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The clinical efficacy and tolerability of sodium hyaluronate, a high-molecular-weight hyaluronic acid preparation, in the treatment of patients with periarthritis of the shoulder was investigated in a multicenter, cooperative study. Of 70 patients seen at 12 participating centers between April and September 1992, follow-up was possible in 62 (28 men and 34 women; mean age, 65.4 years). Patients received sodium hyaluronate 25 mg (1% solution in an ampule) once weekly for 5 weeks by injection into the glenoid cavity or the subacromial bursa. If periarthritis resolved during this period, treatment was stopped; if periarthritis had not fully resolved by the end of the 5 weeks, weekly or biweekly treatment was continued as appropriate. The mean treatment period was 8.16 +/- 0.88 weeks, and the mean total administered dose was 6.05 +/- 0.61 ampules. Rates of improvement over pretreatment values were 75.0% for pain at rest, 73.7% for pain on motion, and 78.8% for pain on pressure. Significant increases in joint angles (measured as components of joint range of motion after administration of sodium hyaluronate) were observed; activities of daily living also improved significantly (P < 0.05 to P < 0.001). No adverse reactions were observed. These results strongly suggest that sodium hyaluronate is an effective agent for the treatment of patients with periarthritis of the shoulder.
186 patients with periarthritis of the shoulder have been studied. The sex ratio was female:male, 1-52:1. The peak age of onset was 54-59 years in both sexes. Over 40% of the patients were referred to the clinic after 6 months had elapsed from the time of onset of the disease. The right shoulder was more frequently involved than the left, particularly in the men. One shoulder only was affected in 75% of patients. There was frequently a previous history of 'rheumatism' before the episode of periarthritis. In one-third of the women 'nonspecific rheumatism' had occurred. Cervicobrachial pain and a previous episode of shoulder pain had occurred more often in the women. There were a number of associated diseases, ischaemic heart disease, thyroid disease among women, diabetes among women, hemiplegia, pulmonary tuberculosis, chronic bronchitis, and epilepsy. Acute trauma was rarely a precipitating factor. Manual workers were more frequently seen than sedentary workers in the sample, and there were more in the sample than in the general population of Leeds. The general psychological background was no different from a control group. The Maudsley Personality Inventory gave no different results among patients with periarthritis of the shoulder than among a control group and among the general population. It is suggested that there is no evidence in this study for a 'periarthritic personality'. It is suggested that the cause of periarthritis of the shoulder is likely to be related to chronic trauma occurring in an age range when changes in connective tissue are occurring. Certain associated diseases may predispose the patient to this disorder.
The association between periarthritis of the shoulder and diabetes mellitus is well recognized. A study of 100 hospitalized patients with diabetes was performed, comparing them with 100 control subjects. The mean +/- SEM age of the subjects was 47 +/- 2 yr. Nineteen percent of the patients with diabetes had periarthritis. The afflicted subjects had a higher incidence of retinopathy (P less than 0.005) and albuminuria (P less than 0.005). The duration of shoulder pain correlated with the duration of the diabetes mellitus (P less than 0.001). However, the presence of other complications in subjects with periarthritis was not as well correlated with the duration of the diabetes mellitus. These data emphasize the common occurrence of periarthritis in subjects with diabetes mellitus and its extension to people of diverse backgrounds.
OBJECTIVE: To explore the effect of treating periarthritis of shoulder with manipulation through evaluating clinical reports with the theory of evidence-based medicine (EMB). METHODS: By retrieval of some main medical literature databases in the past 5 years, 242 articles on treating periarthritis of shoulder with manipulation were available. Selected by admission standard, 10 of them were evaluated with EBM theory. RESULTS: Both single-application and union-application of manipulation were effective to periarthritis of shoulder, but the evaluated articles were all low-quality articles. CONCLUSION: Because of low quality clinic test and larvaceous publication bias, the extant evidence is not enough to recommend replacing other therapeutic methods by manipulation. The low quality of evaluated articles suggests that there exist some methodology problems in the clinic test on treating periarthritis of shoulder with manipulation.
