Definition, Diagnosis, Treatment, and Prognosis of Frozen Shoulder: A Consensus Survey of Shoulder Specialists.

BACKGROUND: The objective of this study was to identify a consensus on definition, diagnosis, treatment, and prognosis of frozen shoulder (FS) among shoulder specialists. METHODS: A questionnaire composed of 18 questions about FS-definition, classification, utilization of diagnostic modalities, the propriety of treatment at each stage, and prognosis-was sent to 95 shoulder specialists in Korea. Most questions (15 questions) required an answer on a 5-point analog scale (1, strongly disagree; 5, strongly agree); three questions about the propriety of treatment were binary. RESULTS: We received 71 responses (74.7%). Of the 71 respondents, 84.5% agreed with the proposed definition of FS, and 88.8% agreed that FS should be divided into primary and secondary types according to the proposed definition. Only 43.7% of the respondents agreed that FS in patients with systemic disease should be classified as secondary FS. For the diagnosis of FS, 71.9% agreed that plain radiography should be used and 64.8% agreed ultrasonography should be used. There was a high consensus on proper treatment of FS: 97.2% agreed on education, 94.4%, on the use of nonsteroidal anti-inflammatory drugs; 76.1%, on intra-articular steroid injections; and 97.2%, on stretching exercise. Among all respondents, 22.5% answered that more than 10% of the patients with FS do not respond to conservative treatment. CONCLUSIONS: The survey revealed a general consensus among shoulder specialists on the definition and treatment of FS. However, classification of FS was found controversial.

Representative survey of frozen shoulder questionnaire responses from the Japan Shoulder Society: What are the appropriate diagnostic terms for primary idiopathic frozen shoulder, stiff shoulder or frozen shoulder?

BACKGROUND: Primary frozen shoulder has unknown etiology and significant restriction of active and passive motion. The distinction between frozen shoulder and stiff shoulder has been unclear. Therefore, the purposes of this study were to perform a survey regarding definition and classification of frozen shoulder proposed by the American Academy of Orthopedic Surgeons (AAOS) among the members of the Japan Shoulder Society (JSS) and to compare the results with those obtained among the members of the American Shoulder and Elbow Surgeons (ASES). METHODS: The Scientific Research Project Committee of the JSS prepared the questionnaire for frozen shoulder and stiff shoulder. Surveys were sent by e-mail on Jan 14, 2016 to JSS registered members and the response dead-line was set on March 13, 2016. RESULTS: The number of respondents was 230, including all directors, councilors, and senior doctors. Agreement with the definition of primary frozen shoulder was 67%, the classification of primary or secondary frozen shoulder was 53%, and the 3 divisions of secondary frozen shoulder was 53%. Diagnostic terms for the cases of shoulder stiffness with unknown etiology were as follows: frozen shoulder (31%), stiff shoulder (22%), periarthritis scapulohumeralis (16%), so called "Gojukata" in Japan, which means shoulder problems in their fifties (16%), idiopathic frozen shoulder (6%), primary frozen shoulder (4%), adhesive capsulitis (3%), others (2%). CONCLUSION: The survey shows lower rates of agreement among the JSS members than the ASES members for the definition of primary frozen shoulder, the classification of primary and secondary frozen shoulder, and the divisions of secondary frozen shoulder. To avoid confusion between stiff shoulder and frozen shoulder, the committee agrees to the ISAKOS recommendation that the term "frozen shoulder" should be used exclusively for primary idiopathic stiff shoulder.

Bursite cotovelar aguda em filhote: Relato De Caso / Elbow acute bursitis in a puppy: Case Report / Bursitis aguda de codo en cachorro de perro: Relato De Caso

Bursite cotovelar é uma cavidade preenchida por fluido, circundada por tecido conjuntivo fibroso denso, que surge na face lateral do olécrano. Normalmente, essa condição clínica é causada por traumatismo crônico. Relata-se um caso de bursite cotovelar aguda bilateral em um cão da raça dálmata, macho, de 35 dias de idade. Clinicamente, o animal apresentava aumento de volume flutuante e indolor, na região do olécrano, bilateral, de um dia de evolução. Na punção aspirativa foi observado um líquido de aspecto seroso e vermelho, e no exame citológico apenas leucócitos e hemácias. Devido ao histórico e tempo de evolução, o diagnóstico presuntivo foi de bursite cotovelar traumática aguda. O tratamento preconizado foi à base de anti-inflamatório, tratamento tópico, bandagem ao redor da lesão e repouso. O cão retornou com sete dias totalmente recuperado. Apesar da bursite em pequenos animais ocorrer devido a traumas repetidos, apresentando uma característica de cronicidade, a bursite pode ser aguda e se originar de um único trauma...

