Adhesive Capsulitis Research Articles

Differences in biomechanical and metabolic factors between patients with frozen shoulder and asymptomatic individuals. A cross-sectional study

Backgroundthe pathogenesis of frozen shoulder (FS) is thought to be one of inflammation and fibrosis possibly influenced by hyperglycemia. Biomechanical changes of the shoulder joint in terms of muscle strength, scapular kinematics and proprioception might occur in FS. Objectivesto compare muscle strength, scapular kinematics, proprioception, and blood glucose levels within patients with FS and to asymptomatic individuals. Designcross-sectional study. MethodThirty-five patients with FS and 35 asymptomatic age and gender-matched individuals underwent physical assessment to determine muscle strength (abduction, external and internal rotation), scapular kinematics (both visually and with a plurimeter), proprioception (joint position sense), and blood glucose level. ResultsPatients with FS showed a decrease in muscle strength in their affected shoulder compared to both the unaffected shoulder and asymptomatic individuals. Significant differences were found between the affected and unaffected shoulder in the FS group and between groups (FS versus controls) in scapular upward rotation (plurimeter) at 30° and 60° abduction. No difference in scapular kinematics (visual observation), proprioception, and blood glucose levels was found neither between shoulders in the FS group nor between groups. ConclusionA clinically relevant difference in muscle strength and increase in scapular upward rotation were found in the affected shoulder of patients with FS compared to their unaffected side and controls. However, no evidence of different levels of scapular kinematics (visual observation), proprioception, and blood glucose levels in the affected shoulder compared to the unaffected shoulder or controls is lacking.

The Feasibility and Efficacy of Remote App-Guided Home Exercises for Frozen Shoulder: A Pilot Study.

Home exercise programs are beneficial in managing frozen shoulder (FS), yet adherence remains challenging. This pilot study introduces the remote app, Defrozen, designed for home exercises and assesses its feasibility and clinical outcomes in FS patients undergoing intra-articular and sub-acromial corticosteroid treatment. Over a four-week period, patients used the Defrozen-app, engaging in guided exercises. The feasibility of the intervention was assessed through several measurement scales, including adherence, the Technology Acceptance Model 2 (TAM2), the System Usability Scale (SUS), and User Satisfaction and Engagement (USE). Clinical outcomes included pain scale, Oxford Shoulder Score (OSS), Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) Score, and passive range of motion. The TAM2 results indicated high perceived usefulness (4.5/5), ease of use (4.8/5), and intention to use (4.4/5); the SUS score was high at 81.7/100, complemented by USE scores reflecting ease of learning (4.9/5) and satisfaction (4.3/5). Clinical outcomes showed significant pain reduction, improved shoulder function, reduced shoulder-related disability, and increased shoulder range of motion. These findings suggest the Defrozen-app as a promising solution for FS, significantly improving adherence and showing potential to enhance clinical outcomes. However, these clinical outcome results are preliminary and necessitate further validation through a large-scale randomized controlled trial to definitively confirm efficacy and assess long-term benefits.

An Unusual Localization of Spinoglenoid Cysts in the Shoulder; Case Report and Comprehensive Literature Analysis

