Secondary Adhesive Capsulitis Research Articles

Effects of Intra-Articular Triamcinolone Injection on Adhesive Capsulitis after Breast Cancer Surgery.

To investigate the effects of intra-articular glenohumeral joint triamcinolone injection in treating secondary adhesive capsulitis after breast cancer surgery. This study prospectively enrolled 37 participants, including 22 in the breast cancer surgery group and 15 in the idiopathic group. All participants received intra-articular glenohumeral joint triamcinolone injection in the affected shoulder joint. The clinical outcomes included the Shoulder Pain and Disability Index (SPADI), passive range of motion (PROM), and pain intensity on the Numeric Rating Scale (NRS), which were evaluated before the intervention and 1, 3, and 6 months after. The primary outcome of this study was the mean difference in the total SPADI from baseline to 6 months after the intervention. The mean differences in the total SPADI scores from baseline to 6 months after the intervention were 36.2 ± 16.4 and 47.9 ± 15.2 in the breast cancer surgery group and the idiopathic group, respectively. There was no significant difference between the two groups (p = 0.1495). However, the improvements in the SPADI pain subscale at the 3- and 6-month follow-up visits (-31.2 vs. -48.8, p = 0.042; -34.1 vs. -50.7, p = 0.0006) and the PROM of abduction at the 3-month follow-up (52.4 vs. 70.3, p = 0.0072) were inferior in the breast cancer surgery group compared to the idiopathic group. There were no adverse events in either group. Intra-articular triamcinolone injection is an effective and safe treatment option for adhesive capsulitis after breast cancer surgery; however, it has less effect than for idiopathic adhesive capsulitis.

Can Secondary Adhesive Capsulitis Complicate Calcific Tendinitis of the Rotator Cuff? An Ultrasound Imaging Analysis.

Adhesive capsulitis (AC) of the glenohumeral joint is a recognized cause of pain associated with both active and passive restricted ranges of movement. AC can be subdivided into primary and secondary forms. Trauma, surgery, immobilization, and diabetes mellitus are the leading well-recognized causes of secondary AC. Calcific tendinitis/tendinitis (CT) of the rotator cuff is considered a possible trigger for AC, as reported in a few previous articles. However, there are no original investigations that assess the frequency and characteristics of this association. The aim of our research was to evaluate the presence of AC in a cohort of patients with a known CT condition of the rotator cuff by an ultrasound (US) examination. We prospectively enrolled all the patients admitted at our single institution (October 2022-June 2023) for the preoperative US evaluation of a known CT condition. In these patients, we searched for parameters related to secondary AC. An axillary pouch (AP) thickness equal to or greater than 4 mm (or greater than 60% of the contralateral AP) was considered diagnostic of AC. Moreover, rotator interval (RI) thickness and the presence of effusion within the long-head biceps tendon (LHBT) sheath was also assessed in all patients. A total of 78 patients (54F, 24M-mean age = 50.0 and range = 31-71 y.o.) were enrolled in the study. In 26 of those patients (26/78-33.3%), US signs of AC were detected. Notably, the mean AP thickness in patients with AC and CT was 3.96 ± 1.37 mm (Group 1) and 2.08 ± 0.40 mm in patients with CT only (Group 2). RI thickness was significantly greater in patients with superimposed AC: 2.54 ± 0.38 mm in Group 1 and 1.81 ± 0.41 mm in Group 2 (p < 0.00001). Moreover, effusion within the LHBT was significantly more frequently detected in patients with AC: 84.61% in Group 1 versus 15.79% in Group 2-p < 0.00001. US signs of AC are found in one-third of patients with CT of the rotator cuff, demonstrating that AC represents a frequent complication that should be routinely evaluated during US investigation to provide more personalized treatment strategies.

