Primary Adhesive Capsulitis Research Articles

Assessing Initial Functional Outcomes Following Arthroscopic Release for Stiff Shoulder in Periarthritis Shoulder

Adhesive capsulitis can manifest as either primary/idiopathic or secondary, often linked to systemic illnesses. Primary adhesive capsulitis is characterized by limited range of motion without underlying systemic or precipitating shoulder conditions and lacks intrinsic pathology. In contrast, secondary frozen shoulder is associated with identifiable intrinsic factors such as diabetes, thyroid disorders, cardiac disease, stroke, prolonged immobilization, trauma, and rotator cuff disease. Our study aims to assess the initial functional outcomes, average recovery duration, and related comorbidities in arthroscopic release for adhesive capsulitis of the shoulder.The study was carried out at the Department of Orthopedics in Saveetha Medical College and Hospital, Thandalam, spanning from June 1, 2022, to June 31, 2023. It comprised 30 patients diagnosed with adhesive capsulitis who met specific criteria. The treatment regimen consisted of Arthroscopic Release followed by intensive physiotherapy and prescribed home exercises. Follow-up appointments were scheduled at regular intervals to track progress, using assessment tools like the UCLA Score and VAS score, and all data were meticulously recorded in a standardized proforma.30 individuals who met specific criteria were diagnosed with adhesive capsulitis. Of these, 12 out of 18 participants were female, and 16 patients experienced more frequent impairments on the left side. The average age of the patients was 65 years, ranging from 57 to 78 years old. Stage 2 was the most common among the approximately 19 patients. Prior to surgery, the UCLA score had a mean of 23, ranging from 18 to 26, while the mean preoperative VAS score was 8, with a range of 7 to 9. Following surgery, significant improvements were observed in the UCLA score, ranging from 26 to 35, and the post-operative VAS score ranged between 2 and 5. In our study, arthroscopic release appears as a safe procedure with favourable postoperative results. This consequently enables early mobilization of the shoulder joint and decreases complication rates.

Effectiveness of subacromial steroid injection and hydrodilatation in the treatment of adhesive capsulitis: A comparative analysis.

Objective: To compare the effectiveness of Subacromial Steroid Injection (SAI) and Hydrodilatation in treating adhesive capsulitis (frozen shoulder). Study Design: Observational study. Setting: Department of Orthopedic, Dr. Ziauddin Hospital, Located in North Nazimabad, Karachi, Pakistan. Period: March 2023 to September 2023. Methods: Included 138 participants with primary adhesive capsulitis. Participants were divided into two groups: one received hydrodilatation and the other received SAI. The Disability of Arm, Shoulder, and Hand (DASH) Score and Visual Analogue Scale (VAS) were used for pre and post-treatment assessments at intervals of 2 weeks, 6 weeks, and 6 months. SPSS version 23 was used to analyze the data. Results: Both groups show significant reductions in pain scores and DASH scores over time (p-value<0.05 for changes within each group). There are significant differences in pain scores and DASH scores between the groups at 6 weeks, 12 weeks, and 6 months (p-value<0.05), with the hydrodilatation group showing better outcomes. Moreover, the mean reduction in pain scores and DASH scores from pre-treatment to 6 months is significantly greater in the hydrodilatation group compared to the SAI group (p-value<0.05). Conclusion: While both Hydrodilatation and SAI are effective in reducing pain and improving functionality in patients with adhesive capsulitis, Hydrodilatation appears to be more effective in achieving these outcomes, particularly in terms of pain management and functional improvement.

Suprascapular nerve blocks with 5mL × 10mL in the treatment of primary adhesive capsulitis: pilot study of clinical trial.

To assess whether 5mL would not be less effective than 10mL when performing a suprascapular nerve block, regarding shoulder function and quality of life in primary adhesive capsulitis. This is a pilot study of a randomized, controlled, double-blind clinical trial conducted at a single center. Patients with AC characterized by constant pain and restricted movements in anterior elevation, 0°/90° external rotation, and internal rotation were selected. Two groups were randomly selected. In group I, a dose of 10mL of bupivacaine was applied, while in group II, only 5mL, in four weekly blocks. Sealed and sequentially numbered envelopes were used. The SF-36 and DASH questionnaires were applied in five moments. The t-Student test was used to compare the means, with a probability of rejecting null hypothesis of 5%. There were 17 participants with primary AC, seven in group I and 10 in group II. The average age was 54.30 and 50.43years in the 5mL and 10mL groups, respectively. There were no differences when the means were compared by DASH: T0 (p = 0.074); T2 (p = 0.285); T4 (p = 0.333); T8 (p = 0.392), and T12 (p = 0.453). As for the SF-36, there were sparse differences in T2 in the domains of vitality (p = 0.006) and social aspects (p = 0.036) in favor of group I, and in the general health status domain in T8, in favor of group II (p = 0.033). The volume of 5mL is not less effective than 10mL when performing SSNB in the treatment of primary adhesive capsulitis.

