Frozen shoulder (FS) is a common shoulder disorder characterized by a gradual increase of pain of spontaneous onset and limitation in range of motion of the glenohumeral joint. The pathophysiology of FS is relatively well understood as a pathological process of synovial inflammation followed by capsular fibrosis, but the cause of FS is still unknown. Treatment modalities for FS include medication, local steroid injection, physiotherapy, hydrodistension, manipulation under anesthesia, arthroscopic capsular release, and open capsular release. Conservative management leads to improvement in most cases. Failure to obtain symptomatic improvement and continued functional disability after 3 to 6 months of conservative treatment are general indications for surgical management. However, there is no consensus as to the most efficacious treatments for this condition. In this review article, we provide an overview of current treatment methods for FS.
BackgroundThe purpose of this study was to investigate the incidence of acromial fracture after reverse total shoulder arthroplasty (RTSA) and clinical and radiological outcomes of treatment of the fracture.MethodsA systematic review was performed to identify studies that reported the results of treatment of acromial fractures after RTSA. A literature search was conducted by two investigators using four databases (PubMed, Embase, Cochrane, and Ovid Medline).ResultsFifteen studies (2,857 shoulders) satisfied our inclusion criteria. The incidence of acromial fracture after RTSA was 4.0% (114 / 2,857). The mean age of the patients at the time of fracture was 72.9 years (range, 51 to 91 years). The mean time from RTSA to diagnosis of acromial fracture was 9.4 months (range, 1 to 94 months). One hundred shoulders (87.7%) were treated conservatively and 14 shoulders (12.3%) were treated surgically. The mean follow-up period after acromial fracture was 33.8 months. The overall union rate was 50.0% (43.8% for conservative treatment and 87.5% for operative treatment). The fracture incidence was significantly different among the medial glenoid and medial humerus prosthesis design (8.4%), the lateral glenoid and medial humerus design (4.0%), and the medial glenoid and lateral humerus design (2.8%). The mean values at final follow-up were as follows: visual analog scale score, 2.2; American Shoulder and Elbow Surgeons score, 59.1; Constant score, 59.7; and Simple Shoulder Test, 5.8. The mean forward flexion, abduction, and external rotation were 102.3°, 92.3°, and 25.8°, respectively.ConclusionsAcromial fractures after RTSA are a complication neither uncommon nor negligible. In the absence of studies with high-level evidence, there is a controversy on the outcomes after treatment. Further well-designed prospective randomized controlled studies with a long-term follow-up should be performed to ascertain the diagnosis, treatment, and prognosis of acromial fractures after RTSA.
Frozen shoulder (FS), also known as adhesive capsulitis, is a common pathologic condition of the shoulder joint. It is characterized by progressive shoulder pain and restriction of the range of motion. 1) Despite its prevalence, FS is one of the most poorly understood shoulder conditions. Its definition, classification, pathophysiology, diagnosis, natu-ral course, treatment, and prognosis remain controversial. [2][3][4][5] Zuckerman and Rokito 6) surveyed members of the American Shoulder and Elbow Surgeons (ASES) association on the definition of FS to assist clinicians in counseling patients with FS. They reported that the heterogeneity of the definition and classification of FS in previous studies makes it difficult to compare the outcome and prognosis of different studies that describe either diagnostic or treatment modalities. 6) In 1934, Codman 7) suggested that FS will resolve spontaneously even in most severe cases regardless of treatment. However, clinicians often encounter patients complaining of residual pain and loss of motion even at 2
Both arthroscopic and open surgery for septic shoulders showed satisfactory clinical outcomes. Old age and comorbidity were poor prognostic factors of clinical outcomes after treatment.
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