Search Results (115)

Adhesive capsulitis is a painful and progressive condition marked by significant limitations in shoulder mobility, particularly affecting external rotation. Although magnetic resonance imaging is regarded as the reference standard for assessing intra-articular structures, its high cost and limited availability present challenges in routine clinical use. In contrast, musculoskeletal ultrasound has emerged as an accessible, real-time, and cost-effective imaging modality for both the diagnosis and treatment guidance of adhesive capsulitis. This narrative review compiles and illustrates current evidence regarding the role of ultrasound, encompassing static B-mode imaging, dynamic motion analysis, contrast-enhanced techniques, and sonoelastography. Key sonographic features—such as thickening of the coracohumeral ligament, fibrosis in the axillary recess, and abnormal tendon kinematics—have been consistently associated with adhesive capsulitis and demonstrate favorable diagnostic performance. Advanced methods like contrast-enhanced ultrasound and elastography provide additional functional insights (enabling evaluation of capsular stiffness and vascular changes) which may aid in disease staging and prediction of treatment response. Despite these advantages, the clinical utility of ultrasound remains subject to operator expertise and technical variability. Limited visualization of intra-articular structures and the absence of standardized scanning protocols continue to pose challenges. Nevertheless, ongoing advances in its technology and utility standardization hold promise for the broader application of ultrasound in clinical practice. With continued research and validation, ultrasound is positioned to play an increasingly central role in the comprehensive assessment and management of adhesive capsulitis. Full article

Background: Adhesive capsulitis (AC) causes a global limitation of both active and passive range of motion (ROM) in the shoulder, with or without pain, and no specific radiographic findings. Its course is self-limiting and progresses through three or four stages. The diagnosis is primarily clinical, since imaging tests are nonspecific. Treatment options include physical therapy (PT), intra-articular corticosteroid injections, suprascapular nerve block (SSNB), and hydrodilatation (HD). The latter is useful for expanding and reducing inflammation of the joint capsule through the insufflation of saline solution, anesthetics, and corticosteroids. Objectives: To compare whether patients with AC, stratified by phase 1 and 2, who receive high-volume HD as treatment achieve better outcomes in terms of shoulder pain and function compared to patients who receive low-volume HD. To compare whether there are differences in PT times and to determine mean axillary recess (AR) values. Methods: A randomized, parallel-block, triple-blind clinical trial will be conducted in 64 patients with AC in phases 1 and 2, aged 30 to 70 years, with limited active and passive ROM in two planes, and shoulder pain lasting more than 3 months. HD will be administered with volumes of 20 mL or 40 mL, followed by a conventional rehabilitation program. Outcomes will be reviewed at the 1st, 3rd, and 6th months of HD. Variables collected will include Shoulder Pain and Disability Index (SPADI), Visual Analog Scale (VAS), Range of motion (ROM), Lattinen index (LI), AR size, and time to completion of PT. Results: HD has been gaining clinical relevance in interventional rehabilitation as a treatment for AC, although its medium- and long-term efficacy remains a matter of debate. The variability in the volumes used for capsular expansion, with studies ranging from 18 mL to 47 mL, is compounded by the fact that most of these studies do not differentiate between AC stages. This could influence treatment effectiveness. Furthermore, diagnosis remains a challenge since valid and specific diagnostic parameters are lacking. Conclusions: Understanding the differences between HD techniques, considering the influence of certain factors such as the volume used or the stages of AC, as well as improving diagnosis and the coordination of scientific work. This could facilitate the development of protocols for the use of HD in AC. Full article