Analysis of patients with adhesive capsulitis treated at the Kosovska Mitrovica Clinical Hospital Center over a two-year period

Introduction/Objective. Adhesive capsulitis (AC) is a condition characterized by pain and significant reduction in active and passive movements in the glenohumeral joint, especially in external rotation. It is one of the most common and challenging clinical disorders encountered by orthopedic surgeons. AC is predominantly an idiopathic condition and has an increased prevalence in women and patients with diabetes mellitus and hypothyroidism. The etiology and pathogenesis are not entirely clear. Treatment options include conservative and surgical approaches, but the results remain controversial. Methods. The study included patients treated for primary (idiopathic) AC from June 2021 to June 2023 at the Kosovska Mitrovica Clinical Hospital Center. A total of 172 patients were treated. All were managed non-operatively with physical therapy and local intra-articular steroid injections. The patients were followed up on an outpatient basis monthly, then at six months, one year, and two years. Results. All patients were divided into two groups. The first group (87 patients) underwent physical procedures, while the second group (85 patients) received intra-articular corticosteroid injections. Patients that were treated with physical therapy were not administered injections of steroids, while the group of patients treated with corticosteroids were not given physical therapy. Patients were selected through randomization. Conclusion. Steroid injections may be beneficial in the early stages of the disease, especially in the first 6-8 weeks, but long-term results did not show any significant difference between the two groups of patients.

Clinical Impairments and Rotator Cuff Tendon Pathology in Primary and Intrinsic Secondary Adhesive Capsulitis.

This study was conducted to compare the differences in clinical impairments between patients with primary and intrinsic secondary adhesive capsulitis and confirm rotator cuff tendon pathology in intrinsic secondary adhesive capsulitis. This study included 130 patients with unilateral adhesive capsulitis in freezing or frozen stages. Clinical impairment was evaluated using visual analog scale score, shoulder passive range of motion, Cyriax stage, and Constant-Murley score. Plain radiography, ultrasonography, single-contrast arthrography, and intravenous gadolinium-enhanced magnetic resonance imaging were performed in all patients. Among 130 patients, 77 patients were diagnosed as primary adhesive capsulitis and 53 patients as intrinsic secondary adhesive capsulitis. Among intrinsic secondary adhesive capsulitis patients, 44 rotator cuff tendon tears, 6 calcific tendinitis, and 3 rotator cuff tendon tears with calcific tendinitis were observed. No significant intergroup difference was observed in all clinical parameters, including shoulder passive range of motion, visual analog scale, Cyriax stage, and Constant-Murley score. The prevalence of subacromial subdeltoid bursitis was significantly higher in intrinsic secondary adhesive capsulitis compared with primary adhesive capsulitis. There was no significant difference in all clinical parameters investigated between patients with primary and intrinsic secondary adhesive capsulitis caused by rotator cuff tendon pathology.

Inertial Sensors and Pressure Pain Threshold to Evaluate People with Primary Adhesive Capsulitis: Comparison with Healthy Controls and Effects of a Physiotherapy Protocol.

Inertial sensors (IMUs) have been recently widely used in exercise and rehabilitation science as they can provide reliable quantitative measures of range of motion (RoM). Moreover, the pressure pain threshold (PPT) evaluation provides an objective measure of pain sensation in different body areas. The aim of this study was to evaluate the efficacy of physiotherapy treatment in people with adhesive capsulitis in terms of RoM and pain improvement measured by IMUs and the PPT. A combined prospective cohort/cross-sectional study was conducted. Nineteen individuals with adhesive capsulitis (10/19 females, 54 ± 8 years) and nineteen healthy controls (10/19 females, 51 ± 6 years) were evaluated for active glenohumeral joint RoM and PPT on shoulder body areas. Then, individuals with adhesive capsulitis were invited to 20 sessions of a physiotherapy protocol, and the assessments were repeated within 1 week from the last session. The range of motion in the flexion (p = 0.001) and abduction (p < 0.001) of the shoulder increased significantly after the physiotherapy protocol. Similarly, the PPT was found to increase significantly in all the assessed shoulder body areas, leading to no significant differences compared to the healthy controls. IMU and PPT assessments could be used to evaluate the efficacy of physical therapy in people with adhesive capsulitis.