Frequency of pulley lesions in patients with frozen shoulder

Background. Analyzing the results of studies conduc­ted at various MRI centers in different cities of our country, demonstrates that the diagnosis of pulley lesion was only established in a few of them, while the diagnosis of adhesive capsulitis was established in every third examination. This fact leads to the disregard of the primary cause of the disease, diagnostic errors, and consequently, treatment mistakes. The purpose was to investigate the frequency of different types of pulley lesions involving the ligaments that maintain the integrity of the long head of the biceps (pulley lesion injuries) in patients with adhesive capsulitis of the shoulder joint (frozen shoulder). Materials and methods. We performed 310 ope­rations on patients with adhesive capsulitis of the shoulder. The patients’ ages ranged from 30 to 90 years. The average duration from the onset of the disease to surgical intervention was 189 ± 104 days. All patients were examined clinically and radiologically and all patients underwent MRI study of anatomical structures and shoulder joint arthroscopy. Results. Pulley lesion injuries of the shoulder joint were detected in 84 (27.1 %) of the patients who underwent surgery for a frozen shoulder. This allows us to assert that in this particular patient group, secondary adhesive capsulitis with the development of shoulder joint contracture was predominant. The third (16.5 %) and fourth (12.4 %) types of pulley lesion injuries were the most prevalent. These particular types of pulley lesion injuries exhibit the most contracture-inducing properties, with the third type predominating over the fourth type. А change in the type of pulley lesion damage (an increase in the number of damaged structures of the shoulder), the average indicators of the mobility of the shoulder decreased. Conclusions. In 27.1% of patients who were opera­ted on for idiopathic adhesive capsulitis was detected pulley lesion, which gives us to reconsider treatment approaches and expand the indications for diagnostic and therapeutic shoulder arthroscopy in the earlier stages of the disease.

Surgical Treatment of Patients with Damage to the Ligaments Holding the Long Head of the Biceps (Pulley Lesion) in Combination with Contracture of the Shoulder Joint

Background. Damage to the ligaments holding the long head of the biceps, or Pulley Lesion injuries, are often accompanied by contracture of the shoulder joint.&#x0D; Objective. The objective of the study was to compare the treatment outcomes of patients with Pulley Lesion injuries and secondary adhesive capsulitis.&#x0D; Material and Methods. The study included 82 patients with contracture of the shoulder joint and damage to the ligaments holding the long head of the biceps. The patients were divided into 2 groups depending on the extent of surgical intervention: group 1 underwent subpectoral tenodesis and selective capsulotomy of the shoulder joint; group 2 underwent subpectoral tenodesis without selective capsulotomy of the shoulder joint. The function of the shoulder joint was assessed using the Constant Shoulder Score and VAS scales before surgery, at 3 and 6 months after the surgery.&#x0D; Results. At 3 months follow-up, the average functional result according to the Constant Shoulder Score was somewhat worse in group 2 (14.5±5.2 points) than in group 1 (8.5±6.4 points), p = 0.031. At 6 months follow-up, the average functional result according to the Constant Shoulder Score was 5.1±5.6 points in group 1 and 10.1±4.1 points in group 2 (p = 0.024). At 3 months follow-up, the average VAS score was worse in group 2 than in group 1 and reached 2.81±0.7 points. At 6 months follow-up, the average VAS score in group 2 was also worse than in group 1 (p = 0.051).&#x0D; Conclusions. Performing selective capsulotomy and subpectoral tenodesis in patients with secondary adhesive capsulitis and damage to the ligaments holding the long head of the biceps (Pulley Lesion injuries) allows us to achieve better functional results both according to the Constant Shoulder Score and the VAS scale at 3 and 6 months after the surgery.

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.

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.

