***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
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    Input: HYPOTHESIS Adhesive capsulitis is a condition that results in restricted glenohumeral motion . Fibroblasts have been implicated in the disease process ; however , their role as a contractile element in the development of fibrosis and capsular contracture is not well understood . We hypothesized ( 1 ) that myofibroblast prevalence in capsular biopsy specimens from patients with adhesive capsulitis would be increased compared with controls and ( 2 ) that patients treated with an intra-articular injection of corticosteroid would have fewer myofibroblasts . METHODS The study prospect ively enrolled 20 consecutive patients with adhesive capsulitis scheduled for capsular release and matched controls . Tissue sample s were collected from the posterior and anterior capsule for histomorphologic and immunohistologic analyses . Identical sectioning and preparation was performed in 14 additional adhesive capsulitis specimens from patients who had not received corticosteroid injections . RESULTS Patients with adhesive capsulitis not treated with preoperative corticosteroid demonstrated more histologic evidence of fibromatosis , synovial hyperplasia , and an increase in positive staining for α-smooth muscle actin than patients who had received intra-articular injections of steroid . No specimens obtained from control patients demonstrated positive staining for α-smooth muscle actin . DISCUSSION There was a higher prevalence of myofibroblast staining in patients with adhesive capsulitis , implicating activation of the myofibroblast in the pathophysiology of capsular contracture . Intra-articular steroid injection decreases the presence and amount of fibromatosis , vascular hyperplasia , fibrosis , and the presence of fibroblasts staining for α-smooth muscle actin . This supports the use of steroid injections to alter the disease process by decreasing the pathologic changes found in the capsular tissue Background and Purpose : The purpose of this study was to determine whether physical therapy interventions predicted meaningful short-term improvement in 4 measures of physical health , pain , and function for patients diagnosed with adhesive capsulitis . Participants : Data were examined from 2,370 patients ( mean age=55.3 years , SD=12.4 ; 65 % female , 35 % male ) classified into ICD-9 code 726.0 who had completed an episode of outpatient physical therapy .  Methods : Principal components factor analysis was used to define intervention categories from specific treatments applied during the episode of care . A nested logistic regression model was used to identify intervention categories that predicted a 50 % or greater change in Physical Component Summary -12 ( PCS-12 ) , physical function ( PF ) , bodily pain ( BP ) , and hybrid function ( HF ) scores . Results : None of the patients achieved a 50 % or greater improvement in PCS-12 scores . Improvement in BP scores was more likely in patients who received joint mobility interventions ( odds ratio=1.35 , 95 % confidence interval=1.10–1.65 ) . Improvement in HF scores was more likely in patients who received exercise interventions ( odds ratio=1.50 , 95 % confidence interval=1.03–2.17 ) . Use of iontophoresis , phonophoresis , ultrasound , or massage reduced the likelihood of improvement in these 3 outcome measures by 19 % to 32 % . Limitations : The authors relied on clinician-identified ICD-9 coding for the diagnosis . Impairment measures were not available to support the diagnosis , and some interventions were excluded because of infrequent use by participating therapists . Discussion and Conclusions : These results are consistent with findings from r and omized clinical trials that demonstrated the effectiveness of joint mobilization and exercise for patients with adhesive capsulitis . Ultrasound , massage , iontophoresis , and phonophoresis reduced the likelihood of a favorable outcome , which suggests that use of these modalities should be discouraged OBJECTIVE To determine whether a short course of prednisolone is superior to placebo for improving pain , function , and range of motion in adhesive capsulitis . DESIGN Double blind , r and omised , placebo controlled trial . SETTING Community based rheumatology practice in Australia . PARTICIPANTS 50 participants ( 24 active , 26 placebo ) ; 46 completed the 12 week protocol . Entry criteria were age > or = 18 years , pain and stiffness in predominantly one shoulder for > or =3 weeks , and restriction of passive motion by > 30 degrees in two or more planes . INTERVENTIONS 30 mg oral prednisolone/day for three weeks or placebo . MAIN OUTCOME MEASURES Overall , night , and activity related pain , SPADI , Croft shoulder disability question naire , DASH , HAQ , SF-36 , participant rated improvement , and range of active motion measured at baseline