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Introduction: Because COVID-19 with extrapulmonary manifestations is likely to lead to the development of musculoskeletal disorders in susceptible individuals due to immunological mechanisms, it is possible to see more frozen shoulder cases during the COVID-19 pandemic. Therefore, this study was performed to evaluate the relationship of frozen shoulder and COVID-19. Materials and Methods: This study was a cross-sectional study from September 2020 to February 2021;patients who were referred to our shoulder clinic with stiffness and shoulder pain and diagnosed with adhesive capsulitis (AC) were evaluated for COVID-19 involvement. Shoulder range of motion was assessed as passive range of motion of forwarding flexion, internal rotation and external rotation in the arm at the side and 90 degrees abduction. The visual analogue scale was also used to assess pain intensity. SPSS software was used for analysis, and Chi-square test was used for qualitative data analysis and a t-test was used for quantitative data. Results: Seventy-two patients with frozen shoulders were included in the study;the results showed that AC occurs at a younger age in patients with COVID-19 infection (P < 0.039);the mean age of all patients was 52.73 +/- 8.68. The severity of pain was higher in patients with COVID-19 (P = 0.012). Furthermore, regarding the duration of referral in terms of months, it was shown that people with COVID-19 were referred in a shorter period after the onset of shoulder symptoms and there was a significant difference in terms of referral time and pain between the two groups (P < 0.01). Regular activity had a lower rate in patients with COVID-19 infection and the difference was significant in patients with and without COVID-19 (P < 0.029). Conclusion: Due to younger age, greater pain and faster visit of patients with a frozen shoulder after COVID-19, it is recommended to look for frozen shoulder in all COVID-19-infected patients by a complete clinical examination. This is more important in patients without regular physical activity.
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BACKGROUND: Frozen shoulder is a disabling condition characterised by severe pain and loss of shoulder movement and may affect up to 5% of the population. Qualitative research documents debilitating pain and how treatment to reduce pain is a priority for people diagnosed with frozen shoulder. Corticosteroid injections are a principal treatment to reduce the pain of frozen shoulder, however little is known about the patient experience. OBJECTIVES: This study aims to address this gap in the knowledge by exploring the lived experience of people with frozen shoulder who have undergone an injection and to highlight other novel findings. DESIGN: This is a qualitative study using interpretative phenomenological analysis. One-to-one, semi-structured interviews were conducted with seven people diagnosed with frozen shoulder who had received a corticosteroid injection as part of their management. METHODOLOGY: A purposive sample of participants were interviewed via MSTeams™ due to Covid-19 restrictions. Data was collected through semi-structured interviews and analysed in accordance with interpretive phenomenological analysis methods. RESULTS: Three group experiential themes were identified: the dilemma surrounding injections; the challenges of understanding the causes of frozen shoulder; the impact on self and others. CONCLUSION: Participants conveyed a strong desire in seeking a corticosteroid injection whilst seemingly dismissing the risks. A novel concept was illuminated as frozen shoulder seemed inextricably linked with the ageing process, which negatively impacted body-image. The impact on others is driven by a sense of the unfamiliar nature of illness and it is incumbent on healthcare professionals to seek opportunities to explore the individual's beliefs.
Subject(s)
Bursitis , COVID-19 , Humans , Pain , Adrenal Cortex Hormones , Qualitative ResearchABSTRACT
Introduction: Shoulder pain is a common secondary impairment for people living with ALS (PALS). Decreased range of motion (ROM) from weakness can lead to shoulder pathology, which can result in debilitating pain. Shoulder pain may limit PALS from participating in activities of daily living and may have a negative impact on their quality of life. This case series explores the efficacy of glenohumeral joint injections for the management of shoulder pain due to adhesive capsulitis in PALS. Methods: People living with ALS and shoulder pain were referred to sports medicine-certified physiatrists for diagnostic evaluation and management. They completed the Revised ALS Functional Rating Scale and a questionnaire asking about their pain levels and how it impacts sleep, function, and quality of life at baseline pre-injection, 1-week post-injection, 1 month post-injection, and 3 months post-injection. Results: We present five cases of PALS who were diagnosed with adhesive capsulitis and underwent glenohumeral joint injections. Though only one PALS reported complete symptom resolution, all had at least partial symptomatic improvement during the observation period. No complications were observed. Conclusions: People living with ALS require a comprehensive plan to manage shoulder pain. Glenohumeral joint injections are safe and effective for adhesive capsulitis in PALS, but alone may not completely resolve shoulder pain. Additional therapies to improve ROM and reduce pain should be considered.
