a mean age of 51.2±10.6 consisted of 19 males and 21 females. The overall SPADI scores were significantly decreased to 66.45±8.8 from 73.99±9.1 post-intervention of 4-weeks inclusive the marked reduction in pain and disability scores respectively CONCLUSION It was concluded that the end-range mobilization technique was effective to reduce pain and disability, subsequently SPADI score pre and post 4-weeks of intervention in adhesive capsulitis patients. Further trials should be conducted in the future taking large samples and varied techniques into account for the identification of optimal strategy in improving health-related outcomes of patients with shoulder joint pathologies.

Effectiveness of proprioceptive training and conventional physical therapy in treating adhesive capsulitis.

Objective:To determine effectiveness of proprioceptive training and conventional physical therapy in managing patients with adhesive capsulitis.Methods:A pre-test post-test control group study was conducted at Rehman Medical Institute from June to December 2019. Thirty-eight patients, aged 30 to 60 years, with diagnosis of adhesive capsulitis for more than four months were divided into two groups. Subjects in Group-I (conventional group; n=19) received conventional physical therapy protocols for one month while subjects in Group-II (proprioceptive group; n=19) received proprioceptive training along with conventional physical therapy for one month. Disability of Arm Shoulder & Hand questionnaire, Shoulder Pain & Disability Index and goniometer were used at baseline and post-treatment to assess functional activity level, pain & disability and range of motion respectively. Data was analyzed using SPSS version 20.Results:The mean age of the participants was 53.13 ± 9.12 years. Baseline characteristics were balanced between the two groups. After the treatment, all measures (functional activity level, pain, disability, ROM) improved in both groups. Post treatment, between group analysis showed that functional activity (DASH) and pain (SPADI pain) significantly (P-value <0.05) improved in proprioceptive group as compared to conventional group. However, there were no significant differences (P-value≥ 0.05) in post treatment SPADI disability, SPADI total and ROM (flexion, abduction, external rotation) scores of both groups.Conclusion:Proprioceptive exercises along with conventional physical therapy are more effective in managing pain and improving functional activities in adhesive capsulitis patients as compared to conventional physical therapy alone.

Instrument assisted soft tissue mobilization in adhesive capsulitis: A randomized clinical trial

IntroductionShoulder adhesive capsulitis is a common pathology in middle aged population, physical therapy being the mainstay treatment for it. Various conventional treatment modalities have been proven to help in this condition. Instrument Assisted Soft Tissue Mobilization (IASTM) is a considerably new technique, which is being used widely for various sports related injuries for a faster recovery. This study proposes to evaluate the effect of IASTM as an added treatment for improving pain, range of motion and functional ability in patients with adhesive capsulitis. Method30 shoulders were randomly allocated into two groups- Group A (IASTM + conventional treatment) and Group B (conventional treatment). Treatment was given for 12 sessions, 3 sessions per week for 4 weeks. Participants were evaluated pre treatment, post 6th session and post 12th session. Outcome measures was Numerical Pain Rating Scale, Shoulder Pain And Disability Index, Shoulder Range of Motion, Apley's scratch test. ResultsPain and Disability scale had shown improvement within the group only. However, in experimental group significant improvement was seen in active and passive mobility including functional performance. ConclusionIASTM along with conventional protocol was able to improve mobility and function among adhesive capsulitis patients.

In shoulder adhesive capsulitis, ultrasound-guided anterior hydrodilatation in rotator interval is more effective than posterior approach: a randomized controlled study

Shoulder adhesive capsulitis, also called frozen shoulder, is a musculoskeletal disorder associated with pain and functional disability. This study aimed to compare the effectiveness of shoulder ultrasound-guided hydrodilatation with corticosteroid, via rotator interval (RI) anteriorly, versus posterior approach, in adhesive capsulitis patients. All patients received exercise program following injection.Patients and methodsA prospective randomized controlled study among 60 consecutive adhesive capsulitis patients was randomized into two equal groups. Group I received ultrasound-guided hydrodilatation with corticosteroid, saline, and local anesthetic via posterior intra-articular approach; group II received the same ultrasound-guided hydrodilatation via anterior rotator interval approach. Both groups received guided stretching exercises for 3 months after injection. Baseline and 3 months evaluation of pain by visual analogue scale (VAS), shoulder pain and disability index (SPADI), and range of motion (ROM) had been recorded for all patients.ResultsBoth groups showed significant improvement 3 months after hydrodilatation regarding VAS pain, external rotation, and SPADI. Only in group II (RI anterior approach) improvement was observed regarding flexion and abduction. There was no improvement regarding extension or internal rotation in either group. When comparing the improvement in both groups after hydrodilatation, group II (anterior approach) showed a statistically significant higher level of improvement regarding VAS pain (p = 0.003), SPADI, flexion, abduction, and external rotation, compared to group I (p < 0.001). Extension, internal rotation, and adduction were not different.ConclusionsUltrasound-guided anterior rotator interval hydrodilatation for adhesive capsulitis, followed by guided exercise, is clinically and functionally more effective than the conventional posterior approach.Key Points• Ultrasound-guided hydrodilatation (with prednisolone acetate (40 mg), 1 ml of 2% lidocaine, and 15 ml saline) for adhesive capsulitis followed by guided exercise is clinically and functionally effective.• The ultrasound-guided anterior rotator interval approach is clinically and functionally significantly more effective than the conventional intra-articular posterior approach as it targets mainly the area of pathology.• This is the first prospective study comparing the effect of the anterior rotator interval approach versus the posterior approach in ultrasound-guided hydrodilatation in adhesive capsulitis patients.