Objective: A spinoglenoid cyst represents a distinctive clinical entity within the realm of shoulder pathology, characterized by the development of a cystic structure in the spinoglenoid notch. Situated in the intricate anatomy of the shoulder, this cyst often involves compression of the suprascapular nerve, introducing a spectrum of symptoms that range from localized discomfort to functional impairment. As an area of increasing interest in orthopedic and neurological literature, the spinoglenoid cyst poses diagnostic and therapeutic challenges. Case: Patient 1: A 31-year-old male presented with right shoulder pain and a positive Hawkins sign. He had a history of bicipital tendinitis. T2-weighted MRI (T2WI) showed a hyperintense 14x16mm spinoglenoid cyst. Patient 2: Another 31-year-old male presented with shoulder pain, positive Hawkins and Neer signs, and pain induced upon shoulder range of motion. T2-weighted MRI (T2WI) revealed a 16x11mm hyperintense ganglion cyst with hypointense septae. Patient 3: A 42-year-old male presented with shoulder pain that started a month ago. He had a history of rotator cuff syndrome, shoulder impingement syndrome, and adhesive capsulitis in the shoulder, along with positive Hawkins and Neer signs. T2-weighted MRI (T2WI) identified a 25x15x28mm hyperintense ganglion cyst. Conclusion: The cases presented highlight the diagnostic challenges posed by spinoglenoid cysts and the importance of advanced imaging techniques, particularly MRI, in confirming their presence and understanding their characteristics. The diverse clinical manifestations, ranging from chronic shoulder pain to neurological deficits, emphasize the need for a nuanced and individualized approach to diagnosis and management.

Assessment of shoulder joint derangements with magnetic resonance imaging in adult Nigerians.

Shoulder pain secondary to various aetiologies is a common musculoskeletal complaint worldwide, and Magnetic Resonance Imaging (MRI) is the most accurate imaging method for evaluating shoulder pain in all age groups. While the patterns of shoulder MRI abnormalities in various demographics have been reported, data on sub-Sahara African populations are still sparse. This study aims to describe the imaging features and spectrum of shoulder joint pathologies on MRI in adult Nigerians. This was a retrospective review of the shoulder MRI of 100 adult Nigerians (with and without trauma) from September 2020 to December 2021. Their clinical data and shoulder MRI findings were extracted and analysed. Statistical significance was set at P ≤ 0.05. There were 64 males and 36 females aged 18-82 years. Right shoulder MRI was done in 53 subjects (53%), while the left shoulder was studied in 47 (47%). Supraspinatus tendinopathy (73%), acromioclavicular joint arthropathy (68%), and subacromial-subdeltoid (SASD) bursitis (64%) were the most frequently detected pathologies. Other demonstrated derangements include glenohumeral joint effusion (24%), long head of biceps tendon sheath effusion (18%), labral abnormalities (16%), subcoracoid bursitis (4%), Hill Sach's deformity (3%), anterior glenohumeral dislocation (2%), fatty degeneration of the supraspinatus/infraspinatus muscles (2%), adhesive capsulitis (1%), and other bony abnormalities (contusion, erosion, subchondral cysts). There was no significant difference in the frequency of shoulder abnormalities between the male and female subjects. Acromioclavicular joint arthropathy, SASD bursitis, and rotator cuff disorders were the dominant pathologies in the participants' shoulders.

MR imaging signs of shoulder adhesive capsulitis: analysis of potential differentials and improved diagnostic criteria.

To evaluate the prevalence of shoulder adhesive capsulitis (AC) signs on MR studies of patients with various common shoulder conditions. MR images of 316 patients were retrospectively evaluated. Patients were divided into three groups: controls (66 patients), clinical AC (63 patients), and study group (187 patients). The final diagnosis of AC was reached clinically. The study group was composed of patients with focal and massive rotator cuff tears, active hydroxyapatite deposition disease, fractures around the shoulder, and post-surgery. The following AC signs were evaluated: inferior glenohumeral ligament (IGHL) thickening; coracohumeral ligament (CHL) thickening; and hyperintensity of the inferior glenohumeral ligament, which was graded in four classes. The IGHL signal intensity was statistically higher in patients with fractures than in controls (P = 0.008). There was no statistically significant difference in IGHL signal between the AC group and patients with massive rotator cuff tears and active hydroxyapatite deposition disease (P > 0.1). IGHL thickness in patients with fractures, massive rotator ruptures, and active hydroxyapatite deposition disease was significantly higher compared to controls (P < 0.02) and significantly lower compared to the AC group (P < 0.0001). Based on these findings, a grading system for fibro-inflammatory capsular changes is proposed. MR AC signs are frequent in patients with shoulder conditions other than AC; however, in these patients, capsular changes are less prominent than in patients with clinical AC.