Background: The personalization of medication through 3D printing enables the development of capsular devices (CDs) tailored to patient-specific needs. This study aimed to evaluate the stability and in vivo performance of 3D-printed polyvinyl alcohol (PVA) CDs with 0.4 and 0.9 mm width wall thicknesses (WT) compared to traditional hard gelatin capsules (HGCs). Methods: Capsules were tested for swelling, erosion, adhesion, water sorption, and in vitro disintegration. Additionally, the release of the model drug (losartan potassium) from CDs was evaluated. In vivo capsule opening times were assessed in dogs using X-ray imaging. Stability studies were conducted under natural (25 ± 2 °C, 60 ± 5% RH) and accelerated (40 ± 2 °C, 75 ± 5% RH) storage conditions. Results: CDs with 0.4 mm WT (CD–0–0.4) exhibited higher swelling and erosion, lower adhesion, and faster disintegration, leading to a more immediate drug release, comparable to HGCs. A strong correlation was found between in vitro and in vivo disintegration behavior. Water sorption tests revealed lower moisture affinity for PVA CDs compared to HGC. Stability studies showed that CD–0–0.4 retained its physical and chemical properties. Instead, CDs with 0.9 mm WT (CD–0–0.9) were sensitive to storage, particularly under accelerated aging, which affected their integrity and release profile. Conclusions: These findings highlight the potential of PVA-CDs, especially the 0.4 mm design, as a promising and stable alternative for compounding pharmacy applications, offering an effective platform for personalized oral drug delivery. Full article

Objectives: Shoulder injury related to vaccine administration (SIRVA), previously observed with influenza vaccines, has gained clinical significance with widespread COVID-19 vaccination. However, few studies correlate vaccine types and demographic factors with the MRI findings of SIRVA. This study aimed to evaluate MRI findings of SIRVA following COVID-19 vaccination and assess associations with vaccine type and patient characteristics. Methods: A retrospective cohort study was conducted on 35 patients with new-onset shoulder complaints within six weeks of COVID-19 vaccination between May 2021 and May 2022. MRI findings suggestive of SIRVA were reviewed, including subacromial bursitis, rotator cuff tears, and adhesive capsulitis. Demographic data, vaccine type, clinical symptoms, and treatments were collected. Follow-up interviews (1–30 September 2024) assessed symptom persistence and vaccine hesitancy. Descriptive statistics and Chi-square tests were used to explore associations. Results: Of the 35 patients (mean age 53.6 ± 9.0 years; 54.3% female), subacromial bursitis was the most common MRI finding (89.5%), followed by tendonitis (47.4%) and adhesive capsulitis (36.8%). Tendonitis correlated with older age (p = 0.024) and AstraZeneca vaccination (p = 0.033). Subacromial bursitis was linked to female sex (p = 0.013) and higher BMI (p = 0.023). Adhesive capsulitis was associated with receiving the Sinopharm vaccine (p = 0.029). Persistent symptoms (22.9%) were more common in younger patients, women, and those with right-sided injections. Conclusions: SIRVA following COVID-19 vaccination showed different MRI patterns associated with female sex, higher BMI, and vaccine type. Awareness of these patterns may expedite recognition of COVID-19-associated SIRVA in routine practice. Full article

Background: Ozone therapy is used for its immunomodulatory, antioxidant, and analgesic properties in several fields. It can be useful in the rehabilitation of musculoskeletal disorders. Studies showed that O₂-O₃ therapy can reduce pain and improve functioning in patients affected by low back pain and knee osteoarthritis. Only a few studies have been published about the efficacy of this treatment in upper limb disease. Objective: The aim of this study is to investigate the use of ozone therapy in upper limb pathologies, evaluating its quantity, quality, and reported results in upper limb musculoskeletal disease, supraspinatus tendinopathy, shoulder impingement, adhesive capsulitis, chronic epicondylitis, and carpal tunnel syndrome. O₂-O₃ reduces inflammation by stimulating anti-inflammatory cytokines and inactivating pro-inflammatory molecules, relieves pain by interacting with pain receptors and improving blood circulation, promotes the regeneration of damaged tissues by stimulating growth factors and improving vascularization, and, finally, activates endogenous antioxidant defense systems by protecting cells from oxidative damage. Methods: A comprehensive search was conducted on PubMed and Scopus using the following MeSH terms: ozone therapy, infiltration joint, musculoskeletal disease, rehabilitation, upper limb, shoulder, wrist, hand, elbow, including English papers published in the last five years. Results: Five papers have been selected: four randomized controlled trials and one retrospective cohort study. The RCTs compared the effectiveness of intra-articular ozone injection with steroid injection alone or with other conservative treatments in shoulder diseases; one paper studied the effectiveness of ozone injection and orthoses in carpal tunnel syndrome compared to orthoses alone; one paper used ozone injections compared with steroid injection in patients with chronic lateral epicondylitis. A total of 218 patients were studied in these trials. Conclusions: Ozone treatment seemed to improve pain and function as well as other therapies in upper limb musculoskeletal disease. However, the trials’ protocols and the upper limb areas treated are different. Further studies are needed to define the effectiveness of ozone therapy in upper limb diseases in rehabilitation fields. Full article

