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Soft tissue disorders of the shoulder. Frozen shoulder, calcific tendintis, and bicipital tendinitis.

The painful periarticular conditions about the shoulder joint-calcific tendinitis, bicipital tendinitis, and frozen shoulder syndrome-are seen commonly in the general practice of medicine or in the practice of orthopedic surgery. Their etiologies are unknown. Their treatment is relatively simple and depends upon a knowledge of the anatomic structures involved and the proper use of rest and exercise. Operative intervention is rarely necessary in any of these conditions. The frozen shoulder syndrome, however, in our experience is best treated in the subacute or chronic stages by infiltration brisement under general anesthesia.

Bursitis

Bioinformatics analysis of ferroptosis in frozen shoulder.

OBJECTIVES: Frozen shoulder is a common shoulder disease that significantly affects the patient's life and work. Ferroptosis is a new type of programmed cell death, which is involved in many diseases. However, there have been no studies reporting the relationship between frozen shoulders and ferroptosis. This study identified potential molecular markers of ferroptosis in frozen shoulders to provide more effective strategies for the treatment of frozen shoulders. METHODS: GSE238053 was downloaded from the Gene Expression Omnibus (GEO) dataset and intersected with ferroptosis genes to obtain differentially expressed genes (DEGs). The signaling pathways and biological functions of DEGs were performed by WebGestalt and Metascape. The interactions related to these DEGs and the key genes between frozen shoulders and ferroptosis was performed by STRING and Cytoscape. A frozen shoulders rat model was used to validate our predicted genes, Western Blot and qRT-PCR was used to assess the expression levels of our genes of interest. RESULTS: A total of 34 DEGs between GSE238053 and Ferroptosis Database were obtained, most of which were involved in the HIF-1 signaling pathway and inflammatory response. A protein-protein interaction network was obtained by Cytoscape and the key genes (IL-6, HMOX1 and TLR4) were screened by MCODE. Our results of Western Blot showed that the protein expression level of TLR4 and HMOX1 were elevated, and the protein level of IL-6 decreased in frozen shoulders rat model. The mRNA level after frozen shoulders showed that IL-6 was upregulated, whereas TLR4 and HMOX1were downregulated. CONCLUSIONS: The results demonstrated that ferroptosis may affect the pathological process of frozen shoulders through these signaling pathways and genes. The identification of IL-6, HMOX1 and TLR4 genes can provide new therapeutic targets for frozen shoulders.

Ferroptosis

Personality in frozen shoulder.

Fifty-six patients with frozen shoulder have had their personality profiles investigated by means of the Middlesex Hospital Questionnaire. Females showed significantly increased somatic anxiety compared with controls. It is suggested that this may be important both to aetiology and treatment. Males and females should be assessed separately in future studies of frozen shoulder.

Adult

HLA-B27 and frozen shoulder.

Histocompatibility antigens were determined in 38 patients with frozen shoulder and 216 normal blood-donors. HLA-B27 was significantly more common in patients with frozen shoulder (42%) than in the controls (10%). The distribution of the other 19 histocompatibility antigens was similar in the patient and control groups. This result may be associated with the suggested immunological pathogenesis of the condition.

Adult

Immunological studies in frozen shoulder.

Serum immunoglobulin levels were determined in 25 patients with frozen shoulder and in 25 age- and sex-matched controls. Serum IgA levels were significantly reduced (P less than 0.001) in the patients with frozen shoulder and remained so after clinical recovery. Lymphocyte transformation to phytohaemagglutinin in 21 patients also showed significant depression (P less than 0.01). These results support the suggested immunological pathogenesis of this condition.

Adult

The natural history of the frozen shoulder syndrome.

