Objective: Primary frozen shoulder causes significant pain and progressively restricts shoulder movements. Diagnosis is primarily clinically based on patient history and physical examination. Management is mainly non-invasive owing to its self-limiting clinical course. However, clinical practice guidelines for frozen shoulder have not yet been developed in Korea. The developed guidelines aim to provide evidence-based recommendations for the diagnosis and treatment of frozen shoulder.Methods: A guideline development committee reviewed the literature from four databases (PubMed, Embase, Cochrane Library, and KMbase). Using the PICO (Population, Intervention, Comparator, and Outcome) framework, the committee formulated two backgrounds and 16 key questions to address common clinical concerns. Recommendations were made using the Grading of Recommendations, Assessment, Development, and Evaluation framework.Results: Diabetes, thyroid disease, and dyslipidemia significantly increase the risk of developing a frozen shoulder. Although frozen shoulder is often self-limiting, some patients may experience long-term disabilities. Ultrasound and magnetic resonance imaging should be used as adjunctive tools alongside clinical diagnosis, and not as independent diagnostic methods. Noninvasive approaches, such as medications, physical modalities, exercises, electrical stimulation, and manual therapy, may reduce pain and improve shoulder function. Other noninvasive interventions have limited evidence, and their application should be based on clinical judgment. Intra-articular steroid injections are recommended for treatment, and physiotherapy or hydrodilatation with steroid injections can also be beneficial.Conclusion: These guidelines provide evidence-based recommendations for diagnosing and treating primary frozen shoulder.

Kim JS, et al. Brain Neurorehabil. 2019 Oct;13(1):e3. https://doi.org/10.12786/bn.2020.13.e3

Objective To determine correlations of alternation motor rate (AMR), sequential motor rate (SMR), and maximum phonation time (MPT) with the severity of dysphagia in subacute stroke patients.Methods This was a retrospective chart review study. Data of 171 subacute stroke patients were analyzed. Patient’s AMR, SMR, and MPT data were collected from their language evaluations. Video fluoroscopic swallowing study (VFSS) was done. Data of dysphagia scales including penetration-aspiration scale (PAS), American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA-NOMS) scale, clinical dysphagia scale (CDS), and videofluoroscopic dysphagia scale (VDS) were obtained. AMR, SMR, and MPT were compared between a non-aspirator group and an aspirator group. Correlations of AMR, SMR, and MPT with dysphagia scales were analyzed.Results AMR ("ka"), SMR, and modified Rankin Scale were significant associated factors between non-aspirator group and aspirator group, while AMR ("pa"), AMR ("ta"), and MPT were not. AMR, SMR, and MPT showed significant correlations with PAS score, ASHA-NOMS scale, CDS, VDS oral, and VDS pharyngeal scores. The cut-off value for distinguishing non-aspirator group and aspiration group was 18.5 for AMR ("ka") (sensitivity of 74.4%, specificity of 70.8%) and 7.5 for SMR (sensitivity of 89.9%, specificity of 61.0%). AMR and SMR were significantly lower in before-swallow aspiration group.Conclusion Articulatory diadochokinetic tasks that can be easily performed at the bedside would be particularly helpful in determining the oral feeding possibility of subacute stroke patients who cannot undergo VFSS, which is the gold standard for dysphagia assessment.

Background/Objectives: Muscle loss is a serious complication in chronic disease patients, yet studies on long-term changes in muscle mass based on insulin sensitivity in the absence of diabetes mellitus are scarce. This community-based cohort study analyzed the longitudinal association between insulin sensitivity and muscle loss in middle-aged South Korean adults. Methods: This study included 6016 subjects (aged 40–65 years) from the Korean Genome and Epidemiology Study, conducted between 2001 and 2016. Fat-free mass, fat mass, body weight, and kidney function were assessed biennially. Subjects were categorized into four groups based on the composite (Matsuda) insulin sensitivity index (ISI) quartiles. The primary outcome was muscle loss, defined as a decline in fat-free mass of 10% or more from baseline. The secondary outcome was the occurrence of all-cause mortality. Results: During 69,480 person–years of follow-up, muscle loss occurred in 311 (5.2%) subjects. Multivariable Cox regression revealed a reverse-graded association between insulin sensitivity and muscle loss risk. Hazard ratios (95% confidence intervals) for the second, third, and highest ISI quartiles were 0.70 (0.51–0.94), 0.69 (0.50–0.95), and 0.65 (0.46–0.92), respectively, compared with the lowest quartile. Insulin sensitivity, however, was not significantly associated with all-cause mortality, though the mortality risk was higher in individuals with muscle loss. Conclusions: A reverse-graded relationship between insulin sensitivity and muscle loss risk was identified in middle-aged South Korean adults, with the lowest risk in the highest ISI quartile. These findings suggest that higher insulin sensitivity may reduce the risk of muscle loss.