Background/Objectives: The utility of artificial intelligence (AI) in medical education has recently garnered significant interest, with several studies exploring its applications across various educational domains; however, its role in orthopedic education, particularly in shoulder and elbow surgery, remains scarcely studied. This study aims to evaluate the performance of multiple AI models in answering shoulder- and elbow-related questions from the AAOS ResStudy question bank. Methods: A total of 50 shoulder- and elbow-related questions from the AAOS ResStudy question bank were selected for the study. Questions were categorized according to anatomical location, topic, concept, and difficulty. Each question, along with the possible multiple-choice answers, was provided to each chatbot. The performance of each chatbot was recorded and analyzed to identify significant differences between the chatbots’ performances across various categories. Results: The overall average performance of all chatbots was 60.4%. There were significant differences in the performances of different chatbots (p = 0.034): GPT-4o performed best, answering 74% of the questions correctly. AAOS members outperformed all chatbots, with an average accuracy of 79.4%. There were no significant differences in performance between shoulder and elbow questions (p = 0.931). Topic-wise, chatbots did worse on questions relating to “Adhesive Capsulitis” than those relating to “Instability” (p = 0.013), “Nerve Injuries” (p = 0.002), and “Arthroplasty” (p = 0.028). Concept-wise, the best performance was seen in “Diagnosis” (71.4%), but there were no significant differences in scores between different chatbots. Difficulty analysis revealed that chatbots performed significantly better on easy questions (68.5%) compared to moderate (45.4%; p = 0.04) and hard questions (40.0%; p = 0.012). Conclusions: AI chatbots show promise as supplementary tools in medical education and clinical decision-making, but their limitations necessitate cautious and complementary use alongside expert human judgment. Full article

Assessing shoulder joint range of motion (ROM) is essential for diagnosing musculoskeletal disorders and optimizing treatments. This single-center pilot study evaluated the reliability and validity of iBalance, a single-camera markerless motion capture system, for measuring shoulder ROM. Forty participants (30 healthy individuals and 10 patients with adhesive capsulitis) underwent measurements of seven shoulder joint movements. Each movement was assessed three times by two raters using both iBalance and a goniometer, with measurements repeated after 1 week. The iBalance demonstrated excellent inter- and intra-rater reliability for flexion (ICC = 0.93 [0.91–0.95], 0.91 [0.88–0.94]), abduction (ICC = 0.97 [0.95–0.98], 0.93 [0.91–0.95]), and passive abduction (ICC = 0.97 [0.96–0.98], 0.98 [0.97–0.98]). The system also showed strong validity compared to the goniometer for flexion (ICC = 0.85 [0.68–0.92]), abduction (ICC = 0.95 [0.94–0.96]), and passive abduction (ICC = 0.97 [0.96–0.98]). Bland–Altman plots showed high consistency between the two devices for flexion, abduction, and passive abduction, with most data points falling within the limits of agreement. Patients with adhesive capsulitis exhibited greater variability than healthy individuals. No adverse events were reported, supporting the safety of the system. This study highlights the potential of a single-camera markerless motion capture system for diagnosing and treating shoulder joint disorders. The iBalance showed clinical applicability for measuring flexion, abduction, and passive abduction. Future enhancements to the algorithm and the incorporation of advanced metrics could improve its performance, facilitating broader clinical applications for diagnosing complex shoulder conditions. Full article

