Pulsed Radiofrequency as a Standalone Treatment for Adhesive Capsulitis
, Alessandro Rizzardo 5, Andrea Tomasi 5, Giulio Edoardo Vigni 5 and Luca Miceli 6,*Round 1
Reviewer 1 Report (Previous Reviewer 3)
1. This article has been submitted to the case report section, but the title does not accurately reflect the case or diagnosis. It gives the impression of a literature review. A more appropriate title, such as "Pulsed Radiofrequency as a Standalone Treatment for Adhesive Capsulitis," would have been ideal.
2. The abstract fails to provide any information about the case, including its findings, treatment, and outcome. It lacks the necessary elements expected of a case report, giving an incomplete impression.
3. Regarding the manuscript, a case report should include an introduction about the presented condition, an explanation of the case history, examination findings, details of the treatment provided, the rationale for choosing the treatment, follow-up information, and a discussion of existing literature. These essential elements are not given much importance in this report.
4. The inclusion of explanation of pain in general, the role of physiotherapy, and the historical progress of medicine is all well known and appears redundant in this specific case report. These details should be given less emphasis, and more attention should be directed towards the case itself.
5. The second paragraph of the introduction, which provides details about the case, holds significant importance and should be placed at the beginning of the introduction.
6. It is important to provide a detailed explanation of the stages of adhesive capsulitis, namely the "Freezing," "Frozen," and "Thawing" stages, along with the accompanying symptoms and duration of each stage.
7. The statement made by the author, "In the field of pain medicine, this means considering not only the reduction of the pain symptom due to a particular pathology as a therapeutic goal but assessing the degree of impairment of the patient and the subsequent health and social impact, and, therefore, setting the goal of restoring a normal range of motion of the injured area," should be acknowledged as a goal of medicine in general, not just pain medicine. The ultimate objective of any treatment strategy is to reduce pain, improve movement, and have a positive impact on overall health. It is unnecessary to make statements that may lead readers to believe that some treatment strategies do not prioritize movement assessment or overall health.
8. Line 70 - It should be clarified that this is a case report, not a study. The authors should refer to it as "Our report" rather than "Our study." Additionally, conclusions cannot be drawn solely from case reports, as they only highlight specific possible scenarios. Only larger studies can provide conclusive evidence on whether pain control independent of physiotherapy will be effective. Authors need to emphasize that this report represents a single case, and caution against drawing broad conclusions solely based on it.
9. The second paragraph can be appropriately titled "2. Case Report."
10. The authors mentioned that a previous orthopedic evaluation provided a diagnosis of "adhesive capsulitis" based on severe pain during movement and limited range of motion (ROM). However, there is no information regarding the exact ROM values at the time of presentation. Please provide ROM values for adduction, abduction, flexion, extension, internal rotation, and external rotation.
11. There is no information available regarding factors that aggravate or relieve the patient's symptoms. It would be helpful to include this information for a comprehensive understanding of the case.
12. The report lacks information about the treatments attempted during the first 6 months of pain and the specific medications the patient took to alleviate their pain. Including this information is necessary.
13. X-rays of the affected shoulder have not been provided. It would be beneficial for the readers to review the X-rays.
14. During the period between the radiofrequency treatment and the check-up visit, it is important to clarify whether the patient was engaging in household activities or had returned to work.
15. Please provide information about the medications the patient took during the period between the radiofrequency treatment and the check-up visit.
16. In the discussion section, it is crucial to explore other potential therapeutic strategies, such as intraarticular steroid injections, arthroscopic capsular release, manipulation under anesthesia, and medical management. These additional strategies should be discussed to provide a more comprehensive analysis of the case.
17. A 3-week follow-up is too short to understand the prognosis of this case and also to justify the publication of the case report.
Extensive language editing is necessary. The excessive use of parentheses should be minimized.
Author Response
We add our reply to reviewer.
Luca Miceli and others co-authors.
Best regards.
Author Response File: 
Author Response.docx
Reviewer 2 Report (Previous Reviewer 2)
Noted changes made as suggested by reviewers. Case study is now acceptable for publication.
Acceptable
Author Response
We add our reply to reviewer.
Luca Miceli and others co-authors.
Best regards.
Author Response File: Author Response.docx
Reviewer 3 Report (Previous Reviewer 1)
The manuscript is ready to publish.
Best
Author Response
We add our reply to reviewer.
Luca Miceli and others co-authors.
Best regards.
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report (Previous Reviewer 3)
The authors propose a case report about pulsed radiofrequency being a standalone treatment for Adhesive capsulitis. To align with the case report format, I suggest the following changes
Introduction
1. Move patient characteristics (Lines 32 – 57) to case report section.
2. Lines 60-70 about pain can be deleted as it does not align with the scope of this report.
3. Introduction should start with line 71 (Adhesive capsulitis, commonly known as "frozen shoulder…. to line 125)
Case Report
4. Start this section with 2.1 patient characteristics, followed by 2.2 pulsed radiofrequency treatment and 2.3 kinematic analysis
5. Move the part about 12-week follow-up teleconsultation (Lines 233 – 235) from Discussion to the case report section.
Conclusion
6. Lines 222 to 233 can be titled “3. Conclusion”
7. Conclusion should highlight this statement - “While this report highlights the effectiveness of RPT (Radiofrequency Pulsed Therapy) for adhesive capsulitis, it is important to note that it should not be regarded as a standalone treatment without conducting additional randomized controlled trials and currently, the gold standard is a combination of radiofrequency and physiotherapy.”
