WorldWideScience

Sample records for subacromial shoulder pain

  1. The role of experimentally-induced subacromial pain on shoulder strength and throwing accuracy.

    Science.gov (United States)

    Wassinger, Craig A; Sole, Gisela; Osborne, Hamish

    2012-10-01

    Shoulder injuries often comprise two separate yet related components, structural tissue damage and pain. The role of each of these components on shoulder function is difficult to ascertain. Experimental pain models allow the assessment of consequences of localized pain when applied to healthy individuals. By understanding the role of pain on shoulder function, clinicians will be able to more efficiently assess and treat shoulder injuries. The objective of the study was to evaluate the role of experimentally-induced sub-acromial pain on shoulder isokinetic rotational strength and throwing accuracy. This was a block counterbalanced, crossover, repeated measures study design utilizing 20 individuals without self-reported shoulder or cervical pathology. Shoulder function was measured with and without experimental pain injection (2 mL of 5% hypertonic saline) in the sub-acromial space. Functional tasks consisted of shoulder rotational strength utilizing isokinetic testing and throwing accuracy via the functional throwing performance index. The hypertonic saline induced moderate pain levels in all participants (4.3-5.1/10). Normalized shoulder internal (t = 3.76, p = 0.001) and external (t = 3.12, p = 0.006) rotation strength were both diminished in the painful condition compared to the pain free condition. Throwing accuracy was also reduced while the participants experienced pain (t = 3.99, p = 0.001). Moderate levels of experimental shoulder pain were sufficient to negatively influence shoulder strength and throwing accuracy in participants without shoulder pathology. Copyright © 2012 Elsevier Ltd. All rights reserved.

  2. Increased substance P in subacromial bursa and shoulder pain in rotator cuff diseases.

    Science.gov (United States)

    Gotoh, M; Hamada, K; Yamakawa, H; Inoue, A; Fukuda, H

    1998-09-01

    The subacromial bursa is recognized as a site associated with the shoulder pain caused by rotator cuff disease in the middle-aged and elderly. Substance P is contained in primary afferent nerves, and its quantity increases during chronic pain. The amount of substance P in the subacromial bursa of patients with rotator cuff disease was examined. Radioimmunoassay and immunohistochemistry were employed to quantify and localize substance P. The preoperative pain level was measured with a visual analogue scale with 0 as no pain, 5 as moderate, and 10 as severe. Thirty-seven patients that had undergone operation were divided into two groups: one composed of 19 patients with subacromial bursitis and a partial-thickness tear of the rotator cuff (nonperforated cuff) and the other composed of 18 patients with a full-thickness tear (perforated cuff). Subacromial bursae obtained from seven fresh cadavers with no shoulder pain before death were used as controls. The visual analogue scale showed significantly greater pain in the group with the nonperforated rotator cuff than in the group with the perforated cuff. Consistent with these results, the amount of substance P in the subacromial bursa was significantly greater in the former group than in the latter. Nerve fibers immunoreactive to substance P were localized around the vessels, with a larger number of fibers in the group with the nonperforated rotator cuff. Therefore, an increased amount of substance P in the subacromial bursa appears to correlate with the pain caused by rotator cuff disease.

  3. Subacromial corticosteroid injection for poststroke shoulder pain: an exploratory prospective case series.

    Science.gov (United States)

    Chae, John; Jedlicka, Lynn

    2009-03-01

    To assess the effectiveness of subacromial corticosteroid injections for poststroke shoulder pain. Exploratory, prospective case series. Ambulatory setting, university-affiliated hospital. Stroke survivors (N=10) with pain in the hemiparetic shoulder. Consecutive stroke survivors with evidence of supraspinatus impingement, supraspinatus tendonitis, or subacromial bursitis received subacromial corticosteroid injections. The primary outcome measure was the Brief Pain Inventory (BPI) question 12 (BPI 12), which assesses "worst pain" in the previous 7 days. Secondary measures included BPI question 15, which assesses present pain and BPI question 23 (BPI 23), which assesses pain interference with 7 daily activities. Outcomes were assessed at baseline, weekly for the first 4 weeks and then at 8 and 12 weeks postinjection. Repeated measure analysis of variance revealed significant within group time effect for BPI 12 (F=7.7, PSubacromial corticosteroid injection is associated with significant reduction in poststroke shoulder pain in patients with evidence of supraspinatus impingement, supraspinatus tendonitis, or subacromial bursitis. However, there is a gradual loss of effect with time. Controlled trials are needed to show a cause and effect relationship.

  4. Topographical pressure pain sensitivity maps of the shoulder region in individuals with subacromial pain syndrome.

    Science.gov (United States)

    Ribeiro, I L; Camargo, P R; Alburquerque-Sendín, F; Madeleine, P; Fernández-de-las-Peñas, C; Salvini, T F

    2016-02-01

    Topographical pain maps (TPM) are useful tools to assess deep tissue sensitivity in musculoskeletal pain conditions. There is evidence suggesting bilateral sensitivity in subacromial pain syndrome (SAPS), although it is not widely accepted. No previous study has investigated TPM of the shoulder in SAPS. To investigate whether differences for TPM of the shoulder are evident among patients with unilateral SAPS and controls. Pressure pain thresholds (PPTs) were assessed 3 times at each point and there was a 20 s rest period between each one. The TPM were calculated using 29 pre-determined points on both shoulders in all groups by inverse distance weighted interpolation of PPT data. Multivariate Analysis of Covariance was applied to detect differences in PPTs between groups, sides, points (gender as covariate). The results revealed significant differences between points and genders (both, P shoulder. Women exhibited bilateral lower PPTs in all points than men in both groups (all, P shoulder. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Involvement of the anterior portion of the subacromial-subdeltoid bursa in the painful shoulder.

    Science.gov (United States)

    Stallenberg, Bernard; Destate, Nathalie; Feipel, Véronique; Gevenois, Pierre Alain

    2006-10-01

    The purpose of our study was to verify that increased widening of the anterior portion of the subacromial-subdeltoid bursa is associated with anteromedial shoulder pain. Bursography, sonography, and CT were performed in six cadaver shoulders and compared with anatomic sections in neutral position and while the humerus was extended and internally rotated. For the clinical study, the width of the anterior portion of the bursa was measured in both positions in both shoulders of 27 patients referred because of shoulder pain and in eight asymptomatic volunteers. Pain was coded as absent, experienced in the anteromedial portion of the shoulder, or experienced elsewhere but not anteromedially, and we compared the pain scores between shoulder positions. In all cadaver shoulders, when compared with CT scans and anatomic sections, sonography showed the morphology of the bursa, its relationships with surrounding structures, and morphologic changes associated with position. In volunteers, the mean width of the bursa was 0.74 +/- 0.05 and 0.93 +/- 0.09 mm (p = 0.013), respectively, in neutral and stress position. In patients, the same values were 0.70 +/- 0.07 and 0.81 +/- 0.14 mm (p = 0.286) in the asymptomatic side and 1.20 +/- 0.11 and 1.75 +/- 0.23 mm (p bursa was wider in patients experiencing pain anteromedially than in those who experienced pain elsewhere and volunteers (p = 0.002 and bursa was wider in symptomatic shoulders than in asymptomatic shoulders (p bursa is associated with anteromedial shoulder pain and the clinical syndrome of coracoid impingement.

  6. Rigid shoulder taping with physiotherapy in patients with subacromial pain syndrome: A randomized controlled trial.

    Science.gov (United States)

    Apeldoorn, Adri T; Kamper, Steven J; Kalter, Joeri; Knol, Dirk L; van Tulder, Maurits W; Ostelo, Raymond W

    2017-04-06

    To assess the effectiveness of individualized physiotherapy in combination with rigid taping compared with individualized physiotherapy alone in patients with subacromial pain syndrome. A prospective randomized trial with concealed allocation. A total of 140 patients between 18 and 65 years of age from primary physiotherapy settings. The intervention group received individualized physiotherapy and shoulder taping. The control group received individualized physiotherapy only. Primary outcomes were: pain intensit (numerical rating scale) and functioning (Simple Shoulder Test). Secondary outcomes were: global perceived effect and patient-specific complaints. Data were collected at baseline, and at 4, 12 and 26 weeks' follow-up. During the 6-month follow-up period multilevel analysis showed a significant difference between groups favouring the control group on pain intensity (p = 0.02), but not on functioning. Regarding secondary outcomes, a significant difference between groups was found favouring the intervention group for global perceived effect (p = 0.02), but not for patient-specific complaints. Rigid shoulder taping, as used in this study, cannot be recommended for improving physiotherapy outcomes in people with subacromial pain syndrome.

  7. Subacromial lipoma causing shoulder impingement syndrome.

    Science.gov (United States)

    Sucuoglu, Hamza; Akgun, Kenan

    2017-01-01

    Subacromial lipoma represents a rare cause of subacromial impingement syndrome (SIS). A 49-year-old male patient presented to clinic with progressive right shoulder pain and limited movement, ongoing for approximately 1 month. Magnetic resonance imaging (MRI) revealed a lesion, compatible with lipoma, extending through subacromial space and pressing on supraspinatus muscle. After histopathological verification of lipoma, mass was excised. Postoperatively, patient completed 1 month physical therapy and rehabilitation program. Patient was free of pain at 4-month follow-up. Subacromial lipoma should be included in differential diagnosis of SIS for patients unresponsive to conservative treatment; MRI is very useful to determine precise etiology and inform surgical treatment.

  8. Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study.

    Science.gov (United States)

    Draghi, Ferdinando; Scudeller, Luigia; Draghi, Anna Guja; Bortolotto, Chandra

    2015-06-01

    The presence of the subacromial-subdeltoid (SASD) bursa inflammation has recently been proposed as a primary radiologic factor predicting persistent limitation and pain in operated patients. The aim of the study was to verify the hypothesis that pain, or increased shoulder pain, could be associated with SASD bursitis not only in operated patients but also in general population. A consecutive series of 1940 shoulder ultrasound examinations were performed by our Department over a 5-year period using linear multi-frequency probes. All reports of examination executed for shoulder pain were reviewed. The video clips were independently reviewed by two radiologists: effusion in the SASD bursa and the presence of other pathological conditions were evaluated and confirmed. A total of 1147 shoulder video clips were re-evaluated, and 1587 pathologies were detected; 65.5 % of patients had only one pathology, 30.4 % had two and 4.1 % presented three pathologies. The difference between the group with and without effusion is statistically significant for acromioclavicular joint arthritis, supraspinatus tendon calcific tendinopathy, full-thickness and superficial tear of the supraspinatus, traumas and rheumatoid arthritis with a p value <0.01. Our study shows that the effusion in the SASD bursa is frequently associated with shoulder pain often independently from the underlying pathology; further studies are needed to confirm the statistical significance of this relationship by clarifying possible confounding factors.

  9. Effects of dry needling to the symptomatic versus control shoulder in patients with unilateral subacromial pain syndrome.

    Science.gov (United States)

    Koppenhaver, Shane; Embry, Robin; Ciccarello, John; Waltrip, Justin; Pike, Rachel; Walker, Michael; Fernández-de-Las-Peñas, Cesar; Croy, Theodore; Flynn, Timothy

    2016-12-01

    Initial reports suggest that treating myofascial trigger points in the infraspinatus with dry needling may be effective in treating patients with shoulder pain. However, to date, high quality clinical trials and thorough knowledge of the physiologic mechanisms involved is lacking. To examine the effect of dry needling to the infraspinatus muscle on muscle function, nociceptive sensitivity, and shoulder range of motion (ROM) in the symptomatic and asymptomatic shoulders of individuals with unilateral subacromial pain syndrome. Within-subjects controlled trial. Fifty-seven volunteers with unilateral subacromial pain syndrome underwent one session of dry needling to bilateral infraspinatus muscles. Outcome assessments, including ultrasonic measures of infraspinatus muscle thickness, pressure algometry, shoulder internal rotation and horizontal adduction ROM, and questionnaires regarding pain and related disability were taken at baseline, immediately after dry needling, and 3-4 days later. Participants experienced statistically significant and clinically relevant changes in all self-report measures. Pressure pain threshold and ROM significantly increased 3-4 days, but not immediately after dry needling only in the symptomatic shoulder [Pressure pain threshold: 5.1 (2.2, 8.0) N/cm(2), internal rotation ROM: 9.6 (5.0, 14.1) degrees, horizontal adduction ROM: 5.9 (2.5, 9.4) degrees]. No significant changes occurred in resting or contracted infraspinatus muscle thickness in either shoulder. This study found changes in shoulder ROM and pain sensitivity, but not in muscle function, after dry needling to the infraspinatus muscle in participants with unilateral subacromial pain syndrome. These changes generally occurred 3-4 days after dry needling and only in the symptomatic shoulders. Published by Elsevier Ltd.