A CLINICAL STUDY TO EVALUATE THE EFFECT OF MASHA TAILA AND PHYSIOTHERAPY IN THE MANAGEMENT OF AVABAHUKA W.S.R.TO FROZEN SHOULDER

Introduction : Paradoxically shoulder joint privileged as the most mobile joint in the body has its nemesis be-cause of this advantage i.e. it become more vulnerable to injuries. Frozen shoulder is a clinical syndrome char-acterized by painful restriction of both active and passive shoulder movements due to abnormalities within the shoulder joint or remote. Prevalence of this disease is around 2.1 - 5% and women suffer more than men be-tween age group of 40-60 years .According to Ayurvedic principles, frozen shoulder can be taken as“Avabahuka”(Frozen shoulder), as its clinical features are almost similar. Ayurvedic principles of manage-ment for these diseases are more effective than other pathies . In modern medicine the current management has many side effects and having success rate of 58% only.Even on surgical decompression recurrence is also there. Aim:- To determine the effect of Masha Taila(oil) and physiotherapy in the management of Avabahuka w.s.r.to Frozen Shoulder. Materials and method : The study was conducted on 30 patients in two groups with symp-toms of Frozen shoulder. Statistical Analysis used : Observations of the study were analyzed, and findings were evaluated by using statistical methods. Result: Group I:-Among15 patients,11patients (73%) had markedly im-proved .Group II:-Among 15 patients, 2 patients (13.33%)had markedly improved. Conclusion: In group I: -Masah Taila (Matar Vasti(Enema) and Sthanic Snehna(Oleation) along with physiotherapy gave better results ,in less duration of time then physiotherapy alone in group II.

Gene association analysis to determine the causal relationship between immune-mediated inflammatory diseases and frozen shoulder.

Multiple studies have indicated a potential correlation between immune-mediated inflammatory diseases (IMIDs) and Frozen shoulder (FS). To explore the genetic causal relationship between IMIDs and FS using 2-sample Mendelian randomization (MR) analysis. Genome-wide association study (GWAS) summary data for FS were obtained from Green's study, while data for 10 IMIDs were sourced from the FinnGen Consortium. The MR analysis was performed using inverse variance weighting, MR Egger, and weighted median methods. IVW, as the primary MR analysis technique, was complemented with other sensitivity analyses to validate the robustness of the results. Additionally, reverse MR analysis was further conducted to investigate the presence of reverse causal relationships. In the forward MR analysis, genetically determined 4 IMIDs are causally associated with FS: rheumatoid arthritis (odds ratio [OR] (95% confidence interval [95% CI]) = 1.05 [1.02-1.09], P < .01); type 1 diabetes (OR [95% CI] = 1.06 [1.03-1.09], P < .01); hypothyroidism (OR [95% CI] = 1.07 [1.01-1.14], P = .02); and Celiac disease (OR [95% CI] = 1.02 [1.01-1.04], P = .01). However, no causal relationship was found between 6 IMIDs (autoimmune hyperthyroidism, Crohn disease, ulcerative colitis, psoriasis, sicca syndrome and systemic lupus erythematosus) and FS. Sensitivity analyses did not detect any heterogeneity or horizontal pleiotropy. In the reverse MR analysis, no causal relationship was observed between FS and IMIDs. In conclusion, this MR study suggests a potential causal relationship between rheumatoid arthritis, type 1 diabetes, hypothyroidism, and Celiac disease in the onset and development of FS. Nevertheless, more basic and clinical research will be needed in the future to support our findings.

The Association Between Cervical Foraminal Stenosis and Adhesive Capsulitis: An Imaging-based Case-Control Study.

