Influencing factors for shoulder stiffness after rotator cuff tear / 中华创伤骨科杂志

Objective:To study the influencing factors for shoulder stiffness after rotator cuff tear.Methods:The data of 228 patients were retrospectively analyzed who had been diagnosed with rotator cuff tear by arthroscopic surgery at Department of Articular Surgery, Hospital Affiliated to Chengde Medical College from June 2019 to May 2021. Their baseline data were recorded immediately after admission, including possible risk factors for shoulder stiffness. The patients were divided into a stiffness group and a non-stiffness group based on passive range of motion of shoulder joint. Univariate and multivariate analyses were performed to find out the influencing factors for shoulder stiffness after rotator cuff tear.Results:Preliminary univariate analysis showed that advanced age, smoking history, misdiagnosis history, no standardized physiotherapy history, high body mass index (BMI) and long duration of disease were all likely risk factors for shoulder stiffness in patients with rotator cuff tear ( P<0.05). Multivariate analysis confirmed that advanced age( OR=1.474, 95% CI: 1.013~2.145, P=0.043), smoking history( OR=2.239, 95% CI: 1.147~4.368, P=0.018), no standardized physiotherapy history( OR=0.167, 95% CI: 0.065~0.424, P<0.001), high BMI( OR=3.029, 95% CI: 1.657~5.536, P<0.001) and long duration of disease ( OR=1.775, 95% CI: 1.384~2.276, P<0.001) were the risk factors for shoulder stiffness. Conclusion:Age>60 years, smoking history, misdiagnosis history, no standardized physiotherapy history, high body mass index and long course of disease may be the important influencing factors for shoulder stiffness after rotator cuff tear.

Survey on Work-related Pain in Photographers and Effects of Acupuncture Treatments / 全日本鍼灸学会雑誌

[Objective] Photographers perform a variety of tasks, including taking photographs for extended periods of time, using personal computers to organize photographic data, and preparing and transporting their equipment. Although photographers may exhibit a variety of symptoms, there have been no reports on investigations of pain or disease in photographers. In this study, we conducted a questionnaire survey on the actual status of work-related pain in photographers. We, then, performed acupuncture and evaluated the effects in subjects for pain or stiffness in the neck and shoulders, which was the most common chief complaint in the questionnaire.[Subjects and Methods] The survey was sent to 138 professional photographers. The survey included seven items, such as symptoms experienced during work activities and the content of the work. Among the respondents who reported chief complaints of pain in the neck and shoulder regions, six (one male and five females) opted to receive acupuncture treatment. We used the visual analog scale (VAS) scores to determine the amount of shoulder stiffness and tenderness in the shoulders and neck, as well as induration, before and immediately after treatment.[Results] Responses were obtained from 60.1% subjects. The most common chief complaint involved the neck and shoulder region in 86% of subjects. In the analysis of sex differences, the most common chief complaint in females was in the neck and shoulder region, whereas the most common chief complaint in males was in the lower back region. In the assessment of effects of acupuncture, the VAS scores for shoulder stiffness decreased after acupuncture (p < 0.05) and tenderness and induration scores decreased after acupuncture (p < 0.05).[Discussion and Conclusion] Low muscle strength may be a contributing factor for a higher complaint of neck and shoulder pain and stiffness in females. A higher complaint of pain and stiffness in the lower back region in males may be attributable to a higher load on the lower back region because they tend to have poor posture owing to height differences with the object being photographed. These results suggest that acupuncture is useful for work-related pain in the neck and shoulder region, which is the most common chief complaint in photographers.

Impact of Physiotherapy Rehabilitation Program on Post-Operative Stiffness of Supraspinatus Tendinitis.