Background and Objectives: Hemiplegic shoulder pain (HSP) is a common and disabling complication in stroke patients, yet its pathogenesis remains unclear. This longitudinal study aimed to investigate the clinical and ultrasound characteristics of HSP emerging within the first 72 h (T0) post-stroke, with follow-ups at one month (T1) and three months (T2). Materials and Methods: A total of 28 stroke patients with hemiparesis were assessed for HSP. Evaluations included pain severity during passive shoulder mobilization, passive and active range of motion, muscle strength, spasticity, and functional disability. Ultrasound examinations were conducted to assess tendon disorders, bursitis, effusion, glenohumeral subluxation, and adhesive capsulitis. Results: HSP prevalence increased over time, affecting 11% of patients at T0, 32% at T1, and 57% at T2. Higher baseline scores on the National Institutes of Health Stroke Scale (NIHSS), an established marker of stroke severity, were significantly associated with HSP (p < 0.05). At T2, patients with HSP exhibited greater impairment, including restricted passive and active range of movement, pronounced muscle weakness, and increased spasticity (p < 0.05). Ultrasound findings at T2 revealed that adhesive capsulitis and glenohumeral subluxation were significantly more frequent in HSP patients (p < 0.05). Adhesive capsulitis showed a significant increase from 0% at T0 to 21% at T2 (p = 0.031), while glenohumeral subluxation exhibited a non-significant rise from 4% to 21% (p = 0.063). Patients with these conditions experienced significantly greater pain progression (p < 0.001). Conclusions: These findings suggest that capsular pathology plays a key role in the development of HSP within the first three months after stroke. The results highlight the need for targeted interventions addressing glenohumeral subluxation and adhesive capsulitis to alleviate pain and improve rehabilitation outcomes. Full article

Background: Pig islets have the potential to address the limited supply of human islets available for transplantation. However, the knowledge of the biology of pig islets is currently limited. Thus, this study evaluated the molecules involved in cell-to-cell adhesion and insulin secretion pathways during the in vitro development of neonatal pig islets to understand the tissue we hope to use as a possible solution to the shortage of human islets for transplantation. Methods: Through RT-qPCR, immunoassays, and assessments of islet function, we explored the expression of E-cadherin and its correlation with the molecules involved in the insulin secretion pathway including GTPase, RAC1, and the membrane fusion protein SNAP25 during neonatal pig islet development. Results: Despite no significant difference observed in gross morphology and viability, as well as variable expression of RAC1, insulin, and SNAP25 in islets from 1-, 3-, and 7-day-old neonatal pigs, there was an apparent trend towards improved function in islets obtained from 3- and 7-day-old pigs compared with 1-day-old pigs. In the presence of 30 mM KCl, the amount of insulin secreted by islets from 3- and 7-day-old pigs but not from 1-day-old pigs was increased. Disruption of E-cadherin interactions with monoclonal antibodies resulted in decreased insulin secretion capacity of islets from 3-day old pigs. Conclusions: Our results show that blocking E-cadherin interactions with monoclonal antibodies resulted in disrupted peri-islet capsule and impaired islet insulin secretion under high glucose conditions. Thus, E-cadherin is important in the in vitro postnatal development and function of pig islets. Full article

DNA methylation is a critical mechanism for regulating gene expression in bacteria and plays an essential role in bacterial pathogenesis. A mutant, WC1535ΔhsdM, lacking hsdM encoding a DNA methyltransferase was constructed using homologous recombination technology. The growth, hemolytic activity, and capsule formation of the mutant were analyzed. The dynamic distribution of the wild-type (WT) and mutant strains in tilapia tissues after artificial infection was determined. The adhesion, invasion, anti-phagocytic, and whole-blood survival abilities of the WT and mutant strains were analyzed. Tilapia were intraperitoneally injected with the WT or mutant strains, and the LD₅₀ values were determined. The expression levels of the immune-related genes in tilapia were analyzed by qRT-PCR. The mutant showed faster growth during the logarithmic growth period (5–10 h) and lower hemolytic activity than the WT strain. Mutant loads in tilapia tissues were significantly lower than those of the WT strain. Mutant strain adhesion to epithelial cells was significantly reduced, it was more easily engulfed by macrophages, and it had decreased intracellular survival. The LD₅₀ of the mutant was 2.06 times higher than that of the WT strain, indicating decreased pathogenicity. Expression levels of immune-related genes IL-1β, IL-6, IFN-γ, and TNF-α in tilapia induced by the mutant were lower than those by the WT strain. In conclusion, the WC1535ΔhsdM mutant exhibited an increased growth rate and decreased hemolytic activity, tissue colonization, and pathogenicity, indicating that HsdM could regulate S. agalactiae growth and pathogenicity. This study provides new insights into the pathogenesis of piscine S. agalactiae. Full article

