Shoulder Function Research Articles

Identification and validation of biomarkers, construction of diagnostic models, and investigation of immunological infiltration characteristics for idiopathic frozen shoulder

BackgroundIdiopathic frozen shoulder (FS) can lead to difficulties in daily activities and significantly impact the quality of life. Early diagnosis and treatment can help alleviate symptoms and restore shoulder function. Therefore, we aimed to explore the diagnostic biomarkers and potential mechanisms of FS from a transcriptomics perspective.MethodsTotal RNA was extracted from tissue samples of 15 FS and 11 controls. At the outset, we conducted differential expression analysis, weighted gene co-expression network analysis (WGCNA), and utilized the cytoHubba plugin, complemented by two machine learning algorithms, receiver operating characteristic (ROC) analysis, and expression level evaluation to identify biomarkers for FS. Subsequently, a nomogram was constructed based on the biomarkers. Additionally, we conducted enrichment and immune infiltration analyses to explore the mechanisms associated with these biomarkers. Finally, we confirmed the expression patterns of the biomarkers at the clinical level through reverse transcription-quantitative polymerase chain reaction (RT-qPCR).ResultsSNAI1, TWIST1, COL1A1, TUBB2B, and DCN were identified as biomarkers for FS. The nomogram constructed based on them had a good predictive value for the occurrence of FS. Except for DCN, the other four genes were upregulated in FS samples, and the expression of SNAI1, TWIST1, and TUBB2B was also observed to be significantly upregulated in RT-qPCR. Moreover, these genes played important roles in pathways such as “ECM receptor interaction” and “lysosome”. We also found that the infiltration abundances of 11 types of immune cells were significantly upregulated in the FS samples, and they were positively correlated with each other. Our biomarkers showed strong correlations with these immune cells; DCN generally displayed a negative correlation, while the other four genes were generally positively correlated.ConclusionThis study established a link between FS biomarkers that have strong diagnostic potential and specific immune responses, highlighting possible targets for diagnosing and treating FS.

Therapeutic Efficacy of Hijāma Dalkiyya (Gliding Cupping) and Targeted Exercises in Waja-i-Mafṣal-i-Katif (Frozen Shoulder) Management: A Case Report

Background: Frozen shoulder (Waja-i-Mafṣal-i-Katif) is a painful condition that leads to stiffness and restricted movement of the shoulder joint. While conventional treatments often rely on medications, Unani regimenal therapy provides a non-invasive alternative for management. Objective: This study aims to assess the effectiveness of Hijāma Dalkiyya (Gliding Cupping) combined with targeted shoulder exercises in improving pain, mobility, and functional ability in individuals with frozen shoulder. Methods: A 67-year-old male diagnosed with right shoulder adhesive capsulitis underwent 21 gliding cupping sessions and structured exercises. Pain levels and shoulder mobility were evaluated using the Shoulder Pain and Disability Index (SPADI) and clinical diagnostic tests before and after treatment. Results: The intervention resulted in a notable improvement in range of motion (ROM), a reduction in SPADI scores, and the negation of previously positive diagnostic tests. The combined effects of cupping therapy and exercise enhanced blood circulation, reduced inflammation, and restored flexibility, improving shoulder function. Conclusion: Unani regimenal therapy, particularly gliding cupping with targeted exercises, shows promise as an effective, non-pharmacological approach for treating frozen shoulder. Further clinical studies are recommended to validate these findings and integrate this method into modern rehabilitation practices. Keywords: Frozen shoulder, Unani therapy, Hijāma Dalkiyya, Gliding cupping, Shoulder rehabilitation

Impairment of neck and shoulder function after neck dissection: a comparative study of goniometry, EMG and paper pencil tool in a randomized controlled trial of level IIb preserving verses conventional neck dissection.