Conservative treatment of patients with secondary adhesive capsulitis

Background. Secondary adhesive capsulitis, similar to idiopathic one, is accompanied by thickening of the glenohumeral joint capsule and loss of its elasticity. Nonoperative management of secondary adhesive capsulitis associated with shoulder soft tissue injuries, impact of prolonged immobilization or surgical treatment still remains controversial. Capsular distension with steroids as in idiopathic adhesive capsulitis is often not used for one reason or another. The purpose: to compare the results of conservative treatment in patients with secondary adhesive capsulitis who underwent or not capsular distension with steroids during the treatment. Materials and methods. From 2015 to 2021 at the Department for Microsurgery and Reconstructive-Recovery Surgery of Upper Limb of the State Institution “Institute of Traumatology and Orthopaedics of the National Academy of Medical Sciences of Ukraine” (Kyiv) and Ivano-Frankivsk Regional Clinical Hospital, we have conducted conservative treatment for 825 patients with various soft tissue pathology of the shoulder joint complicated by secondary adhesive capsulitis. All patients were divided into two groups: first one— conservative treatment, second one — conservative treatment with intraarticular injections (capsular distension) with steroids. In our study, we evaluated the function of the shoulder joint using the Constant Shoulder Score (CSS) and visual analog scale (VAS) before treatment and after 3 and 6 months. Results. Patients from first group (conservative treatment without distension intraarticular injections) had worse average functional results 3 month after starting treatment according to CSS (p=0.13) and VAS (p=0.24) compared to subjects of second group. Six months after the start of treatment, patients from first group had significantly worse results by CSS and VAS than those from group 2, where distension intraarticular injections were performed (p=0.03 and p = 0.06, respectively). Conclusions. Conservative treatment of patients with secondary adhesive capsulitis of the shoulder joint should be comprehensive, differentiated and include both non-drug treatment methods and distension intraarticular injections with long-acting steroids.

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.

Adhesive Capsulitis' Patients Report Improvement in Functionality Trough International Classification of Functioning, Disability and Health Checklist and Dash After Suprascapular Nerve Blocks.

Objective To evaluate the functionality in patients with adhesive capsulitis undergoing suprascapular nerve block (SSNB). Methods A before-and-after clinical prospective study in a single center was conducted with patients with secondary adhesive capsulitis treated with four nerve blocks based on anatomical limits. The sample was non-probabilistic, and it was obtained after a routine appointment at a specialized outpatient clinic. The instruments used for evaluation were the International Classification of Functioning, Disability and Health (ICF) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, which were applied at baseline (T 0 ), one week after the fourth SSNB (T 4 ), and three months after the first SSNB (T 12 ). The paired t -test was used to compare the means of the ICF checklist items and DASH in the different: T 0 xT 4 ; T 4 xT 12 ; and T 0 xT 12 ). The probability of rejecting the null hypothesis was 5%. Results The sample was composed of 25 individuals with a mean age of 58.16 years; 16 of them were female. The duration of the pain symptoms ranged from 2 to 16 months, with a mean of 5.92 months. The ICF checklist showed that all domains had already improved in T 4, except for the environmental factors, which only improved at 03 months ( p = 0.037). The patients reported improvements in shoulder function in T 4 , which increased more in T 12 , at the end of data collection ( p = 0.019). Conclusion The SSNB technique is effective in patients with adhesive capsulitis after 4 weeks of application, with improvements in individual's functionality lasting for 12 weeks.

The effect of single-dose, preoperative intravenous tranexamic acid on early postoperative pain scores after rotator cuff repair: a double-blind, randomized controlled trial

Tranexamic acid (TXA) is commonly used in upper and lower limb arthroplasty to limit blood loss and postoperative hematoma formation. The role of TXA in rotator cuff repair (RCR) surgery is less defined. This trial assessed the effect of preoperative TXA on early postoperative pain scores. A randomized double-blind trail was conducted in 89 patients undergoing RCR. Patients were randomized to either 2 g of intravenous TXA or placebo at induction. The primary outcome was visual analog scale (VAS)-pain score at day 3 postoperation, with secondary outcomes including VAS-pain, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Constant scores at 2, 8, 24, and 52 weeks. There was no significant difference in VAS-pain scores between groups at day 3 postoperation. Pain scores were significantly better in the TXA group at 8 weeks. There was no difference between groups at any time point in the ASES or Constant score. The TXA group had improved motion at 6 months with a reduced rate of secondary adhesive capsulitis. TXA did not improve postoperative pain scores after RCR, however, patients who received the intervention demonstrated greater range of motion at 6 months with lower rates of secondary adhesive capsulitis.

Association of Anxiety and Depressive Symptoms in Patients with Adhesive Capsulitis.