We describe a mother and 2 daughters with familial recurrent calcific periarthritis in a family with an inherited tendency to develop generalized osteoarthritis (OA). Low levels of serum alkaline phosphatase were found in 1 of the daughters while the mother developed erosive OA in later life. HLA typing was noncontributory. However, the 3 individuals with periarthritis possessed blood group A+, while the 6 unaffected family members were O+. The experience of this family adds weight to the case that recurrent calcific periarthritis may be due to an inherited abnormality of alkaline phosphatase production and suggest that this may also be responsible for the recently observed association of calcific periarthritis and erosive OA.
On retrospective reviews of radiographs, periarthritis calcarea was distinguished from os acetabula by interval radiographic progression and regression. Among 59 men and 51 women, there were 137 instances of para-acetabular calcifications and ossifications, which were morphologically classified as 58 discrete, 58 amorphous, and 21 segmented types. Correlations with other radiographic abnormalities, symptoms, signs, and laboratory abnormalities were sought, but not established. Out of 93 serially imaged opacities, 90 changed, including 37 of the 40 instances (92.5%) of the discrete type and 53 instances (100%) of the amorphous and segmented types--due to periarthritis calcarea. At least 43 of 90 densities were newly developed. Mean age at first detection was 47.7 years. Three of the discrete densities were unchanged and represented os acetabula. Thus, recognition of para-acetabular periarthritis calcarea is not only of academic importance; it can facilitate proper treatment as well.
PURPOSE: Evaluation of MRI in radiotherapy of humeroscapular periarthritis. PATIENTS AND METHODS: Seventy-seven patients with humeroscapular periarthritis prospectively underwent MRI before radiotherapy. RESULTS: Six months after radiotherapy, 34% of the patients had achieved complete pain relief, 35% major pain relief. Twenty percent had only slight improvement and 12% no improvement. Positive correlation of radiotherapy outcome and MRI findings could be shown for acute tendinitis, erosions, and complete and incomplete ruptures of the supraspinatus tendon. CONCLUSIONS: Radiotherapy is highly effective in the treatment of humeroscapular periarthritis. The indication can be improved using MRI.
Basic calcium phosphate (BCP) crystal deposition around the joints may sometimes lead to an acute inflammatory condition called calcific periarthritis. In this article, the authors describe a 62-year-old man with BCP crystal-induced periarthritis coexisting with an infection. Rheumatoid arthritis and crystal-induced synovitis complicated by infection has been described in the literature. To date, this is the first report of coexistent calcific periarthritis and an infection.
OBJECTIVE: To evaluate the efficacy and safety of oxaprozin in comparison with diclofenac in patients with periarthritis pain of the shoulder previously unsuccessfully treated with nonsteroidal anti-inflammatory drugs other than diclofenac and oxaprozin. METHODS: In this open, multicentre, randomised, controlled study, eligible patients with periarthritis of the shoulder were randomised to receive either oxaprozin 1200 mg once daily (n = 49) or diclofenac 50 mg three times daily (n = 47). The treatment period was 15 +/- 1 days. The study was planned on a hypothesis of equivalence between the two study drugs. The primary study endpoint was the change from baseline at day 15 in the patient-assessed shoulder pain score. Secondary efficacy variables included investigator-assessed shoulder function, patient-assessed quality of life on the Short-Form-36 (SF-36) Acute Health Survey and both patients' and investigators' overall assessment of efficacy. RESULTS: At day 15, the mean changes in shoulder pain score from baseline in the oxaprozin and diclofenac groups were -5.85 +/- SD 4.62 and -5.54 +/- SD 4.41, respectively. The difference between the two groups was not statistically significant, confirming the hypothesis of the study that oxaprozin is as effective as diclofenac. Investigator-assessed shoulder function improved in both groups but more so in the oxaprozin group (p = 0.028 at day 15). Quality of life as measured by SF-36 total score was also improved in both treatment groups, with a trend toward greater improvement in the oxaprozin group. Furthermore, a significantly more favourable effect on the SF-36 'mental health' item was observed in oxaprozin compared with diclofenac-treated patients at day 15 (p = 0.0202). As assessed by investigators, the overall efficacy of oxaprozin was superior to that for diclofenac at visit 3 (8 +/- 1 days) (p = 0.0067). Patients also assessed the overall efficacy of oxaprozin as superior to that of diclofenac at visits 3 (8 +/- 1 days) (p = 0.0235) and 4 (15 +/- 1 days) (p = 0.0272). Only six adverse events, all of which were mild or moderate in intensity and occurred in four diclofenac recipients, were observed in the study. CONCLUSIONS: As expected, once-daily oxaprozin proved to be as effective as diclofenac three times daily in reducing the primary efficacy variable of patient-assessed shoulder pain score in patients with periarthritis of the shoulder refractory to previous treatments with other NSAIDs. Oxaprozin was shown to be superior to diclofenac in improving shoulder function and was considered by investigators and patients to have greater overall efficacy than diclofenac. In addition, oxaprozin showed a trend toward superior results in improving patients' quality of life compared with diclofenac. A trend towards better tolerability results for oxaprozin compared with diclofenac was also noted.
