Clinical Rheumatology

, Volume 28, Issue 5, pp 495–500

RETRACTED ARTICLE: Inflammation and shoulder pain—a perspective on rotator cuff disease, adhesive capsulitis, and osteoarthritis: conservative treatment

Review Article


Shoulder pain may occur as a secondary symptom to a wide range of conditions, including rotator cuff disorders, glenohumeral osteoarthritis, or adhesive capsulitis. One common factor linking these diseases is inflammation. Understanding the role of inflammation in shoulder disorders can help physicians to manage and treat these common problems. Here, I document a perspective on these pathologies of shoulder.


Conservative treatment Inflammation Shoulder pain 


  1. 1.
    Neer CS (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am 54(1):41–50PubMedGoogle Scholar
  2. 2.
    Neer C (1990) Cuff tears, biceps lesions, and impingement. Shoulder reconstruction. WB Saunders, Philadelphia, pp 141–142Google Scholar
  3. 3.
    Neer CS (1983) Impingement Lesions. Clin Orthop Relat Res 173:70–77PubMedGoogle Scholar
  4. 4.
    Neer CS (2005) Anterior acromioplasty for the chronic impingement syndrome in the shoulder. J Bone Joint Surg Am 87(6):1399PubMedCrossRefGoogle Scholar
  5. 5.
    Neer CS et al (1992) The anatomy and potential effects of contracture of the coracohumeral ligament. Clin Orthop Relat Res 280:182–185PubMedGoogle Scholar
  6. 6.
    Bigliani LU, Levine WN (1997) Subacromial impingement syndrome. J Bone Joint Surg Am 79(2):1854–1868PubMedGoogle Scholar
  7. 7.
    Bigliani LU et al (1991) The relationship of acromial architecture to rotator cuff disease. Clin Sports Med 10(4):823–838PubMedGoogle Scholar
  8. 8.
    Ratcliffe A, Flatow EL, Roth N et al (1996) Biochemical markers in synovial fluid identify early osteoarthritis of the glenohumeral joint. Clin. Orthop 330:45–53PubMedCrossRefGoogle Scholar
  9. 9.
    Blaine TA, Bigliani LU (2002) Arthroscopy for the arthritic shoulder. Orthopedic knowledge update: shoulder and elbow 2. American Academy of Orthopedic Surgery, pp 525–532Google Scholar
  10. 10.
    Rodeo SA et al (1997) Immunolocalization of cytokines and their receptors in adhesive capsulitis of the shoulder. J Orthop Res 15(3):427–436PubMedCrossRefGoogle Scholar
  11. 11.
    Stone D et al (1999) Cytokine-induced tendinitis: a preliminary study in rabbits. J Orthop Res 17(2):168–177PubMedCrossRefGoogle Scholar
  12. 12.
    Gotoh M et al (1999) Increased interleukin-1beta production in the synovium of glenohumeral joints with anterior instability. J Orthop Res 17(3):392–397PubMedCrossRefGoogle Scholar
  13. 13.
    Blaine TA et al (2005) The molecular pathophysiology of subacromial bursitis in rotator cuff disease. J Shoulder Elbow Surg 14(1 suppl. S):84S–89SPubMedCrossRefGoogle Scholar
  14. 14.
    Voloshin I et al (2005) Proinflammatory cytokines and metalloproteases are expressed in the subacromial bursa in patients with rotator cuff disease. Arthroscopy 21(9):1076PubMedGoogle Scholar
  15. 15.
    Neviser JS (1945) Adhesive capsulitis of the shoulder: a study of the pathological findings in periarthritis of the shoulder. J Bone Joint Surg 27:211–222Google Scholar
  16. 16.
    Bunker TD, Anthony PP (1995) The pathology of frozen shoulder: a Dupuytren-like disease. J. Bone Joint Surg 77:677–683Google Scholar
  17. 17.
    Hannafin JA, DiCarlo EF, Wickiewicz TL et al (1994) Adhesive capsulitis: capsular fibroplasias of the glenohumeral joint. J Shoulder Elbow Surg 3(suppl):5Google Scholar
  18. 18.
    Sakai H et al (2001) Immunolocalization of cytokines and growth factors in subacromial bursa of rotator cuff tear patients. Kobe J Med Science 47(1):25–34Google Scholar
  19. 19.
    Yoshida M et al (2003) Pathologic gene expression in adhesive bursa of the human shoulder. Clinical Ortho 412:57–64CrossRefGoogle Scholar
  20. 20.
    Gotoh M et al (2001) Interleukin-1-induced subacromial synovitis and shoulder pain in rotator cuff diseases. Rheumatology 40(9):995–1001PubMedCrossRefGoogle Scholar
  21. 21.
    Kibler WB, McMullen J, Uhl T (2001) Shoulder rehabilitation strategies, guidelines, and practice. Ortho Clinics N America 32(3):527–538CrossRefGoogle Scholar
  22. 22.