Objective The present study aimed to assess the association between anxiety and depression symptoms in patients with adhesive capsulitis. Methods This was a cross-sectional study carried out in a single center from a tertiary hospital with patients presenting with secondary adhesive capsulitis. The control group did not have shoulder disease, thyroid disease, anxiety, and/or depression. The instrument used was the Hospital Anxiety and Depression Scale (HADS). An analysis of covariance compared HADS scores between groups. The significance level was 5%. Results The final sample consisted of 17 patients (case group) and 27 (control group). The Shapiro-Wilk test revealed normal distribution ( p > 0.05). A HADS score > 0.70 (Cronbach alpha) was reliable and presented good internal consistency. Patients with adhesive capsulitis reported "doubtful" (average/standard deviation = 8.88/4.50) "anxious symptoms" ( p = 0.019) but no "depressive symptoms" (average/standard deviation = 6.41/3.69), despite p = 0.015. Conclusion There is a "doubtful" positive association between anxiety symptoms and adhesive capsulitis but a negative association with depressive symptoms.

THU0485 THE EFFECT OF PERINEURAL INJECTION THERAPY IN PERIARTHRITIS SHOULDER

Background:Primary adhesive capsulitis of the shoulder is a common pathology of the glenohumeral joint characterized by shoulder pain and progressive restriction of the range of motion,its treatment options either medication, local injection, physiotherapy, hydrodistension, manipulation under anesthesia, arthroscopic and open capsular release1.Subcutaneous prolotherapy injections can reduce vascular endothelial growth factor levels and restore effective repair processes so induce apoptosis of proliferating peptidergic noceffectors and neovessels and inhibit TRPV1 receptors resulting to reduction of pain2,3.Objectives:To assess the effectiveness of perineural injection therapy in management of pain and physical function in Primary adhesive capsulitis of the shoulder.Methods:One hundred patients with primary adhesive capsulitis in the freezing stage were selected in this study according to the classification of Hannafin and Chiaia and had restriction of passive motion of greater than 30°in 2 or more planes of movement. Patients with previous corticosteroid injection or previous surgery in the affected shoulder, secondary adhesive capsulitis including inflammatory or infectious arthritis,previous fracture, rotator cuff lesions were excluded from this study.Ptients were randomly devided into two equal groups; Group I received 6 weekly subcutaneous injections of 0.5-1 ml of buffered dextrose 5% in each chronic constriction injury points and tender points at shoulder and along course of suprascapular, supraclavicular, axillary, musculocutanous and radial nerves. Group II received oral NSAIDs and muscle relaxants for 6 weeks. All patients in both groups received the same stretching and exercise therapy during the period of treatment. All procedures were done after informed consent. Assessments were performed at baseline, at the end of the treatment and after three and six months using visual analog scale (VAS) for pain, range of mvement measurements by goniometer, Shoulder Pain and Disability Index (SPADI) &amp; the Western Ontario Rotator Cuff (WORC) Index.Results:Patients in Group I had more rapid relief of pain and better functional improvement compared with group II (p&lt;0.05). There was significant improvement in both groups (p&lt;0.05) after 3 and 6 months with significant difference between the 2 groups indicated that better results in perineural group. Results were summarized in table 1.Baseline GIBaseline GIIAfter end of treatment GIAfter end of treatment GIIAfter 3ms GIAfter 3ms GIIAfter 6ms GIAfter 6ms GIIVAS8.7±0.98.4±1.05.0±1.5*¶5.7±1.1*4.4±1.5*¶5.1±1.6*3.8±1.2*¶4.9±1.3*SPADI80.4±9.878.9±10.741.5±10.2*¶50.4±8.8*35.8±7.5*¶46.6±7.9*32.6±10.2*¶44.5±8.7*WORC28.5±10.626.5±11.560.4±9.8*¶55.9±10.5*67.9±9.7*¶57.3±10.3*71.5±12.3*¶60.1±9.6**significant improvement after treatment¶significant difference between the two studied groupsConclusion:Perineural injection therapy is an effective modality in management of pain and physical function of Primary adhesive capsulitis of the shoulder.

A significant relationship between personality traits and adhesive capsulitis.