Retrospective single-center imaging-based case-control study. To determine the association between cervical foraminal stenosis and adhesive capsulitis. Patients with cervical spondylosis often exhibit shoulder symptoms. Cervical radiculopathies, particularly C5, can cause severe shoulder pain and reduced shoulder mobility, mimicking glenohumeral adhesive capsulitis (frozen shoulder), a common shoulder condition. This is the first study investigating the connection between adhesive capsulitis and cervical radiculopathy. 438 patients who underwent glenohumeral hydrodistension between 2012 and 2019 were reviewed. Included were individuals with unilateral frozen shoulder investigated using ultrasound and cervical spine MRI to investigate cervical spondylosis. Foraminal stenosis at C3/4, C4/5, C5/6 and C6/7 was graded in axial T2 MRI, ipsilateral and contralateral to the adhesive capsulitis. The presence of foraminal stenosis ipsilateral to the frozen shoulder (cases) was compared with the contralateral side (control). McNemar's exact test was used to assess the strength of a correlation. Among 438 patients, 107 reported frozen shoulder and neck pain (24.5%), with 48 matching the study criteria. A significant association between ipsilateral frozen shoulder and C4/5 foraminal stenosis was observed (P=0.00000008636). Ipsilateral foraminal stenosis was observed in 57.3% of these cases, with bilateral stenosis in 29.1%. Additionally, 78% had neck pain on the same side as their frozen shoulder, and 44% had pain radiating to the shoulder. 48% patients underwent nerve-targeted interventions, with 44% addressing the C5 nerve (25% C5 steroid injection and 19% C4/5 anterior cervical discectomy and fusion). A substantial association between C5 foraminal stenosis and ipsilateral frozen shoulder was found. C5 radiculopathy could be a risk factor for "neurogenic frozen shoulder". Those diagnosing frozen shoulder and cervicobrachialgia should recognize that frozen shoulder and C5 radiculopathy may coexist. A multidisciplinary approach involving both shoulder and spine specialists is recommended for a definitive diagnosis.

A case report of ansa cervicalis to spinal accessory transposition graft: A new surgical technique to prevent shoulder dysfunction

Introduction and Importance: The spinal accessory nerve is at risk when performing neck dissections for head and neck cancers. Injury to this nerve can result in shoulder syndrome, which can be challenging to manage. Various nerve repair or grafting methods are available to prevent this condition. A safe, simple, and cost-effective option is the ansa cervicalis to spinal accessory transposition graft. Case Presentation: A 60-year-old Afro-Trinidadian female presented to the Outpatient clinic for evaluation of a scalp lesion and a large neck mass for a duration of one year. Preoperative tissue biopsies confirmed she had squamous cell cancer with metastatic spread to the cervical nodes. The patient underwent surgical excision of the scalp lesion and a left neck dissection with the sacrifice of the sternocleidomastoid and the left spinal accessory nerve due to tumour involvement. During the procedure, the ansa cervicalis was successfully joined to the distal remainder of the spinal accessory nerve. After the surgery, the patient fully recovered and achieved a good quality of life during the 24 months follow-up. Clinical Discussion: This is the first reported case of using the ansa cervicalis to reinnervate the trapezius muscle through the spinal accessory nerve. This procedure aims to prevent pain, muscle wasting, and adhesive capsulitis. A quality-of-life questionnaire and adequate range of motion proved the success of this procedure, demonstrating that this option provides practical, functional, and aesthetic benefits for patients. Conclusion The ansa cervicalis to spinal accessory transposition nerve graft is a valuable option for reinnervation. This case report highlights the effectiveness of this single-stage procedure in preventing shoulder syndrome. Keywords

Predictors of balance in individuals with Adhesive Capsulitis: A cross-sectional study

Purpose: The aim of this study was to determine whether the variables pain, mobility, upper extremity functionality and depression (mood status) are predictors of balance in individuals with Adhesive Capsulitis (AC). Material and Methods: A total of 40 individuals with AC, mean age 52.90 ± 6.02 years were included. Patients were assessed via Visual Analog Scale, 6-minute walk test, Time up and go test, Disabilities of Arm, Shoulder and Hand questionnaire, Beck Depression Scale and Berg Balance Scale to understand pain severity, functional mobility and capacity, upper extremity functional status, depression symptoms and balance. Multiple regression analysis was used to determine which predictor variables explain the outcome variable. Results: There was a moderate to high significant correlation of balance level with pain (p

