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CC BY-NC-ND 4.0 · Joints 2019; 07(04): 165-173
DOI: 10.1055/s-0041-1730983
Original Article

Treatment of Primary Shoulder Stiffness: Results of a Survey on Surgeon Practice Patterns in Italy

Davide Cucchi 
1   Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
,
Silvana De Giorgi
2   Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari, Bari, Italy
,
Maristella F. Saccomanno
3   Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
,
Francesco Uboldi 
4   UOC Ortopedia e Traumatologia Pediatrica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
,
Alessandra Menon
5   Department of Biomedical Sciences for Health, Laboratory of Applied Biomechanics, Università degli Studi di Milano, Milan, Italy
6   1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
,
Max J. Friedrich
1   Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
,
Sebastian G. Walter
1   Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
,
Laura de Girolamo 
7   Laboratorio di Biotecnologie applicate all Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
› Author Affiliations Funding None.
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Abstract

Objectives Shoulder stiffness is a condition of restricted glenohumeral range of motion (ROM), which can arise spontaneously or as consequence of a known cause. Several treatment options are available and currently no consensus has been obtained on which treatment algorithm represents the best choice for the patient. The aim of this study was to investigate surgeon practice patterns in Italy regarding treatment of primary shoulder stiffness.

Methods A literature review was performed to identify randomized controlled trials reporting results of shoulder stiffness treatment. The following controversial or critical points in the treatment of primary shoulder stiffness were identified: modalities of physical therapy; indication for oral corticosteroid; indication and frequency for injective corticosteroid; technique and site of injection; and indication, timing, and technique for surgery. A survey composed by 14 questions was created and administrated to the members of a national association specialized in orthopaedics and sports traumatology (SIGASCOT at the time of survey completion, recently renamed SIAGASCOT after the fusion of the societies SIGASCOT and SIA).

Results A total of 204 completed questionnaires were collected. Physical therapy was recommended by 98% of the interviewed. The use of oral corticosteroids was considered by 51%, and injections of corticosteroids by 72%. The posterior injection approach was the one preferred and a number of three was considered the upper limit for repeated injections. Injective therapy with local anesthetics and hyaluronic acid was considered by more than 20% of the interviewed. Thirty percent of the interviewed did not treat shoulder stiffness surgically.

Conclusion Several approaches to shoulder stiffness have been proposed and high-level evidence is available to analyze and discuss their results. Several controversial points emerged both from a literature review and from this national survey. Treatment of shoulder stiffness should be tailored to the patient's clinical situation and the stage of its pathology and should aim at pain reduction, ROM restoration, functional regain, and shortening of symptoms duration, with conservative therapy remaining the mainstay of treatment.

Keywords

shoulder stiffness - adhesive capsulitis - frozen shoulder - treatment - steroid - results - review - survey

Authors' Contributions

D.C.: study design, survey preparation, data collection, original draft preparation; S.D.G.: survey preparation, manuscript correction; M.F.S.: survey preparation, manuscript correction; F.U.: recruitment, management of Web platform for survey administration; A.M.: statistical analysis; M.F.: original draft preparation; S.W.: original draft preparation; L.D.G.: study design, manuscript correction.


Ethical Approval

The final version of the survey was approved by the SIGASCOT Board (and later on by the SIAGASCOT Board).




Publication History

Received: 22 December 2019

Accepted: 19 April 2021

Article published online:
18 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
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  • References