8. Conclusion should also include “The main limitation was the lack of data beyond the initial three weeks of observation to determine the duration of the treatment's effect. However, a teleconsultation after 12 weeks confirmed good pain relief, although contextual kinematic and electromyographic data were unavailable”
9. Following conclusion, the funding, institutional review board statement, informed consent statement are missing. Please follow instructions to authors.
References
10. What is reference 20? The link is incorrect. Please follow instructions to authors regarding online references.
The article will benefit from extensive revisions for language, and formatting as I have mentioned above.
Language needs to be improved. I suggest the authors either utilize the MDPI English editing service or make use of any other professional editing service available to them, or employ language AI models to correct their sentences.
Author Response
Dear reviewer 1,
We send corrected file, thank you and best regards.
Introduction
- Move patient characteristics (Lines 32 – 57) to case report section.
Done
- Lines 60-70 about pain can be deleted as it does not align with the scope of this report.
Done
- Introduction should start with line 71 (Adhesive capsulitis, commonly known as "frozen shoulder…. to line 125)
Done
Case Report
- Start this section with 2.1 patient characteristics, followed by 2.2 pulsed radiofrequency treatment and 2.3 kinematic analysis
Done
- Move the part about 12-week follow-up teleconsultation (Lines 233 – 235) from Discussion to the case report section.
Done
Conclusion
- Lines 222 to 233 can be titled “3. Conclusion”
Done
- Conclusion should highlight this statement - “While this report highlights the effectiveness of RPT (Radiofrequency Pulsed Therapy) for adhesive capsulitis, it is important to note that it should not be regarded as a standalone treatment without conducting additional randomized controlled trials and currently, the gold standard is a combination of radiofrequency and physiotherapy.”
Done
- Conclusion should also include “The main limitation was the lack of data beyond the initial three weeks of observation to determine the duration of the treatment's effect. However, a teleconsultation after 12 weeks confirmed good pain relief, although contextual kinematic and electromyographic data were unavailable”
Done
- Following conclusion, the funding, institutional review board statement, informed consent statement are missing. Please follow instructions to authors.
Done
References
- What is reference 20? The link is incorrect. Please follow instructions to authors regarding online references.
Done
The article will benefit from extensive revisions for language, and formatting as I have mentioned above.
Done
Comments on the Quality of English Language
Language needs to be improved. I suggest the authors either utilize the MDPI English editing service or make use of any other professional editing service available to them, or employ language AI models to correct their sentences.
Author Response File: 
Author Response.pdf
Round 3
Reviewer 1 Report (Previous Reviewer 3)
Thanks for the revisions.
In the conclusion part - The author's have again mentioned this case report as a "study". It is important to emphasize that this should not be regarded as a "study" and should be termed a "report".
I believe the journal will undertake its own English editing prior to the article's publication
Author Response
Good evening,
I send you revised paper.
Best regards and very thanks.
Luca Miceli and others co-authors.
Author Response File: Author Response.pdf
This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.
Round 1
Reviewer 1 Report
Dear authors,
Thank you for your case presentation to Surgeries magazine. Your case presentation is generally acceptable, but your article is very difficult to read in terms of shape. After the following minor corrections, your article can be published.
minor corrections
-Please make the article suitable for magazine kings so that it is fully readable. Different numbers appear everywhere. Please Fix.
-Please give the title of "2. The National Cancer Institute of Aviano experience" by presenting the measurement method under a separate title as the individual characteristics of the patient (physical characteristics and additional ailments and diseases etc.).
-There are some errors in your English spelling, please check again.
Kind regards
Moderate editing of English language required
Reviewer 2 Report
This Case report on Shoulder pain and association between pain doctors, patients and physiotherapists and use of pulsed radio frequency is an interesting case in complex pain management.
Good introduction on current interaction between pain specialists and physiotherapists and orthopaedic surgeons on best rehabilitation techniques for these complex pain cases.
Good description and explanation of case.
Conclusions drawn are appropriate if not innovative
Needs grammatical improvement
Reviewer 3 Report
I note the authors submitted an article to the case report section. It takes several paragraphs to get to the point of the report, which is about a patient with adhesive capsulitis. Some of the information provided in the introduction seems unnecessary or not directly relevant to the case report's scope. For example, the write up about pain and practice in general may be interesting, but do not contribute much to the report's objectives and makes it sound like a commentary.
The report would have been better structured if it had commenced with an overview of adhesive capsulitis, including available treatment options and the self-limiting nature of the condition. Subsequently, a comprehensive depiction of the case, incorporating all the examination outcomes and radiographic images should have been provided. Finally, the authors could have presented a discussion, highlighting the intervention's benefits and its supporting literature.
The use of pulsed radiofrequency to relieve the pain in such cases has been previously reported with available randomised-controlled trials. Hence, this report acks substantial evidence to justify its novelty or importance.
The article does not provide details of the patient's pre-procedural functional status or whether an upper limb functional scoring system was used.
The article is missing how the diagnosis of adhesive capsulitis was considered, and what were the differential diagnosis and how they were ruled out.
It is unclear if the treatment caused the patient's improvements or if other factors played a role - as there is no mention of any treatment modalities that the patient may have undergone during the 6 months symptomatic period.
There is no mention of oral medications that the patient took before or after the procedure.
A 3 week follow-up period is too short for a case report, and it is unclear what happened to the patient after this period.
Is it the patient reported in this case report shown as Figure 1 or an example that is of a different person?
There is no radiological image of the affected shoulder joint provided.
There is no informed consent statement.
In general, this case report lacks proper organization and omits crucial details regarding the patient's clinical status, diagnosis and treatment. Therefore, it is unsuitable in its current form for being published.
Extensive editing of English language required