  10. Single-lead percutaneous peripheral nerve stimulation for the treatment of shoulder pain from subacromial impingement syndrome.

    Science.gov (United States)

    Wilson, Richard D; Harris, Michael A; Bennett, Maria E; Chae, John

    2012-08-01

    This case report demonstrates the feasibility of a single-lead peripheral nerve stimulation system for the treatment of pain secondary to chronic subacromial impingement syndrome. The participant was a 57-year-old man who experienced persistent pain from subacromial impingement syndrome for 20 months despite having undergone conservative therapy of steroid injection and physical therapy. After study enrollment, a single intramuscular lead was placed percutaneously into the deltoid muscle of the affected shoulder. He was treated 6 hours per day for 3 weeks and the lead was removed. The primary outcome measure was the Brief Pain Inventory (Short-form) Question 3 (BPI 3), which queries the worst pain in the last week on a 0-10 numerical rating scale. At baseline, BPI 3 was an 8. At the end of treatment and at 4 and 12 weeks after treatment, BPI 3 scores were 2, 0, and 0, respectively. Substantial improvements in shoulder impairment, quality of life, and shoulder disability measures were also observed. Additional studies are needed to further demonstrate safety and efficacy, determine optimal dose, define optimal prescriptive parameters, expand clinical indications, and demonstrate long-term effect. Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  11. Differences in scapular orientation, subacromial space and shoulder pain between the full can and empty can tests.

    Science.gov (United States)

    Timmons, Mark K; Lopes-Albers, Andrea Diniz; Borgsmiller, Lindsey; Zirker, Catherine; Ericksen, Jeff; Michener, Lori A

    2013-04-01

    The empty and full can arm positions are used as diagnostic tests and in therapeutic exercise programs for patients with subacromial impingement syndrome. The adverse effects of these arm positions on the rotator cuff have not been fully described. The purpose of this investigation was to compare the acromio-humeral distance, three-dimensional scapular position, and shoulder pain during maximum isometric contractions in the empty and full can arm positions. Subjects with subacromial impingement syndrome (n=28) and a matched control group without shoulder pain (n=28) participated. Acromio-humeral distance, scapular/clavicular positions and shoulder pain were measured during maximal isometric contractions in each position. No difference was found in acromio-humeral distance (P=0.314) between the arm positions or between the groups (P=0.598). The empty can position resulted in greater scapular upward rotation (Ppain in the EC position might be due to the lack of an association amongst the scapular positions rather than the deficiency of a single scapular motion. Published by Elsevier Ltd.

  12. Effect of corticosteroid injections versus physiotherapy on pain, shoulder range of motion and shoulder function in patients with subacromial impingement syndrome: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Marlette Burger

    2016-02-01

    Full Text Available Background: Subacromial impingement syndrome (SIS is one of the most common causes of shoulder pain. Limited research has been conducted into the efficacy of corticosteroid injections (CSIs compared to physiotherapy in the management of SIS.Objective: To critically appraise and establish the best available evidence for the effectiveness of CSI in comparison with physiotherapy for the management of pain, shoulder range of motion (ROM and shoulder function in patients with SIS.Methodology:  Seven databases were searched from inception to February 2016, namely PubMed, Science Direct, EBSCO Host: SPORTDiscus, EBSCO Host: CINAHL, Cochrane, Scopus and PEDro. The main search terms were shoulder impingement syndrome and/or subacromial impingement syndrome, corticosteroid injections and/or steroid injections, physical therapy and/or physiotherapy. Only randomised controlled trials (RCTs were considered for inclusion. The articles were appraised according to the PEDro scale. The Revman© Review Manager Software was used to combine the results of shoulder function and the data were illustrated in forest plots.Results: The PEDro scores of the three RCTs that qualified for this review ranged from 7 to 8/10. There is Level II evidence suggesting that besides a significant improvement in shoulder function in favour of CSI at 6–7 weeks follow-up (p < 0.0001, no evidence was found for the superiority of CSIs compared with physiotherapy for pain, ROM and shoulder function in the short- (1–3 months, mid- (6 months and long term (12 months.Conclusion: In patients with SIS only a short term significant improvement in shoulder function was found in favour of CSIs.

  13. Predicting Response to Subacromial Injections and Lidocaine/Tetracaine Patch from Pretreatment Pain Quality in Patients with Shoulder Impingement Syndrome.

    Science.gov (United States)

    Gammaitoni, Arnold R; Trudeau, Jeremiah J; Radnovich, Richard; Galer, Bradley S; Jensen, Mark P

    2015-07-01

    No existing pain treatment is effective for all pain problems, and response to pain treatment is highly variable. Knowledge regarding the patient factors that predict response to different treatments could benefit patients by providing an empirical foundation for patient-treatment matching. This study sought to test the hypothesis that improvements following two treatments thought to operate via similar mechanisms would be predicted by similar baseline pain qualities. Prospective prediction analysis using data from a previously published open label trial comparing a heated lidocaine/tetracaine patch versus subacromial corticosteroid injection for the treatment of pain in individuals with shoulder impingement syndrome. Consistent with the study hypothesis, the response to the two treatments were predicted by similar baseline pain qualities; specifically, higher baseline levels of unpleasant, electric, and sensitive pain predicted subsequent improvements in sleep interference, work/activity interference, and patient global ratings of improvement, respectively. The findings are consistent with the combined ideas that (1) those who have the most to gain (i.e., those reporting the highest levels of various pain qualities) can expect the best response to effective treatments and (2) different pain qualities may be associated with different types of outcomes. The findings support further research to examine how pain quality measures may be used to improve patient-treatment matching, and therefore, ultimately improve the efficiency, efficacy, and overall benefit-risk of pain treatment. Wiley Periodicals, Inc.

  14. Shoulder MRI features with clinical correlations in subacromial pain syndrome: a cross-sectional and prognostic study.

    Science.gov (United States)

    Kvalvaag, Elisabeth; Anvar, Masoud; Karlberg, Anna Cecilia; Brox, Jens Ivar; Engebretsen, Kaia Beck; Soberg, Helene Lundgaard; Juel, Niels Gunnar; Bautz-Holter, Erik; Sandvik, Leiv; Roe, Cecilie

    2017-11-21

    Previous studies on shoulder patients have suggested that the prevalence of rotator cuff or bursa abnormalities are weakly related to symptoms and that similar findings are often found in asymptomatic persons. In addition, it is largely unknown whether structural changes identified by magnetic resonance imaging (MRI) affect outcome after treatment for shoulder pain. The purpose of this study was therefore to evaluate the presence of structural changes on MRI in patients with subacromial pain syndrome and to determine to what extent these changes are associated with symptoms and predict outcome after treatment (evaluated by the Shoulder Pain and Disability Index (SPADI)). A prospective, observational assessment of a subset of shoulder patients who were included in a randomized study was performed. All participants had an MRI of the shoulder. An MRI total score for findings at the AC joint, subacromial bursa and rotator cuff was calculated. Multiple linear regression analysis was applied to examine the relationship between the MRI total score and the outcome measure at baseline and to examine to what extent the MRI total score was associated with the change in the SPADI score from baseline to the one year follow-up. There was a weak, inverse association between the SPADI score at baseline and the MRI total score (β = -3.1, with 95% CI -5.9 to -0.34; p = 0.03), i.e. the SPADI score was higher for patients with a lower MRI total score. There was an association between the change in the SPADI score from baseline to the one year follow-up and the MRI total score (β = 8.1, 95% CI -12.3 to -3.8; p bursitis (p = 0.04) were associated with a poorer outcome after one year. In this study, MRI findings were significantly associated with the change in the SPADI score from baseline and to one year follow-up, with a poorer outcome after treatment for the patients with higher MRI total score, tendinosis and bursitis on MRI. Clinicaltrials.gov no NCT01441830

  15. The relationship between subacromial bursa thickness on ultrasound and shoulder pain in open water endurance swimmers over time.

    Science.gov (United States)

    Couanis, G; Breidahl, W; Burnham, S

    2015-07-01

    To help clinicians understand the clinical relevance of subacromial bursa (SAB) thickness on ultrasound investigations in marathon swimmers. A prospective, observational cohort study. Twenty two open-water marathon swimmers entered in a 19.7km open-water event received comprehensive, bilateral, shoulder ultrasounds on three occasions: 4 months prior to the race, 2 weeks prior to the race and within 1 week after the race. The SAB thickness was measured in the longitudinal plane of supraspinatus, with other abnormailities also recorded. The swimmers completed questionnaires detailing presence and severity of shoulder pain, volume of swimming completed that week and their breathing pattern. SAB thickness increased with season progression: mean of 1.55 (± 0.68) 4 months prior to the race, 1.63 (± 0.68) 2 weeks prior to the race and 1.86 (± 0.69) 1 week after the race. SAB thickness is significantly (p=0.05) correlated (β=0.11) with kilometres swum in the pool in the preceding week. SAB thickness was not significantly correlated with pain when measured prior to the race. However, at 1 week post race, SAB thickness of shoulders with pain were significantly greater than those without pain, p-value=0.032. SAB thickness increases with increasing swimming training. Commonly, this increase is not correlated to pain, suggestive of a painless adaptive process. The significant correlation between pain and SAB thickness soon after an exacerbating event suggests that painful acute SAB thickening is a different entity to chronic, painless adaptive SAB thickening. These two entities can only be differentiated by clinical history and examination. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  16. Electromyographic activity of the shoulder muscles during rehabilitation exercises in subjects with and without subacromial pain syndrome: a systematic review.

    Science.gov (United States)

    Kinsella, Rita; Pizzari, Tania

    2017-04-01

    Subacromial pain syndrome (SPS) is a common cause of shoulder pain and muscle activity deficits are postulated to contribute to the development and progression of the disorder. The purpose of this systematic review was to definitively determine whether evidence exists of differences in electromyography (EMG) characteristics between subjects with and without SPS. Six key databases were searched: MEDLINE, EMBASE, CINAHL, SPORTdiscus, PEDro and The Cochrane Library (inception to May 2016). The search yielded 1414 records using terms relating to shoulder impingement, EMG, scapular and rotator cuff muscles. Twenty-two papers remained once duplicates were removed and selection criteria applied. Data extraction, quality assessment and data synthesis were performed. Effect sizes and 95% confidence intervals were calculated. There was limited evidence that serratus anterior has lower amplitude, delayed activation and earlier termination in SPS participants. For the majority of muscles, regardless of task, load or arm position, significant differences were not demonstrated or results were contradictory. The understanding of SPS is changing and EMG appears unable to capture the complexities associated with this condition. Addressing aberrant movement patterns and facilitating balanced activation of all shoulder muscles may be a more appropriate treatment direction for the future.

  17. Effects of local microwave diathermy on shoulder pain and function in patients with rotator cuff tendinopathy in comparison to subacromial corticosteroid injections: a single-blind randomized trial.

    Science.gov (United States)

    Rabini, Alessia; Piazzini, Diana B; Bertolini, Carlo; Deriu, Laura; Saccomanno, Maristella F; Santagada, Domenico A; Sgadari, Antonio; Bernabei, Roberto; Fabbriciani, Carlo; Marzetti, Emanuele; Milano, Giuseppe

    2012-04-01

    Single-blind randomized clinical trial, with a follow-up of 24 weeks. To determine the effects of hyperthermia via localized microwave diathermy on pain and disability in comparison to subacromial corticosteroid injections in patients with rotator cuff tendinopathy. Hyperthermia improves symptoms and function in several painful musculoskeletal disorders. However, the effects of microwave diathermy in rotator cuff tendinopathy have not yet been established. Ninety-two patients with rotator cuff tendinopathy and pain lasting for at least 3 months were recruited from the outpatient clinic of the Department of Orthopaedics and Traumatology, University Hospital, Rome, Italy. Participants were randomly allocated to either local microwave diathermy or subacromial corticosteroids. The primary outcome measure was the short form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH). Secondary outcome measures were the Constant-Murley shoulder outcome score and a visual analog scale for pain assessment. At the end of treatment and at follow-up, both treatment groups experienced improvements in all outcome measures relative to baseline values. Changes over time in QuickDASH, Constant-Murley, and visual analog scale scores were not different between treatment arms. In patients with rotator cuff tendinopathy, the effects of localized microwave diathermy on disability, shoulder function, and pain are equivalent to those elicited by subacromial corticosteroid injections.