Surgical management of oral cancer poses significant challenges due to the proximity of critical nerves, like spinal accessory, which increases the risk of inadvertent damage or neuropraxia during surgery. A randomized controlled trial enrolled 32 patients with histologically confirmed oral cavity carcinoma and clinically and radiologically negative cervical neck nodes. Patients were assigned to either level IIb-preserving or conventional selective neck dissection. Shoulder function was evaluated using goniometry, electromyography (EMG), and the Neck Dissection Impairment Index (NDII). Outcomes from these three assessment methods were compared. Both groups exhibited impaired spinal accessory nerve function. In the IIb-preserving group, EMG detected impairment in 50% of patients, compared to 95% in the control group. Statistically significant differences were observed between groups across all three assessment methods. However, EMG and goniometry indicated functional recovery at 6 and 12 months, whereas NDII scores remained significantly different at 12 months, despite full nerve recovery observed on EMG and goniometry. The study demonstrates agreement between shoulder function measurements (goniometry and EMG) but discordance with NDII. This discrepancy may arise from the distinct constructs used by NDII to assess neck dissection impairment, highlighting potential limitations in its sensitivity to functional recovery.

Translation and Validation of the Persian Version of the Rotator Cuff Quality of Life Questionnaire (RC‐QOL): A Cross‐Cultural Adaptation Study

ABSTRACTBackground and AimsRotator cuff injuries have a significant impact on shoulder function and life quality. The Rotator Cuff Quality of Life (RC‐QOL) questionnaire is a validated tool designed to assess this impact. This study aimed to translate the RC‐QOL into Persian, adapting it culturally, and evaluate its psychometric properties in Persian‐speaking patients.MethodThe Persian version of the RC‐QOL was developed through a rigorous translation and cultural adaptation process, including forward translation, expert review, back‐translation, and pilot testing. The final version underwent thorough content and face validity checks. Internal consistency was assessed using Cronbach'α, test‐retest reliability was evaluated using the intraclass correlation coefficient (ICC), construct validity was examined using confirmatory factor analysis, and convergent validity was assessed by correlating the RC‐QOL with the DASH and WOSI questionnaires.ResultsAmong the 176 Persian‐speaking participants, the average age was 38.01 ± 9.36 years. The Persian RC‐QOL displayed outstanding internal consistency, with Cronbach'α values ranging from 0.84 to 0.88, and strong test‐retest reliability, with ICC values between 0.82 and 0.88. Convergent validity was affirmed by significant correlations with DASH and WOSI questionnaires (ranging from −0.863 to −0.895, p < 0.001). Construct validity was confirmed using confirmatory factor analysis, with favorable fit indices: RMSEA = 0.04 and CFI = 0.97.ConclusionThe Persian version of RC‐QOL proves to be a reliable and valid tool for evaluating the quality of life in Iranian patients with rotator cuff injuries. Its successful cross‐cultural adaptation enhances its applicability in Iranian clinical and research domains, potentially extending to other Persian‐speaking regions.

Outcome comparison of arthroscopic latissimus dorsi tendon transfer and muscle advancement for irreparable rotator cuff tear: a systematic review.

To compare the clinical outcomes and complications between latissimus dorsi tendon transfer (LDTT) and muscle advancement (MA) for irreparable rotator cuff tears (IRCTs). A PRISMA-guided systematic review included 24 studies (956 shoulders: 750 LDTT, 206MA) from MEDLINE, Embase, and Cochrane Library (searched October 2024). Eligible studies involved arthroscopic-assisted procedures for Patte stage 3 tears with Goutallier stage 3-4 fatty degeneration and ≥12-month follow-up. The analyzed outcomes included functional scores (Constant-Murley, UCLA, ASES), pain (VAS), acromiohumeral distance (AHD), range of motion (ROM), and complications. Risk of bias was assessed using the ROBINS-I and Cochrane tools, and statistical synthesis employed RevMan and R. In this analysis, 24 studies (1 RCT, 13 cohort, 10 case series) involving 956 shoulders were included: 206 in the MA group (mean age 64.6years, mean follow-up 19.7months) and 750 in the LDTT group (mean age 60.8years, mean follow-up 31.2months). Both techniques resulted in significant functional improvement. Comparative analysis revealed no significant differences in the pooled mean improvements for the Constant-Murley Score, UCLA score, ASES score, VAS pain, forward flexion, or abduction. The MA group experienced significantly higher rates of total complications (25.7% vs. 18.0%, P=0.0206) and failure/retear/reoperation (20.8% vs. 8.9%, P=0.0003). The rates of infection, nerve palsy, and stiffness were comparable between groups. Significant heterogeneity was observed in most continuous outcomes. LDTT and MA effectively restore shoulder function in IRCTs; however, their mechanisms differ. The LDTT excels in dynamic biomechanical compensation for external rotation, whereas MA achieves superior static joint stability. LDTT's lower retear rates and higher complication risks associated with MA highlight the need for patient-specific surgical selection.