and at 3 , 6 , and 12 weeks . RESULTS At 3 weeks , there was greater improvement in overall pain in the prednisolone group than in the placebo group ( mean ( SD ) change from baseline , 4.1 ( 2.3 ) v 1.4 ( 2.3 ) ; adjusted difference in mean change between the two groups , 2.4 ( 95 % CI , 1.1 to 3.8 ) ) . There was also greater improvement in disability , range of active motion , and participant rated improvement ( marked or moderate overall improvement in 22/23 v 11/23 ; RR = 2 ( 1.3 to 3.1 ) , p = 0.001 ) . At 6 weeks the analysis favoured the prednisolone group for most outcomes but none of the differences was significant . At 12 weeks , the analysis tended to favour the placebo group . CONCLUSIONS A three week course of 30 mg prednisolone daily is of significant short term benefit in adhesive capsulitis but benefits are not maintained beyond six weeks Background : Frozen shoulder has always been considered important because of the impact on the quality -of-life and long period of illness . Therefore , the use of noninvasive and safe techniques that can speed up the healing process of the disease is important . Methods : This study was a r and omized clinical trial study on patients suffering from frozen shoulder who were referred to Isfahan University of Medical Sciences hospitals in 2011 and 2012 . A total of 36 patients were enrolled in the study . Eligible patients were allocated into two groups . Intervention group received extracorporeal shockwave therapy ( ESWT ) once a week for 4 weeks . The control group received sham shockwave therapy once a week for 4 weeks . On the follow-up period , changes in individual performance and the amount of pain and disability were assessed by the Shoulder Pain and Disability Index ( SPADI ) question naire and the range of motion changes were assessed by a goniometer . Data obtained were analyzed using SPSS software . Results : Variance analysis revealed a difference in the mean pain and disability score of the SPADI question naire , flexion , extension , and abduction , external rotation of involved shoulder between two groups before and after the shockwave therapy ( P < 0.05 ) . Improvement was more satisfactory in the intervention group , but the mean internal rotation did not differ significantly in two groups ( P > 0.05 ) . Conclusions : The use of ESWT seems to have positive effects on treatment , quicker return to daily activities , and quality -of-life improvement on frozen shoulder Seventy seven patients with soft tissue shoulder lesions including adhesive capsulitis and disorders of the rotator cuff and acromioclavicular joint were admitted to a trial comparing two different methods of corticosteroid injection with local anaesthetic in a r and omly allocated double blind study . The method of anatomical injection after diagnosis by the technique of selective tissue tension gave 60 % success compared with the method using tender or trigger point localisation , giving 20 % success ( p less than 0.001 ) BACKGROUND AND PURPOSE In many physical therapy programs for subjects with adhesive capsulitis of the shoulder , mobilization techniques are an important part of the intervention . The purpose of this study was to compare the effectiveness of high- grade mobilization techniques ( HGMT ) with that of low- grade mobilization techniques ( LGMT ) in subjects with adhesive capsulitis of the shoulder . SUBJECTS One hundred subjects with unilateral adhesive capsulitis lasting 3 months or more and a > or = 50 % decrease in passive joint mobility relative to the nonaffected side were enrolled in this study . METHODS Subjects r and omly assigned to the HGMT group were treated with intensive passive mobilization techniques in end-range positions of the glenohumeral joint , and subjects in the LGMT group were treated with passive mobilization techniques within the pain-free zone . The duration of treatment was a maximum of 12 weeks ( 24 sessions ) in both groups . Subjects were assessed at baseline and at 3 , 6 , and 12 months by a masked assessor . Primary outcome measures included active and passive range of motion and shoulder disability ( Shoulder Rating Question naire [ SRQ ] and Shoulder Disability Question naire [ SDQ ] ) . An analysis of covariance with adjustments for baseline values and a general linear mixed-effect model for repeated measurements were used to compare the change scores for the 2 treatment groups at the various time points and over the total period of 1 year , respectively . RESULTS Overall , subjects in both groups improved over 12 months . Statistically significant greater change scores were found in the HGMT group for passive abduction ( at the time points 3 and 12 months ) , and for active and passive external rotation ( at 12 months ) . A statistically significant difference in trend between both groups over the total follow-up period of 12 months was found for passive external