Three patients with limited cutaneous scleroderma (CREST syndrome) and acute calcific periarthritis are presented. "Chalky" bursal effusion in one patient demonstrated masses of calcium hydroxyapatite crystals. In contrast to idiopathic acute calcific periarthritis, resorption of periarticular calcifications after resolution of acute attacks occurs both less frequently and incompletely in scleroderma associated acute calcific periarthritis.
BACKGROUND: Radiation therapy is applied in painful degenerative shoulder diseases. Aim of this work was to evaluate the contribution of radiation therapy to symptomatic improvement in periarthritis humeroscapularis. METHODS: Ninety-four patients with periarthritis humeroscapularis were treated in two institutions. Mean age was 68 years, sex distribution were 32 men and 62 women. In 58 cases the right side was affected, left in 36 cases. At single doses of 0.75 Gy once a week a total dose of 6 Gy was applied (Fig. 1). The treatment effect was evaluated by the standardized von Pannewitz-score at the end of the treatment up to 6 months thereafter. RESULTS: The treatment results of all the 94 patients were documentated at the end of therapy. Seventy-one patients were followed at least for further 4 months. Radiogenic side-effects were not noticed. The symptoms of 54 patients (57.4%) were improved or vanished, in 40 cases the symptoms were not significantly affected (42.6%) (Table 1). Four months after therapy 42 of 71 patients were improved (59.2%), 29 unchanged (40.8%) (Table 2). The treatment effect occured typically up to 2 months after therapy, there were no age-related differences. Also in recurrent radiation therapies the symptoms improved, in 80 percent after one preceding therapy (Table 3), however only in 31.2 percent after multiple prior radiotherapies (Table 4). CONCLUSION: Radiation therapy is effective in the symptomatic treatment of periarthritis humeroscapularis. Treatment should be performed early after initial conservative treatment prior to any invasive therapy.
OBJECTIVE: To introduce to establishment method of evidence-based acupuncture and moxibustion treatment program for periarthritis of shoulder from the point of view of evidence-based medicine. METHODS: One patient of periarthritis of shoulder was used as an example, and it was introduced how to raise clinical questions, to retrieval relative literature, to evaluate the retrieval literature, and at last, how to use the retrieval evidences to stipulate treatment program in combination with concrete condition of this case and the doctor's experience. RESULTS: The acupuncture and moxibustion treatment program for periarthritis of shoulder established by evidence-based medicine was adopted to treat the patient for 15 sessions, as a result the life quality of the patient improved obviously. CONCLUSION: Through clinically raising questions, searching for evidences, analyzing evidences, making a strategic decision, practising evidence-based course, the patient can attain satisfactory therapeutic effect, and the physician can raise theoretical level and clinical ability.