Role of Scapular Stabilisation Exercises on Pain and Range of Motion in Patients with Rotator Cuff Pathologies: A Narrative Review

The rotator cuff is the group of muscles that stabilises the shoulder joint; it includes supraspinatus, infraspinatus, teres minor, and subscapularis. They are the dynamic stabilisers of the shoulder joint. Rotator cuff pathology includes any problem affecting the rotator cuff muscles, including injuries or degeneration due to overuse. These pathologies include impingements, tears, bursitis, or tendinopathies. The most common tendon injury seen in adults is rotator cuff tears, with the tendon being mostly affected. Scapular dyskinesia is an important factor seen in patients with shoulder dysfunction. This review aims to synthesise the current literature on the importance of the role of scapular stabilisation exercises in the treatment plan for improving pain and ROM in patients with rotator cuff pathologies. A narrative review was done by digital searching from PubMed, Google Scholar, PEDro, Science Direct, and EBSCO. The latest evidence was incorporated to synthesise our findings about the role of scapular stabilisation exercises for improving shoulder function. Traditionally, rehabilitation has focused on glenohumeral mobility and strengthening; however, recent research supports the role of scapular stabilisation exercises as a critical component in restoring optimal shoulder function. Scapular stabilisation exercises are effective in improving shoulder pain and function and enhance the effect when given with other interventions in patients with rotator cuff pathologies. This article provides valuable insights into the use of scapular stabilisation exercises for improving shoulder pain and range of motion, primarily focusing on rotator cuff pathologies. The aim was to offer a deeper understanding in this regard and assist clinicians in devising effective treatment strategies. The review concludes that scapular stabilisation exercises are effective in improving shoulder pain and function and enhance the effect when given with other interventions. It is essential to thoroughly assess each patient and design an individualised treatment plan to maximise clinical outcomes.

Comparative Effectiveness of Combination Versus Single-Modality Physiotherapy for Rotator Cuff-Related Shoulder Pain: A Systematic Review and Network Meta-Analysis.

Background/Objective: The objective of this study is to compare the relative effectiveness of combination therapy (exercise plus manual therapy) versus single-modality physiotherapy interventions for improving pain and function in patients with rotator cuff-related shoulder pain (RCRSP), using a network meta-analysis (NMA) approach. Methods: We systematically searched five electronic databases from inception to October 2023 for randomized controlled trials (RCTs) evaluating non-invasive physiotherapy interventions in adults with RCRSP. Primary outcomes included pain intensity and shoulder function, assessed at 12 weeks. A frequentist NMA was conducted to estimate standardized mean differences (SMDs) with 95% confidence intervals (CIs). Risk of bias was assessed using the Cochrane RoB 2.0 tool. Results: Eleven RCTs (n = 548) were included. Combination therapy demonstrated the greatest improvement in function (SMD = -1.02; 95% CI: -2.59 to 0.56) and pain (SMD = -1.05; 95% CI: -2.41 to 0.30), although the wide confidence intervals crossing the null suggests statistical uncertainty. Exercise therapy alone showed moderate functional improvement (SMD = -0.41; 95% CI: -1.64 to 0.82), and Kinesio taping (KT) provided moderate pain relief (SMD = -0.53; 95% CI: -1.81 to 0.75). While these effects approached known minimal clinically important difference (MCID) thresholds (e.g., DASH: 10-15; VAS: 1.4-2.0), they did not reach statistical significance. Conclusions: Based on 11 RCTs, combination therapy (exercise plus manual therapy) appears to be the most effective non-invasive approach for improving pain and function in patients with RCRSP. However, the wide confidence intervals highlight uncertainty. Further large-scale and long-term trials are warranted to confirm its clinical utility and sustainability.