  • 1 Itoi E, Arce G, Bain GI. et al. Shoulder stiffness: current concepts and concerns. Arthroscopy 2016; 32 (07) 1402-1414
    CrossrefPubMedGoogle Scholar
  • 2 Cucchi D, Marmotti A, De Giorgi S. et al; SIGASCOT Research Committee. Risk factors for shoulder stiffness: current concepts. Joints 2017; 5 (04) 217-223
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Yano T, Hagiwara Y, Ando A. et al. RAGE-dependent NF-kB inflammation processes in the capsule of frozen shoulders. J Shoulder Elbow Surg 2020; 29 (09) 1884-1891
    CrossrefPubMedGoogle Scholar
  • 4 Buchbinder R, Green S, Youd JM, Johnston RV. Oral steroids for adhesive capsulitis. Cochrane Database Syst Rev 2006; (04) CD006189
    PubMedGoogle Scholar
  • 5 Page MJ, Green S, Kramer S, Johnston RV, McBain B, Buchbinder R. Electrotherapy modalities for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev 2014; (10) CD011324
    PubMedGoogle Scholar
  • 6 Page MJ, Green S, Kramer S. et al. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev 2014; (08) CD011275
    PubMedGoogle Scholar
  • 7 Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev 2003; (01) CD004016
    PubMedGoogle Scholar
  • 8 Bloom JE, Rischin A, Johnston RV, Buchbinder R. Image-guided versus blind glucocorticoid injection for shoulder pain. Cochrane Database Syst Rev 2012; (08) CD009147
    PubMedGoogle Scholar
  • 9 Buchbinder R, Green S, Youd JM, Johnston RV, Cumpston M. Arthrographic distension for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev 2008; (01) CD007005
    PubMedGoogle Scholar
  • 10 Cucchi D, Walter SG, Wirtz DC, Friedrich MJ. Shoulder stiffness - how to treat?. Z Orthop Unfall 2019; 157 (06) 668-675
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Artino Jr AR, Durning SJ, Sklar DP. Guidelines for reporting survey-based research submitted to academic medicine. Acad Med 2018; 93 (03) 337-340
    CrossrefPubMedGoogle Scholar
  • 12 Cucchi D, Walter SG, Menon A. et al. A survey on surgeon practice shows lack of consensus on the management of primary shoulder stiffness. J Biol Regul Homeost Agents 2020; 34 (4 Suppl 3): 59-67
    PubMedGoogle Scholar
  • 13 Lorbach O, Anagnostakos K, Scherf C, Seil R, Kohn D, Pape D. Nonoperative management of adhesive capsulitis of the shoulder: oral cortisone application versus intra-articular cortisone injections. J Shoulder Elbow Surg 2010; 19 (02) 172-179
    CrossrefPubMedGoogle Scholar
  • 14 Ranalletta M, Rossi LA, Bongiovanni SL, Tanoira I, Elizondo CM, Maignon GD. Corticosteroid injections accelerate pain relief and recovery of function compared with oral NSAIDs in patients with adhesive capsulitis: a randomized controlled trial. Am J Sports Med 2016; 44 (02) 474-481
    CrossrefPubMedGoogle Scholar
  • 15 Sun Y, Zhang P, Liu S. et al. Intra-articular steroid injection for frozen shoulder: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. Am J Sports Med 2017; 45 (09) 2171-2179
    CrossrefPubMedGoogle Scholar
  • 16 Wang W, Shi M, Zhou C. et al. Effectiveness of corticosteroid injections in adhesive capsulitis of shoulder: a meta-analysis. Medicine (Baltimore) 2017; 96 (28) e7529
    CrossrefPubMedGoogle Scholar
  • 17 Sun Y, Lu S, Zhang P, Wang Z, Chen J. Steroid injection versus physiotherapy for patients with adhesive capsulitis of the shoulder: a PRIMSA systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2016; 95 (20) e3469
    CrossrefPubMedGoogle Scholar
  • 18 Yoon S-H, Lee HY, Lee HJ, Kwack K-S. Optimal dose of intra-articular corticosteroids for adhesive capsulitis: a randomized, triple-blind, placebo-controlled trial. Am J Sports Med 2013; 41 (05) 1133-1139
    CrossrefPubMedGoogle Scholar