Efficacy of Marma Chikitsa in the management of Avabahuka (frozen shoulder) - A Single Case Study

Avabahuka (frozen shoulder) is a type of Vata Vyadhi caused by vitiated Vata Dosha with Anubhandha of Kapha Dosha. The symptoms of Avabahuka can be correlated with the symptoms of adhesive capsulitis, which is commonly known as frozen shoulder. Being a disease of shoulder joint, which has the greatest range of motion, it seriously affects routine day-to-day activities. A 56-year-old female came to the OPD of Pt. Khushilal Sharma Government Ayurvedic College and Hospital, Bhopal (MP) with pain and restricted movement in the right shoulder since 6 months, having undergone conventional treatment without any significant improvement. In this case study effect of Marma Chikitsa in the management of Avabahuka (frozen shoulder) is evaluated. The patient was treated with Marma Chikitsa for 10 days. The range of movements improved gradually from 45 to 123° for abduction, 102° to 165° for flexion, 53 to 65 for external rotation, and 30° to 45° for extension. VAS score for pain in the right shoulder was 7 before treatment, which came down to 4 after first course of the treatment regimen and gradually to 3 after completion of the treatment. The study suggested that Marma Chikitsa may be used for relieving symptoms of Avabahuka; however, study on large population was suggested.

Effectiveness of Mindfulness Based Cognitive Therapy Verses Conventional Physiotherapy on Kinesiophobia in Patients with Frozen Shoulder: A Comparative Study

Background: Frozen Shoulder is defined as a clinical syndrome characterized by painful restriction of both active and passive shoulder movements (1) . there is high degree of kinesiophobia among patients having shoulder pain(2). Mindfulness based cognitive therapy (MBCT) may be an effective intervention for the treatment of active depression in a population with chronic pain (3) . The treatment goal of MBCT program, is to find ways of managing the pain and the adverse consequences on mental health and quality of life (4). considering that in patients with frozen shoulder treatment of pain alone was not enough to reduce fear of movement , Hence this study aimed to find the effect of MBCT on pain and kinesiophobia in patients with frozen shoulder. Objective: To find the effect of mindfulness based cognitive therapy on pain and kinesiophobia in patients with frozen shoulder. Methodology: After designing the study Institutional Ethical Approval was taken. Consent was obtained from all the participants. 30 samples were screened based on eligibility criteria, 2 were excluded and 28 were further divided into Group A (experimental group) received MBCT and conventional therapy and Group B (control group) received conventional therapy. Pre-assessment was by Tampa scale for kinesiophobia and VAS scale for pain done at Week 0. The experimental group received the MBCT and regular exercise program for 8 sessions 2 hours per day for 8 weeks. The control group received regular exercise program. Post-assessment was done at week 8. Result: The (INSTAT) was used for comparison of mean of group A and group B. One participant from the experimental group and one from the control group did not complete the study. The comparison of mean post intervention scores for group A and B of TSK Scores was found to be Extremely significant which was calculated using un-paired t test with t value t= 3.922, p value p= &lt;0.0006. Comparison of mean post intervention scores for group A and B of VAS Scores was found to be Not significant which was calculated using un-paired t test with t value t= 0.4583, p value p= 0.6505. Conclusion: The study concludes that MBCT along with conventional physiotherapy is effective in reducing kinesiophobia in patients with frozen shoulder.