Сравнительный анализ эффективности современных методов лечения синдрома вращательной манжеты плеча

Damages to the structure and function of the rotator cuff can cause severe shoulder pain and disability. Treatment options include physical therapy or surgery, although there are not enough studies comparing these treatment options. To date, physical therapy provides an uncertain treatment outcome that needs to be combined with other methods for progress of the patient's quality of life. Given these significant research gaps, it is difficult to advise the best mono-treatment method for clinicians who treat patients with massive rotator cuff injuries, so a comprehensive approach to this problem is being studied. As yet, it is not certain that surgery to repair the rotator cuff has clinically meaningful benefit for people with tear symptoms; it may provide little or no benefit in terms of pain intensity, functionality, overall quality of life, according to patients, as compared to non-operative treatment. Surgery may not relieve shoulder pain or functionality compared to exercise, with or without glucocorticoid injections. There is growing evidence for physical therapy as a treatment method for subacromial shoulder pain. Further research is needed to make recommendations on the type of exercise, its dosage, duration and expected outcomes. It is safe to recommend the inclusion of manual therapy at the initial phase of treatment [19].

Deficits in Upper Limb Long Lever Isometric Force After Shoulder Stabilization Surgery in Australian Rules Footballers

Background:Early surgical interventions are common for traumatic anterior shoulder instability in contact and collision sport athletes. It is unclear which tests, and which criteria, should be used to guide return to sport after surgery. As such, additional knowledge on postoperative shoulder function is needed to guide this decision making.Purpose:To assess deficits in upper limb long lever isometric force and the rate of force development (RFD) in Australian rules footballers after anterior shoulder stabilization surgery.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 30 male Australian rules footballers who had undergone unilateral anterior shoulder stabilization surgery were assessed at 4 to 6 months postoperatively. An uninjured age-, sex-, and sport-matched control group (n = 30) was assessed on a single occasion. Isometric peak force and RFD (within the first 100 and 200 milliseconds) were measured using the Athletic Shoulder (ASH) test in 3 positions (ISO-I, ISO-Y, and ISO-T). Data were analyzed for interlimb differences within the surgical group and between-group differences against controls. The reliability of the measurements was also assessed, and correlations between peak force and RFD were determined.Results:In all ASH test positions, the surgical arm showed significantly lower peak force and RFD within 200 milliseconds than both the nonsurgical arm and control group (P < .05). No differences were found in the RFD within 100 milliseconds (P > .05). Large effect sizes were noted in peak force deficits between the surgical arm and control group, particularly in the ISO-T position (d = 1.19; P < .001). Interlimb asymmetries were highly variable and did not consistently favor the nonsurgical arm.Conclusion:Australian rules footballers at 4 to 6 months after shoulder stabilization surgery exhibited significant deficits in long lever isometric force and late-phase RFD. Clinicians should be cautious in interpreting limb asymmetry and RFD measurements during return-to-sport assessments. Further research should explore the long-term outcomes and relationship between these physical measurements, patient-reported outcomes, and reinjury rates.

Scapular Asymmetries and Dyskinesis in Young Elite Swimmers: Evaluating Static vs. Functional Shoulder Alterations