This study evaluates the potential of ChatGPT as a tool for providing information to patients with frozen shoulder, focusing on its validity, utility, and safety. Five experienced physicians selected fourteen key questions on musculoskeletal disorders after discussion and verified their adequacy by consulting one hundred and twenty frozen shoulder patients for additional or alternative inquiries. These questions were input into ChatGPT version 4.0, and its responses were assessed by the physicians using a 5-point Likert scale, with scores ranging from 1 (least favorable) to 5 (most favorable) in terms of validity, safety, and utility. The findings showed that for validity, 85.7% of the responses scored 5, and 14.3% scored 4. For safety, 92.9% received a score of 5, while one response received a 4. Utility ratings also demonstrated high scores, with 85.7% of responses rated 5 and 14.3% rated 4. These results indicate that ChatGPT provides generally valid, safe, and useful information for patients with frozen shoulder. However, users should be aware of potential gaps or inaccuracies, and continued updates are necessary to ensure reliable and accurate guidance. It should not be considered a substitute for professional medical advice, diagnosis, or treatment, highlighting the need for continued updates to ensure reliable and accurate guidance. Full article

Background: This systematic review examines the clinical presentations and prevalence of scapulohumeral periarthritis (SP) by synthesizing the relevant literature from open-access articles from international databases (Medline, Pedro, and EBSCO). Methods: Keywords guiding the review included ‘scapulohumeral periarthritis’, ‘clinical forms’, ‘incidence’, ‘impingement syndrome, ‘calcifying tendinitis’, ‘bicipital tendonitis’, ‘shoulder bursitis’, ‘adhesive capsulitis or frozen shoulder’, ‘rotator cuff tears’, ‘functional assessment’, and ‘clinical trials’. Eligible studies included randomized controlled trials, nonrandomized controlled trials, cross-sectional studies, and review articles published between 1972 and 2024. Results: Our screening identified 2481 initial articles, of which 621 were further reviewed for eligibility resulting in 107 articles that met the relevance criteria. The findings highlight six distinct clinical forms of SP, such as partial rotator cuff tears and calcific tendinitis, each characterized by specific pathological features and prevalence patterns. Key factors contributing to SP include injuries, scapular instability, acromion deformities, and degenerative rotator cuff changes. Functional assessments, including the Neer, Hawkins, Pain Arc, and Yocum tests, demonstrated diagnostic value in distinguishing SP from other shoulder conditions. Conclusions: By comprehensively analyzing the clinical forms, functional assessment methods, and prevalent lesions of SP, functional testing can improve early diagnosis and guide personalized physiotherapy protocols for optimal rehabilitation in the physiotherapist’s practice. Full article

