Shoulder adhesive capsulitis in cancer patients undergoing positron emission tomography-computed tomography and the association with shoulder pain

BACKGROUND Adhesive capsulitis is a relatively common condition that can develop in cancer patients during treatment.Positron emission tomography-computed tomography(PET-CT)is routinely performed as a follow-up study in cancer patients after therapy.Being aware of PET-CT findings to suggest shoulder adhesive capsulitis may help to alert clinicians for the diagnosis of unsuspected shoulder capsulitis.AIM To assess the association of shoulder adhesive capsulitis with cancer/therapy type and symptoms in cancer patients undergoing PET-CT.METHODS Our prospective study received Institutional Review Board approval.Written informed consent was obtained from all patients,who answered a questionnaire regarding shoulder pain/stiffness at the time of PET-CT study,between March 2015 and April 2019.Patients with advanced glenohumeral arthrosis,metastatic disease or other mass in the shoulder,or shoulder arthroplasty were excluded.Patterns of shoulder capsule 18F-fluorodeoxyglucose(FDG)uptake were noted.Standard Uptake Value(SUV)max and SUVmean values were measured at rotator interval(RI)and deltoid muscle in bilateral shoulders.Normalized SUV(SUV of RI/SUV of deltoid muscle)was also calculated.We assessed if SUV values are different between symptomatic and asymptomatic patients in both shoulders.Covariates were age,gender,and therapy type(surgery,chemotherapy,radiation).Wilcoxon rank sum tests were used to compare unadjusted marginal differences for age,SUV measurements between symptomatic and asymptomatic patients.Multiple linear regression models were used to examine the relationship between right or left shoulder SUV measurements and symptom status,after adjusting for covariates.Statistical significance level was set at P<0.05.RESULTS Of 252 patients initially enrolled for the study(mean age 66 years,67 symptomatic),shoulder PET-CT data were obtained in 200 patients(52 were excluded due to exclusion criteria above).The most common cancer types were lymphoma(n=61),lung(n=54)and breast(n=53).No significant difference was noted between symptomatic and asymptomatic patients in terms of age,gender,proportion of patients who had surgical therapy and radiation therapy.A proportion of patients who received chemotherapy was higher in patients who were asymptomatic in the right shoulder compared to those symptomatic in the right shoulder(65%vs 48%,P=0.012).No such difference was seen for the left shoulder.In both shoulders,SUVmax and SUVmean were higher in symptomatic shoulders than asymptomatic shoulders(Left SUVmax 2.0 vs 1.6,SUVmean 1.6 vs 1.3,both P<0.002;Right SUVmax 2.2 vs 1.8,SUVmean 1.8 vs 1.5,both P<0.01).For lung cancer patients,bilateral RI SUVmax and SUVmean values were higher in symptomatic shoulders than asymptomatic shoulders.For other cancer patients,symptomatic patients had higher left RI SUVmax/mean than asymptomatic patients after adjustment.CONCLUSION In symptomatic patients metabolic activities in RI were higher than asymptomatic patients.Adhesive capsulitis should be considered in cancer patients with shoulder symptoms and positive FDG uptake in RI.

Effectiveness of Kaltenborn Joint Mobilization Technique Versus Muscle Energy Technique on Pain and Disability in Patients with Shoulder Adhesive Capsulitis

The objective of this study was to compare the effectiveness of Kaltenborn joint mobilization techniques with muscle energy techniques in adhesive capsulitis.Study was conducted in population of Sargodha who is seeking physiotherapy treatment for adhesive capsulitis in physiotherapy rehabilitation departments and centers.The study design was randomized,controlled,and multicenter.Around 75 patients were selected by inclusion and exclusion criteria,and were divided into three groups by lottery method of randomization.Group 1 obtained Kaltenborn method of treatment,Group 2 obtained muscle energy technique,and Group 3 is control group that obtained conventional treatment in the form of heat and range of motion exercises.Duration of study was 6 months,and the interventions were performed for two weeks,with a total of 10 sessions.A baseline measurement was taken on shoulder pain and disability index(SPADI).A post intervention measurement was taken on same outcome measurement tools and was compared using ANOVA statistical analysis.The pre-intervention measurements on SPADI were 61.11±8.79,60.91±9.90,and 61.18±9.00 in control,Kaltenborn,and METs groups,respectively.The post intervention measurements were 49.33±9.95,39.09±9.45,and 27.69±11.97 in control,Kaltenborn,and METs groups,respectively.This study concluded that both techniques are effective in the treatment of adhesive capsulitis to decrease the pain and disability in experimental groups in comparison to control groups.METs is superior to Kaltenborn in pain and disability management when compared to each other.