A prospective study has been made of 49 patients with the frozen shoulder syndrome (as distinct from tendinitis, calcific deposits and frozen shoulders occurring after coronary infarction or with pulmonary tuberculosis) of whom forty-one have been followed up for 5-10 years, always to their greatest recovery. There were three consecutive stages: pain, stiffness, and recovery. The stiffness stage was usually related to the duration of the recovery stage. The total duration was longer than is generally supposed (an average total of 30.1 months in contrast to about 18 months as often postulated). Generally speaking, the longer the stiffness stage is, the longer is the recovery stage. In 4 patients the second shoulder became similarly affected, 6 months to 7 years after the first, and followed a similar chronological sequence to the first. After greatest recovery, slight restriction of movement was found in more than half the cases, but in only 3, all of long duration, was the restriction a handicap. Arthrography, carried out on both shoulders in all patients during the recovery stage, showed in the affected shoulder fewer rotator cuff defects than expected at this age and fewer (four) than in the contralateral one (twenty-three); seemingly, the condition leads to the obliteration of some defects.

Adult

The frozen shoulder: diagnosis and treatment. Prospective study of 50 cases of adhesive capsulitis.

A prospective study of randomized analysis treatment of 50 cases of frozen shoulder was carried out in 3 Swiss medical centres. Three separate aetiological groups were studied: post-traumatic (40%), neurological (14%) and idiopathic (46%). An increased radioisotope bone scan (99 mTc diphosphonate) was found in 96% of cases, regardless of aetiology. The so-called idiopathic frozen shoulder showed a scapulo-humeral increase in radioisotope uptake in several areas (in 82% of cases) without involvement of the ipsilateral carpus. Clinically, the neurological type was associated with a shoulder-hand syndrome with positive bone scan of the shoulder and the wrist in all cases. The post-traumatic type showed a diffuse (in 50% of the cases) or at several circumscribed areas (also in 50%) increase in radioisotope uptake in the shoulder. In 45% of the post-traumatic type, there was also a shoulder-hand syndrome with uptake in the wrist also. A physical treatment and early mobilization, associated with the administration of subcutaneous salmon calcitonin for 21 days (100 U Calcitonin Sandoz) had a statistically significant increased effect on pain compared to treatment with physiotherapy alone by patients with post-traumatic frozen shoulders (p < 0.02). There was no significant difference, however, in the speed of recovery of function between the two treatment groups. These observations strengthen the hypothesis that adhesive capsulitis behave like an algoneurodystrophic process.

Adult

[Morphology of the incisura scapulae in relation to the frozen shoulder (author's transl)].

A flat incisura scapulae was registered on radiological examination of four cases of frozen shoulder. A modified X-ray technique was used to investigated 250 patients with spondylosis cervicalis in a morphological study of the incisura scapulae. Three types were found: Type I with a deep, sharp incisura, type 2 with a widened, balloon-sharped incisura and type 3 with a flat, barely-distinguishable incisura. The significance of the X-ray appearance is discussed.

Adult

Physiotherapy and the frozen shoulder: a comparative trial of ice and ultrasonic therapy.

In a prospective study ice and ultrasonic applications have been compared in a series of patients with the frozen shoulder syndrome. No significant advantage of one treatment over the other could be demonstrated. It would appear that both of these physiotherapy methods can shorten the painful stage of the condition and, in conjunction with specific exercises, hasten recovery of the range of shoulder movement.

Adult

[Frozen shoulder].

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Exercise Therapy

Spectrum of lesions of the anterior capsular mechanism of the shoulder.

The anterior capsular mechanism appears to be the common denominator in a number of shoulder problems ranging from the recurrent dislocation ("too loose") to the frozen shoulder ("too tight"). The shoulder region and the anterior capsular mechanism can be carefully and accurately assessed by arthrography and cineradiography. Bicipital tenosynovitis has been held accountable for shoulder problems at each extreme of the spectrum. Bicipital tenosynovitis may exist in many shoulders; however, in corrective procedures for the unstable shoulder, the biceps becomes a dynamic reinforcement of the anterior capsule. In the frozen shoulder, the biceps tendon frequently is seen as normal at surgery and the anterior capsular mechanism is identified as the site of the essential lesion. Surgery may switch the patient's problem from one side of the spectrum to the other. Shoulder problems should be investigated thoroughly and evaluated in terms of the patient's requirements for shoulder motion as well as in terms of the orthopaedic surgeon's usual criteria for recommending corrective procedures.

Adolescent