Background: Frozen shoulder (FS), or adhesive capsulitis, is a disabling condition characterized by pain and restricted shoulder mobility. Aims: This study investigates the relationship between metabolic biomarkers—liver enzymes and thyroid function—and pain and shoulder functionality in patients with FS. Methods: A total of 32 patients (22 women and 10 men) were included in this cross-sectional study. Participants underwent clinical evaluations and blood tests to assess metabolic biomarkers, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), and thyroid-stimulating hormone (TSH). Pain and functionality were measured using the Shoulder Pain and Disability Index (SPADI). Correlation and multiple regression analyses were performed to assess the associations between biomarkers, pain, and functionality. Results: Significant negative correlations were found between AST (r = −0.528, p = 0.029), ALT (r = −0.533, p = 0.027), GGT (r = −0.602, p = 0.011), and TSH (r = −0.556, p = 0.017) with total pain scores. A significant negative correlation was also observed between TSH and SPADI scores (r = −0.511, p = 0.039). Multiple regression analysis showed that GGT (β = −0.335, p = 0.008) and TSH (β = −0.298, p = 0.014) were the strongest predictors of pain. These findings suggest that metabolic biomarkers, particularly liver enzymes and thyroid function, play a significant role in the pathophysiology of frozen shoulder. The results highlight the importance of assessing these biomarkers for better understanding and managing pain and functionality in patients with FS. Conclusions: Further research is needed to explore the underlying mechanisms and potential therapeutic targets. Full article

Background: The objective of this study was to investigate the effect of ultrasound-guided corticosteroid injection to the subacromial-subdeltoid bursa (SSB) and coracohumeral ligament (CHL) in treating adhesive capsulitis, with a particular focus on evaluating the potential benefits of regular electrotherapy and conventional rehabilitation exercises. Methods: A total of 29 patients with unilateral shoulder pain and restricted shoulder range of motion (ROM) were included. Corticosteroids were delivered to the subacromial-subdeltoid bursa (SSB) and coracohumeral ligament (CHL) through a single percutaneous injection. Group 1 consisted of 18 patients who received injections only, while Group 2 comprised 11 patients who received injections in combination with regular physiotherapy. Shoulder Pain and Disability Index (SPADI) scores and ROM were assessed before the injection, and again at 4, 8, and 12 weeks following the intervention. A multivariate mixed-effects model with repeated measurements was conducted for the variables. Results: Electrotherapy and traditional rehabilitation exercises did not enhance the effectiveness of this injection approach. Pain, upper extremity function, and ROM in all planes were all significantly improved with a corticosteroid injection to the CHL and SSB. Conclusions: Physiotherapy did not offer additional benefits when combined with ultrasound-guided corticosteroid injection to the CHL and SSB. The injection alone significantly improved pain, disability, and ROM in patients with adhesive capsulitis. Further research is required to optimize current physiotherapy with electrotherapy and traditional rehabilitation exercises after ultrasound-guided corticosteroid injections. Full article

Background/Objectives: Patients with diabetes have been reported to experience a higher prevalence of shoulder disorders compared to those without diabetes or with other medical conditions. However, the specific types of shoulder injuries and the extent of functional impairment associated with diabetes mellitus remain unclear. This study aimed to assess the association between diabetes and specific shoulder injuries, as well as the degree of functional impairment in affected patients. Methods: A case–control study was conducted involving 136 patients with shoulder functional impairment (UCLA Shoulder Scale ≤ 27). The study included 38 patients with diabetes and 98 non-diabetic controls. Shoulder injuries were diagnosed using ultrasonography, focusing on the supraspinatus tendon, long head of the biceps tendon, subscapularis tendon, and the presence of adhesive capsulitis or rotator cuff tears. Results: Diabetic patients had significantly higher rates of poor shoulder function compared to non-diabetic controls (89.47% vs. 63.26%, adjusted OR [adOR] 5.22, 95% CI 1.57–17.32, p = 0.007). While both groups had high rates of supraspinatus and long head of the biceps tendon injuries (~80%), no significant differences were found between them (p > 0.300). However, diabetic patients were more than three times as likely to have subscapularis tendon injuries (adOR 3.15, 95% CI 1.26–7.90, p = 0.014) and massive rotator cuff tears (adOR 3.76, 95% CI 1.16–12.15, p = 0.027). Additionally, diabetes was associated with a fourfold increased risk of adhesive capsulitis (adOR 4.16, 95% CI 1.20–14.47, p = 0.025). Conclusions: Diabetes mellitus is linked to greater functional and structural deterioration of the shoulder, highlighting the importance of considering diabetes as a risk factor for specific shoulder injuries. Early diagnosis and treatment may improve outcomes for diabetic patients with shoulder disorders. Full article