Assessment of Scapulothoracic, Glenohumeral, and Elbow Motion in Adhesive Capsulitis by Means of Inertial Sensor Technology: A Within-Session, Intra-Operator and Inter-Operator Reliability and Agreement Study.

Adhesive capsulitis (AC) is a glenohumeral (GH) joint condition, characterized by decreased GH joint range of motion (ROM) and compensatory ROM in the elbow and scapulothoracic (ST) joint. To evaluate AC progression in clinical settings, objective movement analysis by available systems would be valuable. This study aimed to assess within-session and intra- and inter-operator reliability/agreement of such a motion capture system. The MVN-Awinda® system from Xsens Technologies (Enschede, The Netherlands) was used to assess ST, GH, and elbow ROM during four tasks (GH external rotation, combing hair, grasping a seatbelt, placing a cup on a shelf) in 10 AC patients (mean age = 54 (±6), 7 females), on two test occasions (accompanied by different operators on second occasion). Standard error of measurements (SEMs) were below 1.5° for ST pro-retraction and 4.6° for GH in-external rotation during GH external rotation; below 6.6° for ST tilt, 6.4° for GH flexion-extension, 7.1° for elbow flexion-extension during combing hair; below 4.4° for GH ab-adduction, 13° for GH in-external rotation, 6.8° for elbow flexion-extension during grasping the seatbelt; below 11° for all ST and GH joint rotations during placing a cup on a shelf. Therefore, to evaluate AC progression, inertial sensors systems can be applied during the execution of functional tasks.

Shoulder joint mobility in patients with primary adhesive capsulitis after treatment with continuous mode of ultrasound: A systematic review of randomized controlled trials.

Background: Although the continuous mode of ultrasound therapy improves joint mobility, its role in primary adhesive capsulitis (AC) remains unclear. Therefore, this systematic review aims to address this evidence gap. Methods: The literature search included databases (SCOPUS, CINAHL, EMBASE, and PubMed) and in-text references of articles read full-text. Randomized controlled trials (RCT) on primary AC patients (published in the English language between 1979-2019) comparing the ROM changes (in degrees) mainly between continuous mode of US therapy with any other non-electrotherapeutic treatment were eligible for inclusion. The trials were reviewed narratively along with an assessment of the risk of bias. Results: Out of 174 search results, two eligible single-center trials comprising of 100 participants compared ROM in four separate directions at the 10th session and after three months post-intervention. The risk of selection bias, performance bias, and attrition bias was unclear among the trials. While in both the trials ROM (in all directions) improved in the respective intervention groups at follow up, most of these changes varied between the intervention groups in one trial. However, in the latter trial, participants in the treatment group had the worst ROM values at baseline with poor compliance to the adjunct exercise therapy. Conclusion: The contemporary evidence in the context remains inconclusive due to a lack of large multicentric well-conducted RCTs.

Value of Anterior Band of the Inferior Glenohumeral Ligament Area as a Morphological Parameter of Adhesive Capsulitis

Objective Thickened inferior glenohumeral ligament (IGHL) is considered as one of the major morphological parameters of adhesive capsulitis (AC). Previous studies reported that the anterior band of inferior glenohumeral ligament thickness (aIGHLT) is correlated with shoulder capsular contracture, luxatio erecta humeri, and AC. However, the thickness varies from the measured angle. To reduce this measurement error, we devised a new morphological parameter, called the anterior band of inferior glenohumeral ligament area (aIGHLA). Methods The aIGHL samples were collected from 54 patients with AC and from 50 control subjects who underwent shoulder magnetic resonance imaging (MRI) without any evidence of AC. Coronal T2-weighted MRI images were obtained at the shoulder level from each patient. We measured the aIGHLA and aIGHLT at the maximal view of the IGHL in the coronal plane using our picture archiving and communication system. The aIGHLA was measured at the whole cross-sectional area of the IGHL in the most hypertrophied segment of the coronal MR images. The aIGHLT was measured at the thickest point of the IGHL. Results The average aIGHLA was 55.58 ± 14.16 mm2 in the control group and 83.71 ± 28.45 mm2 in the AC group. The average aIGHLT was 3.47 ± 0.99 mm in the control group and 4.52 ± 1.02 mm in the AC group. AC patients showed significantly greater aIGHLA (p < 0.001) and aIGHLT (p < 0.001) than control subjects. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off score of the aIGHLA was 63.37 mm2, with 79.6% sensitivity, 80.0% specificity, and AUC of 0.84 (95% CI, 0.76–0.92). The optimal cut-off point of the IGHLT was 3.81 mm, with 74.1% sensitivity, 74.0% specificity, and AUC of 0.77 (95% CI, 0.68–0.86). Conclusions Although the aIGHLA and aIGHLT were both significantly associated with AC, the aIGHLA was a more sensitive diagnostic parameter.