Elbow bursitis is a cavity filled with fluid and surrounded by dense fibrous connective tissue, which appears on the lateral side of the olecranon. Typically, this medical condition is caused by chronic trauma. This paper reports a case of bilateral acute bursitis in the elbow in a Dalmatian dog, male, with 35 days of age. Clinically, the animal presented painless swelling of the floating volume in the olecranon region, bilateral, with a one-day evolution. In aspiration, serous red fluid could be observed, and upon cytological examination, only leukocytes and erythrocytes were observed. Due to the history and evolution time, the presumptive diagnosis was that of acute traumatic bursitis in the elbow. The treatment was based on anti-inflammatory medication, topical treatment, bandage around the lesion and rest. The dog returned after 7 days fully recovered. Although bursitis occurs in small animals due to repeated trauma, presenting a chronicity characteristic, it can also be acute and originated from a single trauma...

La bursitis de codo es una cavidad llena de fluido y rodeada por tejido conectivo fibroso denso, que surge en el lado lateral del olécranon. Por lo general, esa condición clínica es causada por un trauma crónico. Se presenta un caso de bursitis aguda bilateral en el codo de un perro de la raza dálmata, macho, de 35 días de edad. Clínicamente, el animal presentaba aumento de volumen flotante y sin dolor, en la región del olécranon, bilateral, un día de evolución. En una aspiración se ha observado un líquido de aspecto seroso y rojo, y en el examen citológico sólo leucocitos y eritrocitos. Debido al histórico y tiempo de evolución, el diagnóstico presuntivo fue bursitis de codo traumática aguda. El tratamiento preconizado fue a base de antiinflamatorio, tratamiento tópico, vendaje alrededor de la lesión y reposo. El perro volvió con siete días totalmente recuperado. Aunque la bursitis se produce en animales pequeños debido a traumas repetidos, presentando una característica de cronicidad, la bursitis puede ser aguda y originarse a partir de un único trauma...

Frozen shoulder: a consensus definition.

INTRODUCTION: Frozen shoulder (FS) is a common diagnosis treated by orthopaedic surgeons and other physicians caring for musculoskeletal problems. However, there is no standard definition and classification for this common condition. MATERIALS AND METHODS: We asked 211 clinician members of the American Shoulder and Elbow Surgeons to review our proposed definition of FS and its classification into primary and secondary types. Secondary FS was further divided into intrinsic, extrinsic, and systemic types. The survey required responses to 5 specific questions via an analog scale (1, strongly disagree; 5, strongly agree). Agreement was defined as a 4 or 5 on the analog scale. RESULTS: We received 190 responses (90%). Eighty-two percent agreed with the proposed definition of FS. Eighty-five percent agreed that FS should be divided into primary and secondary types. Sixty-six percent agreed with subdivision of secondary FS into intrinsic, extrinsic, and systemic types. Eighty-four percent agreed that there was a clinical entity of primary or idiopathic FS. Eighty-five percent agreed that obtaining a consensus definition and classification of FS was a worthwhile endeavor. DISCUSSION: Significant benefits can be gained from the development of a standard definition and classification of FS, achieved through a consensus of shoulder specialists, that provides a strong foundation for potential acceptance by all musculoskeletal specialists who treat this condition.

Qualidade de vida de paciente com capsulite adesiva / Quality of life of patient with adhesive capsulitis

Capsulite adesiva é uma condição clínica da articulação glenoumeral, caracterizada por dor, rigidez articular fibrosa de origem capsular, muitas vezes relacionada a períodos de desuso do ombro, de evolução arrastada, associada ou não a outras doenças. É freqüente causa de dor e incapacidade funcional, sendo que a dor é a queixa mais freqüente nas afecções músculo-esqueléticas e esta por sua vez leva a incapacidade física. A imobilidade física produz redução da capacidade funcional, desta forma a precocidade para iniciar os procedimentos fisioterapêuticos é imprescindível, uma vez que o exercício é o estímulo fisiológico específico que aumentam a capacidade funcional e revertem a hipotrofia por desuso e a fraqueza muscular, se a intensidade, freqüência e duração apropriada são aplicadas. Este relato de caso teve como objetivo mensurar o impacto da doença na qualidade de vida do paciente utilizando o questionário Medical Outcome Survey 36 e demonstrar que mesmo com o início da fisioterapia após a instalação da capsulite adesiva, ainda é possível reverter o quadro em longo prazo, bem como incentivar a precocidade da fisioterapia.