In the general population, shoulder pain is a common musculoskeletal problem. Older people are frequently affected, and the most common causes of shoulder pain are the problems with rotator cuffs which are seen in primary care practice. The incidence of rotator cuff tear increases with advanced age and it has been estimated that the prevalence of shoulder pain in older patients ranges from 21% to 27%.(1)Tendons are thick, fibrous tissues that transmits muscle-generated force to the bones and thus generates joint movement. Repeated activities and complex muscle-tendon overuse can damage tendons that lead to pain and decrease function.(2)The supraspinatus muscle is a part of the rotator cuff of shoulder.(3) The inflammation of a muscle tendon causes tendinitis and it has varying levels of pain. Supraspinatus tendonitis is an inflammation of supraspinatus tendon often associated with shoulder impingement syndrome.(4) The Supraspinatus tear that causes the supraspinatus tendon to affect the acromion leading to pain is the cause of Supraspinatus Tendinitis. The main cause of the Supraspinatus tear is constant pressure, increased workload and wear and tear associated with age.(5)Total loss of active abduction at the glenohumeral joint is due to a complete tear of supraspinatus.(6) Supraspinatus tendonitis complications include leading to a rotator cuff tear. Initially, rotator cuff tears were almost identified as secondary to tendon haemorrhage and tendonitis products of untreated impingement.(7)The primary purpose of rehabilitation to achieve short-term and long-term goal, patient education and consistent plan of care. The patient's awareness on the need to take non-operative steps, improvement, and the availability of choices will assist them in being active participants in their treatment.(7)

Hombro Rígido Idiopático. Revisión de Conceptos Actuales. / Idiopathic frozen shoulder. Review of Current Concepts

La restricción de movilidad de la articulación glenohumeral genera una disfunción importante en todos los ámbitos del desempeño personal. Diversas patologías del hombro convergen en este cuadro sindromático caracterizado por dolor severo asociado a una restricción de movilidad variable, activa y pasiva, que generalmente es autolimitado y con una resolución espontánea, satisfactoria para la mayoría de los pacientes. Se realiza una revisión narrativa de la etiología, historia natural, presentación clínica, diagnóstico diferencial, los tratamientos más comunes del cuadro sindromático de hombro rígido idiopático y su pronóstico.?La revisión de la literatura, describe una multitud de tratamientos, con resultados variables, lo cual refleja la dificultad encontrada por los clínicos para establecer un tratamiento, teniendo en cuenta que la etiología no esta esclarecida. Una mayor precisión en el diagnóstico nos permitirá establecer un tratamiento efectivo y una reincorporación más predecible a las actividades cotidianas de cada paciente. La elección del tratamiento continua con baja evidencia sujeta a la experiencia del ortopedista tratante.

Restriction of mobility of the glenohumeral joint is associated with a significant dysfunction in all areas of personal performance. Several shoulder conditions merge in this syndrome-type disorder characterised by: severe shoulder pain and reduced active and passive range of motion. It is generally self-limited and resolves spontaneously, which is satisfactory for most patients. A narrative review is presented that describes the aetiology, natural history, clinical presentation, differential diagnosis, the most common treatments, and prognosis of the idiopathic stiff shoulder.The review of the literature describes a multitude of treatments, with variable results, which reflects the difficulties encountered by clinicians to establish a treatment, considering that the aetiology is not clear. ?A greater precision in the diagnosis would enable an effective treatment to be established, and a more predictable return to the patient's daily tasks.

Effectiveness of rotator cuff repair with manipulation release and arthroscopic debridement for rotator cuff tear with shoulder stiffness / 中国修复重建外科杂志

Objective: To investigate effectiveness of rotator cuff repair with manipulation release and arthroscopic debridement for rotator cuff tear with shoulder stiffness.