Predictive Factors of Intra-articular Corticosteroid Injections With Ultrasound-Guided Posterior Capsule Approach for Patients With Primary Adhesive Capsulitis.

Adhesive capsulitis affects the shoulder joint, causing pain and limiting motion. In clinical practice, the effectiveness of injections varies, and the factors influencing their success remain unclear. This study investigates the predictors of effective corticosteroid injections in patients with primary adhesive capsulitis. This retrospective study enrolled adhesive capsulitis patients older than 35 yrs who received intra-articular corticosteroid injections. The response was determined based on patients' pain and range of motion 3 mos after the injection. Demographic data, medical comorbidities, and radiographic parameters (critical shoulder angle and acromial index) were compared between the effective and noneffective groups. Receiver operating characteristic curves and logistic regression were used to identify the predictors of injection effectiveness. This study included 325 patients with primary adhesive capsulitis, who were divided into responder (189 patients, 58.2%) and nonresponder (136 patients, 41.8%) groups. The receiver operating characteristic curve revealed that the acromial index score indicated favorable discrimination for predicting a poor response to injections, whereas the critical shoulder angle score did not. Logistic regression revealed that the pain period, diabetes mellitus, and acromial index are predictors of nonresponders to injections. Long pain duration, the presence of diabetes mellitus, and an acromial index score greater than 0.711 were predictors of nonresponse to corticosteroid injections for primary adhesive capsulitis patients.

Ultrasound-guided rotator interval or subacromial corticosteroid injection in primary adhesive capsulitis of the shoulder: Does it make a difference?

Primary adhesive capsulitis occurs spontaneously without any predisposing factors. Diabetes, diseases of thyroid, cerebrovascular accident, coronary artery diseases, autoimmune disease and Dupuytren’s contracture are some of the associated conditions. Various treatment methods for adhesive capsulitis of shoulder including physical therapy, intraarticular corticosteroid injections, manipulation under anaesthesia, and arthroscopic or open capsular release have been described. Intra-articular, subacromial, rotator interval and bicipital grove are the various sites for corticosteroid injection in adhesive capsulitis. Ultrasound has been used widely in shoulder joint injections to improve accuracy. There is limited data comparing these sites for their efficacy in adhesive capsulitis when injected under ultrasound guidance. In this study, we compared ultrasound-guided corticosteroid injection through rotator interval and subacromial route shoulder joint in adhesive capsulitis of shoulder.

The effects of end-range interventions in the management of primary adhesive capsulitis of the shoulder: a systematic review and meta-analysis

Purpose To compare the effects of end-range manual therapy versus other conservative intervention on pain intensity, shoulder range of movement (ROM), and physical function in adhesive capsulitis (AC). Methods Two reviewers conducted a comprehensive search from inception to December 2022. PUBMED, Cochrane Library, CINAHL, EMBASE, and PEDro databases were searched. Clinical trials investigating the effects of end-range mobilisation techniques on pain, ROM, and physical function in patients with AC were included. Methodological quality was evaluated using the PEDro scale, and bias risk was assessed using the Cochrane Collaboration tool. GRADE was used to assess the certainty of the evidence. Data were presented using forest plots, and the random effects models were applied according to the Cochrane handbook. Results Ten randomised controlled trials were reviewed, involving 424 AC patients aged 20–70 years. Methodological quality of studies ranged from high to low. The end-range mobilisation showed improvements in pain intensity, shoulder abduction, internal rotation, and external rotation, and physical function compared to other conservative interventions in the short-and medium-terms. Certainty of the evidence was downgraded to very low. Conclusions Very low certainty evidence suggests that end-range mobilisation techniques improve pain intensity, shoulder ROM, and physical function in the short-and medium-term in AC.

Analysis of patient factors associated with selection of corticosteroid injection in the freezing phase of idiopathic adhesive capsulitis.