    Kamkar A, Irrgang JJ, Whitney SL (1993) Nonoperative management of secondary shoulder impingement syndrome. J Ortho Sports PhysTherapy 17(5):212–224Google Scholar
  23. 23.
    Walther M et al (2004) The subacromial impingement syndrome of the shoulder treated by conventional physiotherapy, selftraining, and a shoulder brace: results of a prospective, randomized study. J Shoulder Elbow Surg 13(4):417–423PubMedCrossRefGoogle Scholar
  24. 24.
    American Academy of Orthopedic Surgeons (2001) AAOS clinical guideline on shoulder pain: support document. American Academy of Orthopedic Surgeons, Rosemont (IL)Google Scholar
  25. 25.
    Ferro T, Iain R, McKeag DB (2003) A non-operative approach to shoulder impingement syndrome. Adv Stud Med 3:518–526Google Scholar
  26. 26.
    Lastayo PC, Wright T, Jaffe R et al (1998) Continuous passive motion after repair of the rotator cuff. A prospective outcome study. J Bone Joint Surg Am 80:1002–1011PubMedGoogle Scholar
  27. 27.
    Raab MG, Rzeszutko D, O’Connor W et al (1996) Early results of continuous passive motion after rotator cuff repair: a prospective, randomized, blinded, controlled study. Am J Orthop 25:214–220PubMedGoogle Scholar
  28. 28.
    Haahr JP, Ostergaard S, Dalsgaard J et al (2005) Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomized, controlled study in 90 cases with a one year follow-up. Ann Rheum Dis 64:760–764PubMedCrossRefGoogle Scholar
  29. 29.
    Maybach A, Schlegel T (1995) Shoulder rehabilitation for the arthritic glenohumeral joint: preoperative and postoperative considerations. Semin Arthroplasty 6:297–304PubMedGoogle Scholar
  30. 30.
    Guler-Uysal F, Kozanoglu (2004) Comparison of the early response to two methods of rehabilitation in adhesive capsulitis. Swiss Med Week 134:353–358Google Scholar
  31. 31.
    Ryans I, Montgomery A, Galway R et al (2005) A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis. Rheumatology 44:529–535PubMedCrossRefGoogle Scholar
  32. 32.
    Mao CY, Jaw WC, Cheng H (1997) Frozen shoulder: correlation between the response to physical therapy and follow-up shoulder arthrography. Arch Phys Med Rehabil 78:857–859PubMedCrossRefGoogle Scholar
  33. 33.
    Siegel LB, Cohen NJ, Gall EP (1999) Adhesive capsulitis: a sticky issue. Am Fam Physician 59:1843–1852PubMedGoogle Scholar
  34. 34.
    Andrews JR (2005) Diagnosis and treatment of chronic painful shoulder: review of non-surgical interventions. Arthroscopy 21:333–347PubMedCrossRefGoogle Scholar
  35. 35.
    Petri M, Hufman SL, Waser G et al (2004) Celecoxib effectively treats patients with acute shoulder tendonitis/bursitis. J Rheumatol 31:1614–1620PubMedGoogle Scholar
  36. 36.
    Heller B, Tarricone R (2004) Oxaprozin versus diclofenac in NSAID-refractory periarthritis pain of the shoulder. Curr Med Res Opin 20:1279–1290PubMedCrossRefGoogle Scholar
  37. 37.
    White RH, Paull DM, Fleming KW (1986) Rotator cuff tendonitis: comparison of subacromial injection of a long-acting corticosteroid versus oral indomethacin therapy. J Rheumatol 13:608–613PubMedGoogle Scholar
  38. 38.
    Akarca US (2005) Gastrointestinal effects of selective and non-selective non-steroidal anti-inflammatory drugs. Curr Pharm Des 11:1779–1793PubMedCrossRefGoogle Scholar
  39. 39.
    Bolten WW (2006) The problem of the atherothrombotic potential of nonsteroidal anti-inflammatory drugs. Ann Rheum Dis 65:7–13PubMedCrossRefGoogle Scholar
  40. 40.
    Ray WA, MacDonald TM, Solomon DH et al (2003) COX-2 selective non-steroidal anti-inflammatory drugs and cardiovascular disease. Pharmacoepidemiol Drug Saf 12:67–70PubMedCrossRefGoogle Scholar
  41. 41.
    Graham DJ, Campen D, Hui R et al (2005) Risk of acute myocardial infarction and sudden cardiac death in patients treated with cyclooxygenase-2 selective and non-selective non-steroidal anti-inflammatory drugs: nested case-control study. Lancet 365:475–481PubMedGoogle Scholar
  42. 42.
    Stollberger C, Finsterer J (2003) Nonsteroidal anti-inflammatory drugs in patients with cardio- or cerebrovascular disorders. Z Kardiol 92:721–729PubMedCrossRefGoogle Scholar
  43. 43.
    Peterson GM (2005) Selecting non-prescription analgesics. Am J Ther 12:67PubMedCrossRefGoogle Scholar
  44. 44.
    Savage R (2005) Cyclooxygenase-2 inhibitors: when should they be used in the elderly? Drugs Aging 22:185–200PubMedCrossRefGoogle Scholar