A Randomized Comparative Study of Blind versus Ultrasound Guided Glenohumeral Joint Injection of Corticosteroids for Treatment of Shoulder Stiffness

BACKGROUND: We prospectively compared the response to blind and ultrasound-guided glenohumeral injection of corticosteroids for treatment of shoulder stiffness. METHODS: A total of 77 patients with shoulder stiffness between April 2008 and March 2012 were recruited. Patients were randomized to receive either a blind (group 1, n=39) or ultrasound-guided (group 2, n=38) glenohumeral injection of 40 mg triamcinolone. The clinical outcomes and shoulder range of motion (ROM) before injection, at 3, 6, and 12 months after injection and at the last follow-up were assessed. The same rehabilitation program was applied in both groups during the follow-up period. RESULTS: There was no significant difference in demographic data on age, sex, ROM, and symptom duration before injection between groups (p>0.05). There were no significant differences in ROM including forward flexion, external rotation at the side, external rotation at 90o abduction, and internal rotation, visual analogue scale for pain and functional outcomes including American Shoulder and Elbow Surgeons score, Simple Shoulder test between the two groups at any time point (p>0.05). CONCLUSIONS: Based on the current data, the result of ultrasound-guided glenohumeral injection was not superior to that of blind injection in the treatment of shoulder stiffness. We suggest that ultrasound-guided glenohumeral injection could be performed according to the patient's compliance and the surgeon's preference. Once familiar with the non-imaging-guided glenohumeral injection, it is an efficient and reliable method for the experienced surgeon. Ultrasound could be performed according to the surgeon's preference.

A Randomized Comparative Study of Blind versus Ultrasound Guided Glenohumeral Joint Injection of Corticosteroids for Treatment of Shoulder Stiffness

BACKGROUND: We prospectively compared the response to blind and ultrasound-guided glenohumeral injection of corticosteroids for treatment of shoulder stiffness. METHODS: A total of 77 patients with shoulder stiffness between April 2008 and March 2012 were recruited. Patients were randomized to receive either a blind (group 1, n=39) or ultrasound-guided (group 2, n=38) glenohumeral injection of 40 mg triamcinolone. The clinical outcomes and shoulder range of motion (ROM) before injection, at 3, 6, and 12 months after injection and at the last follow-up were assessed. The same rehabilitation program was applied in both groups during the follow-up period. RESULTS: There was no significant difference in demographic data on age, sex, ROM, and symptom duration before injection between groups (p>0.05). There were no significant differences in ROM including forward flexion, external rotation at the side, external rotation at 90o abduction, and internal rotation, visual analogue scale for pain and functional outcomes including American Shoulder and Elbow Surgeons score, Simple Shoulder test between the two groups at any time point (p>0.05). CONCLUSIONS: Based on the current data, the result of ultrasound-guided glenohumeral injection was not superior to that of blind injection in the treatment of shoulder stiffness. We suggest that ultrasound-guided glenohumeral injection could be performed according to the patient's compliance and the surgeon's preference. Once familiar with the non-imaging-guided glenohumeral injection, it is an efficient and reliable method for the experienced surgeon. Ultrasound could be performed according to the surgeon's preference.

Effectiveness of Subacromial Anti-Adhesive Agent Injection after Arthroscopic Rotator Cuff Repair: Prospective Randomized Comparison Study

BACKGROUND: Arthroscopic rotator cuff repair generally has a good clinical outcome but shoulder stiffness after surgery due to subacromial adhesion is one of the most common and clinically important complications. Sodium hyaluronate (HA) has been reported to be an anti-adhesive agent in a range of surgical procedures. However, there are few reports of the outcomes of arthroscopic rotator cuff repair of the shoulder. This study examined whether a subacromial injection of HA/carboxymethylated cellulose (CMC) affected the postoperative shoulder stiffness and healing of rotator cuff repair, as well as the safety of an injection. METHODS: Between January 2008 and May 2008, 80 consecutive patients with arthroscopic rotator cuff repair were enrolled. The patients were assigned randomly to the HA/CMC injection group (n = 40) or control group (n = 40). All patients were evaluated using the visual analog scale (VAS) for pain, passive range of motion at 2, 6 weeks, 3, 6, 12 months after surgery, and the functional scores at 6, 12 months postoperatively. Cuff healing was also evaluated using CT arthrography or ultrasonography at 6 or 12 months after surgery. RESULTS: The HA/CMC injection group showed faster recovery of forward flexion at 2 weeks postoperatively than the control group but the difference was not statistically significant (p = 0.09). There were no significant difference in pain VAS, internal rotation, external rotation and functional scores between two groups at each follow-up period. The functional scores improved 6 months after surgery in both groups but there were no differences between the two groups. The incidence of unhealed rotator cuff was similar in the two groups. There were no complications related to an injection of anti-adhesive agents including wound problems or infections. CONCLUSIONS: A subacromial injection of an anti-adhesive agent after arthroscopic rotator cuff repair tended to produce faster recovery in forward flexion with no adverse effects on cuff healing. However, its anti-adhesive effects after rotator cuff repair should be considered carefully with further studies.