To compare the effect of home based program and supervised occupational therapy program in adhesive capsulitis patients with diabetes mellitus

To compare the effect of home based program and supervised occupational therapy program in adhesive capsulitis patients with diabetes mellitus

Contrast-enhanced Ultrasonography for the Diagnosis of Frozen Shoulder.

Introduction:Adhesive capsulitis (AC), also known as frozen shoulder, is challenging for diagnosis, particularly in early stages. A promising tool is contrast-enhanced ultrasonography (CEUS), which has been successfully applied on musculoskeletal ultrasonography.Methods and Results:Two antecedent studies reported the application of CEUS on AC patients although different methods were used. The first research team administered the contrast media intravenously to facilitate detection of microcirculation through observing different distributions of time–intensity curves between the affected and unaffected shoulders. The second study has introduced a pioneering approach, injecting the contrast media mixed with saline directly into the glenohumeral joint. The authors designated this novel method as “US arthrography”. According to our best knowledge, this is the first study reporting the application of intraarticular CEUS in humans.Conclusion:Both presented studies reported CEUS to be capable of differentiating shoulders with AC from normal controls.

Responsiveness and Minimal Clinically Importance Difference of Thai QuickDASH in Individuals with Adhesive Capsulitis

Objective: To explore consistency between clinical outcomes derived from patient self-assessment and physical therapy evaluation. Also, to determine the minimal clinically importance difference (MCID), responsiveness, and optimal cut-off point specific to adhesive capsulitis for conditions of high and low disability, using the Thai version of QuickDASH. Methods: A cohort study was conducted in two hospitals over six weeks of physical therapy. Eighty-seven adhesive capsulitis patients participated in this study. Clinical outcomes provided by participant self-assessment using Thai QuickDASH and Global Rating of Change (GRoC) scales were compared with irritability outcomes provided by a physical therapist. Thai QuickDASH is the validated outcomes measurement tool for adhesive capsulitis and GRoC is recommended as a standard external anchor. This anchor-based method and receiver-operating characteristics (ROC) were analysed to clarify MCID and responsiveness. Results: The highest correlation was between the Thai QuickDASH and pain during passive shoulder elevation (rho = 0.638). MCID scores ranged from 9.1 to 20.4. The optimal cut-off point between high and low disability was 31.8, attained by a combination of two references; one was a score of at least GRoC+1 and the other was irritability outcome defined by pain during passive shoulder elevation. Conclusion: Responsiveness and MCID measured by the Thai QuickDASH is specific to adhesive capsulitis. A combination of GRoC as a standard external anchor and irritability outcome gave a precise cut-off point for improvement. Overall management of adhesive capsulitis, including continuing evaluation, treatment justification, and decision planning, should be based on qualified confirmation of MCID and responsiveness.

Shoulder adhesive capsulitis: epidemiology and predictors of surgery

Adhesive capsulitis is characterized by a gradual, painful loss of shoulder motion. This study evaluated patient variables significantly associated with developing adhesive capsulitis compared with a sex-matched control group without adhesive capsulitis. We also sought to determine those factors associated with adhesive capsulitis patients requiring surgical intervention. All patients presenting to our hospital with adhesive capsulitis between 2004 and 2014 were identified. Demographic characteristics were collected, and a sex-matched control group was randomly generated from the electronic medical record and used for comparison. Patients who underwent surgical intervention for adhesive capsulitis were also identified, and factors associated with surgical intervention were identified with logistic regression analysis. Included were 2190 adhesive capsulitis patients with a normal age distribution of 56.4 ± 13.1 years. Most were classified as overweight (30.7%) or obese (27.0%). Compared with controls, adhesive capsulitis patients were more likely to be younger (<50 vs. ≥50 years; odds ratio [OR], 0.69; P < .001), obese (OR, 1.26; P < .001), black/African American (OR, 1.71; P < .001), Hispanic/Latino (OR, 4.85; P < .001), or diabetic (OR, 1.12; P < .001) and less likely to have hypertension (OR, 0.93; P = .006). Overall, 361 subsequently underwent surgical intervention. Older patients, racial minorities, and government-sponsored/uninsured patients were significantly less likely to have surgery for adhesive capsulitis (P < .01), whereas workers' compensation patients were 8 times more likely to receive surgery compared with privately insured patients (P < .001). Obesity and diabetes were significantly associated with adhesive capsulitis and should be considered modifiable patient factors. Additionally, younger patients and racial minorities were also significantly more likely to be diagnosed with adhesive capsulitis. Younger, white, and workers' compensation patients were more likely to receive surgery, whereas patients with government-sponsored or no insurance status were more likely to receive nonoperative treatment.