A Comparative Study of the Efficacy of Ultrasound Therapy against Intra-articular Corticosteroid Injection in Adhesive Capsulitis: A Randomised Open-label Study

Abstract Introduction: Adhesive capsulitis is idiopathic, progressive, painful, and restricted active and passive shoulder range of motion in patients with normal radiographs. Adhesive capsulitis can be effectively treated by ultrasound therapy, exercise, and intra-articular steroids. Objective: To see the efficacy of ultrasound therapy and intraarticular corticosteroid injection in adhesive capsulitis. And compare the efficacy of ultrasound therapy and intra-articular corticosteroid injection. Materials and Methods: Study Design: A comparative study. Setting: Tertiary care center. Time period:from October 2019 to September 2020. Participants: 80 patients who attended the Physical Medicine and Rehabilitation department during the study period, met the inclusion criteria. Intervention: Patients were randomly assigned to the intra-articular corticosteroid injection (Group A) and ultrasound therapy treatment (Group B). Main Outcome Measures: Parameters such as the Visual Analogue Scale (VAS), Shoulder Pain and Disability Index (SPADI) and range of motion with goniometry. The examination was performed at the 1st visit (0 week) and then 4th, 8th and 12th weeks. Results: At the end of the study, a statistically significant improvement was obtained in all clinical parameters: VAS (P &lt; 0.001), SPADI (P &lt; 0.001) and goniometry (P &lt; 0.001) in both Group A (the intra-articular corticosteroid injection) and Group B (ultrasound therapy treatment). While in combination with therapeutic exercises, the greatest pain improvement was seen in the local corticosteroid injection group, the ultrasound therapy group also showed significant and comparable improvement. Conclusions: Both intra-articular corticosteroid injection and ultrasound therapy were effective in adhesive capsulitis treatment. Thus, ultrasound therapy can be an alternative treatment for adhesive capsulitis, particularly in patients who do not accept injections.

Ultrasound-Guided Hydrodistention with Corticosteroid Instillation in Glenohumeral Joint for Relief in Frozen Shoulder: A Case Series

Abstract The frozen shoulder (FS) also known as adhesive capsulitis is one of the most common causes of shoulder pain and disability. It is marked by pain and limitation of movement resulting in progressive deterioration of quality of life. Although a few patients with an FS recover without any intervention, the majority of patients have persistent pain with or without movement restriction. Ultrasound (USG)-guided hydrodistension of the shoulder joint is an upcoming mode of treatment for FS which can theoretically lead to pain relief, functional improvement, and a better quality of life, especially if combined with the anti-inflammatory effects of intra-articular corticosteroids. Here, we are presenting our experience with USG-guided hydrodistention of the shoulder joint along with intra-articular corticosteroid in cases of FS both in terms of objective indices of shoulder functionality and subjective outcomes of pain. Eight patients who presented to the outpatient department of pain medicine in our hospital having FS (stage 2/3) were selected. Outcome measures included pain score, Shoulder Pain and Disability Index (SPADI) and Shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Visual Analogue Scale, and range of movement. Data were collected at baseline, as well as at 6 weeks, 12 weeks, and 6 months. We performed hydrodistension with 30 ml of volume constituted by adding lignocaine and triamcinolone acetate to normal saline immediately, followed by physiotherapy of the shoulder joint and cryotherapy. We found promising results with all our patients both in the short term as well as long term with both SPADI and QuickDASH scores as well as the range of motion of the shoulder joint improving significantly in all eight patients at 6 weeks and 12 weeks. This improvement notably persisted in all the patients when reassessed at 6 months indicating a long-term benefit of the intervention.