Efficacy of acupuncture on VDT workers (1) / 全日本鍼灸学会雑誌

[Introduction]Recently, in the development of information technology, VDT workers are increasing rapidly. Physical and mental health symptoms associated with working at visual display terminals (VDTs) are controversial. However, there are few studies about the effect of acupuncture treatment on eye fatigue, neck and shoulder stiffness that many VDT workers have.<BR>Therefore, in this prospective study, we examined the effect of acupuncture treatment for complaints of VDT workers.<BR>[Methods]Sixty-one VDT workers participated as subjects (41 males, 20 females). Acupuncture sessions were performed once a week for four weeks. Acupuncture points were decided by the patient's muscleskeletal distress.<BR>Disposable press tack needles were used. Visual Analogue Scale (VAS) was used to determine eye fatigue, neck and shoulder stiffness. Improvements of each VAS were evaluated. Then we analyzed improvement on shoulder and neck stiffness associated with eye fatigue.<BR>[Results]The neck and shoulder distress of patients was reduced in four weeks by acupuncture treatment. A regular correlation between the improvement rate of eye fatigue and neck/shoulder stiffness was observed.<BR>[Conclusion]The neck and shoulder stiffness was improved by acupuncture treatment. According to improved symptoms, eye fatigue was mitigated as well. Thus it was suggested that utility of acupuncture is high in the field of industrial medicine.

Four Cases Successfully Treated with Keishikyokeikabukuryobyakujutsuto / 日本東洋医学雑誌

We report four cases which were successfully treated with keishikyokeikabukuryobyakujutsuto. Case 1 was a 53-year-old female who presented with a 15-year history of fatigue, headache and shoulder stiffness. After 1 month's treatment with keishikyokeikabukuryobyakujutsuto, her complaints improved remarkably. Case 2 was a 29-year-old female who was suffering from allergic rhinitis. After 6 month's treatment with keishikyokeikabukuryobyakujutsuto, her symptoms completely resolved. Case 3 was a 37-year-old female who was diagnosed with Meniere's disease. Some formulas had been prescribed before, but provided no relief. After the start of treatment with keishikyokeikabukuryobyakujutsuto, however, the patient's symptoms resolved completely within 2 weeks. Case 4 was a 50-year-old female who presented with tension headache. After 2 week's treatment with keishikyokeikabukuryobyakujutsuto, her headache had almost completely resolved. Most of the cases presented with slight epigastric tenderness and superficial-like symptoms such as headache and shoulder stiffness. Many of them also showed symptoms suggestive of fluid imbalances in the body, such as dizziness, rhinorrhea and teeth marks on both sides of the tongue. Keishikyokeikabukuryobyakujutsuto is a useful formula for patients with superficial-like symptoms accompanied by disorders of the body fluid homeostasis.

Relationship between katakori (shoulder stiffness) and shoulder hardness / 全日本鍼灸学会雑誌

[Objective]The present study investigated the relationship between subjective symptoms of katakori (shoulder stiffness) and shoulder hardness which was examined both with clinical palpation and a mechanical device, as well as the correlation between these two measurements. <BR>[Methods]Subjects were enrolled to the study if they had a stiff shoulder on the day of the visit (katakori group, n = 60) or if they had no experience of katakori in their lifetime (non-katakori group, n = 10). The intensity of the katakori was evaluated with a visual analogue scale (VAS). Shoulder hardness was evaluated at acupoint Jianjing (GB21) and at the point where the subject felt the most intensive symptom by both palpation of experienced acupuncturists who were unaware of the allocation and a hardness meter. The method of acupuncture treatment was decided by acupuncturists who were not an evaluator of the hardness.<BR>[Results and Discussion]There was no significant relationship in the hardness measured with the device and palpation between the katakori group and non-katakori group. Also, the intensity of katakori (VAS) and the changes after treatment showed no significant correlation with the hardness and its changes. These results support the validity of our clinical experience that patients who complain of severe shoulder stiffness do not always have a hard shoulder.