  • 19 Kim Y-S, Lee H-J, Lee D-H, Choi K-Y. Comparison of high- and low-dose intra-articular triamcinolone acetonide injection for treatment of primary shoulder stiffness: a prospective randomized trial. J Shoulder Elbow Surg 2017; 26 (02) 209-215
    CrossrefPubMedGoogle Scholar
  • 20 Raeissadat SA, Rayegani SM, Langroudi TF, Khoiniha M. Comparing the accuracy and efficacy of ultrasound-guided versus blind injections of steroid in the glenohumeral joint in patients with shoulder adhesive capsulitis. Clin Rheumatol 2017; 36 (04) 933-940
    CrossrefPubMedGoogle Scholar
  • 21 Shin S-J, Lee S-Y. Efficacies of corticosteroid injection at different sites of the shoulder for the treatment of adhesive capsulitis. J Shoulder Elbow Surg 2013; 22 (04) 521-527
    CrossrefPubMedGoogle Scholar
  • 22 Oh JH, Oh CH, Choi J-A, Kim SH, Kim JH, Yoon JP. Comparison of glenohumeral and subacromial steroid injection in primary frozen shoulder: a prospective, randomized short-term comparison study. J Shoulder Elbow Surg 2011; 20 (07) 1034-1040
    CrossrefPubMedGoogle Scholar
  • 23 Prestgaard T, Wormgoor MEA, Haugen S, Harstad H, Mowinckel P, Brox JI. Ultrasound-guided intra-articular and rotator interval corticosteroid injections in adhesive capsulitis of the shoulder: a double-blind, sham-controlled randomized study. Pain 2015; 156 (09) 1683-1691
    CrossrefPubMedGoogle Scholar
  • 24 Cho C-H, Kim H, Bae K-C, Lee D, Kim K. Proper site of corticosteroid injection for the treatment of idiopathic frozen shoulder: results from a randomized trial. Joint Bone Spine 2016; 83 (03) 324-329
    CrossrefPubMedGoogle Scholar
  • 25 Pushpasekaran N, Kumar N, Chopra RK, Borah D, Arora S. Thawing frozen shoulder by steroid injection. J Orthop Surg (Hong Kong) 2017; 25 (01) 2309499016684470
    Google Scholar
  • 26 Kim D-Y, Lee S-S, Nomkhondorj O. et al. Comparison between anterior and posterior approaches for ultrasound-guided glenohumeral steroid injection in primary adhesive capsulitis: a randomized controlled trial. J Clin Rheumatol 2017; 23 (01) 51-57
    CrossrefPubMedGoogle Scholar
  • 27 Elhafez HM, Elhafez SM. Axillary ultrasound and laser combined with postisometric facilitation in treatment of shoulder adhesive capsulitis: a randomized clinical trial. J Manipulative Physiol Ther 2016; 39 (05) 330-338
    CrossrefPubMedGoogle Scholar
  • 28 Çelik D, Kaya Mutlu E. Does adding mobilization to stretching improve outcomes for people with frozen shoulder? A randomized controlled clinical trial. Clin Rehabil 2016; 30 (08) 786-794
    CrossrefPubMedGoogle Scholar
  • 29 Kim SH, Kim YH, Lee H-R, Choi YE. Short-term effects of high-intensity laser therapy on frozen shoulder: a prospective randomized control study. Man Ther 2015; 20 (06) 751-757
    CrossrefPubMedGoogle Scholar
  • 30 Chen C-Y, Hu C-C, Weng P-W. et al. Extracorporeal shockwave therapy improves short-term functional outcomes of shoulder adhesive capsulitis. J Shoulder Elbow Surg 2014; 23 (12) 1843-1851
    CrossrefPubMedGoogle Scholar
  • 31 Hsu W-C, Wang T-L, Lin Y-J, Hsieh L-F, Tsai C-M, Huang K-H. Addition of lidocaine injection immediately before physiotherapy for frozen shoulder: a randomized controlled trial. PLoS One 2015; 10 (02) e0118217
    CrossrefPubMedGoogle Scholar
  • 32 Kreuz PC, Steinwachs M, Angele P. Single-dose local anesthetics exhibit a type-, dose-, and time-dependent chondrotoxic effect on chondrocytes and cartilage: a systematic review of the current literature. Knee Surg Sports Traumatol Arthrosc 2018; 26 (03) 819-830
    CrossrefPubMedGoogle Scholar
  • 33 Hsieh L-F, Hsu W-C, Lin Y-J, Chang H-L, Chen C-C, Huang V. Addition of intra-articular hyaluronate injection to physical therapy program produces no extra benefits in patients with adhesive capsulitis of the shoulder: a randomized controlled trial. Arch Phys Med Rehabil 2012; 93 (06) 957-964
