Friday, August 28, 2009

Frozen shoulder as a algo-neuro-dystrophic process!

Waldburger et al (1992) of Switzerland subjected 50 cases of frozen shoulder across 3 Swiss medical centres to a radioisotope bone scan (99 mTc diphosphonate) study. They included 3 separate aetiological groups: post-traumatic (40%), neurological (14%) and idiopathic (46%). The findings are interesting:

a. 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.
b. Clinically, the neurological type was associated with a shoulder-hand syndrome with positive bone scan of the shoulder and the wrist in all cases.
c. 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.

These findings made the resesrchers to intervene the FS subjects with calcitonin administration along with Physical treatment. Calcitonin (100 U Calcitonin Sandoz) was administered for 21 days subcutaneously.

The researchers claim that this form of treatment (Calcitonin + physical activity) had a statistically significant increased effect on pain compared to treatment with physiotherapy alone by patients with post-traumatic frozen shoulders (p < 0.02). However they also found no significant difference in the speed of recovery of function. These observations made the researchers claim that adhesive capsulitis behave like an algoneurodystrophic process.

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