  18. Subacromial shoulder disorders among baggage handlers

    DEFF Research Database (Denmark)

    Thygesen, Lau Caspar; Mikkelsen, Sigurd; Pedersen, Ellen Bøtker

    2016-01-01

    PURPOSE: To assess the influence of cumulative employment as baggage handler on the risk of incident subacromial shoulder disorders. Baggage handling is characterized by repetitive work primarily consisting of heavy lifting in awkward positions and time pressure. METHODS: This cohort study is based...... System. The primary exposure was cumulative years of employment as a baggage handler, and the primary outcome was diagnoses and surgical treatment of subacromial shoulder disorders. RESULTS: The cohort contained 3396 baggage handlers and 63,909 workers in the reference group. Baggage handlers with longer...... increased incidence of subacromial shoulder disorders for workers with longer cumulative years of employment. These results support that long-term lifting in awkward positions and time pressure influences the risk of subacromial shoulder disorders....

  19. Glenohumeral and scapulothoracic strength impairments exists in patients with subacromial impingement, but these are not reflected in the shoulder pain and disability index

    DEFF Research Database (Denmark)

    Clausen, M B; Witten, A; Holm, K

    2017-01-01

    BACKGROUND: Pain and loss of function are cardinal symptoms associated with Subacromial impingement syndrome (SIS), while the presence and magnitude of deficits in strength and range of motion (ROM) are largely undescribed in non-athletic patients with SIS. Moreover, the relevance of impairments...... diagnostic criteria. Prior to specialist examination, questionnaires regarding shoulder function (Shoulder Pain And Disability Index, SPADI) demographics and kinesiophobia (TSK-11) were collected, and shoulder strength and ROM was measured by trained testers, with the patient reporting pain levels during...... testing and for the last week. Impairments in strength (abduction, external-rotation, (protraction and horizontal-extension) and ROM (abduction and internal rotation) were investigated in patients with unilateral shoulder pain, using one-sample t-tests. SPADI total score (SPADI) and SPADI function score...

  20. A randomized clinical study of the heated lidocaine/tetracaine patch versus subacromial corticosteroid injection for the treatment of pain associated with shoulder impingement syndrome.

    Science.gov (United States)

    Radnovich, Richard; Trudeau, Jeremiah; Gammaitoni, Arnold R

    2014-01-01

    Treatment for pain due to shoulder impingement syndrome (SIS) typically begins conservatively with nonsteroidal anti-inflammatory drugs and physical therapy and can include subacromial injection of corticosteroids, particularly in patients unresponsive to conservative measures. The heated lidocaine/tetracaine (HLT) patch has been reported to reduce SIS pain in a small case series. This was a prospective, randomized, open-label clinical trial in which adult patients with SIS pain lasting at least 14 days, with an average intensity of ≥4 on a 0-10 scale (0= no pain, 10= worst pain) were randomized to treatment with the HLT patch or a single subacromial injection of triamcinolone acetonide (10 mg). Patients in the HLT patch group applied a single HLT patch to the shoulder for 4 hours twice daily, with a 12-hour interval between treatments during the first 14 days, and could continue to use the patch on an as-needed basis (up to twice daily) during the second 14-day period. No treatment was allowed in the final 14-day period. At baseline and at days 14, 28, and 42, patients rated their pain and pain interference with specific activities (0-10 scale). Sixty patients enrolled in the study (average age =51 years, range 18-75, n=21 female). Average pain scores declined from 6.0±1.6 at baseline to 3.5±2.4 at day 42 in the HLT patch group (n=29, Pwork, or sleep; and range of motion. No significant between-group differences were seen for any pain or pain interference scores at any time point. These results suggest that short-term, noninvasive treatment with the HLT patch has similar efficacy to subacromial corticosteroid injections for the treatment of pain associated with SIS.

  1. Guideline for diagnosis and treatment of subacromial pain syndrome

    NARCIS (Netherlands)

    Diercks, Ronald; Bron, Carel; Dorrestijn, Oscar; Meskers, Carel; Naber, René; de Ruiter, Tjerk; Willems, Jaap; Winters, Jan; van der Woude, Henk Jan

    Treatment of "subacromial impingement syndrome" of the shoulder has changed drastically in the past decade. The anatomical explanation as "impingement" of the rotator cuff is not sufficient to cover the pathology. "Subacromial pain syndrome", SAPS, describes the condition better. A working group

  2. Ultrasound-guided versus blind subacromial-subdeltoid bursa injection in adults with shoulder pain: A systematic review and meta-analysis.

    Science.gov (United States)

    Wu, Tao; Song, Hai Xin; Dong, Yan; Li, Jian Hua

    2015-12-01

    This systematic review and meta-analysis aimed to assess the effectiveness of ultrasound-guided (USG) versus blind (landmark-guided, LMG) corticosteroid subacromial-subdeltoid bursa injection in adults with shoulder pain. The searches were performed on PubMed, Ovid MEDLINE, Ovid EMBASE, Ovid CochraneCENTRAL, Web of Science, Google Scholar, and Scopus from database inception through March 27, 2015. Studies were included trials comparing USG versus LSG injections for the treatment of adults with subacromial-subdeltoid bursitis. Two reviewers independently performed data extraction and appraisal of the studies. The outcome measures collected were the decreased VAS and SDQ scores, the increased shoulder function scores and shoulder abduction motion range, and the effective rate at 6 weeks after injection. Seven papers including 445 patients were reviewed; 224 received LMG injections and 221 received USG injections. There was a statistically significant difference in favor of USG for pain score [MD = 1.19, 95% CI (0.39, 1.98), P = 0.003] and SDQ score [MD = 5.01, 95% CI (1.82, 8.19), P = 0.02] at 6 weeks after injection. Also there was a statistically significant difference between the groups, with greater improvement reported of shoulder function scores [SMD = 0.89, 95% CI (0.56, 1.23), P < 0.001] and shoulder abduction motion range [MD 32.69, 95% CI (14.82, 50.56), P < 0.001] in the USG group. More effective rate was also reported with USG group and the difference was statistically significant [risk ratio = 1.6, 95% CI (1.02, 2.50), P = 0.04]. Ultrasound-guided corticosteroid injections potentially offer a significantly greater clinical improvement over blind SASD bursitis injections in adults with shoulder pain. Copyright © 2015. Published by Elsevier Inc.

  3. A randomized clinical study of the heated lidocaine/tetracaine patch versus subacromial corticosteroid injection for the treatment of pain associated with shoulder impingement syndrome

    Directory of Open Access Journals (Sweden)

    Radnovich R

    2014-12-01

    Full Text Available Richard Radnovich,1 Jeremiah Trudeau,2 Arnold R Gammaitoni3 1Injury Care Medical Center, Boise, ID, USA; 2Analgesic Solutions, Natick, MA, USA; 3Nuvo Research Inc., West Chester, PA, USA Background: Treatment for pain due to shoulder impingement syndrome (SIS typically begins conservatively with nonsteroidal anti-inflammatory drugs and physical therapy and can include subacromial injection of corticosteroids, particularly in patients unresponsive to conservative measures. The heated lidocaine/tetracaine (HLT patch has been reported to reduce SIS pain in a small case series. Methods: This was a prospective, randomized, open-label clinical trial in which adult patients with SIS pain lasting at least 14 days, with an average intensity of ≥4 on a 0–10 scale (0= no pain, 10= worst pain were randomized to treatment with the HLT patch or a single subacromial injection of triamcinolone acetonide (10 mg. Patients in the HLT patch group applied a single HLT patch to the shoulder for 4 hours twice daily, with a 12-hour interval between treatments during the first 14 days, and could continue to use the patch on an as-needed basis (up to twice daily during the second 14-day period. No treatment was allowed in the final 14-day period. At baseline and at days 14, 28, and 42, patients rated their pain and pain interference with specific activities (0–10 scale. Results: Sixty patients enrolled in the study (average age =51 years, range 18–75, n=21 female. Average pain scores declined from 6.0±1.6 at baseline to 3.5±2.4 at day 42 in the HLT patch group (n=29, P<0.001 and from 5.6±1.2 to 3.2±2.6 in the injection group (n=31, P<0.001. Similar improvements were seen in each group for worst pain; pain interference with general activity, work, or sleep; and range of motion. No significant between-group differences were seen for any pain or pain interference scores at any time point. Conclusion: These results suggest that short-term, noninvasive treatment

  4. A randomized clinical study of the heated lidocaine/tetracaine patch versus subacromial corticosteroid injection for the treatment of pain associated with shoulder impingement syndrome

    Science.gov (United States)

    Radnovich, Richard; Trudeau, Jeremiah; Gammaitoni, Arnold R

    2014-01-01

    Background Treatment for pain due to shoulder impingement syndrome (SIS) typically begins conservatively with nonsteroidal anti-inflammatory drugs and physical therapy and can include subacromial injection of corticosteroids, particularly in patients unresponsive to conservative measures. The heated lidocaine/tetracaine (HLT) patch has been reported to reduce SIS pain in a small case series. Methods This was a prospective, randomized, open-label clinical trial in which adult patients with SIS pain lasting at least 14 days, with an average intensity of ≥4 on a 0–10 scale (0= no pain, 10= worst pain) were randomized to treatment with the HLT patch or a single subacromial injection of triamcinolone acetonide (10 mg). Patients in the HLT patch group applied a single HLT patch to the shoulder for 4 hours twice daily, with a 12-hour interval between treatments during the first 14 days, and could continue to use the patch on an as-needed basis (up to twice daily) during the second 14-day period. No treatment was allowed in the final 14-day period. At baseline and at days 14, 28, and 42, patients rated their pain and pain interference with specific activities (0–10 scale). Results Sixty patients enrolled in the study (average age =51 years, range 18–75, n=21 female). Average pain scores declined from 6.0±1.6 at baseline to 3.5±2.4 at day 42 in the HLT patch group (n=29, P<0.001) and from 5.6±1.2 to 3.2±2.6 in the injection group (n=31, P<0.001). Similar improvements were seen in each group for worst pain; pain interference with general activity, work, or sleep; and range of motion. No significant between-group differences were seen for any pain or pain interference scores at any time point. Conclusion These results suggest that short-term, noninvasive treatment with the HLT patch has similar efficacy to subacromial corticosteroid injections for the treatment of pain associated with SIS. PMID:25525385

  5. Glenohumeral and scapulothoracic strength impairments exists in patients with subacromial impingement, but these are not reflected in the shoulder pain and disability index.

    Science.gov (United States)

    Clausen, M B; Witten, A; Holm, K; Christensen, K B; Attrup, M L; Hölmich, P; Thorborg, K

    2017-07-17

    Pain and loss of function are cardinal symptoms associated with Subacromial impingement syndrome (SIS), while the presence and magnitude of deficits in strength and range of motion (ROM) are largely undescribed in non-athletic patients with SIS. Moreover, the relevance of impairments in strength and ROM to patient-reported shoulder function is not well described, even though testing of strength is recommended in clinical guidelines. The purpose of this study was, first, to investigate impairments in glenohumeral and scapulothoracic strength and in abduction and internal rotation ROM in patients with SIS. Secondly, to investigate the influence of these impairments on patient-reported shoulder function. Cross-sectional study based on a consecutive cohort of 157 patients referred to specialist examination and diagnosed with shoulder impingement (SIS) using predefined validated diagnostic criteria. Prior to specialist examination, questionnaires regarding shoulder function (Shoulder Pain And Disability Index, SPADI) demographics and kinesiophobia (TSK-11) were collected, and shoulder strength and ROM was measured by trained testers, with the patient reporting pain levels during testing and for the last week. Impairments in strength (abduction, external-rotation, (protraction and horizontal-extension) and ROM (abduction and internal rotation) were investigated in patients with unilateral shoulder pain, using one-sample t-tests. SPADI total score (SPADI) and SPADI function score (SPADI-F), were chosen as dependent variables in multiple regressions to investigate the influence of impairments on patient-reported shoulder function. Independent variables of interest were; strength in abduction and external rotation, abduction ROM, pain-during-tests, pain-last-week and kinesiophobia. Significant impairments were found for all impairment tests, but most pronounced for glenohumeral strength and abduction ROM (29-33% deficits), and less for scapulothoracic strength and internal

  6. Responsiveness and minimal important change of the Norwegian version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) in patients with subacromial pain syndrome.