Supplementation Effect of Astaxanthin on Blood Flow and Shoulder Stiffness-A Preliminary Pilot Study- / 日本補完代替医療学会誌

An exploratory open-label human clinical study was performed in healthy adults with shoulder stiffness to evaluate the efficacy of Astaxanthin by means of measuring blood flow change in the shoulders and subjective questionnaires on physical conditions, including alleviation of stiffness before and after treatment. Two capsules containing 3 mg Astaxanthin each (6 mg in total) were administered once daily (6 mg a day) on days 1 to 28 (4 weeks) to 13 patients (3 men/10 women). All patients were assessed for efficacy and the study demonstrated significant improvements in physical conditions such as shoulder stiffness, physical fatigue, sense of mental irritation, sense of coldness in hands and feet, eye fatigue and eye bleariness. Significant increases of blood flow in shoulders were observed at the end of treatment using laser-doppler graphics. Blood tests conducted to confirm safety before and at the end of treatment showed no clinical differences, and no adverse side effects were reported. In conclusion, Astaxanthin appeared to safely alleviate stiff shoulders and improve other physical conditions during a 4-week open-label study.<br>

The Effect of Trigger Point Acupuncture Treatment on Chronic Neck and Shoulder Pain-Questionnaire and Acupuncture Treatment for Unversity Students- / 全日本鍼灸学会雑誌

[Purpose] This study investigated shoulder stiffness in university students and compared three different treatment procedures for shoulder stiffness.<BR>[Method] The questionnaire (7 items) was distributed to 30 university students with a 3-month history of shoulder stiffness treated by three different treatments procedures. There were no abnormal findings on neuro logical examination.<BR>[Result] The questionnaire response rate was 64.6%. The overall prevalence of shoulder stiffness was 61.9%, most patients had asthenopia and headache along with shoulder stiffness. However, immediately after the tender point and sham treatment periods, there were no remarkable clinical effect on shoulder stiffness, whereas after trigger point treatment, there were remarkable clinical effects on shoulder stiffness, as evaluated by the visual analogue scale.<BR>[Conclusion] These results suggest that trigger point acupuncture treatment may be more effective for shoul- der stiffness in university students than other acupuncture treatments

Characteristics of Spontaneous Electrical Activities at the Trigger Point in a Chronic Shoulder Pain Patient-A Case of Trigger Point on Trapezuis Muscle- / 全日本鍼灸学会雑誌

[Purpose] The characteristic of electrical activities recorded at the clinical trigger point was examined.<BR>[Materials] A 26-year-old woman complained of chronic shoulder pain. She had a trigger point near GB 21 (Jianjing, Kensei). The electrical activities were recorded at the trigger point and a non- tender point.<BR>[Results] Electrical activities were detected only when the electrode was located on the trigger point andthere was a subjective dull pain sensation. The amplitudes of electrical activities did not change during psychological stress. [ Conclusion ] These results suggest that the electrical activities were the result of nociceptive reflex.