Objective To investigate the relationship between Trunk Impairment Scale (TIS) and lumbar spine bone mineral density (BMD) in subacute stroke patients.Methods Twenty-three subacute male stroke patients under the age of 65 were prospectively enrolled to exclude both postmenopausal and senile effects on BMD. The TIS, Berg Balance Scale, the Korean version of the Modified Barthel Index, and manual muscle test were measured at admission and 3 months after stroke onset. BMD of the bilateral lower extremities and lumbar vertebrae was measured by dual-energy X-ray absorptiometry 3 months after stroke onset.Results TIS at baseline (TIS_B) and TIS at 3 months after stroke (TIS_3m) showed significant correlations with lumbar BMD (TIS_B, r=0.522; TIS_3m, r=0.517). Through multiple regression analysis, the TIS_B was associated with lumbar BMD (adjusted R2=0.474). However, BMD of the bilateral lower extremities was not correlated with any clinical measurements except body mass index.Conclusion We found a relationship between TIS_B and lumbar BMD in subacute young male stroke patients. Stroke patients with poor trunk control in the early subacute stage would have low BMD of vertebral bones at 3 months. The TIS can be useful for estimating bone fragility in the lumbar vertebrae of subacute stroke patients.

Background and Objectives: Comparisons of swallowing physiology between coronavirus disease 2019 (COVID-19) pneumonia and clinically diagnosed aspiration pneumonia (AP) have largely relied on ordinal scales, leaving etiology-specific biomechanical profiles unclear. We quantitatively compared videofluoroscopic swallowing study (VFSS) measures of pharyngeal residue and clearance mechanics to identify differential dysphagia phenotypes. Materials and Methods: This single-center retrospective cohort study included 50 adult inpatients with pneumonia (COVID-19, n = 25; AP, n = 25) who underwent VFSS for suspected dysphagia. COVID-19 pneumonia was laboratory-confirmed, and AP was clinically diagnosed after negative tests for severe acute respiratory syndrome coronavirus 2. Blinded ImageJ analysis examined the first standardized semisolid yogurt swallow (International Dysphagia Diet Standardisation Initiative level 4). Primary outcomes were Normalized Residue Ratio Scale values for the valleculae (NRRSv) and piriform sinuses (NRRSp); secondary outcomes were upper esophageal sphincter (UES) opening width and epiglottic rotation angle. Penetration–Aspiration Scale (PAS) score, hyoid displacement, and pharyngeal transit time were exploratory. Results: Baseline characteristics were comparable. COVID-19 pneumonia showed higher NRRSv (0.20 [0.12–0.56] vs. 0.13 [0.00–0.20]; p = 0.01). NRRSp was numerically higher but not statistically significant (0.12 [0.00–0.43] vs. 0.00 [0.00–0.17]; p = 0.07). COVID-19 pneumonia also showed smaller UES opening width (5.08 ± 2.48 vs. 6.50 ± 2.01 mm; p = 0.03) and reduced epiglottic rotation angle (66.0 [29.0–80.8] vs. 93.4 [74.2–100.4] degrees; p = 0.04). No statistically significant between-group difference was detected in PAS-defined airway invasion severity on the standardized semisolid task. Conclusions: These findings suggest an efficiency-predominant dysphagia phenotype in COVID-19 pneumonia, characterized by greater vallecular residue and restrictive clearance-related mechanics on a standardized semisolid task. The results indicate that PAS-defined safety metrics alone may underestimate residue-related dysphagia burden in this population.