Primary idiopathic adhesive capsulitis (AC) is characterized by shoulder pain and global limitations in range of motion (ROM). The aim of this study was to determine (1) if a spectrum of symptom severity exists during the freezing phase of AC and (2) identify factors associated with patient selection of corticosteroid injection (CSI) for treatment. Patients presenting within 6 months of symptom onset of AC (freezing phase) were enrolled in this single-site retrospective case control study. Visual analog pain scale (VAS) score, shoulder ROM, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores, and Patient-Reported Outcomes Measurement Information System (PROMIS function and pain) scores were collected. Each patient was offered oral anti-inflammatory medication, physical therapy, and intra-articular CSI. Patients were divided into 2 cohorts: those electing vs. those deferring CSI. Multivariable logistic regression was performed to identify patient or symptom characteristics predictive of electing CSI. A total of 112 patients (mean age=54.7 ± 8.8 years, female=76 [67.9%], mean symptom duration =13.2 ± 7.9 weeks, elected CSI=74 [66.1%]) were included in our analysis. The overall study population demonstrated a wide spectrum of VAS pain scores (6.0 ± 2.8, range: 0-10) and ROM: forward elevation (99° ± 27°, range: 30°-150°), abduction (82° ± 24°, range: 30°-130°), external rotation (47° ± 13°, range: 0°-90°), internal rotation (38° ± 26°, range: 5°-90°). The CSI group had higher mean VAS pain score (6.6 ± 2.5 vs. 4.9 ± 3.0, P=.005) and greater limitations in ROM for forward elevation (92° ± 27° vs. 113° ± 25°, P=.001) and abduction (77° ± 24° vs. 90° ± 21°, P=.005) compared with the non-CSI cohort. The CSI group demonstrated significantly worse shoulder function based on Constant (P<.05), ASES (P=.001), P-UE (P=.016), P-Intensity (P=.002), and P-Interference (P=.004). Logistic regression demonstrated decreased total shoulder ROM in forward elevation and abduction plane (OR=0.98, 95% CI=0.97-0.99, P=.004). Hispanic ethnicity and increased VAS pain score (OR=1.20, 95% CI=1.01-1.43, P=.04) were associated with increased likelihood of electing CSI. A spectrum of symptom severity exists during the freezing phase of primary AC, despite similar etiology. AC patients with greater pain severity, and greater limitations in ROM at initial evaluation were associated with patient selection of CSI.

Ultrasound-guided Shoulder Intraarticular Ozone Injection Versus Pulsed Radiofrequency Application for Shoulder Adhesive Capsulitis: A Randomized Controlled Trial

BACKGROUND: A diseased shoulder due to pain, stiffness, or weakness negatively affects patients’ quality of life and their ability to carry out activities of daily living. Adhesive capsulitis is a disease characterized by shoulder pain and global limitation of movement in the shoulder joint. Many interventions have been proposed for the treatment of primary adhesive capsulitis. The current study compares the effect of ultrasound-guided intraarticular injection of ozone versus steroid versus intraarticular application of pulsed radiofrequency. OBJECTIVES: The primary outcome of the current study was to compare the improvement in the Visual Analog Scale (VAS) after the 3 treatment modalities. The secondary outcomes included functional improvement measured by the Shoulder Pain and Disability Index (SPADI) and level of inflammatory biomarkers measured by serum intercellular adhesion molecule (ICAM-1) and high-sensitivity C-reactive protein(hs-CRP). STUDY DESIGN: The current study is a prospective, double blinded, randomized controlled trial. We employed a double blinding technique for both the patients and the outcome assessors. SETTING: Our study was carried out at the Medical Research Institute, Alexandria University, Egypt, after approval of the local ethical committee (IORG0008812). The study was registered in the “clinical trials library for protocol registration and results system” with number NCT04724317. The study included 45 patients with a diagnosis of primary adhesive capsulitis. METHODS: Patients were randomly assigned to 3 equal groups: steroid group, ozone group, and pulsed radiofrequency group. Pain and global shoulder functions were assessed using the VAS at rest and with movement, range of motion (ROM), and the SPADI. Moreover, ICAM-1 and hs-CRP were measured as inflammatory markers. RESULTS: The results of the current study reveal that all patients in all groups have had a statistically significant improvement after their intervention regarding pain, disability, ROM, and inflammatory markers. Pairwise comparisons revealed that improvement of the VAS during movement had a statistically significant improvement starting from the second week and continuing to the fourth and eighth week. VAS during rest had a significant improvement starting from follow-up week one in the steroid group. Moreover, improvement in the ROM and SPADI scores started from the second week follow-up. Percent improvement was calculated for each group and there was a statistically significant difference between groups in VAS at rest and ROM in the pulsed radiofrequency group compared to the steroid group. Regarding inflammatory markers, both ICAM-1 and hs-CRP had a significant improvement after all 3 interventions with no statistically significant difference among the groups. LIMITATIONS: This study is a single-center study. A shortage of previously published data, and heterogeneity in the published methodology of the 3 interventions limited our discussion data for comparison with the previous literature. CONCLUSION: Ultrasound-guided shoulder joint intraarticular injection of steroid, ozone, or pulsed radiofrequency application all result in a significant improvement in pain, disability, and ROM in primary adhesive capsulitis. They can be used as an effective treatment modality for this condition. Comparing groups statistically, the pulsed radiofrequency group had a more delayed, but statistically better long-term improvement compared to the other 2 groups. KEY WORDS: Adhesive capsulitis, pulsed radiofrequency, ozone, shoulder, glenohumeral joint, pain, hs-CRP, triamcinolone acetonide

Effectiveness of scapular mobilization in patients with primary adhesive capsulitis: A systematic review and meta-analysis.