  45. 45.
    Bombardier C, Laine L, Reicin A et al (2000) Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis: VIGOR Study Group. N Engl J Med 343:1520–1528PubMedCrossRefGoogle Scholar
  46. 46.
    Agrawal NM, Campbell DR, Safdi MA et al (2000) Superiority of lansoprazole vs. ranitidine in healing nonsteroidal antiinflammatory drug-associated gastric ulcers: results of a double-blind, randomized, multicenter study. NSAID-Associated Gastric Ulcer Study Group. Arch Intern Med 160:1455–1461PubMedCrossRefGoogle Scholar
  47. 47.
    Hawkey CJ, Karrasch JA, Szczepanski L et al (1998) Omeprazole compared with misoprostol for ulcers associated with nonsteroidal antiinflammatory drugs. Omeprazole versus Misoprostol for NSAID-induced Ulcer Management (OMNIUM) Study Group. N Engl J Med 338:727–734PubMedCrossRefGoogle Scholar
  48. 48.
    Forman JP, Stampfer MJ, Curhan GC (2005) Non-narcotic analgesic dose and risk of incident hypertension in US women. Hypertension 46:500–507PubMedCrossRefGoogle Scholar
  49. 49.
    Raffa RB (2001) Pharmacology of oral combination analgesics: rational therapy for pain. J Clin Pharm Ther 26:257–264PubMedCrossRefGoogle Scholar
  50. 50.
    Akgun K, Birtane M, Akarirmak U (2004) Is local subacromial corticosteroid injection beneficial in subacromial impingement syndrome? Clin Rheumatol 23:496–500PubMedCrossRefGoogle Scholar
  51. 51.
    Blair B, Rokito AS, Cuomo F et al (1996) Efficacy of injections of corticosteroids for subacromial impingement syndrome. J Bone Joint Surg Am 78:1685–1689PubMedGoogle Scholar
  52. 52.
    Alvarez CM, Litchfield R, Jackowski D et al (2005) A prospective, double-blind, randomized clinical trial comparing subacromial injection of betamethasone and xylocaine to xylocaine alone in chronic rotator cuff tendonosis. Am J Sports Med 33:255–262PubMedCrossRefGoogle Scholar
  53. 53.
    Carette S, Moffet H, Tardif J et al (2003) Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial. Arthritis Rheum 48:829–838PubMedCrossRefGoogle Scholar
  54. 54.
    Buchbinder R, Green S,Youd JM (2003) Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev CD004016Google Scholar
  55. 55.
    Altman RD (2003) Status of hyaluronan supplementation therapy in osteoarthritis. Curr Rheumatol Rep 5:7–14PubMedCrossRefGoogle Scholar
  56. 56.
    Wang CT, Lin J, Chang CJ et al (2004) Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A metaanalysis of randomized controlled trials. J Bone Joint Surg Am 86-A:538–545PubMedGoogle Scholar
  57. 57.
    Lo GH, LaValley M, McAlindon T et al (2003) Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a metaanalysis. JAMA 290:3115–3121PubMedCrossRefGoogle Scholar
  58. 58.
    Shibata Y, Midorikawa K, Emoto G et al (2001) Clinical evaluation of sodium hyaluronate for the treatment of patients with rotator cuff tear. J Shoulder Elbow Surg 10:209–216PubMedCrossRefGoogle Scholar
  59. 59.
    Ramonda R, Franceschini M, Leardini G (1998) Treatment of shoulder periarthritis with hyaluronic acid. Riv It Biol Med 18(suppl. 2):51Google Scholar
  60. 60.
    Itokazu M, Matsunaga T (1995) Clinical evaluation of high-molecular-weight sodium hyaluronate for the treatment of patients with periarthritis of the shoulder. Clin Ther 17:946–955PubMedCrossRefGoogle Scholar
  61. 61.
    Rovetta G, Monteforte P (1998) Intra-articular injection of sodium hyaluronate plus steroid versus steroid in adhesive capsulitis of the shoulder. Int J Tissue React 20:125–130PubMedGoogle Scholar
  62. 62.
    Leardini G, Perbellini A, Franceschini M et al (1998) Intra-articular injections of hyaluronic acid in the treatment of painful shoulder. Clin Ther 10:521–526Google Scholar
  63. 63.
    Altman R, Moskowitz R, Jacobs S et al (2005) A double-blind, randomized trial of intra-articular injection of sodium hyaluronate (HYALGAN”) for the treatment of chronic shoulder pain. abstract (ACR 2005), presented at the American College of Rheumatology, San Diego, CA (November 12–17 2005)Google Scholar

Copyright information

© Clinical Rheumatology 2009

Authors and Affiliations

  1. 1.University of Chieti via dei VestiniChietiItaly
  2. 2.Sondalo Hospital via Zubiani SondaloSondaloItaly

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