ABSTRACT
Shoulder injury related to vaccine administration (SIRVA) is a term given to describe shoulder pain and dysfunction arising within 48 hours after vaccine administration and lasting for more than one week. While SIRVA is most commonly seen after influenza and tetanus vaccines, there have been a few recent case reports describing SIRVA-like symptoms after COVID-19 vaccine administration. Two patients presented to the shoulder surgeon's practice center with complaints of shoulder stiffness and pain following the COVID-19 vaccine. The first patient was a 33-year-old man;he presented within 2 days of onset of the pain and 14 days from the vaccine date. He had a complete restriction of shoulder motion (0degree flexion, and no external or internal rotation) at presentation. This patient was treated with non-steroidal anti-inflammatory drugs (NSAID) and rested in a sling for a week. The second patient was a 53-year-old woman;she presented with a 6-week duration of mild restriction of active shoulder motion and shoulder pain. Her magnetic resonance imaging (MRI) revealed the presence of subacromial-subdeltoid bursitis. She was treated with subacromial steroid injection and range of motion shoulder exercises. Both patients recovered a near-normal range of motion recovery within a month, and their pain improved significantly. The main lessons from this case report were: (1) patients presenting with a recent increase in pain and acute loss of shoulder movements after vaccination may be managed conservatively with rest and NSAID medications and (2) in case of a subacromial-subdeltoid bursitis in the MRI, subacromial injection of steroid may provide good pain relief. Copyright © 2022, Yale Journal of Biology and Medicine Inc. All rights reserved.
ABSTRACT
Introduction: Because COVID-19 with extrapulmonary manifestations is likely to lead to the development of musculoskeletal disorders in susceptible individuals due to immunological mechanisms, it is possible to see more frozen shoulder cases during the COVID-19 pandemic. Therefore, this study was performed to evaluate the relationship of frozen shoulder and COVID-19. Materials and Methods: This study was a cross-sectional study from September 2020 to February 2021;patients who were referred to our shoulder clinic with stiffness and shoulder pain and diagnosed with adhesive capsulitis (AC) were evaluated for COVID-19 involvement. Shoulder range of motion was assessed as passive range of motion of forwarding flexion, internal rotation and external rotation in the arm at the side and 90° abduction. The visual analogue scale was also used to assess pain intensity. SPSS software was used for analysis, and Chi-square test was used for qualitative data analysis and a t-test was used for quantitative data. Results: Seventy-two patients with frozen shoulders were included in the study;the results showed that AC occurs at a younger age in patients with COVID-19 infection (P < 0.039);the mean age of all patients was 52.73 ± 8.68. The severity of pain was higher in patients with COVID-19 (P = 0.012). Furthermore, regarding the duration of referral in terms of months, it was shown that people with COVID-19 were referred in a shorter period after the onset of shoulder symptoms and there was a significant difference in terms of referral time and pain between the two groups (P < 0.01). Regular activity had a lower rate in patients with COVID-19 infection and the difference was significant in patients with and without COVID-19 (P < 0.029). Conclusion: Due to younger age, greater pain and faster visit of patients with a frozen shoulder after COVID-19, it is recommended to look for frozen shoulder in all COVID-19-infected patients by a complete clinical examination. This is more important in patients without regular physical activity. [ FROM AUTHOR]
ABSTRACT