Atypical progress of frozen shoulder after COVID-19 vaccination:A case report

BACKGROUND After vaccination was mandated worldwide,various adverse effects associated with the coronavirus disease 2019(COVID-19)vaccination,including shoulder pain,have been reported.Here,we report a case of new-onset shoulder pain after BNT162b2(Comirnaty,Pfizer-BioNTech)mRNA vaccination.CASE SUMMARY A 50-year-old man visited our rehabilitation center with left shoulder range of motion(ROM)limitation that had persisted for more than 5 mo.The history included no specific noteworthy events,except vaccination.The pain in the patient’s left deltoid muscle appeared 1 day after the second BNT162b2 vaccination and intensified to severe pain.The patient self-administered aspirin,with which the pain subsided immediately,whereas ROM limitation persisted.At the first visit,the patient complained of dull pain and ROM restriction of the left shoulder(flexion 130°,abduction 110°,and external rotation 40°).Among the diagnostic studies conducted for the evaluation of the shoulder,magnetic resonance imaging showed a thickened coracohumeral ligament.Nerve conduction studies and needle electromyography showed no electrodiagnostic abnormalities.The patient received comprehensive rehabilitation for 7 mo and had an overall improvement in pain and ROM of the left shoulder.CONCLUSION In this case of severe shoulder pain after COVID-19 vaccination that subsided immediately with aspirin treatment,the exact cause and mechanism of pain are unclear.However,the clinical symptoms and diagnostic workups in our report suggest the possibility that the COVID-19 vaccination triggered an immunochemical response that resulted in shoulder pathology.

Pain management of hemiplegic shoulder pain post stroke in patients from Nanjing,China

We selected 106 hemiplegic patients with shoulder pain hospitalized after stroke from three hospi- tals in Nanjing, China between February 2007 and January 2012. All patients had complete clinical data sets and accounted for 45.5% of the inpatients because of stroke. Results showed that the number of patients with hemiplegic shoulder pain post stroke increased yearly, attacking mainly males 50-69 years of age. Of 106 patients, there were 60 cases （56.6%） of adhesive capsulitis, 19 （17.9%） of shoulder subluxation, 14 （13.2%） of complex regional pain syndrome, and 13 （12.6%） of central pain. The main symptoms were shoulder pain （100%）, limit of shoulder mobility （98.1%）, and adhesion of the scapula （56.6%）. MRI of the shoulder showed tendon and ligament lesions （57.1%） and rotator cuff tear （38.1%）. 53.8% of central pain was related to the thalamus, in addition to the basal ganglia, brain stem, and cerebellopontine angle. Shoulder pain, upper limb motor function, and function independence were significantly improved after comprehensive rehabilitation. In par- ticular, electroacupuncture based on basic physical therapy exhibited efficacy on shoulder subluxa- tion and complex regional pain syndrome. Multiple linear regression results showed a negative re- lationship of efficacy of pain management with the attack period of shoulder pain, involvement of the posterior limb of the internal capsule, and duration between onset and rehabilitation treatment, but a positive correlation with pain-related education, pain regression period, and pain diagnosis.

Arthroscopic capsular release and manipulation under anaesthesia for frozen shoulders:A hot topic

A frozen shoulder is a common cause of shoulder pain and stiffness.The etiology and pathology of frozen shoulders is not fully understood yet.Frozen shoulderis characterized by a decrease in intra-articular volume and capsular compliance.This can lead to significant limitations in daily life.The majority of the patients can be treated conservatively,with functional recovery to be expected in two to three years.However,if conservative treatment fails,manipulation under anaesthesia and arthroscopic capsular release can both be considered as appropriate treatments.Manipulation is a traditionally well-established technique but in recent years it seems that arthroscopic capsular release has gained popularity.Manipulation is a relative time efficient and technically low-demanding procedure in which the glenohumeral joint is forced into different directions under general anaesthesia to release the capsular contracture,thereby increasing the range of motion of the joint.In arthroscopic capsular release the glenohumeral capsule can be released in a more controlled manner under direct vision.There are no prospective comparative trials available to display superiority of one procedure over the other.In addition,the optimal timing of both these interventions still has to be determined.An overview of the literature concerning this topic and a description of both procedures with its own advantages and disadvantages is provided.

Patients with Shoulder Dysfunction After Mastectomy Can Benefit from Nurse-Assisted Home-Based Range of Motion Exercises

Background:Shoulder dysfunction is very common after mastectomy,and there is also less follow-up for physiotherapy services among patients with mastectomy.Objective:A study was conducted to determine the role of nurse-assisted home-based range of motion(ROM)exercises in patients with shoulder dysfunction after mastectomy.Methods:A pre-and post-interventional study design was used to collect data from 30 post-mastectomy patients.The subjects were selected on a voluntary basis.Informed consent was obtained from post-mastectomy patients who were discharged from different oncology hospitals in Pakistan prior to their inclusion in this study.After obtaining a baseline measurement,the patients were supervised with nurse-assisted ROM exercises at home.The nurse-assisted home-based ROM exercise program was designed for such patients,and the patients were followed-up for up to 1 month.The total duration of the study was 1 year from August 2015 to August 2016.Post-intervention measurement was performed at the patients’home.The difference in terms of pain reduction and ROM improvement at the shoulder joint was recorded using goniometric measurements and the 100 mm visual analogue scale(VAS).Results:The mean age of the 30 subjects was 39.83±5.89.The mean ROM of shoulder flexion before the exercise program was 106.03°,which improved to 133.93°after 1 month of the exercise program.The mean ROM of shoulder abduction before treatment was 94.83°,which improved to 127.13°after 1 month of supervised exercise program.The mean ROM of shoulder rotation before the exercise program was 127.53°,which improved to 152.03°after 1 month of the exercise program.Conclusion:The nurse-assisted home-based shoulder ROM exercise program is effective in terms of improving the range of motion and reducing pain at the shoulder joint in post-mastectomy patients.