Higher body mass index increases the risk of shoulder adhesive capsulitis in young adults: a nationwide cohort study

BackgroundThe impact of overweight on the incidence of shoulder adhesive capsulitis (AC) has not been clearly proven. This study aimed to investigate the association between overweight and AC by age using a large-scale nationwide population-based cohort in Korea. MethodsWe analyzed clinical data from 3,517,066 individuals older than 20 years who had undergone a National Health Insurance Service health checkup in 2009. Patients who visited a hospital or private clinic to treat shoulder pain at least three times in one year and were assigned a diagnostic code for AC (ICD-10 code M75.00) were identified using claims data during a median follow-up duration of 8.3 years. Hazard ratios (HRs) and 95% confidence intervals for AC were calculated using the Cox proportional hazards model. ResultsThe adjusted HR for AC in the < 40 year group started to increase in overweight status and was associated with the severity of obesity (body mass index (BMI) < 18.5; 0.654 (0.613–0.697), < 23; 1, < 25; 1.272 (1.231–1.315), < 30; 1.322 (1.281–1.364), ≥ 30; 1.332 (1.253–1.416)). But in the 40–64 year group and the ≥65 year group, there was no significant increasing trend of HR for AC according to BMI level. We conducted a subgroup analysis based on the BMI 23 for defining overweight and presence of comorbidities including diabetes and hyperlipidemia. The adjusted HR for AC was highest with overweight and comorbidities of diabetes and hyperlipidemia (diabetes; 1.528 (1.508–1.549), hyperlipidemia; 1.212 (1.199–1.226)). ConclusionsIn the young age group (20–40 years), a higher BMI level increased the HR for AC. Overweight along with diabetes or hyperlipidemia significantly increased the risk of AC.

Matrix metalloproteinase-1 and matrix metalloproteinase-9 are highly expressed in the joint capsule of diabetic frozen shoulder

BackgroundThe pathophysiology of frozen shoulder (FS) involves abnormal expressions of matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases (TIMPs) that lead capsular fibrosis. However, there has been little concern for why diabetic FS has more protracted fibrotic condition. The objective of this study was to compare the expression levels of MMPs and TIMPs in the joint capsule of patients with diabetic and non-diabetic FS. Materials and methodsSamples of capsular tissue were collected from 20 patients with FS (10 diabetic patients; diabetic group, and 10 non-diabetic patients; non-diabetic group) and 10 patients (control group) with chronic anterior shoulder instability. Quantitative real-time RT-PCR and Western blot analysis were performed to determine the expression levels of mRNA and protein for MMP-1, 3, 9, 13, 14, and TIMP-1, 2. ResultsThe results of quantitative real-time RT-PCR showed significantly higher expression levels of all MMPs and TIMP-1 and significantly lower expression levels of TIMP-2 in the joint capsule of patients in the diabetic or non-diabetic groups compared with the control group. Significantly higher expression levels of MMP-1, 9, 14, and TIMP-1 were detected in the diabetic group compared with the non-diabetic group. The results of Western blot analysis showed significantly higher levels of MMP-3, 13, 14, and TIMP-1 in the joint capsule of patients in the diabetic or non-diabetic groups compared with the control group. However, no significant differences of protein levels of them were observed between diabetic and non-diabetic groups. ConclusionsThe findings of this study demonstrate the potential involvement of MMP-1 and 9 in the pathophysiology of diabetic FS. These findings may be helpful in identification of therapeutic targets for development of novel treatments for this protracted chronic fibrosing condition.

Musculoskeletal disorders of the upper and lower limb: Prevalence among patients in Eastern province, Saudi Arabia.

To determine the prevalence of upper and lower limb musculoskeletal (MSK) disorders among adult patients referred to physical therapy. Data were retrospectively analyzed from electronic health records of patients referred to physical therapy between April 2021 and April 2023. MSK disorders were categorized based on the affected body region (upper or lower limb). A total of 11,243 patients were referred to physical therapy, of whom 4,156 (37%) had MSK disorders. The 4 most commonly affected regions were the knee (27.7%), followed by the shoulder (26.9%), the ankle/foot (14.9%), and the wrist/hand (11.8%). Within each region, the most prevalent disorders were as follows: knee (arthritis [26.5%], sprain/strain [20.1%], pain [10.1%]); shoulder (pain [20.2%], rotator cuff-related syndrome [18.5%], adhesive capsulitis [8.5%]); ankle/foot (sprain/strain [23.3%], fracture [14.3%], pain [8.9%]); and wrist/hand (fracture [24.1%], pain [8.9%], sprain/strain [7.6%]). Cramer's V analysis revealed a strong association between age and the region of MSK disorders (Cramer's V=0.234, p<0.001) and between patient sex and the region of MSK disorders (Cramer's V=0.189, p<0.001). This study demonstrates the prevalence of upper and lower limb MSK disorders among adult patients referred to physical therapy. Further research involving larger, representative samples is warranted to fully understand the prevalence and risk factors of MSK disorders in Saudi Arabia.