Background/Objectives: Overhead athletes, including swimmers, are prone to shoulder adaptations and pathologies, such as scapular dyskinesis (SD) and glenohumeral internal rotation deficit (GIRD). While SD has been extensively studied in various overhead sports, its prevalence and clinical implications in swimmers remain unclear. This study aims to evaluate static scapular asymmetries (SAs), defined as differences in the observed position of the scapulae at rest or in a fixed position, in young elite swimmers and compare these findings with functional scapular dyskinesis (SD) tests, which assess alterations in scapular motion patterns during arm movement. It also assesses potential relationships between SA and SD. Methods: A cohort of 661 young elite swimmers (344 males, 317 females) was assessed during the National Young Swimming Championships. Scapular asymmetries were measured in two positions: at rest and at 90° abduction with internal rotation. The measurements included the following: (1) dHeight: Difference in superomedial scapular angle height from the C7 spinal process; (2) dDistance: Difference in the distance of the superomedial scapular angle from the body midline; (3) dAngle: Angular deviation of the medial scapular border from the plumb line, assessed using a goniometer. The presence of scapular dyskinesis (SD) was determined using a functional test, and SA findings were compared with SD results. Statistical analyses included ANOVA and chi-square tests, with significance set at p &lt; 0.05. Results: Scapular asymmetries were observed in 3.63% to 15.43% of swimmers, with no significant associations with age, gender, BMI, training years, or swimming characteristics (p &gt; 0.05). A significant difference was observed between dominant limb and scapular height in abduction (p &lt; 0.05). In position 1 (resting position), SA was significantly more prevalent in swimmers without SD (p &lt; 0.001 for dHeight, p = 0.016 for dDistance). In position 2 (abduction), SA was significantly associated with SD-negative subjects in dAngle (p = 0.014) and dDistance (p = 0.02), while dHeight was not significant (p &gt; 0.05). These findings suggest that static scapular asymmetries do not necessarily correlate with dynamic scapular dysfunction (SD), and, indeed, a negative correlation was observed where SA was significantly more prevalent in swimmers without SD in several measures (position 1, p &lt; 0.001 for dHeight and p = 0.016 for dDistance; position 2, p = 0.014 for dAngle and p = 0.02 for dDistance). Conclusions: Young elite swimmers exhibit a relatively symmetrical scapular positioning, with scapular asymmetries potentially representing normal adaptations rather than pathological findings. The lack of positive correlation between SA and SD, and the higher prevalence of SA in SD-negative subjects, suggests the need for caution when interpreting static scapular assessments in swimmers as SA may reflect sport-specific adaptations rather than pathology.

Comparing the Efficacy of Intra-articular (I/A) Platelet Rich Plasma (PRP) and Steroid Injections in Patients with Frozen Shoulder in a Tertiary Care Hospital

Introduction: Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by pain and progressive restriction of both active and passive range of motion in the shoulder joint. Aim of the study: This study aims to evaluate and compare the effectiveness of intra-articular (I/A) Platelet-Rich Plasma (PRP) injections versus corticosteroid injections in treating frozen shoulder, focusing on pain reduction, improvement in shoulder function, range of motion, and patient satisfaction. Methods: This comparative study was conducted at Sylhet Women's Medical College Hospital, Sylhet, Bangladesh, from January 2024 to December 2024. A total of 60 patients with frozen shoulder were randomly assigned to receive either PRP injections (n=30) or corticosteroid injections (n=30). Result: The study compared PRP and corticosteroid injections for frozen shoulder, assessing pain (VAS), shoulder function (UCLA Shoulder Score), and range of motion at baseline, 1, 2, 3, and 6 months. At baseline, both groups were similar; PRP had a VAS score of 7.6, and steroids had 7.7. At one month, VAS scores were 5.0 (PRP) and 5.2 (steroids, p = 0.380). By six months, PRP showed superior outcomes with VAS 2.5 vs. 3.8 (p &lt; 0.001), UCLA scores of 30.0 vs. 25.5 (p &lt; 0.001), and range of motion 130.3° vs. 110.9° (p &lt; 0.001). Conclusion: In conclusion this study suggests that at one month follow-up both group shows effective but PRP injections offer superior short and long term outcomes compared to corticosteroid injections for the treatment of frozen shoulder.

Competitive swimming and shoulder adaptations: The role of stroke specialty in adolescent swimmers.

Competitive swimming and shoulder adaptations: The role of stroke specialty in adolescent swimmers.

Orthogonal soft tissue reconstruction for acute acromioclavicular joint dislocations: 'A novel technique ensures predictable outcome'.

Orthogonal soft tissue reconstruction for acute acromioclavicular joint dislocations: 'A novel technique ensures predictable outcome'.