CASE: A 62-year-old woman presented with 4 months of sharp progressive left shoulder pain, radiating down her arm with associated weakness, numbness and tingling most pronounced at the 4th and 5th digit. Her symptoms began within hours of receiving the influenza vaccine to her left shoulder. She denied prior left shoulder or neck pain, headaches, changes in vision, other neurologic symptoms, or trauma. Exam: Left upper extremity without skin changes or deformity, normal muscle bulk, tone and DTRs, lateral upper arm tenderness to light and deep palpation, reduced sensation to light touch at the 4th and 5th left digit with loss of two-point discrimination, reduced active and passive ROM of the glenohumeral joint to flexion/extension/abduction, and restricted internal and external rotation. Cervical x-rays showed spondylosis at C5-6, C5-6 neural foramen narrowing. Normal left shoulder x-ray. Left shoulder MRI showed high grade bursal surface, full-thickness tear of the distal supraspinatus tendon at its insertion, mild subscapularis tendinosis, and small subacromial subdeltoid bursitis. She was treated with a topical NSAIDs, tramadol and cyclobenzaprine as needed and referred to physiotherapy and PM&R. Despite maximum therapy, there was only marginal improvement of left shoulder pain and function at 9 months, she is still unable to perform her ADLs or return to work, and currently receiving home care through her daughter as a caregiver. IMPACT/DISCUSSION: The MRI findings and the temporal relationship between vaccine administration and onset of symptoms, suggest Shoulder Injury Related to Vaccine Administration (SIRVA) as the most likely diagnosis. SIRVA is defined as shoulder pain with limited ROM that commences within 48 hours after vaccine receipt in individuals without prior history of pain, inflammation, or dysfunction of the affected shoulder. SIRVA occurs when a vaccine is delivered into the sub-deltoid bursa or joint space, leading to a robust inflammatory response. The single most important factor in SIRVA diagnosis is the temporal association between vaccine administration and symptom onset. Commonly reported symptoms include shoulder pain, decreased limb mobility, numbness/tingling and muscle tightness. SIRVA complications include bursitis, tendonitis, rotator cuff tear, and adhesive capsulitis. Approximately 65% of patients with SIRVA will have pain lasting more than 3 months. SIRVA is challenging to treat, but there has been some success with early corticosteroid injection within 5 days of symptom onset. Given the current increase in vaccine administration with COVID-19, this case highlights SIRVA as a diagnostic consideration for patients who present with shoulder pain post-vaccination. CONCLUSION: SIRVA should be considered in any patient with new-onset shoulder pain that began within 48 hours of vaccine administration. SIRVA is a post-vaccination complication resulting in shoulder injury that can be prevented with proper vaccine administration technique.
ABSTRACT
Shoulder pain is a common symptom after intramuscular vaccination. However, only a few cases of shoulder joint injury have been reported after coronavirus disease 2019 vaccination. A 52-year-old woman experienced clinically significant pain in the left shoulder joint after receiving the first dose of a coronavirus disease 2019 vaccine. She neglected the shoulder pain, hoping that it would spontaneously improve without medical attention. However, the pain continued with obvious limitations in shoulder movement and function. After 8 months, she presented to the outpatient clinic with a frozen left shoulder. Such rare consequences of vaccinations, known as shoulder injury related to vaccine administration, can be prevented by using an appropriate needle gauge and length according to the patient's sex and weight with the correct injection site away from shoulder structures.