    Science.gov (United States)

    Rysstad, Tarjei; Røe, Yngve; Haldorsen, Benjamin; Svege, Ida; Strand, Liv Inger

    2017-06-08

    The Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) is a valid and reliable patient-reported outcome measure (PROM). It was designed to measure physical disability and symptoms in patients with musculoskeletal disorders of the upper extremity, and is one of the most commonly used PROMs for patients with shoulder pain. The aim of this study was to examine responsiveness, the smallest detectable change (SDC) and the minimal important change (MIC) of the DASH, in line with international (COSMIN) recommendations. The study sample consisted of 50 patients with subacromial pain syndrome, undergoing physical therapy for 3-4 months. Responsiveness to change was examined by calculating area under the receiver operating characteristic curves (AUC) and testing a priori-formulated hypothesis regarding correlations with changes in other instruments that measuring the same construct. The SDC was calculated using a test re-test protocol, and the MIC was calculated by the anchor-based MIC distribution. MIC values for patients with low and high baseline scores were also calculated. DASH appeared to be responsive, as it was able to distinguish patients who reported to be improved from those unchanged (AUC 0.77). All of the hypotheses were accepted. The SDC was 11.8, and the MIC was 4.4. This study shows that the Norwegian version of the DASH has good responsiveness to change and may thus be recommended to measure outcome in patients with shoulder pain in Norway.

  7. Subacromial Anesthetics Increase Proprioceptive Deficit in the Shoulder and Elbow in Patients With Subacromial Impingement Syndrome.

    Science.gov (United States)

    Ettinger, Lucas R; Shapiro, Matthew; Karduna, Andrew

    2017-01-01

    Shoulder proprioception gives information regarding arm joint position and movement direction. Several studies have investigated shoulder proprioceptive acuity in patients with subacromial impingement syndrome (SIS); however, differences in protocols and between-subjects designs have limited scientific inferences regarding proprioception and SIS. We aimed to determine within-subject differences in shoulder and elbow proprioceptive acuity in 17 patients with stage 2 SIS following treatment of a local anesthetic injection. In addition, we used 17 healthy, age-, sex-, and arm dominance-matched controls to determine the magnitude of differences after treatment. Joint position sense (JPS) was measured before and after treatment in both groups in the sagittal plane for the shoulder and elbow. Our results indicate that patients with SIS have less sensitivity to angular position and tended to overshoot their targets with greater variability during angle-matching tasks for the shoulder (1.8° difference, P = .042) and elbow (5.6° difference, P = .001) than controls. The disparities in JPS found in patients with SIS were not resolved following subacromial injection; in fact, the magnitude of the errors increased after treatment where postinjection errors were significantly greater (P = .046) than controls, with an average difference of 2.4°. These findings suggest that patients with SIS have decrements in either the signaling or processing of proprioceptive information and may use pain to reduce these inequalities.

  8. Subacromial Anesthetics Increase Proprioceptive Deficit in the Shoulder and Elbow in Patients With Subacromial Impingement Syndrome

    Directory of Open Access Journals (Sweden)

    Lucas R Ettinger

    2017-06-01

    Full Text Available Shoulder proprioception gives information regarding arm joint position and movement direction. Several studies have investigated shoulder proprioceptive acuity in patients with subacromial impingement syndrome (SIS; however, differences in protocols and between-subjects designs have limited scientific inferences regarding proprioception and SIS. We aimed to determine within-subject differences in shoulder and elbow proprioceptive acuity in 17 patients with stage 2 SIS following treatment of a local anesthetic injection. In addition, we used 17 healthy, age-, sex-, and arm dominance–matched controls to determine the magnitude of differences after treatment. Joint position sense (JPS was measured before and after treatment in both groups in the sagittal plane for the shoulder and elbow. Our results indicate that patients with SIS have less sensitivity to angular position and tended to overshoot their targets with greater variability during angle-matching tasks for the shoulder (1.8° difference, P  = .042 and elbow (5.6° difference, P  = .001 than controls. The disparities in JPS found in patients with SIS were not resolved following subacromial injection; in fact, the magnitude of the errors increased after treatment where postinjection errors were significantly greater ( P  = .046 than controls, with an average difference of 2.4°. These findings suggest that patients with SIS have decrements in either the signaling or processing of proprioceptive information and may use pain to reduce these inequalities.

  9. Shoulder pain

    Science.gov (United States)

    ... and ligaments inside the shoulder become stiff, making movement difficult and painful Overuse or injury of nearby tendons, such as the bicep muscles of the arms Tears of the rotator cuff tendons Watch this video about: Shoulder joint dislocation Sometimes, shoulder pain may ...

  10. Subacromial injections of corticosteroids and xylocaine for painful subacromial impingement syndrome.

    Science.gov (United States)

    Yu, Chung-Ming; Chen, Chih-Hwa; Liu, Hsien-Tao; Dai, Ming-Hsun; Wang, I-Chun; Wang, Kun-Chung

    2006-01-01

    Subacromial impingement syndrome, with pain and limited motion, is a common disease encountered daily in clinics. This study determined the efficacy of subacromial injections of corticosteroids and local anesthesia for treatment of painful subacromial impingement syndrome. A total of 238 shoulders in 209 patients, with regular follow-up, were enrolled in this study. Mean patient age was 51 years (range 31-72 years). Each patient complained of shoulder pain with progressive motion limitation present for more than one month, which was not relieved by various nonsurgical treatments. The mean duration of symptoms before injection was five months (range 1-12 months). Each patient had a positive Neer impingement sign, Hawkins impingement sign, painful tendon sign, limited range of motion and did not show clinical evidence of a rotator cuff tear. Each patient was administered an injection of 1 ml of 2% Xylocaine and 1 ml of Rinderon suspension. A second injection was administered one week later for patients without obvious improvement. Following injections, patients were instructed to perform a home rehabilitation program for four weeks. Follow-up examinations were scheduled for one, two and four weeks, and three, six, nine and 12 months after injection. Outcome measures included the Constant-Murley score and shoulder range of motion. At follow-up four weeks after the first injection, 216 shoulders (91%) had satisfactory improvement in amount of pain and range of motion: mean improvements in the active range of motion of forward elevation, abduction, internal rotation and external rotation were 56 degrees, 48 degrees, 18 degrees and 22 degrees, respectively. However, at the first year follow-up, the satisfaction rate was slightly down at 88%, and 19 shoulders (8%; 16 patients) had recurrent pain and motion limitation after an average of 5.4 months (range 3-12 months). Each of these patients received another injection. Surgery was recommended for 22 shoulders (9%; 18

  11. SHOULDER MUSCLE IMBALANCE AND SUBACROMIAL IMPINGEMENT SYNDROME IN OVERHEAD ATHLETES

    Science.gov (United States)

    2011-01-01

    Subacromial impingement is a frequent and painful condition among athletes, particularly those involved in overhead sports such as baseball and swimming. There are generally two types of subacromial impingement: structural and functional. While structural impingement is caused by a physical loss of area in the subacromial space due to bony growth or inflammation, functional impingement is a relative loss of subacromial space secondary to altered scapulohumeral mechanics resulting from glenohumeral instability and muscle imbalance. The purpose of this review is to describe the role of muscle imbalance in subacromial impingement in order to guide sports physical therapy evaluation and interventions. PMID:21655457

  12. Shoulder pain.

    Science.gov (United States)

    Ramponi, Denise R

    2011-01-01

    Shoulder pain is a frequent complaint encountered in the emergency setting. A brief review of shoulder anatomy and physical examination sets the foundation for evaluation of shoulder pain. Considerations of patient's age are helpful to predict injuries. Fractured clavicles are often seen in traumatic injuries in children and young adults, whereas fractures of the humeral head are more often seen in the elderly from traumatic injuries. Shoulder dislocations are more common in teens to fourth decade. This article reviews specific acute injuries, chronic conditions, and radiologic considerations of patients with shoulder complaints encountered in emergency settings.

  13. Cost-effectiveness of exercise therapy after corticosteroid injection for moderate to severe shoulder pain due to subacromial impingement syndrome: a trial-based analysis.

    Science.gov (United States)

    Jowett, Sue; Crawshaw, Dickon P; Helliwell, Philip S; Hensor, Elizabeth M A; Hay, Elaine M; Conaghan, Philip G

    2013-08-01

    To perform a cost-effectiveness analysis of subacromial corticosteroid injection combined with exercise compared with exercise alone in patients with moderate to severe shoulder pain from subacromial impingement syndrome. A within-trial cost-effectiveness analysis with 232 patients randomized to physiotherapy-led injection combined with exercise (n = 115) or exercise alone (n = 117). The analysis was from a health care perspective with 24-week follow-up. Resource use information was collected from all patients on interventions, medication, primary and secondary care contacts, private health care use and over-the-counter purchases. The measure of outcome was quality-adjusted life years (QALYs), calculated from EQ-5D responses at baseline and three further time points. An incremental cost-effectiveness analysis was conducted. Mean per patient NHS costs (£255 vs £297) and overall health care costs (£261 vs £318) were lower in the injection plus exercise arm, but this difference was not statistically significant. Total QALYs gained were very similar in the two trial arms (0.3514 vs 0.3494 QALYs), although slightly higher in the injection plus exercise arm, indicating that injection plus exercise may be the dominant treatment option. At a willingness to pay of £20,000 per additional QALY gained, there was a 61% probability that injection plus exercise was the most cost-effective option. Injection plus exercise delivered by therapists may be a cost-effective use of resources compared with exercise alone and lead to lower health care costs and less time off work. International Standard Randomised Controlled Trial Number Register, http://www.controlled-trials.com/isrctn/, ISRCT 25817033.

  14. Detection of subacromial bursa thickening by sonography in shoulder impingement syndrome.

    Science.gov (United States)

    Tsai, Yao-Hung; Huang, Tsung-Jen; Hsu, Wei-Hsiu; Huang, Kuo-Chin; Li, Yen-Yao; Peng, Kuo-Ti; Hsu, Robert Wen-Wei

    2007-01-01

    Normally, the subacromial-subdeltoid bursa is thinner than 2 mm using ultrasound examination. The subtle thickening of the bursa could be an early sign of subacromial impingement and possibly a rotator cuff tear. The aim of this study was to compare the thickness of subacromial bursa measured using ultrasonography in the painful shoulder with normal side, and also to differentiate Neer stages I and II impingements in patients with unilateral shoulder pain. We performed bilateral shoulder sonography in 268 consecutive patients with unilateral shoulder pain and clinical suggestion of rotator cuff pathology. The study group consisted of 102 cases of Neer stage I and 166 cases of Neer stage II impingement syndrome. The bursa thickness was calculated from the superficial peribursal fat to the upper margin of the supraspinatus. A statistically significant association was detected (p bursa in patients with Neer stage I impingement had no statistically important link the results of the patients with Neer stage II impingement. Increased bursa thickness in the symptomatic side may be an alternative sonographic indicator of subacromial bursitis and partial-thickness rotator cuff tears, even when measured to be less than 2 mm. Sonographic examination of subacromial bursa thickness is not an appropriate technique to differentiate the Neer stages I and II impingement. Further study is needed to quantify the echogenicity of the supraspinatus tendon and to show a level of accuracy in patients with rotator cuff tendinosis or partial tears.