The aim of this study was to determine the effectiveness of scapular mobilization on range of motion, shoulder disability, and pain intensity in patients with primary adhesive capsulitis (AC). An electronic search was performed in the MEDLINE, EMBASE, SCOPUS, CENTRAL, LILACS, CINAHL, SPORTDiscus, and Web of Science databases up to March 2023. The eligibility criteria for selected studies included randomized clinical trials that included scapular mobilization with or without other therapeutic interventions for range of motion, shoulder disability, and pain intensity in patients older than 18 years with primary AC. Two authors independently performed the search, study selection, and data extraction, and assessed the risk of bias using the Cochrane Risk of Bias 2 tool. Six randomized clinical trials met the eligibility criteria. For scapular mobilization versus other therapeutic interventions, there was no significant difference in the effect sizes between groups: the standard mean difference was -0.16 (95% confidence interval [CI] = -0.87 to 0.56; P = .66) for external rotation, -1.01 (95% CI = -2.33 to 0.31; P = .13) for flexion, -0.29 (95% CI = -1.17 to 0.60; P = .52) for shoulder disability, and 0.65 (95% CI = -0.42 to 1.72; P = .23) for pain intensity. Scapular mobilization with or without other therapeutic interventions does not provide a significant clinical benefit regarding active shoulder range of motion, disability, or pain intensity in patients with primary AC, compared with other manual therapy techniques or other treatments; the quality of evidence was very low to moderate according to the grading of recommendation, assessment, development and evaluation approach.

AN EXPERIMENTAL STUDY ON THE EFFECT OF TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) WITH CAPSULAR STRETCHING AND HOT PACK ON PAIN AND RANGE OF MOTION (ROM) IN ADHESIVE CAPSULITIS.

Objective: - to nd the effect of transcutaneous electrical nerve stimulation (tens) with capsular stretching and hot pack on pain and range of motion (ROM) in adhesive capsulitis. Total 50 subjects of two groups were selected according to i Methods:- nclusion criteria having primary adhesive capsulitis with age group 40-50 years of both male and female. Patients in group A 25 subjects (M=12, F=13), receiving TENS and Conventional therapy for 20 minutes and Capsular stretching (30 sec. stretch with 10 repetitions) for 8 weeks (6 sessions per week with one day rest). Patients in group B 25 subjects (M=12, F=13), receiving Conventional therapy for 20 minutes and Capsular stretching (30 sec. stretch with 10 repetitions) for 8 weeks (6 sessions per week with one day rest). All the subjects had given written consent prior to participation. Pre-test Results:- and post-test evaluation of outcome measures- VAS and ROM was done. The mean and S.D. values of VAS group A (4.48 and 0.963) and group B (2.68 and 0.748). The mean and S.D. values of ROM group A (Flexion- 28.24 and 7.573), (Abduction- 27.44 and 4.805), (External rotation- 11.04 and 6.361). group B (Flexion- 16.40 and 7.984), (Abduction- 10.32 and 4.571), (External rotation-7.52 and 4.144). This study can Conclusions: - be concluded that TENS with capsular stretching and hot packs on pain intensity and range of motion (ROM) has an effective role in the treatment of Adhesive capsulitis. Both the groups showed signicance in decreasing pain and increasing range of motion. But in group A subjects there is a signicant result in reducing pain intensity and improving ROM after the treatment. Group B subjects came back with mild increase in pain intensity and reduced ROM