OBJECTIVE: Two typical clinical courses of calcific periarthritis in the shoulder are known: acute, with severe inflammation, and chronic, in the form of impingement syndrome with secondary subacromial bursitis. It remains unclear what factors determine these clinical courses. Our objectives were to clarify whether the calcified deposits that occur in both acute and chronic cases are composed of carbonate apatite; and to compare the Ca:P molar ratio in the 2 forms and to determine if there was any correlation in this respect with the intensity of inflammation induced by basic calcium phosphate crystals. METHODS: Ten samples were aspirated from 10 women (ages 42-65 yrs) with acute inflammation. The average time from first attack to aspiration was 2.3 days. A further 10 samples were operatively removed from 10 women (ages 35-58 yrs) with refractory chronic subacromial bursitis, among whom an average of 7.8 months had passed since the onset of symptoms. All samples were analyzed by x-ray diffraction, Fourier transform infrared spectroscopy, and Raman spectroscopy, and Ca:P molar ratios were measured by x-ray fluorescence spectrometry. RESULTS: Calcified deposits from both acute and chronic cases were identified as carbonate apatite, and not hydroxyapatite, octacalcium phosphate, tricalcium phosphate, or dicalcium phosphate dihydrate. The average Ca:P molar ratio of calcified deposits was calculated as 1.71 +/- 0.16 in acute cases and 1.71 +/- 0.16 in chronic cases (statistically nonsignificant). CONCLUSION: Deposits around the shoulder in both acute and chronic calcific periarthritis are composed of carbonate apatite, Ca:P molar ratios being almost identical in the 2 forms. The results suggest that some factor other than the composition of the crystalline deposits may determine clinical course in calcific periarthritis of the shoulder.
OBJECTIVE: To observe the therapeutic effect of transcutaneous point electric stimulation on periarthritis of shoulder at different stages and compare with electroacupuncture. METHODS: Three hundred and sixty cases of periarthritis of shoulder at different stages were divided into a treatment group (n=186) treated with transcutaneous point electric stimulation, and a control group (n=174) treated with electroacupuncture. Same acupoints were selected in the two groups. RESULTS: The total effective rate of transcutaneous point electric stimulation was 96.6% at the adhesion prophase and 96.9% at the adhesive stage, but electroacupuncture stimulation was 93.5% and 97.9%, respectively, with no significant differences between the two groups; transcutaneous point electric stimulation not only could relieve pain, but also significantly improve dysfunction of shoulder joints at the adhesive stage. CONCLUSION: Transcutaneous point electric stimulation is an effective and convenient therapy for periarthritis of shoulder.
To clarify the scapulo-humeral rhythm in twenty-five patients with periarthritis scapulo-humeralis, the movements of the scapula and the humerus during arm elevation were measured and analysed using a fluoroscope and a computer, and the rhythm of five patient with rotator cuff tear was compared with that of seven normal subjects. The ratio of scapular movement to humeral one in the patients with severe shoulder contracture due to periarthritis scapulohumeralis was greater than that of patients with mild contracture and that of normal subjects. In the patients with rotator cuff tear, wider range of scapular rotation was observed in the early phase of the motion. During the early phase of arm elevation, the humeral head moved to the upper direction by means of gliding in the patients with severely contracted shoulder and rotator cuff tear, and in the patients with mildly contracted shoulder the humeral head moved to the upper direction by means of ball rolling. In the normal subjects no such upward movement of the humeral head was observed. We believe that the restriction of the glenohumeral joint motion and dysfunction of the rotator cuff, which were caused by periarthritis scapulohumeralis, may break down the scapulohumeral rhythm.
The condition of generalized periarthritis calcarea (hydroxyapatite deposition disease) is characterised by multiple periarticular calcification which can be localised around practically any joint and also in proximity to the spine. This calcification consists of hydroxyapatite crystals which are responsible for the episodes of acute, subacute or chronic periarticular or articular inflammation so typical of the condition. Because of this one can classify periarthritis calcarea along with gout and chondrocalcinosis in the group of crystal deposition diseases. The actual cause of the calcification remains unknown but it is probable that, along with hereditary factors, disturbances in metabolism play an important role. The diagnosis of generalised periarthritis is made from the characteristic X-ray picture in conjunction with the clinical findings and, on occasion, the demonstration of hydroxyapatite crystals in the affected tissues. In the differential diagnosis gout, chondrocalcinosis, various inflammatory rheumatic conditions and septic arthritis must be excluded and various calcification processes, particularly interstitial calcinosis and lipocal cinogranulomatosis, must also be considered. Since the etiology of the calcification remains unknown to specific treatment is available. Symptomatic treatment with colchicine is mostly inadequate which is why one often has recourse to the use of non-steroid anti-inflammatory drugs and corticosteroids.