  15. Painful shoulder

    Directory of Open Access Journals (Sweden)

    Benno Ejnismann

    2008-03-01

    Full Text Available Many factors can be involved in the painful shoulder. Beyond articularcauses other pathologies such as artrosis, periarticular diseases as rotadorcuff tears, long head of the biceps tendinitis, adhesive capsulitis, calcifyingtendinitis, degenerative arthritis of the acromioclavicular joint, cervicalradiculopathy and nervous injuries can cause pain in the shoulder.

  16. Painful shoulder

    OpenAIRE

    Benno Ejnismann; Gustavo Cará Monteiro; Luis Fernando Uyeda

    2008-01-01

    Many factors can be involved in the painful shoulder. Beyond articularcauses other pathologies such as artrosis, periarticular diseases as rotadorcuff tears, long head of the biceps tendinitis, adhesive capsulitis, calcifyingtendinitis, degenerative arthritis of the acromioclavicular joint, cervicalradiculopathy and nervous injuries can cause pain in the shoulder.

  17. Static and Dynamic Shoulder Imaging to Predict Initial Effectiveness and Recurrence After Ultrasound-Guided Subacromial Corticosteroid Injections.

    Science.gov (United States)

    Chang, Ke-Vin; Wu, Wei-Ting; Han, Der-Sheng; Özçakar, Levent

    2017-10-01

    To explore factors contributing to initial effectiveness and recurrence after ultrasound (US)-guided subacromial corticosteroid injections by assessing clinical measurements and static and dynamic shoulder US images. Retrospective cohort study. Rehabilitation outpatient clinic. Adults with shoulder pain referred for injection therapy (N=164). US-guided subacromial corticosteroid injection. The association of initial effectiveness (defined as >50% decrease in any of the 3 pain subdomains after the first injection) and recurrent shoulder pain that required repeated intervention with record-based clinical measurements and static/dynamic shoulder US. This study included 164 patients, 106 of whom were responsive to a first injection. Among the 106 participants, 42 received a second injection because of recurrent shoulder pain. By using the multivariate logistic regression analysis, initial effectiveness was positively associated with right handedness, grade 2 subacromial impingement during the dynamic US examination, and bicipital groove tenderness. However, these patients had a negative association with subdeltoid bursitis, grade 3 subacromial impingement, and shoulder stiffness. Subdeltoid bursitis and a positive painful arc test were predictors of recurrent shoulder pain that necessitated a repeated injection in the Cox proportional hazards model. The initial effectiveness and recurrence after US-guided subacromial corticosteroid injection were associated with certain clinical measurements and static and dynamic shoulder US, which should be carefully evaluated (and can be used) to guide the best treatment outcomes. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  18. Effects of conservative therapy applied before arthroscopic subacromial decompression on the clinical outcome in patients with stage 2 shoulder impingement syndrome.

    Science.gov (United States)

    Aydin, Ali; Yildiz, Vahit; Topal, Murat; Tuncer, Kutsi; Köse, Mehmet; Şenocak, Eyüp

    2014-01-01

    To investigate the effects of conservative therapy applied before arthroscopic subacromial decompression on the clinical outcome in patients with stage 2 shoulder impingement syndrome. Sixty-eight patients having stage 2 shoulder impingement syndrome and treated with arthroscopic subacromial decompression were included in the study. We divided these patients into 2 groups, whereby 32 (47%) patients received conservative therapy before arthroscopic subacromial decompression and 36 (53%) patients did not receive conservative therapy. We compared both groups in terms of the the Constant, UCLA, and VAS scores for shoulder pain before and after arthroscopic subacromial decompression. Constant, UCLA, and VAS scores were statistically significantly improved in both groups after arthroscopic subacromial decompression (P 0.05). Conservative therapy applied in patients with stage 2 shoulder impingement syndrome before arthroscopic subacromial decompression does not have a positive contribution on the clinical outcome after arthroscopic subacromial decompression.

  19. Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome

    DEFF Research Database (Denmark)

    Storgaard, Filip Holst; Pedersen, Christina Gravgaard; Jensen, Majbritt Lykke

    Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome.......Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome....

  20. Subacromial Bursa Injection of Hyaluronate with Steroid in Patients with Peri-articular Shoulder Disorders

    Science.gov (United States)

    Byun, Seung Deuk; Choi, Won Duck; Lee, Zee Ihn

    2011-01-01

    Objective To investigate the additive effect of sono-guided subacromial bursa injection of hyaluronate with steroid in patients with peri-articular shoulder disorders. Method This prospective randomized controlled trial involved 26 patients who had shoulder pain. Group A, consisting of 13 patients, was treated with a sono-guided subacromial bursa injection containing a mixture of 0.5% lidocaine (5 ml) and triamcinolone 40 mg (1 ml), followed by injection with sodium hyaluronate (2 ml) once a week for 3 weeks. The other 13 patients (Group B) were treated with a sono-guided subacromial bursa injection containing a mixture of 0.5% lidocaine (5 ml) and triamcinolone 40 mg (1 ml) once a week for 3 weeks. The effects were assessed using a visual analogue scale (VAS) of shoulder pain, active range of motion (AROM), shoulder function assessment scale (SFA), shoulder disability questionnaire (SDQ) at study entry and every week from first injection until 4 weeks after the 1st injection (= 2 weeks after 3rd injection). Results (1) Demographic features and all parameters measured before injection did not show a significant difference between the 2 groups. (2) Statistically significant improvements were shown in VAS, SFA, SDQ during the 1st, 2nd, and 4th week after the first injection in both groups (pbursa injection of hyaluronate with steroid in patients with peri-articular shoulder disorders has additive effects on functional improvement of the affected shoulder, including the AROM of internal rotation. PMID:22506189

  1. Glenohumeral and scapulothoracic strength impairments exists in patients with subacromial impingement, but these are not reflected in the shoulder pain and disability index

    DEFF Research Database (Denmark)

    Clausen, M B; Witten, A; Holm, K

    2017-01-01

    diagnostic criteria. Prior to specialist examination, questionnaires regarding shoulder function (Shoulder Pain And Disability Index, SPADI) demographics and kinesiophobia (TSK-11) were collected, and shoulder strength and ROM was measured by trained testers, with the patient reporting pain levels during...... (SPADI-F), were chosen as dependent variables in multiple regressions to investigate the influence of impairments on patient-reported shoulder function. Independent variables of interest were; strength in abduction and external rotation, abduction ROM, pain-during-tests, pain-last-week and kinesiophobia...

  2. The effect of experimentally-induced subacromial pain on proprioception.

    Science.gov (United States)

    Sole, Gisela; Osborne, Hamish; Wassinger, Craig

    2015-02-01

    Shoulder injuries may be associated with proprioceptive deficits, however, it is unknown whether these changes are due to the experience of pain, tissue damage, or a combination of these. The aim of this study was to investigate the effect of experimentally-induced sub-acromial pain on proprioceptive variables. Sub-acromial pain was induced via hypertonic saline injection in 20 healthy participants. Passive joint replication (PJR) and threshold to detection of movement direction (TTDMD) were assessed with a Biodex System 3 Pro isokinetic dynamometer for baseline control, experimental pain and recovery control conditions with a starting position of 60° shoulder abduction. The target angle for PJR was 60° external rotation, starting from 40°. TTDMD was tested from a position of 20° external rotation. Repeated measures ANOVAs were used to determine differences between PJR absolute and variable errors and TTDMD for the control and experimental conditions. Pain was elicited with a median 7 on the Numeric Pain Rating Scale. TTDMD was significantly decreased for the experimental pain condition compared to baseline and recovery conditions (≈30%, P = 0.003). No significant differences were found for absolute (P = 0.152) and variable (P = 0.514) error for PJR. Movement sense was enhanced for the experimental sub-acromial pain condition, which may reflect protective effects of the central nervous system in response to the pain. Where decreased passive proprioception is observed in shoulders with injuries, these may be due to a combination of peripheral tissue injury and neural adaptations that differ from those due to acute pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Does Subacromial Osteolysis Affect Shoulder Function after Clavicle Hook Plating?

    Directory of Open Access Journals (Sweden)

    Siwei Sun

    2016-01-01

    Full Text Available Purpose. To evaluate whether subacromial osteolysis, one of the major complications of the clavicle hook plate procedure, affects shoulder function. Methods. We had performed a retrospective study of 72 patients diagnosed with a Neer II lateral clavicle fracture or Degree-III acromioclavicular joint dislocation in our hospital from July 2012 to December 2013. All these patients had undergone surgery with clavicle hook plate and were divided into two groups based on the occurrence of subacromial osteolysis. By using the Constant-Murley at the first follow-up visit after plates removal, we evaluated patients’ shoulder function to judge if it has been affected by subacromial osteolysis. Results. We have analyzed clinical data for these 72 patients, which shows that there is no significant difference between group A (39 patients and group B (33 patients in age, gender, injury types or side, and shoulder function (the Constant-Murley scores are 93.38±3.56 versus 94.24±3.60, P>0.05. Conclusion. The occurrence of subacromial osteolysis is not rare, and also it does not significantly affect shoulder function.

  4. Does Subacromial Osteolysis Affect Shoulder Function after Clavicle Hook Plating?

    Science.gov (United States)

    Sun, Siwei; Gan, Minfeng; Sun, Han; Wu, Guizhong; Yang, Huilin; Zhou, Feng

    2016-01-01

    To evaluate whether subacromial osteolysis, one of the major complications of the clavicle hook plate procedure, affects shoulder function. We had performed a retrospective study of 72 patients diagnosed with a Neer II lateral clavicle fracture or Degree-III acromioclavicular joint dislocation in our hospital from July 2012 to December 2013. All these patients had undergone surgery with clavicle hook plate and were divided into two groups based on the occurrence of subacromial osteolysis. By using the Constant-Murley at the first follow-up visit after plates removal, we evaluated patients' shoulder function to judge if it has been affected by subacromial osteolysis. We have analyzed clinical data for these 72 patients, which shows that there is no significant difference between group A (39 patients) and group B (33 patients) in age, gender, injury types or side, and shoulder function (the Constant-Murley scores are 93.38 ± 3.56 versus 94.24 ± 3.60, P > 0.05). The occurrence of subacromial osteolysis is not rare, and also it does not significantly affect shoulder function.

  5. Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion--dynamic sonographic evaluation.

    Science.gov (United States)

    Lin, Hsin-Yu; Wong, Poo-Kuang; Ho, Wei-Pin; Chuang, Tai-Yuan; Liao, Yi-Shyan; Wong, Chin-Chean

    2014-02-06

    Clavicular hook plates are effective fixation devices for distal clavicle fractures and severe acromioclavicular joint dislocations. However, increasing number of studies has revealed that subacromial portion of the hook may induce acromial bony erosion, shoulder impingement, or even rotator cuff damage. By sonographic evaluation, we thus intended to determine whether the presence of hook plate may induce subacromial shoulder impingement and its relationship relative to surrounding subacromial structures. We prospectively followed 40 patients with either distal clavicle fracture or acromioclavicular joint dislocation that had surgery using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate. All patients were evaluated by monthly clinical and radiographic examinations. Static and dynamic musculoskeletal sonography examinations were performed at final follow-up before implant removal. Clinical results for pain, shoulder function, and range of motion were evaluated using Constant-Murley and Disability of Arm, Shoulder, and Hand (DASH) scores. Clinically, 15 out of 40 patients (37.5%) presented with subacromial impingement syndrome and their functional scores were poorer than the non-impinged patients. Among them, six patients were noted to have rotator cuff lesion. Acromial erosion caused by hook pressure developed in 20 patients (50%). We demonstrated by musculoskeletal sonography that clavicular hook plate caused subacromial shoulder impingement and rotator cuff lesion. The data also suggest an association between hardware-induced impingement and poorer functional scores. To our knowledge, the only solution is removal of the implant after bony consolidation/ligamentous healing has taken place. Thus, we advocate the removal of the implant as soon as bony union and/or ligamentous healing is achieved.