Adhesive capsulitis: a review of current clinical treatments

Adhesive Capsulitis of the shoulder or arthrofibrosis describes a pathological process in which the body forms excessive scar tissue or adhesions across the glenohumeral joint, leading to pain, stiffness, and dysfunction. It is a debilitating condition that can occur spontaneously (primary or idiopathic adhesive capsulitis) or following shoulder surgery or trauma (secondary adhesive capsulitis). Here we review the pathophysiology of adhesive capsulitis of the shoulder, highlighting its clinical presentation, natural history, risk factors, pathoanatomy, and pathogenesis. Both current non-operative and operative treatments for adhesive capsulitis are discussed and evidence-based studies are presented in support of or against each corresponding treatment. Research carried out in the MEDLINE/ PubMed / Research gate/ Google scholars using Mesh Terms: “adhesive capsulitis”, “frozen shoulder”, and “treatment”. The articles in English published were selected, after which non-relevant articles were excluded based on the title, reading of the abstract, and full article. Physical therapy along with medication has proven to be beneficial either isolated or concomitantly with other therapeutic approaches. Alternate options like capsular distension, manipulation under anesthesia, and arthroscopic surgery have reported good results, especially in refractory cases. No significant benefits were found with the use of oral corticosteroids, NSAIDs, or acupuncture. New treatment options are currently being tested with promising results. There are several effective options for the treatment of Adhesive capsulitis. In the early stages, conservative measures should be chosen with special emphasis on physical therapy within the limits of pain associated with low-dose intra-articular injection of corticosteroids. More invasive treatment options should be suggested namely capsular distention and manipulation under anesthesia.

Assessment of the Effectiveness of Kinetic Chain Approach for Primary Adhesive Capsulitis of ShoulderAn Experimental Study

Introduction: Idiopathic adhesive capsulitis is characterised by gradual onset of pain in shoulder and its limited mobility of motion due to a thickened capsule with an unknown cause. The peak incidence rate is between the ages of 40 and 60 years with less chances of occurrence in the younger group and individuals, who engage in physical labour are far less likely to experience it. In order to determine whether the kinetic chain approach is more effective, researchers tested it on individuals with adhesive capsulitis. Aim: To assess effectiveness of the kinetic chain approach for treating primary adhesive capsulitis. Materials and Methods: This pre and postexperimental study was conducted at the Department of Physiotherapy, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India, for a period of one year from January 2020 to December 2020. A total of 60 patients with primary adhesive capsulitis were included in the trial and were divided into Group-A and Group-B using a systematic random sampling process. Group A received traditional physiotherapy in addition to the Kinetic chain technique. In Group B, regular physiotherapy was the only treatment provided to patients. The Range of Motion (ROM), Visual Analog Scale (VAS) and the Shoulder Pain and Disability Index (SPADI) were measured in both groups pre, mid and posttreatment groups. Non parametric statistical techniques were used to analyse the data owing its originality. Results: A total of 30 patients in each Group (A and B) were provided with Kinetic chain approach (mean age=53.93 years) and conventional physiotherapy (mean age=55.40 years), respectively. For comparing data within the same group, Wilcoxon signed-ranks test was used for this. Mann Whitney U-test was used to compare the data between groups. The p-values for the VAS, SPADI, and ROM showed statistical significance at the 0.001 level. In terms of pain, functional impairment, and range of motion, with Group A showing greater strides than Group B. Conclusion: The combination of kinetic chain technique and traditional physiotherapy was more beneficial than either group when used singularly to reduce discomfort, increase the range of motion, and enhance functional capacity in adhesive capsulitis patients.

Comparative Effect of Niel-Asher Technique and Positional Release Technique on Pain, Active ROM and Functional Disability in Adhesive Capsulitis: An Experimental Study

Introduction: Adhesive Capsulitis of Shoulder (ACS) is a common self-limiting disorder characterised by painful, progressive loss of active and passive shoulder motion due to fibrosis and rigidity of the joint capsule. ACS occurs in 2-5% of the population overall and up to 20% of those with diabetes. Women between the ages of 40 and 60 are at increased risk, and one in four patients may have bilateral illness. Several studies have been done to prove the effectiveness of electrotherapeutic modalities and manual mobilisation techniques on Adhesive Capsulitis, but very few studies have been done to find out and compare the effectiveness of Niel-Asher technique and Positional Release Technique (PRT) on adhesive capsulitis. Aim: To compare effect of Niel-Asher technique and positional release technique on pain, active Range of Motion (ROM) and functional disability in patients with adhesive capsulitis. Materials and Methods: This was a pre and post-experimental design conducted at Santosh Medical College and Hospital, Ghaziabad, India, for a duration of two years conducted on 110 patients with a diagnosis of stage II primary adhesive capsulitis. The patients were divided into group A and group B using a systematic random sampling procedure. Conventional physiotherapy and the Niel-Asher technique were used on patients in group A. Patients in group B received conventional physiotherapy and Positional Release Technique. The therapy was given to patients, three times weekly for a total of six weeks. The Shoulder Pain and Disability Index (SPADI), Range of Motion (ROM) and Visual Analogue Scale (VAS) were measured in both groups in pre, mid and post-therapy. The analysis of the collected data was done by Statistical Package for Social Sciences (SPSS) software version 17.0. Results: A total of 110 patients with adhesive capsulitis patients, 55 in each group A (mean age: 51.78±7.810 years) and group B (mean age: 52.33±7.794 years) were included in the study and the mean age of total study subjects was 52.05±7.80 years. On analysis of the collected data, statistically significant outcomes across all three measures (VAS, SPADI, and ROM) were observed with a p-value of less than 0.001. In pain, functional impairment and restricted ROM, group A, outperformed group B in this comparison. Conclusion: Both conventional physiotherapy along with NielAsher technique group and conventional physiotherapy along with PRT group were individually effective in relieving pain and improving Range of Motion and Functional ability in patients with Adhesive capsulitis, but among these two groups, the group that received Niel-Asher technique in addition to conventional physiotherapy reported more significant improvements when compared to PRT group, in pain, range of motion and functional ability.