Superior Fulcrum Reconstruction for Massive Irreparable Rotator Cuff Tears Using the Peroneus Longus Tendon in 2 Variations: A Cadaveric Static Biomechanical Study

Background:Massive and irreparable rotator cuff tears (MIRCTs) pose unique challenges, and clinicians have explored a variety of surgical approaches to manage them. However, the optimal treatment strategies for MIRCT remain widely debated.Purpose:To investigate the biomechanical effects of 2 superior fulcrum reconstruction (SFR) techniques—using either 2 halved autologous peroneus longus tendons (SFR-H) in a sutured bridge configuration or a single entire autologous peroneus longus tendon (SFR-E) in an “X” configuration—on MIRCT in a static biomechanical setup. This study explores the biomechanical implications of these methods, aiming to address MIRCTs affecting the entire supraspinatus tendon and 50% of the infraspinatus tendon.Study Design:Controlled laboratory study.Methods:Eight cadaveric shoulders were subjected to biomechanical testing under 4 different conditions: Intact, MIRCT, SFR-E, and SFR-H. These tests were conducted at 0°, 30°, and 60° of glenohumeral abduction. The parameters measured included the rotational range of motion, superior translation of the humeral head, and subacromial contact pressure. Statistical analysis was performed using repeated-measures analysis of variance with Tukey post hoc tests, with significance set at P < .05.Results:The MIRCT condition led to a significant increase in the superior translation of the humeral head at all tested abduction angles (P < .05 for all). By contrast, SFR-E significantly reduced this translation across all angles (P < .05 for all), while SFR-H effectively reduced it at 0° and 30° (P < .05 for both). After MIRCT, subacromial contact pressure significantly increased at all tested abduction angles compared with the Intact state (P < .05 for all). Following SFR-E, significant pressure reductions were observed at 0° and 30° abduction angles (P < .05 for both). Similarly, SFR-H led to significant pressure reductions at all abduction angles (P < .05 for all).Conclusion:Compared with MIRCT, both SFR-H and SFR-E techniques significantly reduce superior translation of the humeral head and subacromial contact pressure, without limiting the range of motion of the humerus. In cadaveric biomechanical experiments, the use of peroneus longus tendon for SFR via bone tunnels has been proven to be a reliable method. Additionally, peroneus longus tendon is a viable source for autografting.Clinical Relevance:The results of this study are significant for patients suffering from MIRCTs, as they demonstrate that both surgical techniques may be used to treat these tears, potentially improving shoulder function and alleviating associated symptoms. The success of the cadaveric experiments lays the groundwork for further clinical trials.

Effect of Preoperative Bone Defect Severity on Results After Latarjet Procedure: A Comparative Cohort of 310 Patients With a Minimum Follow-up of 5 Years

Background: There is a lack of studies in the literature evaluating the influence of the severity of the preoperative glenoid bone loss on the results of the Latarjet procedure. Purpose: To compare functional outcomes, return to sport, and complications in a consecutive series of athletes undergoing Latarjet surgery for glenohumeral instability by dividing patients for analysis into 3 groups according to the severity of glenoid bone loss (GBL) (group 1, GBL between 0% and 10%; group 2, GBL between 11% and 20%; group 3, GBL >20%). Study Design: Case series; Level of evidence, 4. Methods: A comparative retrospective cohort study was performed in a consecutive series of competitive athletes with anterior glenohumeral instability who underwent surgery between January 2014 and January 2019. The clinical assessment included range of motion, Rowe score, American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS), Athletic Shoulder Outcome Scoring System (ASOSS), and return to sports. Graft consolidation was assessed by 3D computed tomography in all patients. All intraoperative and postoperative complications were documented. All results were compared between the 3 groups of patients. Results: A total of 310 patients were evaluated (n = 120 in group 1, n = 105 in group 2, and n = 85 in group 3). The mean follow-up was 8.3 years (range, 6.3-9.9 years) and the mean age was 22.1 ± 3.69 years. Range of motion and Rowe, ASES, VAS, and ASOSS scores showed significant improvement after surgery (P < .001). No statistically significant differences were found in range of motion pain or functional scores in relation to the severity of the preoperative GBL. In total, 286 patients (92%) returned to sport, and of these, 259 patients (90%) were able to return to competition at their preinjury level. The overall mean interval between surgery and return to sport was 5.4 months (range, 3-7 months). In total, 48 complications (15%) and 11 reoperations (3.5%) were noted, with no significant differences between groups. The control 3D computed tomography was performed at a mean of 3.4 months. The graft consolidated in 94.5% of patients. At the end of follow-up, 11% of patients had mild-stage osteoarthritis and 6% had moderate-stage osteoarthritis with no significant differences between groups. Conclusion: The majority of athletes with recurrent glenohumeral instability who underwent Latarjet surgery returned to sport at their preinjury level, with complete recovery of shoulder function and a similar percentage of complications regardless of the severity of the preoperative GBL.