  6. Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion - dynamic sonographic evaluation

    Science.gov (United States)

    2014-01-01

    Background Clavicular hook plates are effective fixation devices for distal clavicle fractures and severe acromioclavicular joint dislocations. However, increasing number of studies has revealed that subacromial portion of the hook may induce acromial bony erosion, shoulder impingement, or even rotator cuff damage. By sonographic evaluation, we thus intended to determine whether the presence of hook plate may induce subacromial shoulder impingement and its relationship relative to surrounding subacromial structures. Methods We prospectively followed 40 patients with either distal clavicle fracture or acromioclavicular joint dislocation that had surgery using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate. All patients were evaluated by monthly clinical and radiographic examinations. Static and dynamic musculoskeletal sonography examinations were performed at final follow-up before implant removal. Clinical results for pain, shoulder function, and range of motion were evaluated using Constant-Murley and Disability of Arm, Shoulder, and Hand (DASH) scores. Results Clinically, 15 out of 40 patients (37.5%) presented with subacromial impingement syndrome and their functional scores were poorer than the non-impinged patients. Among them, six patients were noted to have rotator cuff lesion. Acromial erosion caused by hook pressure developed in 20 patients (50%). Conclusions We demonstrated by musculoskeletal sonography that clavicular hook plate caused subacromial shoulder impingement and rotator cuff lesion. The data also suggest an association between hardware-induced impingement and poorer functional scores. To our knowledge, the only solution is removal of the implant after bony consolidation/ligamentous healing has taken place. Thus, we advocate the removal of the implant as soon as bony union and/or ligamentous healing is achieved. PMID:24502688

  7. Effects of Repetitive Shoulder Activity on the Subacromial Space in Manual Wheelchair Users

    Directory of Open Access Journals (Sweden)

    Yen-Sheng Lin

    2014-01-01

    Full Text Available This study investigated (1 the effect of repetitive weight-relief raises (WR and shoulder external rotation (ER on the acromiohumeral distance (AHD among manual wheelchair users (MWUs and (2 the relationship between shoulder pain, subject characteristics, and AHD changes. Twenty-three MWUs underwent ultrasound imaging of the nondominant shoulder in an unloaded baseline position and while holding a WR position before and after the WR/ER tasks. Paired t-tests and Spearman correlational analysis were used to assess differences in the AHD before and after each task and the relationships between pain, subject characteristics, and the AHD measures. A significant reduction in the subacromial space (P<0.01 occurred when subjects performed a WR position compared to baseline. Individuals with increased years of disability had greater AHD percentage narrowing after WR (P=0.008. Increased shoulder pain was associated with AHD percentage narrowing after ER (P≤0.007. The results support clinical practice guidelines that recommend MWUs limit WR to preserve shoulder function. The isolated repetitive shoulder activity did not contribute to the changes of subacromial space in MWUs. The ultrasonographic measurement of the AHD may be a target for identifying future interventions that prevent pain.

  8. Shoulder Pain

    Science.gov (United States)

    ... Another common cause is soreness of the subacromial bursa (a sac of fluid under the highest part ... improve the blood flow to the tendon or bursa. The blood flow will help reduce soreness. Smokers ...

  9. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association

    NARCIS (Netherlands)

    Diercks, R.; Bron, C.; Dorrestijn, O.; Meskers, C.; Naber, R.; Ruiter, T. de; Willems, J.; Winters, J.; Woude, H.J. van der; et al.,

    2014-01-01

    Treatment of "subacromial impingement syndrome" of the shoulder has changed drastically in the past decade. The anatomical explanation as "impingement" of the rotator cuff is not sufficient to cover the pathology. "Subacromial pain syndrome", SAPS, describes the condition better. A working group

  10. The clinical utility of ultrasonography for rotator cuff disease, shoulder impingement syndrome and subacromial bursitis.

    Science.gov (United States)

    Awerbuch, Mark S

    2008-01-07

    Periarticular shoulder disorders are common in clinical practice, and diagnosis is often difficult. Medicare statistics indicate that between 2001 and 2006 the use of diagnostic shoulder ultrasonography increased significantly. Rotator cuff disease, shoulder impingement syndrome and subacromial bursitis are among the most common diagnoses reported on shoulder ultrasonography. Shoulder ultrasonography is useful in the diagnosis of full thickness tears, but its utility for other rotator cuff disorders, shoulder impingement syndrome and subacromial bursitis is less well established.

  11. Exercise therapy after ultrasound-guided corticosteroid injections in patients with subacromial pain syndrome

    DEFF Research Database (Denmark)

    Ellegaard, Karen; Christensen, Robin; Rosager, Sara

    2016-01-01

    BACKGROUND: Subacromial pain syndrome (SAPS) accounts for around 50 % of all cases of shoulder pain. The most commonly used treatments are glucocorticosteroid (steroid) injections and exercise therapy; however, despite treatment SAPS patients often experience relapse of their symptoms. Therefore...... the clinical effect of combining steroid and exercise therapy is highly relevant to clarify. The aim of this randomized controlled trial was to investigate if exercise therapy added to steroid injection in patients with SAPS will improve the effect of the injection therapy on shoulder pain. METHODS......: In this two-arm randomized trial running over 26 weeks, patients with unilateral shoulder pain (> 4 weeks) and thickened subacromial bursa (> 2 mm on US) were included. At baseline all participants received two steroid injections into the painful shoulder with an interval of one week. Subsequently they were...

  12. Shoulder Retractor Strengthening Exercise to Minimize Rhomboid Muscle Activity and Subacromial Impingement

    Science.gov (United States)

    Fennell, Jeremy; Mochizuki, George; Ismail, Farooq; Boulias, Chris

    2016-01-01

    Purpose: We investigated the best position for shoulder retractor strengthening exercise to maximize middle trapezius activity and minimize rhomboid major activity. Although both trapezius and rhomboids are scapular retractors, rhomboids also act as downward rotators of the scapula, which can worsen subacromial impingement. Methods: Twelve healthy participants (age 30 [SD 6] y) with no history of shoulder pain were recruited for this study, which used fine-wire electromyography to examine maximal muscle activation of the middle trapezius and rhomboid major muscle fibres in four different positions: with the shoulder in 90° abduction with elbow completely extended and (1) shoulder internal rotation, (2) shoulder neutral rotation, (3) shoulder external rotation, and (4) rowing (shoulder neutral rotation and elbow flexed 90°). The ratio of trapezius to rhomboid muscles was compared with Wilcoxon signed-rank tests. Results: Muscle activation ratio during shoulder retraction exercise was significantly lower by 22% (i.e., rhomboid was more active than middle trapezius) when performed with the shoulder in rowing position (elbow flexed) than with the shoulder in external rotation (elbow extended) position (p=0.031). All four positions produced coactivation of trapezius and rhomboids. Discussion: Rowing position may not be the best position for shoulder retractor strengthening in patients with impingement syndrome. The preferable position for maximizing middle trapezius activity and minimizing rhomboid activity may be shoulder external rotation with elbow extended. PMID:27504044

  13. The Painful Shoulder: Shoulder Impingement Syndrome

    Science.gov (United States)

    Khan, Yousaf; Nagy, Mathias Thomas; Malal, Joby; Waseem, Mohammad

    2013-01-01

    Rotator cuff disorders are considered to be among the most common causes of shoulder pain and disability encountered in both primary and secondary care. The general pathology of subacromial impingment generally relates to a chronic repetitive process in which the conjoint tendon of the rotator cuff undergoes repetitive compression and micro trauma as it passes under the coracoacromial arch. However acute traumatic injuries may also lead to this condition. Diagnosis remains a clinical one, however advances in imaging modalities have enabled clinicians to have an increased understanding of the pathological process. Ultrasound scanning appears to be a justifiable and cost effective assessment tool following plain radiographs in the assessment of shoulder impingment, with MRI scans being reserved for more complex cases. A period of observed conservative management including the use of NSAIDs, physiotherapy with or without the use of subacromial steroid injections is a well-established and accepted practice. However, in young patients or following any traumatic injury to the rotator cuff, surgery should be considered early. If surgery is to be performed this should be done arthroscopically and in the case of complete rotator cuff rupture the tendon should be repaired where possible. PMID:24082973

  14. The influence of experimentally induced pain on shoulder muscle activity.

    Science.gov (United States)

    Diederichsen, Louise Pyndt; Winther, Annika; Dyhre-Poulsen, Poul; Krogsgaard, Michael R; Nørregaard, Jesper

    2009-04-01

    Muscle function is altered in painful shoulder conditions. However, the influence of shoulder pain on muscle coordination of the shoulder has not been fully clarified. The aim of the present study was to examine the effect of experimentally induced shoulder pain on shoulder muscle function. Eleven healthy men (range 22-27 years), with no history of shoulder or cervical problems, were included in the study. Pain was induced by 5% hypertonic saline injections into the supraspinatus muscle or subacromially. Seated in a shoulder machine, subjects performed standardized concentric abduction (0 degrees -105 degrees) at a speed of approximately 120 degrees/s, controlled by a metronome. During abduction, electromyographic (EMG) activity was recorded by intramuscular wire electrodes inserted in two deeply located shoulder muscles and by surface-electrodes over six superficially located shoulder muscles. EMG was recorded before pain, during pain and after pain had subsided and pain intensity was continuously scored on a visual analog scale (VAS). During abduction, experimentally induced pain in the supraspinatus muscle caused a significant decrease in activity of the anterior deltoid, upper trapezius and the infraspinatus and an increase in activity of lower trapezius and latissimus dorsi muscles. Following subacromial injection a significantly increased muscle activity was seen in the lower trapezius, the serratus anterior and the latissimus dorsi muscles. In conclusion, this study shows that acute pain both subacromially and in the supraspinatus muscle modulates coordination of the shoulder muscles during voluntary movements. During painful conditions, an increased activity was detected in the antagonist (latissimus), which support the idea that localized pain affects muscle activation in a way that protects the painful structure. Further, the changes in muscle activity following subacromial pain induction tend to expand the subacromial space and thereby decrease the load

  15. Is radial Extracorporeal Shock Wave Therapy (rEWST) combined with supervised exercises (SE) more effective than sham rESWT and SE in patients with subacromial shoulder pain? Study protocol for a double-blind randomised, sham-controlled trial.

    Science.gov (United States)

    Kvalvaag, Elisabeth; Brox, Jens Ivar; Engebretsen, Kaia Beck; Søberg, Helene Lundgaard; Bautz-Holter, Erik; Røe, Cecilie

    2015-09-11

    Subacromial shoulder pain is a common complaint. Radial Extracorporeal Shock Wave Therapy (rESWT) has being increasingly used to treat calcific and non-calcific tendinosis, although there is no evidence of the effectiveness of rESWT in non-calcific tendinosis of the rotator cuff. A randomised single blind study showed that the short-term effect of supervised exercises (SE) was significantly better than rESWT on subacromial shoulder pain, but both groups improved. In a clinical trial on achilles tendinopathy rESWT improved the effectiveness of treatment with eccentric loading. The objective of this present study is to evaluate if rESWT in addition to SE is more effective in improving shoulder pain and function compared with sham rESWT and SE in patients with subacromial shoulder pain. This is a double blind, randomised sham-controlled trial which is performed at the shoulder clinic at the Department of Physical Medicine and Rehabilitation in Oslo University Hospital, Norway. One-hundred-forty-four patients with subacromial shoulder pain lasting at least 3 months, age from 25 to 70 years old are included in the trial. Patients are randomly allocated in 1:1 ratio to receive either rESWT or sham rESWT once a week in addition to SE once a week for the initial 4 weeks. Subsequently SE are provided twice a week for 8 weeks. The primary outcome measure is a change in the Shoulder Pain and Disability Index (SPADI) at 24 weeks follow-up. Secondary outcomes include return to work, pain at rest and on activity, function, and health related quality of life. The patients, the physiotherapist providing the exercise regimen and the outcome assessor are blinded to group assignment. The physiotherapist providing the rESWT is not blinded. Because of the extensive use of rESWT in the treatment of subacromial shoulder pain the results of this trial will be of importance and have impact on clinical practice. ClinicalTrials.gov NCT01441830.

