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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two female patients, aged 57 and 58 year-old presented with pain and stiffness in shoulder and/or pelvic girdles and a high ESR, suggesting polymyalgia rheumatica (PMR). The lack of response to low dose of steroids prompted us to reconsider this diagnosis and, after a careful evaluation and taking into account past clinical history, a final diagnosis of spondyloarthropathy (SpA) was made. The clinical spectrum of late SpA is heterogeneous, and in some instances may present as a polymyalgia-like syndrome.
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PMID:Spondyloarthropathy presenting as a polymyalgia rheumatica-like syndrome. 945 15

Shoulder stiffness occurs as a result of (1) contractures of the intraarticular capsule or muscle-tendon units or (2) adhesions within the extraarticular humeroscapular or scapulothoracic motion interface. These contractures or adhesions may occur independently or in combination. A thorough history and physical examination usually reveal the diagnosis (idiopathic frozen shoulder or posttraumatic stiff shoulder) and the anatomical locations of fibrosis that is causing stiffness, and identifies other treatable conditions associated with shoulder stiffness (such as diabetes). A gentle home program of passive stretching is effective in most patients. When the home program is not effective, a manipulation or surgical release may be indicated. If manipulation is not effective, capsular contractures are best released arthroscopically as this allows circumferential release without damaging the rotator cuff and thus allows rehabilitation without the need to protect the rotator cuff. The humeroscapular motion interface adhesions can be released either open or arthroscopically, but we believe that an open release combined with an arthroscopic capsular release is quicker and does not interfere with rehabilitation. When necessary, operative management coupled with an aggressive rehabilitation program can provide significant relief of pain and restoration of shoulder motion. Approximately 90% of patients can expect a good result with this treatment algorithm.
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PMID:Management of the stiff shoulder. 1066 31

Shoulder stiffness is commonly encountered in clinical practice but varies greatly in severity and etiology. Loss of shoulder range of motion can be a patient's primary complaint or may be a secondary finding. Possible causes of stiffness include guarding due to pain or secondary gain issues (nonanatomic), true mechanical blockage due to acute or chronic trauma, adhesive capsulitis, rotator cuff disease, or surgery on or near the shoulder. This review includes a more detailed discussion of these causes as well as the appropriate history and physical and diagnostic testing recommended for each. Finally, treatment strategies for each group of patients will be presented.
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PMID:Shoulder stiffness. 1865 45

The treatment of complex humeral fractures or fracture-dislocations presents several challenges. Late complications such as malunion, avascular necrosis, or nonunion are frequent and often lead to articular incongruence. Patients can be severely handicapped, presenting with considerable pain, stiffness, and important functional impairment. Stiff shoulders with distorted proximal humerus, soft tissue damage, a scarred deltoid, and rotator cuff tears make shoulder arthroplasty a challenging procedure, often with unpredictable results and a high risk of complications. The overall results of patients with old trauma are inferior to the results currently obtained in patients with primary osteoarthritis or with recent 4-part fractures who are treated initially with humeral head replacement. In certain circumstances, with important distortion of the proximal humerus, poor bone quality, rotator cuff lesions, or muscle atrophy a reverse shoulder arthroplasty can be proposed in elderly patients instead of a non-constrained arthroplasty.
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PMID:Treatment of fracture sequelae of the proximal humerus: anatomical vs reverse shoulder prosthesis. 2561 30

Shoulder stiffness is associated with diabetes mellitus. It is characterized by pain and restriction of active and passive range of motion. Like other complications of diabetes (e.g., arterial stiffness, pancreatic or renal fibrosis), shoulder stiffness is due to a fibrotic process. The clinical course is generally benign, but it can last for months, with remaining disabilities in the long term. Several possibilities of treatment are being used. The practitioner should be aware of this complication, its natural history, and the current treatments available in order to adequately tailor the best treatment to the patient, sometimes combining more than one option.
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PMID:The stiff shoulder in diabetic patients. 2730 1

Shoulder stiffness is a condition of painful restriction in active and passive glenohumeral range of motion, which can arise spontaneously or as consequence of a known cause. Numerous therapeutic approaches are available; however, no consensus has been reached on the best algorithm for successful treatment. The aim of this study was to investigate local practice patterns regarding management of primary shoulder stiffness. Randomized controlled trials reporting results of shoulder stiffness treatment were collected and analyzed prior to study begin. Controversial elements in the treatment of primary shoulder stiffness were identified and a survey was created and administrated to clinicians participating at an annual national congress dedicated to shoulder pathologies and their treatment. 55 completed questionnaires were collected. Physical therapy was recommended by 98% of the interviewed. The use of oral corticosteroids was considered by 58% and injections of corticosteroids by 60%. Injective therapy with local anaesthetics was considered by 56% of the clinicians and acupuncture by 36%. 38% of the interviewed did never treat shoulder stiffness surgically. Various strategies to manage shoulder stiffness have been proposed and high-level evidence has been published. Numerous controversial points and a substantial lack of consensus emerged both from literature reviews and from this survey. The treatment of shoulder stiffness should be tailored to the patient's clinical situation and the stage of its pathology, aiming primarily at identifying risk factors for recurrence, reducing pain, restoring range of motion and function and shortening the duration of symptoms.
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PMID:A survey on surgeon practice shows lack of consensus on the management of primary shoulder stiffness. 3326 Dec 57