rotation , SRQ , and SDQ with greater change scores in the HGMT group . DISCUSSION AND CONCLUSION In subjects with adhesive capsulitis of the shoulder , HGMTs appear to be more effective in improving glenohumeral joint mobility and reducing disability than LGMTs , with the overall differences between the 2 interventions being small PURPOSE The purpose of this study was to examine the effectiveness of an arthroscopically placed intra-articular pain catheter for controlling postoperative pain and also review the results following arthroscopic release of refractor adhesive capsulitis . TYPE OF STUDY Retrospective clinical trial . METHODS Twenty-three consecutive cases ( 20 patients ) of arthroscopic adhesive capsulitis release in which an intra-articular pain catheter was used were review ed . Follow-up ranged from 12 to 37 months ( average , 22.4 months ) . An intra-articular catheter was placed under direct arthroscopic visualization from a superior approach into the glenohumeral joint . Postoperatively , patients were injected with 10 mL of 0.5 % bupivacaine every 6 hours as needed . Preoperatively , all patients had filled out a question naire based on the American Shoulder and Elbow Surgeons ( ASES ) outcome guidelines and examined for range of motion . Postoperatively , patients were asked for their precatheter and postcatheter injection pain level based on the visual analog scale ( 1 to 10 points , 1 = no pain ) . Patients were then examined for range of motion and retested with the outcome question naire . An ASES Shoulder Score Index was calculated for each patient before and after the procedure . RESULTS The average forward elevation preoperatively was 102 degrees and external rotation at the side was 4.5 degrees . At most recent follow-up , average forward elevation was 169 degrees with external rotation at the side 47 degrees . The Shoulder Score Index increased from an average of 37.1 out of 100 to 90.9 ( P < .001 ) . Before being injected with anesthetic through the catheter , patients had an average visual analog scale score of 8.1 . Postinjection average pain level was 1.2 ( P < .001 ) and all patients indicated that the pain catheter significantly reduced postoperative pain .  Nineteen of 20 patients were satisfied with the procedure . CONCLUSIONS Placement of an intra-articular pain catheter for delivery of bupivacaine was highly effective in controlling postoperative pain . In all cases , postoperative pain was essentially eliminated and this substantially assisted with range of motion exercises . Near complete restoration of range of motion without pain was achieved in 95 % of the patients PRINCIPLE A r and omised , comparative prospect i ve clinical trial was planned to compare the early response to different rehabilitation methods for adhesive capsulitis taking into consideration the clinical efficacy and the cost effectiveness of the methods . METHODS Forty patients with adhesive capsulitis were r and omised into two treatment groups . The first group ( CYR ) received the Cyriax approach of deep friction massage and mobilisation exercises three times weekly . The second group ( PT ) had daily physical therapy including hot pack and short wave diathermy application . Both groups concluded their treatments with stretching exercises and were also instructed to a daily home exercise program . The primary end point of the study was to reach 80 % of the normal passive range of motion ( ROM ) of the shoulder in all planes within a period of two weeks . Secondary end points were the overall ROM and pain response ( spontaneous pain , night pain and pain with motion ) to each treatment . RESULTS 19 patients in the CYR group ( 95 % ) and 13 patients in the PT group ( 65 % ) reached sufficient ROM at the end of the second week ( p < 0.05 ) . The improvement in shoulder flexion , inner and outer rotation values and the decrease in pain with motion were significantly better in the CYR group after the first week of treatment . CONCLUSION The Cyriax method of rehabilitation provides a faster and better response than the conventional physical therapy methods in the early phase of treatment in adhesive capsulitis . The method is non-invasive , effective and requires fewer hospital visits for a sufficient early response Seventy-seven patients with idiopath 
    Output:
    
Areas of agreement Shoulder stiffness could be treated with conservative means including nonsteroidal anti-inflammatory medications , corticosteroid injections , or transcutaneous electrical nerve stimulation , manipulation under anaesthesia , and arthroscopic capsular release .
Growing points The rate of failure after treatment for stiff shoulder is higher in the surgical group than in the conservative group .
Areas timely for developing research There is insufficient evidence to establish whether surgical or conservative management is the best choice to manage shoulder stiffness .