We investigated the associations between adhesive capsulitis (AC) and a specific psychological profile. We assessed 72 patients with phase-II AC. In our study, 36 patients were affected by primary disease and 36 by secondary disease. The inclusion criteria were as follows: unilateral AC and pain in the shoulder for at least two months. The exclusion criteria were: psychiatric and neurological manifestations with a previous diagnosis and inability to comprehend the instruments. Outcomes were determined at 52 weeks. Shoulder pain severity was assessed with the Visual Analog Scale. We also measured the range of motion with a universal goniometer and the strength with the Medical Research Council. We assessed the personality traits of our patients with the Cloninger's Temperament and Character Inventory and the Multidimensional Perfectionism Scale. Patients with primary AC needed more time to improve the symptomatology compared to the group with the secondary disease (p<0.01). Patients with primary AC complained of severe and lasting pain more frequently than patients with the secondary disease (p< 0.01). In patients with primary disease, the prevalence of perfectionism, low levels of novelty seeking, and high levels of harm avoidance were 88.2 and 86.2%, and 80.4, respectively, and below 20 percent in patients with secondary AC disease. We found a significant correlation between primary AC and particular personality traits, indicating an interaction between psychological and somatic factors.

Traitement médical actuel de la capsule rétractile idiopathique et secondaire

Management of adhesive capsulitis of the shoulder depends on its severity, its stage, its physiopathology and its nature (idiopathic or secondary adhesive capsulitis). Today, there is no high level of evidence for its treatment's efficiency. During the first stage, called “freezing phase”, the main symptom is pain. The urgency is to relieve the pain and to prevent the shoulder from stiffness. The first treatment is painkiller with or without NSAID. If the patient is not enough relieved, we suggest intra-articular injection of corticosteroids which are efficient in reducing pain and gaining articular mobility in the short term. During stage two, called “frozen shoulder”, the objectives will be to improve articular mobility and to relieve pain. We suggest intra articular injection of corticosteroids in second line therapy, if there is no contraindication, when pain is intense and inflammatory. It showed to relieve pain and to improve mobility in the short term and to improve articular mobility in the mid term, in comparison to oral treatment, placebo and physical exercices. There is no place for oral corticosteroids, as it showed no superiority and they have many side effects, except in case of contra indication to intra-articular injections of corticosteroids. We still have to determinate if the earliness of diagnostic (thanks to the MRI) and the earliness of intra-articular injection could reduce the disease evolution. If the patient is not enough relieved and stiffness is important, we can propose capsular distension followed by intensive mobilization. At every stage, rehabilitation is very important in order to gain articular mobility. No study shows side effects of physical exercises. Several other treatments are under development and show promising results such as radio arterial embolization, intra-articular injection of hyaluronic acid, etc. These treatments could be really interesting in case of chronic stiff capsulitis as an alternative to surgery.

Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments.

Adhesive shoulder capsulitis, 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 shoulder capsulitis, highlighting its clinical presentation, natural history, risk factors, pathoanatomy and pathogenesis. Both current non-operative and operative treatments for adhesive capsulitis are described, and evidence-based studies are presented in support for or against each corresponding treatment. Finally, the review also provides an update on the gene expression profile of adhesive capsulitis and how this new understanding can help facilitate development of novel pharmacological therapies.

Musculoskeletal Problems in Lower Extremity after Stroke

Musculoskeletal problems in the upper extremity after stroke are common conditions affecting the shoulder, elbow, wrist and hand, which are often symptomatic. These symptomatic conditions include complex regional pain syndrome type 1, secondary adhesive capsulitis of the shoulder, spasticity, secondary mechanical injuries, which often presents simultaneously in combined nature, so that one targeted treatment is not always successful. Musculoskeletal pain and complication is one of the reasons, for patients not being possible to start or participate in the daily regular rehabilitation programs actively after stroke. (Brain & NeuroRehabilitation 2016; 9: 6-12)

Musculoskeletal Problems in Upper Extremity after Stroke

Musculoskeletal problems in the upper extremity after stroke are common conditions affecting the shoulder, elbow, wrist and hand, which are often symptomatic. These symptomatic conditions include complex regional pain syndrome type 1, secondary adhesive capsulitis of the shoulder, spasticity, secondary mechanical injuries, which often presents simultaneously in combined nature, so that one targeted treatment is not always successful. Musculoskeletal pain and complication is one of the reasons, for patients not being possible to start or participate in the daily regular rehabilitation programs actively after stroke. (Brain & NeuroRehabilitation 2016; 9: 6-12)

Is Pancapsular Release More Effective than Selective Capsular Release for the Treatment of Adhesive Capsulitis?