Involvement of Glycation and Oxidative Stress in Frozen Shoulder

Involvement of Glycation and Oxidative Stress in Frozen Shoulder

Subacromial bursa in patients with rotator cuff tear with or without adhesive capsulitis exhibits a differential transcriptome with potential molecular biomarkers

BackgroundAlthough adhesive capsulitis (AC) is a common condition, the pathological mechanisms remain understudied. The purpose of our research was to evaluate variations in gene expression across the entire genome in the subacromial bursa tissue of individuals with rotator cuff tears (RCT), with or without AC, and to explore the factors that may influence the occurrence and progression of AC. MethodsTranscription profiles of subacromial bursa samples from 12 RCT patients, of whom 6 had also AC, were evaluated. Data were generated using RNA-seq. DESeq2 was utilized to identify the differentially expressed genes (DEGs) in both groups. In order to conduct a more in-depth examination of the DEGs, we performed Gene Ontology (GO) functional enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. A network of interactions between proteins was built, and the central genes were determined using Cytoscape. The hub genes were confirmed through qRT-PCR and immunohistochemistry. Results324 of the 16,251 detected genes were identified as DEGs. Analysis of GO functional enrichment showed that the DEGs were enriched in domains of biological process, molecule function and cellular component. Analysis of KEGG pathways revealed enrichment of DEGs in pathways like IL-17 signaling and ECM-receptor interaction. We verified that the association between AC and the increase in expression of the PPI network hub genes. ConclusionThis study investigated the transcriptome differences of subacromial bursa in RCT patients with or without AC. Using bioinformatics technology, we identified the DEGs and screened out the hub genes. The research enhanced the data on gene expression profiles of DEGs in the subacromial bursa tissue of patients with RCT, offering fresh perspectives on the regulation of gene transcription.

Health Care Utilization for Common Shoulder Disorders: Analysis of the 2010-2019 National Patient Sample Data from the Health Insurance Review and Assessment Service in Korea.

Background and Objective: The aim of this study was to analyze trends in surgical and non-surgical service utilization for common shoulder disorders in Korea from 2010 to 2019. Methods and Materials: This retrospective, cross-sectional, descriptive study utilized National Patient Sample data from the Health Insurance and Review Assessment Service (HIRA) of Korea. These data constitute a 2% sample out of the entire Korean population and include data for a variety of parameters instrumental for health care research. Patients with at least one medical service use for rotator cuff syndrome or tear, impingement syndrome, or adhesive capsulitis between January 2010 and December 2019 were included. Trends in healthcare utilization by disorder type, patient demographics, seasonal service use, and treatment details were examined. Results: There was an upward trend in the total number of patients and costs for shoulder disorders, from 35,798 patients and USD 5,485,196 in 2010 to 42,558 and USD 11,522,543 in 2019, respectively. The number of patients aged ≥60 and hospital visits increased. March had the highest number of claims. Physical therapy was the most common non-surgical procedure, while nerve block claims more than doubled. Opioid prescription rates also tripled. Surgical treatments were dominated by shoulder rotator cuff repair and acromioplasty. Conclusions: There was a significant increase in healthcare utilization for shoulder disorders, marked by rising costs and patient numbers. The use of nerve blocks and opioids notably increased. These data are valuable for clinicians, researchers, and policymakers.