    CrossrefPubMedGoogle Scholar
  • 34 Lim TK, Koh KH, Shon MS, Lee SW, Park YE, Yoo JC. Intra-articular injection of hyaluronate versus corticosteroid in adhesive capsulitis. Orthopedics 2014; 37 (10) e860-e865
    PubMedGoogle Scholar
  • 35 Park KD, Nam H-S, Lee JK, Kim YJ, Park Y. Treatment effects of ultrasound-guided capsular distension with hyaluronic acid in adhesive capsulitis of the shoulder. Arch Phys Med Rehabil 2013; 94 (02) 264-270
    CrossrefPubMedGoogle Scholar
  • 36 Lin J. Platelet-rich plasma injection in the treatment of frozen shoulder: a randomized controlled trial with 6-month follow-up. Int J Clin Pharmacol Ther 2018; 56 (08) 366-371
    CrossrefPubMedGoogle Scholar
  • 37 Klç Z, Filiz MB, Çakr T, Toraman NF. Addition of suprascapular nerve block to a physical therapy program produces an extra benefit to adhesive capsulitis: a randomized controlled trial. Am J Phys Med Rehabil 2015; 94 (10, Suppl 1): 912-920
    CrossrefPubMedGoogle Scholar
  • 38 Koh PS, Seo BK, Cho NS, Park HS, Park DS, Baek YH. Clinical effectiveness of bee venom acupuncture and physiotherapy in the treatment of adhesive capsulitis: a randomized controlled trial. J Shoulder Elbow Surg 2013; 22 (08) 1053-1062
    CrossrefPubMedGoogle Scholar
  • 39 Park YC, Koh PS, Seo BK. et al. Long-term effectiveness of bee venom acupuncture and physiotherapy in the treatment of adhesive capsulitis: a one-year follow-up analysis of a previous randomized controlled trial. J Altern Complement Med 2014; 20 (12) 919-924
    CrossrefPubMedGoogle Scholar
  • 40 Rouhani A, Mardani-Kivi M, Bazavar M. et al. Calcitonin effects on shoulder adhesive capsulitis. Eur J Orthop Surg Traumatol 2016; 26 (06) 575-580
    CrossrefPubMedGoogle Scholar
  • 41 Waldburger M, Meier JL, Gobelet C. The frozen shoulder: diagnosis and treatment. Prospective study of 50 cases of adhesive capsulitis. Clin Rheumatol 1992; 11 (03) 364-368
    CrossrefPubMedGoogle Scholar
  • 42 Tveitå EK, Tariq R, Sesseng S, Juel NG, Bautz-Holter E. Hydrodilatation, corticosteroids and adhesive capsulitis: a randomized controlled trial. BMC Musculoskelet Disord 2008; 9 (01) 53
    CrossrefPubMedGoogle Scholar
  • 43 Saltychev M, Laimi K, Virolainen P, Fredericson M. Effectiveness of hydrodilatation in adhesive capsulitis of shoulder: a systematic review and meta-analysis. Scand J Surg 2018; 107 (04) 285-293
    CrossrefPubMedGoogle Scholar
  • 44 Yoon JP, Chung SW, Kim J-E. et al. Intra-articular injection, subacromial injection, and hydrodilatation for primary frozen shoulder: a randomized clinical trial. J Shoulder Elbow Surg 2016; 25 (03) 376-383
    CrossrefPubMedGoogle Scholar
  • 45 Mun SW, Baek CH. Clinical efficacy of hydrodistention with joint manipulation under interscalene block compared with intra-articular corticosteroid injection for frozen shoulder: a prospective randomized controlled study. J Shoulder Elbow Surg 2016; 25 (12) 1937-1943
    CrossrefPubMedGoogle Scholar
  • 46 Jacobs LG, Smith MG, Khan SA, Smith K, Joshi M. Manipulation or intra-articular steroids in the management of adhesive capsulitis of the shoulder? A prospective randomized trial. J Shoulder Elbow Surg 2009; 18 (03) 348-353
    CrossrefPubMedGoogle Scholar
  • 47 Quraishi NA, Johnston P, Bayer J, Crowe M, Chakrabarti AJ. Thawing the frozen shoulder. A randomised trial comparing manipulation under anaesthesia with hydrodilatation. J Bone Joint Surg Br 2007; 89 (09) 1197-1200
    CrossrefPubMedGoogle Scholar
  • 48 Chen J, Chen S, Li Y, Hua Y, Li H. Is the extended release of the inferior glenohumeral ligament necessary for frozen shoulder?. Arthroscopy 2010; 26 (04) 529-535
    CrossrefPubMedGoogle Scholar