  16. Swimmer's Shoulder: Painful Shoulder in the Competitive Swimmer.

    Science.gov (United States)

    Matzkin, Elizabeth; Suslavich, Kaytelin; Wes, David

    2016-08-01

    Swimmer's shoulder is a broad term often used to diagnose shoulder injury in swimmers. However, research has elucidated several specific shoulder injuries that often are incurred by the competitive swimmer. Hyperlaxity, scapular dyskinesis, subacromial impingement, labral damage, os acromiale, suprascapular nerve entrapment, and glenohumeral rotational imbalances all may be included within a differential diagnosis for shoulder pain in the competitive swimmer. An understanding of the mechanics of the swim stroke, in combination with the complex static and dynamic properties of the shoulder, is essential to the comprehension and identification of the painful swimmer's shoulder. It is important for the athlete, coach, and clinician to be aware of the discerning characteristics among these different injuries to ensure a proper diagnosis and treatment plan to aid the swimmer in his or her return to competition.

  17. Hemiplegic Shoulder Pain.

    Science.gov (United States)

    Wilson, Richard D; Chae, John

    2015-11-01

    Hemiplegic shoulder pain is a common complaint for stroke survivors. Many pathologies are included in the diagnosis of hemiplegic shoulder pain, and many with shoulder pain have a multifactorial cause. This article provides rehabilitation specialists with an approach to evaluation and management of those with hemiplegic shoulder pain. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Shoulder Pain and Common Shoulder Problems

    Science.gov (United States)

    .org Shoulder Pain and Common Shoulder Problems Page ( 1 ) What most people call the shoulder is really several joints that ... article explains some of the common causes of shoulder pain, as well as some general treatment options. Your ...

  19. Tendon vascularity in overhead athletes with subacromial pain syndrome and its correlation with the resting subacromial space.

    Science.gov (United States)

    Tsui, Sammi Sin Mei; Leong, Hio Teng; Leung, Vivian Yee Fong; Ying, Michael; Fu, Siu Ngor

    2017-05-01

    Supraspinatus tendinopathy is one of the common causes of subacromial pain syndrome (SAPS) in overhead athletes. Changes in tendon vascularity have been reported in painful tendons; however, the prevalence and distribution have not been investigated in young overhead athletes. We conducted a cross-sectional study of 47 overhead athletes (male, 31; female, 16) aged 18 to 36 years with SAPS for >3 months. A sonographer graded the severity of the tendinopathy and area of vascularization. Ultrasound imaging was used to measure supraspinatus tendon thickness, vascularity, and resting subacromial space. A self-written program was used to semiquantify the intensity of vascularity, expressed as the vascular index. The majority (87.2%) of the participants had signs of tendinopathy in the supraspinatus tendon, and 40 (85.1%) of the tendinopathic tendons had vascularity. The majority (66.0%) of the vascularized subjects presented with minimal increase in vascularity, and 19.1% had moderate to severe vascularization. Most (79.2%) of the vascularization was observed in the pericortical region. The vascular index was negatively correlated with the resting subacromial space in male athletes with a reduced subacromial space (ρ = -0.63; P = .038). Of overhead athletes with SAPS, 87.2% had supraspinatus tendinopathy with minimal to moderate vascularization, with the majority of vascularization occurring in the pericortical region. In male athletes with a reduced subacromial space, greater vascularity in the supraspinatus tendon was associated with a smaller resting subacromial space. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. Efficacy of a Subacromial Corticosteroid Injection for Persistent Pain After Arthroscopic Rotator Cuff Repair.

    Science.gov (United States)

    Shin, Sang-Jin; Do, Nam-Hoon; Lee, Juyeob; Ko, Young-Won

    2016-09-01

    Corticosteroid injections have been widely used for reducing shoulder pain. However, catastrophic complications induced by corticosteroid such as infections and tendon degeneration have made surgeons hesitant to use a corticosteroid injection as a pain control modality, especially during the postoperative recovery phase. To determine the effectiveness and safety of a subacromial corticosteroid injection for persistent pain control during the recovery period and to analyze the factors causing persistent pain after arthroscopic rotator cuff repair. Cohort study; Level of evidence, 3. A total of 458 patients who underwent arthroscopic rotator cuff repair were included in this study. Patient-specific parameters, tear size and pattern, and pain intensity were reviewed. Seventy-two patients were administered a postoperative subacromial corticosteroid injection under ultrasound guidance. The corticosteroid injection was administered to patients who awakened overnight because of constant severe shoulder pain or whose pain was exacerbated at the time of rehabilitation exercises within 8 weeks after surgery. Pain intensity, patient satisfaction, and functional outcomes using the American Shoulder and Elbow Surgeons (ASES) and Constant scores were compared between the patients with and without a subacromial corticosteroid injection. The retear rate was evaluated with magnetic resonance imaging at 6 months postoperatively. In patients with an injection, the mean (±SD) visual analog scale for pain (pVAS) score was 7.7 ± 1.2 at the time of the injection. This significantly decreased to 2.3 ± 1.4 at the end of the first month after the injection, demonstrating a 70.2% reduction in pain (P rotator cuff tears (41.8%) showed a higher occurrence of severe postoperative persistent pain. Preoperative shoulder stiffness was revealed as a predisposing factor for persistent pain (odds ratio, 0.2; P = .04). A subacromial corticosteroid injection can be considered as a useful and safe

  1. Shoulder proprioception in patients with subacromial impingement syndrome.

    Science.gov (United States)

    Sahin, Ebru; Dilek, Banu; Baydar, Meltem; Gundogdu, Mehtap; Ergin, Burcu; Manisali, Metin; Akalin, Elif; Gulbahar, Selmin

    2017-01-01

    Recently, proprioception deficits of the rotator cuff and the deltoid muscles have been suggested to play a pivotal role in the subacromial impingement syndrome (SIS). To date, there are no study has been found where the kinesthesia and joint position senses have been evaluated together in SIS. To investigate the shoulder proprioception in patients with SIS. Sixty-one patients with SIS and 30 healthy controls, aging between 25 and 65 years, were included in the study. Main outcome measure was proprioception, assessed with an isokinetic dynamometer. Kinesthesia, active and passive joint repositioning senses were tested at 0° and 10° external rotation. All tests were repeated 4 times and the mean of angular errors were obtained. The mean age was 49.14 ± 10.27 and 48.80 ± 11.09 years in patient group and in control group respectively. No significant difference was found between two groups in terms of age, gender and dominance. When involved and uninvolved shoulders of the patient group were compared, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders at all angles (P shoulders of the patient group were compared to the control group, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders in patient group at all angles (P shoulders of the patient group were compared to the control group, kinesthesia at 10° was significantly impaired (P shoulder proprioception was impaired in patients with SIS. This proprioceptive impairment was found not only in involved shoulders but also in uninvolved shoulders in patients with SIS.

  2. Shoulder abduction torque steadiness is preserved in subacromial impingement syndrome.

    Science.gov (United States)

    Camargo, Paula Rezende; Avila, Mariana Arias; de Oliveira, Ana Beatriz; Asso, Naoe Aline; Benze, Benedito Galvão; de Fátima Salvini, Tania

    2009-06-01

    This study compared peak torque and torque steadiness during isometric abduction in subjects with subacromial impingement syndrome (SIS) and those with no upper limb disorders. The SIS group consisted of 27 subjects (33.48 +/- 9.94 years) with unilateral SIS. The control group consisted of 23 healthy and active subjects (32.26 +/- 9.04 years). Peak torque and torque steadiness were measured during isometric abduction (80 masculine in the scapular plane) of the shoulder. Standard deviation, coefficient of variation, stability time, median frequency, and relative power were measured from the steadiness trials. There were neither significant interactions between group and side (P > 0.05), nor were there significant main effects of group and side (P > 0.05) for all variables analyzed. The results of this study showed that steadiness is preserved by SIS during isometric abduction of the shoulder.

  3. Effectiveness of Kinesiotaping and Subacromial Corticosteroid Injection in Shoulder Impingement Syndrome.

    Science.gov (United States)

    Şahin Onat, Şule; Biçer, Seda; Şahin, Zehra; Küçükali Türkyilmaz, Ayşegül; Kara, Murat; Özbudak Demir, Sibel

    2016-08-01

    The aim of this study was to investigate whether kinesiotaping or subacromial corticosteroid injection provides additional benefit when used with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with shoulder impingement syndrome. Patients with shoulder impingement syndrome were divided into 3 groups as follows: NSAID group (n = 33), kinesiotaping group (kinesiotaping + NSAID) (n = 33), and injection group (subacromial corticosteroid injection + NSAID) (n = 33). Outcome measures including visual analog scale, shoulder ranges of motion, Shoulder Disability Questionnaire, and University of California-Los Angeles (UCLA) scale were evaluated before and after the treatment (fourth week). A total of 99 patients (21 male and 78 female patients) were enrolled in this study. Demographic and baseline clinical characteristics of the groups (except for body mass index and visual analog scale at night, both P = 0.05) were similar between the groups (all P > 0.05). Clinical parameters were found to have improved in the 3 groups (all P kinesiotaping and injection groups showed similar improvements (all P > 0.05), each group had better outcome than did the NSAID group as regards pain (activity visual analog scale), ranges of motion, and Shoulder Disability Questionnaire and UCLA scale scores (all P kinesiotaping or subacromial corticosteroid injection to NSAID treatment seems to have better/similar effectiveness in patients with shoulder impingement syndrome. Therefore, kinesiotaping might serve as an alternative treatment in case (injection of) corticosteroids are contraindicated. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Delineate appropriate treatment options for shoulder impingement syndrome; (2) Identify treatment benefits of kinesiotaping and corticosteroid injections in shoulder impingement syndrome; and (3) Incorporate

  4. Contrast-enhanced MRI of the subdeltoid, subacromial bursa in painful and painless rotator cuff tears

    Science.gov (United States)

    Hodgson, R J; O'Connor, P J; Hensor, E M A; Barron, D; Robinson, P

    2012-01-01

    Objective Although shoulder pain is often associated with rotator cuff tears, many tears are asymptomatic and are not the cause of the patient's pain. This may explain the persistence of symptoms in some patients despite technically successful rotator cuff repair. It has been proposed that rotator cuff tears cause pain through subdeltoid/subacromial bursal inflammation. The aim of this study was to determine whether bursal inflammation seen on MRI is associated with pain in patients with rotator cuff tears of the shoulder. Methods The shoulders of 255 patients were screened with ultrasound. 33 full-thickness rotator cuff tears (18 with shoulder pain and 15 without pain) were identified and subsequently studied using contrast-enhanced MRI of the shoulder. Enhancement of the subacromial bursa was scored independently by two musculoskeletal radiologists. Logistic regression was used to determine whether bursal enhancement was independently associated with pain. Results There was a significant association between pain and age, with greater likelihood of pain in younger patients. Bursal enhancement was common in both painful and painless tears. No statistically significant link between pain and bursal enhancement was seen, even after accounting for age. Conclusion Although enhancement of the subdeltoid/subacromial bursa was common, no evidence was found to support the hypothesis that bursal enhancement is associated with pain in rotator cuff tears. It is therefore unlikely to determine reliably which patients would benefit from rotator cuff repair. Advances in knowledge Bursal enhancement and thickening does not reliably correlate with symptoms or presence of rotator cuff tear. PMID:23091289

  5. Evaluation and treatment of shoulder pain.

    Science.gov (United States)

    Greenberg, Deborah L

    2014-05-01

    Shoulder pain is a common symptom in the adult population. The most common cause of shoulder pain is SIS, reflecting a problem with the rotator cuff or subacromial bursa. Determining the cause of a patient’s pain is usually a clinical diagnosis based on careful history taking and physical examination. Limited use of imaging studies will be needed in the setting of trauma, possible glenohumeral arthritis, or when a complete tendon tear is suspected. Therapy is based on pain control and therapeutic exercises in almost all cases. Despite the prevalence of shoulder pain, there is no consensus on the best way to achieve pain control or on the type of exercise most likely to achieve speedy recovery. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Subacromial impingement syndrome: An electromyographic study of shoulder girdle muscle fatigue.