Exploring the impact of active release technique combined with strengthening exercises on shoulder function and scapular position in upper cross syndrome

The purpose of this study was to evaluate the effect of the active release technique combined with strengthening exercises using the SPADI to improve shoulder function and a vernier caliper to measure scapular position in upper cross syndrome. In this experimental study at SMCH, 70 participants aged 30 to 50 were selected based on inclusion and exclusion criteria. Written informed consent was obtained from all subjects prior to the commencement of the study. The experimental protocol and procedures were explained to all subjects before obtaining their consent. These 70 participants were allocated into two groups using convenient sampling: the ART with strengthening group and the conventional group. Both groups received a 30-minute exercise program. The study employed standard outcome measures including the SPADI score to evaluate shoulder function and a vernier caliper to assess scapular position. The pre-test and post-test values were analysed. The results suggest that the ART with strengthening group showed significant improvement when compared with the conventional group, with p &lt; 0.0001, indicating superior changes in scapular position and shoulder function. The active release technique group demonstrated better outcomes. According to this study, the ART with strengthening group achieved better results than the conventional group. ART with strengthening is more effective in improving shoulder function and scapular position among subjects with upper cross syndrome.

&lt;b&gt;EFFECTIVENESS OF SHOULDER GLIDES WITH ROTATION IN ADHESIVE CAPSULITIS: A RANDOMIZED CONTROLLED TRIAL&lt;/b&gt;

Background: Adhesive capsulitis (frozen shoulder) is a common condition characterized by pain and restricted shoulder range of motion (ROM), significantly affecting functional independence. While several treatments exist, evidence remains limited regarding the efficacy of shoulder glides with rotation as a therapeutic intervention. Objective: To evaluate the effectiveness of shoulder glides with rotation in reducing pain and improving shoulder ROM and function in individuals with primary adhesive capsulitis. Methods: A single-masked, parallel-group randomized controlled trial was conducted over 8 weeks at two rehabilitation centers in Peshawar, Pakistan. Sixty participants aged 40–65 years with idiopathic adhesive capsulitis were randomized into two groups: an intervention group (shoulder glides with rotation and home exercise) and a control group (conventional physiotherapy). Both groups received treatment three times per week for 6 weeks. The primary outcome was the Shoulder Pain and Disability Index (SPADI); secondary outcomes included a range of motion (ROM) in flexion, abduction, and external rotation, a Visual Analog Scale (VAS) for pain, and the Functional External Rotation Reach Test (FERRT). Assessments were conducted at baseline, week 3, week 6, and week 8. Data were analyzed using repeated-measures ANOVA and intention-to-treat analysis. Results: Fifty-seven participants completed the study (SGR = 29, Control = 28). The intervention group showed significantly greater improvements in SPADI scores (Week 6: 31.4 ± 6.8 vs. 45.7 ± 7.2; p &lt; 0.001), ROM (flexion gain: +41.5°, abduction: +41.4°, external rotation: +30.2°; all p &lt; 0.001), and VAS for pain at rest (–4.3) and during activity (–4.5) compared to controls. Functional reach (FERRT) improved significantly in the intervention group (+13.2 cm vs. +6.1 cm; p &lt; 0.001). Effect sizes for all key outcomes were large (Cohen’s d &gt; 1.0). Conclusion: Shoulder glides with rotation significantly improved pain, ROM, and functional performance in patients with adhesive capsulitis compared to conventional physiotherapy. These findings support the integration of rotational joint mobilization into evidence-based rehabilitation protocols for frozen shoulders.

Clinical Practice Guidelines for Diagnosis and Non-Surgical Treatment of Primary Frozen Shoulder.