Effect of Press Tack Needle Treatment on Shoulder Stiffness / 全日本鍼灸学会雑誌

[Objective] This study examined the effect of press tack needle (PTN) treatment onshoulder stiffness.<BR>[Method] A total of 53 volunteers with shoulder stiffness were randomly divided into 2 groups, the press tack needlegroup and placebo (P) group. The points stimulated by PTN or P were a maximum of 4 tender points around the shoulder treated for 3 days. Evaluation of the effect was based on the consciousness of shoulder stiffness and visual analog scale (VAS) estimating the grade of the shoulder stiffness. The evaluations were done in prior to treatment (Pr), immediately after treatment (Post 1), and 3 days after treatment (Post 2).<BR>[Result] As a result, the number of the volunteers reporting awareness of stiff shoulder after 3 days decreased to 12 of28 persons in the PTN group, 23 of 25 in the P group. There was a significant difference between the 2 groups (p<0.01). The VAS value decreased in the PTN group from 52.5±20.7 (Pr) to 40.5±22.4 (Post1), to 342±19.7 (Post2), while in the P group from 55.2±17.5 (Pr) to 46.5±19.7 (Post1) to 45.9±21.7 (Post2). There were significant differences between Pr and Post1 (p<0.05), and between Pr and Post2 (p<0.01) in PTN group.<BR>[Conclusion] It was suggested that PTN stimulation on the tender points improved shoulder stiffness.

A Study of the Shoulder Stiffness of High School Student as an Epidemiologic Research. The 1st Report / 全日本鍼灸学会雑誌

Purpose : To study and promote the practical use of acupuncture and moxibustion treatment for the young, we investigated shoulder stiffiness in high school students.<BR>Method : We surveyed 6, 251 students at twelve high schools in Kyoto, Japan about the prevalence and the characteristics of shoulder stiffness using our original questionnaire. We used chi-square test to compare the proportion of the respondents.<BR>Result : Of the subjects we inquired, 5, 846 completed the questionnaire. The overall prevalence rate of shoulder stiffness was 65.3%. The sense of “languid” was 54.9% and “heavy” was 43.9%. While 11.5% of respondents considered their condition to be in tolerable 68.0% said it was “tolerable”. The result of crosstabulation showed that women were more likely to have the symptoms than men and the prevalence rate significantly increased as the academic grade increased.<BR>Conclusion : The rate of shoulder stiffness, 65.3% was higher than we expected. And 12th grades had the most frequency of shoulder stiffness. We considered that the stresses at the graduation on to study hard to graduate are important factors of affecting from shoulder stiffness. The application of acupuncture and moxibustion may help relieve the symptoms among high school students.

The Effects of Kakkon-To on Shoulder Stiffness and Neck Body Surface Temperature by Thermotracer / 日本東洋医学雑誌

Although the herbal preparation Kakkon-to is known to improve shoulder stiffness, there have been few studies attempting to elucidate the extent and mechanism of this effect. Kanebo Kakkon-to extract was administered orally to a group (n=19) of patients (pts) with shoulder stiffness (SS) at a dose of 2.5-7.5g/day, as well as to a group (n=9) of normal healthy subjects (NS). The effects and any side effects of Kakkon-to were then evaluated. The body surface temperature (BST) of the side of the neck was recorded from the Bide view position with a thermotracer before administration, after 30 minutes, after 60 minutes, after 90 minutes, and after 120 minutes. As for the general improvemant rates for this formula in the SS group, the rate of ‘remarkable improvement’ was 21.1%, ‘improvement’ 42.1%, and ‘slight improvement’ 15.8%. The overall utility rating, evaluated from the degree of improvement, was that the formula was considered ‘useful’ or better in 63.2% or the cases, and ‘slightly useful’ or better in 78.9% of the cases. Before administration of Kakkon-to, there was no significant difference between the BST of the SS group and that of the NS group, and no significant difference between the BST of improved pts in the SS group (n=12) and the BST of the Insufflciently improved pts in the SS group (n=7). The BST of the NS group 120 minutes after administration of Kakkon-to was higher than the pre-administration BST. There was no significant difference in the BST of the insufficiently improved pts of the SS group upon administration of Kakkon-to. The changes in the BST before and after administration of Kakkon-to were greater for the sufficiently improved SS group than for the insufficiently improved SS group or NS group. It was suspected that the effect of Kakkon-to on shoulder stiffness was due to improvement of blood circulation, as indicated by the higher BST.