Adhesive capsulitis is a clinical condition of the glenohumeral articulation, characterized by pain, fibrous articular rigidity from capsular origin, mainly related to periods in which the shoulder was not being used, with slow evolution and associated or not to other diseases. Pain and functional incapability are frequent, being pain the most common complain in muscle-skeletal illness, leading to physical incapability. Physical immobility results in functional incapability, therefore the precociousness to initiate physical therapy is essential, once the exercise is a specific physiological stimulus that increases functional capability and reverts the hypotrophy caused by the disuse and the muscular weakness, if the intensity, the frequency and the apropriate duration are applied. This case report aims to measure the impact of the refered illness in the patient’s quality of life through the Medical Outcome Survey 36 and demonstrates that even with the beginning of the physical therapy after the arise of the adhesive capsulitis, it is still possible to revert the presented state in the long term, as well as to encourage precocious physical therapy.

Lack of uniformity in diagnostic labeling of shoulder pain: time for a different approach.

Diagnostic labels for shoulder pain (e.g., frozen shoulder, impingement syndrome) are widely used in international research and clinical practice. However, about 10 years ago it was shown that the criteria to define those labels were not uniform. Since an ongoing lack of uniformity seriously hampers communication and does not serve patients, we decided to evaluate the uniformity in definitions. Therefore, we compared the selection criteria of different randomised controlled trials (RCTs). This comparison revealed some corresponding criteria, but no uniform definition could be derived for any of the diagnostic labels. Besides the lack of uniformity, the currently used labels have only a fair to moderate interobserver reproducibility and in systematic reviews none of the separate trials using a diagnostic label show a large benefit of treatment. This, altogether, seems sufficient reason to reconsider their use. Therefore, we strongly suggest to abolish the use of these labels and direct future research towards undivided populations with "general" shoulder pain. Possible subgroups with a better prognosis and/or treatment result, based on common characteristics that are easily and validly reproducible, can then be identified within these populations.

Technetium-99m human immunoglobulin scintigraphy in patients with adhesive capsulitis: a correlative study with bone scintigraphy.

Adhesive capsulitis (AC) is a disorder that is characterized by shoulder pain and progressive limitation of both active and passive shoulder motion. Although the underlying pathological mechanisms of the disease are not well understood, the inflammatory reactions depending on the stage have been demonstrated histologically. The purpose of the study is to investigate the inflammatory changes that can be demonstrated with Tc-99m HIG in AC, and to determine the presence of correlations between scintigraphic findings and the clinical assessment. Twenty-one patients (12 females and 9 males) with a mean age of 50.57+/-8.49 were included in the study. AC was diagnosed according to recognized criteria. The planar X-ray images of the affected shoulders of all patients were normal. The patients were evaluated with the Constant Scoring System, and the functional and pain assessment parts of the American Shoulder and Elbow Surgeons' Form (ASES). Three phase bone scans and Tc-99m HIG scintigraphy were performed at least two days apart. Bone scan and Tc-99m HIG scintigraphy were evaluated visually and HIG uptake was evaluated in comparison with the contralateral normal shoulder. Bone scan demonstrated hypervascularity in 9 of the 21 patients (43%), whereas increased osteoblastic activity was detected in 19 (90%) in the affected shoulder. Tc-99m HIG uptake was positive in 12 (57%), and negative in 9 (43%) patients. All patients with increased Tc-99m HIG accumulation in the affected shoulder, also had increased osteoblastic activity on Tc-99m bone scintigraphy. A significant correlation was found between HIG uptake and constant, functional and pain scores. The difference between these scores was also statistically significant in patients with HIG positive and negative uptake. This study indicates that there is a good correlation between Tc-99m HIG scan findings and clinical scores. Tc-99m HIG accumulation in the affected shoulder may be related to continuing inflammatory reaction to AC. Tc-99m HIG scan may be a noninvasive, complementary method for demonstrating continuing inflammatory changes and may help in staging the disease.

Bursitis reumática: su valoración mediante ecografía / Rheumatic bursitis: its US evaluation

Se evaluaron 30 pacientes con enfermedades reumáticas (artritis reumatoidea, LES, colagenopatías mixtas) y diversas afecciones articulares con preponderancia del estudio ultrasonográfico sobre patología bursal. Determinando la ubicación, extensión, forma y contenido o presencia de derrame articular asociado, definimos patrones ecográficos de las bursitis del hombro, codo, rodilla, tobillo y cadera (trocanteritis mayor), bases sonográficas para el seguimiento evolutivo de esta frecuente afectación reumatológica

Bursitis reumática: su valoración mediante ecografía / Rheumatic bursitis: its US evaluation

Se evaluaron 30 pacientes con enfermedades reumáticas (artritis reumatoidea, LES, colagenopatías mixtas) y diversas afecciones articulares con preponderancia del estudio ultrasonográfico sobre patología bursal. Determinando la ubicación, extensión, forma y contenido o presencia de derrame articular asociado, definimos patrones ecográficos de las bursitis del hombro, codo, rodilla, tobillo y cadera (trocanteritis mayor), bases sonográficas para el seguimiento evolutivo de esta frecuente afectación reumatológica