A comparison of two surgical methods in the treatment of shoulder adhesive capsulitis.

The purpose of the study was to compare the outcomes of arthroscopic capsular release surgery and manipulation of patients with resistant primary adhesive capsulitis (AC) under anesthesia. The study comprised forty-four patients who had surgery after being given a diagnosis of primary AC. Patients who had both passive and active glenohumeral and scapulothoracic movements equal to or less than 100° elevation and less than 50% of external rotation compared to the contralateral side were considered to have resistant adhesive capsulitis and were included in the study. Conservative treatments such as intra-articular steroid injections and physical therapy had failed to relieve the pain in these patients for at least six months. The patients who took part in the trial underwent manipulation under anesthesia (group 1) and arthroscopic capsular release (group 2) operations. The chosen surgical procedure was chosen at random and based on the surgeon's preferences. examining the patients' demographic information. After treatment, the patients were examined at three-month, six-month, and one-year intervals. Joint range of motion, visual analogue scale (VAS), and Constant-Murley shoulder scores were all recorded. Statistics were used to compare the outcomes of the two surgical techniques in this study both before and after the procedure. The study's participants' gender, side, extra procedure, and age factors did not show a statistically significant difference between groups 1 and 2 (p<0.05). According to the age, gender, side, additional process, and homogeneous distribution throughout the groups. No statistically significant difference was discovered between groups 1 and 2 in any of the measurements taken from study participants during the follow-up period: Pre-op visual pain scores (VPS), Post-op 3rd month VPS, Post-op 1st year VPS, Pre-op Constant score, Post-op 6th month Constant score, and Post-op 1st year Constant score (p<0.05). The change in VPS and Constant Score values over time did not show a statistically significant difference between the groups (p<0.05). A statistically significant difference between the groups was discovered in each of the Pre-op period and Post-op 6th month VPS assessments (p<0.05). Although there was no statistically significant difference between the two studied therapies, the surgical method was shown to be more beneficial in both groups the shorter the pre-op period was between the onset of the complaints and the operation.

Prognostic factors associated with improvements in patient-reported outcomes in idiopathic adhesive capsulitis

The purpose of this study was to identify prognostic factors that are associated with improvements in patient-reported outcomes measures (PROMs) related to upper extremity function and pain in those suffering from idiopathic adhesive capsulitis. All patients treated conservatively for primary idiopathic adhesive capsulitis were identified from our institutional database between 2019 and 2021. Exclusion criteria included any patients treated surgically, follow-up less than one year, or incomplete survey results. PROMs including Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Test Version 2.0 (P-UE), Pain Interference (P-Interference), Pain Intensity (P-Intensity), and visual analog scale (VAS) pain scores. They were obtained at initial consultation and at one year to assess patient-perceived impact of their condition. Multiple linear and multivariable logistic regressions were performed to identify factors associated with improvement in patient-perceived pain and shoulder function using final PROM scores and difference in PROM scores from initial consultation. An independent t-test was used to compare baseline and one-year minimum follow-up PROMs. Odds ratios and their 95% confidence intervals were calculated for each factor; a P value of < .05 was considered statistically significant. A total of 56 patients (40 females and 16 males) were enrolled in the study with an average age of 54.7±7.7 years. A significant improvement (P<.001) was demonstrated at one-year minimum outcomes for P-UE, P-Interference, P-Intensity, and VAS scores. With respect to comorbid conditions, hypothyroidism [P-UE (β: 9.57, P=.006)] was associated with greater improvements in PROMs, while hyperlipidemia [P-UE (β:-4.13, P=.01) and P-Intensity (β: 2.40, P=.02)] and anxiety [P-UE (β:-4.13, P=.03)] were associated with poorer reported changes in PROMs. Female sex [P-UE (β: 4.03, P=.007) and P-Interference (β:-2.65, P=.04)] and employment in manual labor professions [P-Interference (β:-3.07, P=.01), P-Intensity (β:-2.92, P=.006), and VAS (β:-0.66, P=.03)] were associated with significantly better patient-perceived outcomes. Hispanic heritage was associated with higher reported changes of P-Intensity (β: 8.45, P=.004) and VAS (β: 2.65, P=.002). Patient-perceived improvements in PROMIS score during the natural history of adhesive capsulitis are likely multifactorial, with anxiety, hyperlipidemia, increased body mass index, and Hispanic heritage associated with reduced improvement in PROMIS scores.