Background: We assessed the effectiveness of arthroscopic capsular release for the treatment of adhesive capsulitis. Further, we tried to ascertain the clinical benefits, if any, of pancapsular release over selective capsular release, where the two differ by performing or not performing a posterior capsular release, respectively. Methods: Thirty-five consecutive patients with either primary or secondary adhesive capsulitis who failed conservative treatment for more than 6 months were enrolled in the study. A total of 16 patients allocated in group 1 received a pancapsular release that comprises the release of the rotator interval, anteroinferior capsular, and the posterior capsular release, whereas 19 patients in group 2 received a selective capsular release that comprises only the release of the rotator interval release and anteroinferior capsular release. The clinical outcomes, visual analogue scale (VAS) score, Constant score, and range of motion, were assessed preoperative and postoperatively. Results: In both groups, the preoperative VAS score, Constant score, and ROM showed a significant improvement by the 6-month follow-up. We found that the immediate postoperative internal rotation was significantly higher in group 1 than group 2. Despite significant differences seen between the two groups at the initial postoperative period, there were no significant differences in Constant score, VAS score, and the ROM at all the subsequent follow-ups between the two groups. Conclusions: Arthroscopic capsular release for the treatment of adhesive capsulitis is very effective. However, pancapsular release did not show any advantage over selective capsular release in terms of overall clinical outcome.

Factors affecting short- and long-term outcomes of manipulation under anaesthesia in patients with adhesive capsulitis of the shoulder.

The present study aimed to evaluate and determine the factors that affect short- and long-term outcome following manipulation under anaesthesia (MUA) of patients with adhesive capsulitis. Patients recruited from January 1999 to January 2010 were retrospectively analyzed and classified as having primary or secondary adhesive capsulitis. All patients were assessed for range of movement (ROM) and Oxford Shoulder Scores (OSS) before and immediately postoperatively, as well as for OSS more than 1 year post MUA. In total, 295 patients (315 shoulders) were sequentially recruited, and information was collected at baseline, as well as at a mean follow-up of 28 days and 3.6 years. A significant improvement in OSS and ROM was noted 1 month post MUA (p < 0.0001) with females benefiting more than males (p < 0.0025). Long-term follow-up revealed that the improvement in OSS was maintained (p < 0.0001). Secondary adhesive capsulitis significantly reduced the efficacy of MUA as assessed by ROM (p < 0.0001). Other factors (age, initial ROM and OSS, and length of symptoms prior to MUA) did not significantly affect the outcome over the short- or long-term. The findings of the present study show that all patient groups had a significantly improved ROM and OSS in the short-term with long-term maintenance of improved OSS.

Mid-term results following arthroscopic capsular release in patients with primary and secondary adhesive shoulder capsulitis

The purpose of this study was to assess the effectiveness of arthroscopic capsular release carried out for refractory cases of both primary and secondary adhesive shoulder capsulitis that were not responsive to at least 6 months of prior conservative therapy. Arthroscopic 360-degree capsular release was performed on 167 patients (173 shoulders) with adhesive shoulder capsulitis. Ninety-one shoulders (52.6%) had primary and 82 shoulders (47.4%) secondary adhesive capsulitis. The median follow-up period was 36 months (range 14-67 months). All patients were evaluated according to the constant score. Both groups (primary and secondary adhesive capsulitis) experienced a significant improvement for all ranges of motion immediately postoperative, as well as at the time of follow-up. The median preoperative constant score was 41 (range 18-61) points and increased significantly to a median of 83 (range 27-100) at the time of follow-up. In the group of primary adhesive capsulitis, median preoperative score was 42 points (range 19-58) and increased to 85 points (range 36-100) at follow-up. In the group of secondary adhesive capsulitis, the preoperative mean increased from 41 points (range 18-61) to 74 points (range 27-100) at the time of the follow-up. The constant score component for pain and the visual analogue scale (VAS) score were also significantly increased. Arthroscopic capsular release in patients with primary and secondary adhesive shoulder capsulitis represents a valuable therapeutic choice with minimal complications, to effectively reduce pain and improve movement in all planes of motion. Therapeutic retrospective case series study, Level IV.