不同针法分期治疗肩关节周围炎90例

Objective:To observe the clinical efficacy of different acupuncture modalities in the treatment of adhesive capsulitis a tthrough different clinical stages.Methods:Ninety patients of adhesive capsulitis weregraded in three different stages based on clinical presentations.Patients in painful stage were treated with silver needles once every 5 to 7 days for two courses;patients in adhesive stage were given acupotomy treatment every 7 to 10 days for two courses;while patients in recovery stage were treated with acupuncture with warm needles by moxibustion on tendon knots,once a day 10 times in a course,for two courses of treatment.The disease scores were compared between all groups before and after the treatment,and clinical efficacy was evaluated after the treatment.Results:The disease scores in patients of all three stages were higher after treatment,and the differences were statistically significant(all P<0.05).Among 90 patients with adhesive capsulitis,32 cases were clinically under controlled,37 cases claimed remarkably effective,18 were effective,and 3 ineffective cases,thus the total effective rate for this stage-based treatment is 96.7%.Conclusion:For adhesive capsulitis,different acupuncture modalities targeting patients in different clinical stages were feasible and effective,the disease scores of patients were significantly improved.

Human bone marrow mesenchymal stem cell-derived extracellular vesicles inhibit shoulder stiffness via let-7a/Tgfbr1 axis

Shoulder stiffness(SS)is a common shoulder disease characterized by increasing pain and limited range of motion.SS is considered to be an inflammatory and fibrotic disorder pathologically.However,there is no consensus on the most effective conservative treatment for fibrosis.Given that human Bone Marrow Mesen-chymal Stem Cell-derived extracellular vesicles(BMSC-EVs)displayed promising therapeutic effects for various tissues,we investigated the therapeutic effect of BMSC-EVs on fibrosis in a mice immobilization model and two cell models.By conducting a series of experiments,we found that BMSC-EVs can significantly inhibit the fibrogenic process both in vitro and in vivo.In detail,BMSC-EVs suppressed the aberrant proliferation,high collagen production capacity,and activation of fibrotic pathways in TGF-β-stimulated fibroblasts in vitro.Besides,in vivo,BMSC-EVs reduced cell infiltration,reduced fibrotic tissue in the shoulder capsule,and improved shoulder mobility.In addition,via exosomal small RNA sequencing and qPCR analysis,let-7a-5p was verified to be the highest expressed miRNA with predicted antifibrotic capability in BMSC-EVs.The antifibrotic capacity of BMSC-EVs was significantly impaired after the knockdown of let-7a-5p.Moreover,we discovered that the mRNA of TGFBR1(the membrane receptor of transforming growth factorβ)was the target of let-7a-5p.Together,these findings elucidated the antifibrotic role of BMSC-EVs in shoulder capsular fibrosis.This study clarifies a new approach using stem cell-derived EVs therapy as an alternative to cell therapy,which may clinically benefit patients with SS in the future.

Prevalence and pattern of soft‐tissue rheumatism in a rural community in South‐South Nigeria: A cross‐sectional survey

Background:Soft tissue rheumatism arises from the pathology of periarticular structures.They are marked by pain and disability.Epidemiological studies in sub‐Saharan Africa are sparse.This study aimed to determine the epidemiology of soft‐tissue rheumatism in a rural community in South‐South Nigeria.Methods:This was a community‐based,cross‐sectional study conducted from February to July 2017 in South‐South Nigeria among 319 participants using the Community Oriented Program for the Control of Rheumatic Diseases(COPCORD)methodology.Participants aged 18 years and older were included in the study.Subjects reporting positive musculoskeletal pain were examined for specific soft tissue rheumatism.The diagnosis was based on established criteria.Results:The mean age of the study population was 48.87±19.58 years.The prevalence of soft‐tissue rheumatism was 11.0%(35/319).Soft tissue rheumatism was more prevalent in females(24,68.6%)than in males(11,31.4%).The most common form of soft‐tissue rheumatism diagnosed was adhesive capsulitis(20.0%),closely followed by rotator cuff tendinitis(14.3%),carpal tunnel syndrome(14.3%),and plantar fasciitis(14.3%).Age(p=0.06),body mass index(p=0.034),and dyslipidemia(p=0.028)were significantly associated with the prevalence of soft‐tissue rheumatism.A significant disability index(HAQ‐DI≥1)was recorded in 40.0%of participants with soft tissue rheumatism.Twelve(34.3%)participants with soft‐tissue rheumatism attributed the disorder to their work,and 74.3%used hospital‐prescribed medications for treatment.Conclusion:Soft‐tissue rheumatism is associated with a significant disability affecting activities of daily living.Factors associated with its prevalence include increasing age and obesity.