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Background: The data on frozen shoulder and shoulder injury related to vaccine administration (SIRVA) after coronavirus disease 2019 (COVID-19) vaccination are absent from the literature. Hence, the purpose of this case series was to describe the clinical presentation and short-term follow-up of patients who developed frozen shoulder after COVID-19 vaccination. Methods: In the present study, 10 patients (9 women and 1 man) with a mean age of 53 ± 8 years (range, 43-68 years) who presented to the shoulder surgeon's practice center with painful stiffness of the shoulder after COVID-19 vaccination between June 1 and September 30, 2021, were retrospectively evaluated. Results: All 10 patients had normal radiographs and were diagnosed as frozen shoulder. Eight patients (80%) had a comorbidity during presentation (4 patients with hypothyroidism, 3 patients with diabetes mellitus, and 1 patient with prediabetes/hyperglycemia). Symptoms developed immediately after the vaccination in 6 patients (60%), at 48 hours in 1 patient (10%), and at 10 days in 3 patients (30%). The mean pain visual analog scale score was 6.5 ± 1.9 (range, 2.5-8), and both active and passive range of motion were limited in all the patients at the time of presentation. Conclusion: The musculoskeletal specialists who will see such patients with painful shoulder stiffness should be aware of the frozen shoulder diagnosis, which can occur after COVID-19 vaccination, so that such patients can be identified and treated early.
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Keywords: Digital;Website;Musculoskeletal Purpose: In 2018 the Scottish Government's Digital Health and Care strategy detailed the importance of how technology could support patient-centred care whilst enhancing existing services. Consequently, embedding digital into current systems was suggested towards maximising health outcomes for patients’. Prior to this strategy NHS Ayrshire and Arran's musculoskeletal service developed a local self-management website for common MSK conditions. This innovation was developed to embrace the Scottish Governments 2020 vision concerning improving accessibility and supporting self-management. As a result the aim of this retrospective evaluation of practice was to see if the digital transformation could: 1. Influenced referral numbers into the service 2. Be accepted by local service users 3. Be inclusive within Ayrshire communities. Methods: The website was audited retrospectively via Google Analytics™ to ascertain the monthly views from July 2019 to July 2020. Referral numbers were then collated from Trackcare from previously triaged referrals into the South locality of the musculoskeletal service. Each referral and subsequent discharge report was reviewed to establish the diagnosed conditions pre-website (2018) to gain an average referral rate. The 2018 data was then compared with referral trends post-website development (2019/2020) to assess the impact. Finally, service users feedback, opinion and locality was obtained from NHS Ayrshire and Arrans Facebook page where social media posts. Results: (A) The total number of website views from July 2019 to July 2020 was 80,307. In Ayrshire it is estimated to have a population of 366,800 thus if the website has only exclusively used by the local population then it has reach 21.9% of the total local population. The website has averaged 6177 page views per month. (B) Knee Referrals (OA and Patellofemoral Combined): Pre-website average monthly referrals was 60. Post-website saw a 29.4% reduction. Elbow Referrals (Tennis and Golfers Elbow Combined): Pre-website average monthly referrals was 9.75. Post-website saw a 38.1% reduction. Hip Referrals (Greater Trochanteric Pain Syndrome): Pre-website average monthly referrals was 21.4. Post-website saw a 43.9% reduction. Shoulder Referrals (Frozen Shoulder): Pre-website average monthly referrals was 36.7. Post-website saw a 17.9% reduction. Shoulder Referrals (Subacromial Impingement): Pre-website average monthly referrals was 60.5. Post-website saw a 15.2% reduction. Low Back Pain Referrals (Mechanical): Pre-website average monthly referrals was 115.6. Post-website saw a 21.0% reduction. (C) Qualitative Feedback: Local GP: “An excellent resource. It is an effective tool especially during the pandemic. I have found that patients’ using the website can self-manage without referral” User: “The website has been a very valuable resource in my recovery from my hip pain. Very clear and informative.” (D) Inclusivity: Facebook analytics has shown the geographic areas of access: 1. Glasgow, Scotland 2. Kilmarnock, Scotland 3. Ayr, Scotland 4. Irvine, Scotland 5. Prestwick, Scotland This shows the website inclusiveness towards accessibility to diverse areas within Ayrshire. Conclusion(s): The collated data shows that having a local condition specific website is effective for an MSK department. The findings maybe generalizable to other localities of Ayrshire. Impact: This evaluation shows that digital health can improve service provision. This data may help contribute to the national agenda when reforming the national MATS service following the Covid-19 pandemic. Funding acknowledgements: None.