Primary frozen shoulder causes significant pain and progressively restricts shoulder movements. Diagnosis is primarily clinically based on patient history and physical examination. Management is mainly non-invasive owing to its self-limiting clinical course. However, clinical practice guidelines for frozen shoulder have not yet been developed in Korea. The developed guidelines aim to provide evidence-based recommendations for the diagnosis and treatment of frozen shoulder. A guideline development committee reviewed the literature from four databases (PubMed, Embase, Cochrane Library, and KMbase). Using the PICO (Population, Intervention, Comparator, and Outcome) framework, the committee formulated two backgrounds and 16 key questions to address common clinical concerns. Recommendations were made using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Diabetes, thyroid disease, and dyslipidemia significantly increase the risk of developing a frozen shoulder. Although frozen shoulder is often self-limiting, some patients may experience long-term disabilities. Ultrasound and magnetic resonance imaging should be used as adjunctive tools alongside clinical diagnosis, and not as independent diagnostic methods. Noninvasive approaches, such as medications, physical modalities, exercises, electrical stimulation, and manual therapy, may reduce pain and improve shoulder function. Other noninvasive interventions have limited evidence, and their application should be based on clinical judgment. Intra-articular steroid injections are recommended for treatment, and physiotherapy or hydrodilatation with steroid injections can also be beneficial. These guidelines provide evidence-based recommendations for diagnosing and treating primary frozen shoulder.

Effectiveness of scapular clock exercises in scapular dyskinesia in post operative cardiac patients: A randomized clinical trial

Background: Scapular dyskinesia is a frequent complication after cardiac surgery due to thoracic immobility, pectoral tightness, and muscle imbalances, contributing to persistent shoulder pain and functional deficits. Objective: To evaluate the effectiveness of scapular clock exercises combined with conventional physiotherapy versus conventional physiotherapy alone in reducing pain, improving range of motion (ROM), and enhancing shoulder function in post-operative cardiac patients. Material and Methods: This randomized clinical trial included n=28 post-cardiac surgery patients with scapular dyskinesia, who were allocated to either Group A (scapular clock exercises plus conventional physiotherapy) or Group B (conventional physiotherapy). Both groups were treated thrice weekly for 4 weeks. The primary outcome was the Numeric Pain Rating Scale (NPRS), and secondary outcomes included QuickDASH and shoulder ROM. Statistical analysis was conducted using RM-ANOVA and independent t-tests. Results: The mean age of n=17(60%) male and n=11(40%) female subjects were 55.21±7 years. Both groups significantly improved pain, disability, and ROM over 4 weeks (p&lt;0.05). Group A demonstrated markedly greater improvements in NPRS, QuickDASH, and all ROM directions at 2- and 4-week follow-ups compared to Group B, with large effect sizes. Conclusion: Scapular clock exercises combined with conventional physiotherapy offer superior outcomes for pain, disability, and mobility compared to conventional physiotherapy alone. These findings highlight the importance of incorporating targeted scapular exercises into cardiac rehabilitation to address under-recognized musculoskeletal deficits. Keywords: scapular clock exercises; postoperative rehabilitation; numeric pain rating scale (NPRS); quickdash; resistance training; post sternotomy complications; physiotherapy; upper limb function.

Clinical Observation of Exercise Prescription Combined with Joint Mobilization for the Treatment of Frozen Shoulder

Objective: To evaluate the clinical efficacy of combining exercise prescription with joint mobilization therapy in patients with frozen shoulder. Methods: A retrospective analysis was conducted on the clinical data of 86 patients with frozen shoulder treated between April 2022 and March 2024. Patients who received joint mobilization therapy from April 2022 to March 2023 were assigned to the control group (n=43) , while those treated with a combination of exercise prescription and joint mobilization from April 2023 to March 2024 were assigned to the observation group (n=43) . Shoulder function improvement and hormone levels were compared between the two groups. Result: The overall treatment efficacy in the observation group was significantly higher than in the control group, P &lt;0. 05; There was no statistically significant differences in shoulder function scores and hormone level between the two groups before treatment (P &lt; 0. 05) . After treatment, the observation group showed significantly better shoulder function improvement and higher hormone levels compared to the control group (P &lt;0. 05) . Conclusion: The combination of exercise prescription and joint mobilization therapy demonstrates superior clinical outcomes in the treatment of frozen shoulder, significantly enhancing shoulder joint function. This approach is effective and merits wider clinical application.