Evaluation of the Differences in the MRI Findings Related to Primary and Secondary Adhesive Capsulitis.

Purpose: The aim of this study is to describe the radiological findings of adhesive capsulitis due to different etiological factors and reveal that different clues due to different etiological causes should be considered in the diagnosis of adhesive capsulitis. Methods: The study group comprised 24 primary and 22 supraspinatus tendon rupture-related adhesive capsulitis patients with 24 individuals without adhesive capsulitis and with normal shoulder magnetic resonance imaging. Independent samples t-test and one-way analysis of variance tests were used to compare the measurements between the groups. Paired sample t-test and Cohen's kappa statistic were used to determine inter-observer reliability. The chi-squared test was used to determine the relationships between groups and categorical variables. Study participants were evaluated both qualitatively and quantitatively. Quantitative measurements included the thickness of the humeral and glenoid segment of the joint capsule and the thickness of the anterior joint capsule and the fluid depth within the biceps tendon sheath. The qualitative assessments included the detection of any signal abnormality at the rotator interval, the grading of the humeral and glenoid segment of the joint capsule, and the detection of any signal abnormality in respect of the anterior joint capsule. Results: A statistically significant difference was found between the groups of patients with primary adhesive capsulitis and with supraspinatus tear-related adhesive capsulitis in terms of the thickness of the humeral segment of the joint capsule at the axillary recess level (AUC = .729) (P: .006). Furthermore, setting the cutoff value for the thickness of the humeral segment of the capsule to 4.6mm allowed the differentiation of primary adhesive capsulitis and supraspinatus tear-related adhesive capsulitis with a sensitivity of 70.8% and a specificity of 87.3%. Conclusion: In conclusion, the humeral segment of the joint capsule thickness at the axillary recess was found to be affected by different degrees depending on whether it is a primary or supraspinatus tear-related adhesive capsulitis.

Factors related to initial treatment for adhesive capsulitis in the medicare population

BackgroundPrimary adhesive capsulitis (AC) is not well understood, and controversy remains about the most effective treatment approaches. Even less is known about the treatment of AC in the Medicare population. We aimed to fully characterize initial treatment for AC in terms of initial treatment utilization, timing of initial treatments and treatment combinations.MethodsUsing United States Medicare claims from 2010–2012, we explored treatment utilization and patient characteristics associated with initial treatment for primary AC among 7,181 Medicare beneficiaries. Patients with primary AC were identified as patients seeking care for a new shoulder complaint in 2011, with the first visit related to shoulder referred to as the index date, an x-ray or MRI of the shoulder region, and two separate diagnoses of AC (ICD-9-CM codes: 726.00). The treatment period was defined as the 90 days immediately following the index shoulder visit. A multivariable logistic model was used to assess baseline patient factors associated with receiving surgery within the treatment period.ResultsNinety percent of beneficiaries with primary AC received treatment within 90 days of their index shoulder visit. Physical therapy (PT) alone (41%) and injection combined with PT (34%) were the most common treatment approaches. Similar patient profiles emerged across treatment groups, with higher proportions of racial minorities, socioeconomically disadvantaged and more frail patients favoring injections or watchful waiting. Black beneficiaries (OR = 0.37, [0.16, 0.86]) and those residing in the northeast (OR = 0.36, [0.18, 0.69]) had significantly lower odds of receiving surgery in the treatment period. Conversely, younger beneficiaries aged 66–69 years (OR = 6.75, [2.12, 21.52]) and 70–75 years (OR = 5.37, [1.67, 17.17]) and beneficiaries with type 2 diabetes had significantly higher odds of receiving surgery (OR = 1.41, [1.03, 1.92]).ConclusionsFactors such as patient baseline health and socioeconomic characteristics appear to be important for physicians and Medicare beneficiaries making treatment decisions for primary AC.