    Science.gov (United States)

    Alizadehkhaiyat, Omid; Roebuck, Margaret M; Makki, Ahmed T; Frostick, Simon P

    2018-02-01

    Muscle fatigue affecting glenohumeral and/or scapular muscles is suggested as one of the contributing factors to the development of subacromial impingement syndrome (SAIS). Nonetheless, the fatigability of shoulder girdle muscles in association with the pathomechanics of SAIS has not been reported. This study aimed to measure and compare fatigue progression within the shoulder girdle musculature of patients and healthy controls. 75 participants including 39 patients (20 females; 19 males) and 36 healthy controls (15 females; 21 males) participated in the study. Study evaluated the progression of muscle fatigue in 15 shoulder girdle muscles by means of surface and fine-wire EMG during submaximal contraction of four distinct movements (abduction, flexion, internal and external rotation). Shoulder strength, subjective pain experience (McGill Pain Questionnaire), and psychological status (Hospital Anxiety and Depression Scale) were also assessed. The results were compared between patient and control groups according to the gender. Despite marked fatigue observed in the majority of muscles particularly during flexion and abduction at 90°, overall results indicated a lower tendency of fatigue progression in the impingement group across the tests (p fatigue progression in the impingement group can be attributed to the presence of fear avoidance and pain-related muscle inhibition, which in turn lead to adaptations in motor programme to reduce muscle recruitment and activation. The significantly higher levels of pain experience and anxiety/depression in the impingement group further support this proposition. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Decreased shoulder function and pain common in recreational badminton players.

    Science.gov (United States)

    Fahlström, M; Söderman, K

    2007-06-01

    The aim of this study was to describe the prevalence and consequences of painful conditions in the shoulder region in recreational badminton players. A questionnaire study was performed on 99 players, of whom 57 were also assessed with Constant score. Previous or present pain in the dominant shoulder was reported by 52% of the players. Sixteen percent of the players had on-going shoulder pain associated with badminton play. A majority of these players reported that their training habits were affected by the pain. Total Constant score was lower in the painful shoulders. Furthermore, range of active pain-free shoulder abduction was decreased. However, isometric shoulder strength test showed no differences when compared with pain-free shoulders. Even though the pain caused functional problems, the players were still playing with on-going symptoms. The diagnoses were mostly unknown, although history and clinical tests indicate problems resembling subacromial impingement.

  8. Association of Bicipital Peritendinous Effusion with Subacromial Impingement: A Dynamic Ultrasonographic Study of 337 Shoulders

    OpenAIRE

    Ke-Vin Chang; Wei-Ting Wu; Levent Özçakar

    2016-01-01

    Bicipital peritendinous effusion (BPE) is the most common biceps tendon abnormality and can be related to various shoulder ultrasonographic findings. Since the association of BPE with subacromial impingement is unclear, our study aimed to explore its association with the dynamic subacromial impingement test during ultrasound (US) imaging. We included 337 shoulders referred for US examinations and quantified the amount of BPE. Effusion more than 1?mm in thickness was considered a positive find...

  9. The influence of experimentally induced pain on shoulder muscle activity

    DEFF Research Database (Denmark)

    Diederichsen, Louise Pyndt; Winther, Annika; Dyhre-Poulsen, Poul

    2009-01-01

    Muscle function is altered in painful shoulder conditions. However, the influence of shoulder pain on muscle coordination of the shoulder has not been fully clarified. The aim of the present study was to examine the effect of experimentally induced shoulder pain on shoulder muscle function. Eleven...... healthy men (range 22-27 years), with no history of shoulder or cervical problems, were included in the study. Pain was induced by 5% hypertonic saline injections into the supraspinatus muscle or subacromially. Seated in a shoulder machine, subjects performed standardized concentric abduction (0 degrees...... -105 degrees) at a speed of approximately 120 degrees/s, controlled by a metronome. During abduction, electromyographic (EMG) activity was recorded by intramuscular wire electrodes inserted in two deeply located shoulder muscles and by surface-electrodes over six superficially located shoulder muscles...

  10. The influence of experimentally induced pain on shoulder muscle activity

    DEFF Research Database (Denmark)

    Diederichsen, L.P.; Winther, A.; Dyhre-Poulsen, P.

    2009-01-01

    Muscle function is altered in painful shoulder conditions. However, the influence of shoulder pain on muscle coordination of the shoulder has not been fully clarified. The aim of the present study was to examine the effect of experimentally induced shoulder pain on shoulder muscle function. Eleven...... healthy men (range 22-27 years), with no history of shoulder or cervical problems, were included in the study. Pain was induced by 5% hypertonic saline injections into the supraspinatus muscle or subacromially. Seated in a shoulder machine, subjects performed standardized concentric abduction (0A degrees......-105A degrees) at a speed of approximately 120A degrees/s, controlled by a metronome. During abduction, electromyographic (EMG) activity was recorded by intramuscular wire electrodes inserted in two deeply located shoulder muscles and by surface-electrodes over six superficially located shoulder...

  11. Methicillin-resistant Staphylococcus aureus infection of the subacromial bursa: an unusual complication following subacromial corticosteroid injection (a report of two cases).

    Science.gov (United States)

    Teoh, Kar H; Jones, Sian A; Gurunaidu, Subramaniam; Pritchard, Mark G

    2015-07-01

    Subacromial corticosteroid injections are frequently used for both diagnostic and therapeutic purposes in shoulder pain. Subacromial septic bursitis is a recognized but rare complication. There have been no reports of methicillin-resistant Staphylococcus aureus infections of the subacromial bursa after subacromial injections in the literature. We describe case reports of two patients who presented with subacromial methicillin-resistant Staphylococcus aureus septic bursitis following subacromial corticosteroid injections in the community and highlight the diagnostic and management challenges of this condition.

  12. Methicillin-resistant Staphylococcus aureus infection of the subacromial bursa: an unusual complication following subacromial corticosteroid injection (a report of two cases)

    OpenAIRE

    Teoh, Kar. H.; Jones, Sian A; Gurunaidu, Subramaniam; Pritchard, Mark G.

    2014-01-01

    Subacromial corticosteroid injections are frequently used for both diagnostic and therapeutic purposes in shoulder pain. Subacromial septic bursitis is a recognized but rare complication. There have been no reports of methicillin-resistant Staphylococcus aureus infections of the subacromial bursa after subacromial injections in the literature. We describe case reports of two patients who presented with subacromial methicillin-resistant Staphylococcus aureus septic bursitis following subacromi...

  13. Inflammatory cytokines are overexpressed in the subacromial bursa of frozen shoulder.

    Science.gov (United States)

    Lho, Yun-Mee; Ha, Eunyoung; Cho, Chul-Hyun; Song, Kwang-Soon; Min, Byung-Woo; Bae, Ki-Cheor; Lee, Kyung-Jae; Hwang, Ilseon; Park, Hyung-Bin

    2013-05-01

    Frozen shoulder is a debilitating condition characterized by gradual loss of glenohumeral motion with chronic inflammation and capsular fibrosis. Yet its pathogenesis remains largely unknown. We hypothesized that the subacromial bursa may be responsible for the pathogenesis of frozen shoulder by producing inflammatory cytokines. We obtained joint capsules and subacromial bursae from 14 patients with idiopathic frozen shoulder and from 7 control subjects to determine the expression levels of interleukin (IL) 1α, IL-1β, IL-6, tumor necrosis factor α (TNF-α), cyclooxygenase (COX) 1, and COX-2 by real-time reverse transcriptase-polymerase chain reaction, immunohistochemistry, and enzyme-linked immunosorbent assay. IL-1α, IL-1β, TNF-α, COX-1, and COX-2 were expressed at significantly high levels in the joint capsules of the frozen shoulder group compared with those of the control group. Intriguingly, IL-1α, TNF-α, and COX-2 were also expressed at significantly high levels in the subacromial bursae of the frozen shoulder group compared with those of the control group. Immunohistochemical analysis showed increased expression of COX-2 in both the joint capsules and subacromial bursae of the frozen shoulder group. These findings imply that elevated levels of inflammatory cytokines in the subacromial bursa may be associated with the pathogenesis of inflammation evolving into fibrosis. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  14. The subacromial impingement syndrome of the shoulder treated by conventional physiotherapy, self-training, and a shoulder brace: results of a prospective, randomized study.

    Science.gov (United States)

    Walther, Markus; Werner, Andreas; Stahlschmidt, Theresa; Woelfel, Rainer; Gohlke, Frank

    2004-01-01

    This prospective, randomized trial was performed to compare the results of treating subacromial impingement syndrome of the shoulder by a guided self-training program with the treatment by conventional physiotherapy or a functional brace. Sixty patients with the diagnosis of an outlet impingement syndrome of the shoulder (Neer I and II) were treated either by strengthening the depressors of the humeral head with a guided self-training program, by conventional physiotherapy, or by wearing a functional brace. The Constant-Murley score was assessed after 6 and 12 weeks. Shoulder pain was monitored with a visual analog scale. All three groups showed a significant improvement in shoulder function as well as a significant reduction in pain. There were no statistically significant differences among the groups. Guided self-training can lead to results similar to those of conventional physiotherapy. The comparable effect of the functional brace remains unclear and might be explained by an influence on proprioception.

  15. Clinical effectiveness of botulinum toxin type B in the treatment of subacromial bursitis or shoulder impingement syndrome.

    Science.gov (United States)

    Lee, Jung Hwan; Lee, Sang-Ho; Song, Sun Hong

    2011-01-01

    Subacromial steroid injections are used as a treatment method in subacromial bursitis (SB) or shoulder impingement syndrome (SIS). However, the steroid effect is relatively restricted to the short-term and repeated injections are frequently required, which contributes to unwanted side effects. As an alternative, botulinum toxin (BT) has recently been used for pain relief. This study aimed to investigate the clinical effectiveness of BT type B and to compare this with the effectiveness of steroids. Sixty-one patients diagnosed with SB or SIS were divided into 2 groups and treated with BT type B (BT group) and trimacinolone injection (TA group) under ultrasound guidance, respectively. Numeric Rating Scale (NRS), active shoulder abduction angle, and the Korean version of the score on the Disability of Arm, Shoulder, and Hand (DASH) were measured before the treatment, and at 1 and 3 months after the treatment. Both groups obtained a significant improvement of NRS, DASH, and active shoulder abduction at 1 and 3 months follow-up. BT group showed significantly better outcomes in terms of reduction of NRS and DASH at 3 months than TA group. BT group showed strong trend toward the larger degree of active shoulder abduction than the TA group at 3 months follow-up, as well. Whereas, no significant difference was found in NRS, DASH, and active shoulder abduction between the 2 groups at 1 month follow-up. BT type B can be a useful strategy and has great potential for replacing steroids as a treatment for SB or SIS.

  16. Exercises and Dry Needling for Subacromial Pain Syndrome: A Randomized Parallel-Group Trial.

    Science.gov (United States)

    Arias-Buría, José L; Fernández-de-Las-Peñas, César; Palacios-Ceña, María; Koppenhaver, Shane L; Salom-Moreno, Jaime

    2017-01-01

    This randomized clinical trial investigated the effectiveness of exercise versus exercise plus trigger point (TrP) dry needling (TrP-DN) in subacromial pain syndrome. A randomized parallel-group trial, with 1-year follow-up was conducted. Fifty subjects with subacromial pain syndrome were randomly allocated to receive exercise alone or exercise plus TrP-DN. Participants in both groups were asked to perform an exercise program of the rotator cuff muscles twice daily for 5 weeks. Further, patients allocated to the exercise plus TrP-DN group also received dry needling to active TrPs in the muscles reproducing shoulder symptoms during the second and fourth sessions. The primary outcome was pain-related disability assessed using the Disabilities of the Arm, Shoulder, and Hand questionnaire. Secondary outcomes included mean current pain and the worst pain experienced in the shoulder during the previous week. They were assessed at baseline, 1 week, and 3, 6, and 12 months after the end of treatment. Analysis was according to intention to treat with mixed analysis of covariance adjusted for baseline outcomes. At 12 months, 47 patients (94%) completed follow-up. Statistically larger improvements (all, P < .01) in shoulder disability was found for the exercise plus TrP-DN group at all follow-up periods (post: Δ -20.6 [95% confidence interval (CI) -23.8 to -17.4]; 3 months: Δ -23.2 [95% CI -28.3 to -18.1)]; 6 months: Δ -23.6 [95% CI -28.9 to -18.3]; 12 months: Δ -13.9 [95% CI -17.5 to -10.3]). Both groups exhibited similar improvements in shoulder pain outcomes at all follow-up periods. The inclusion of TrP-DN with an exercise program was effective for improving disability in subacromial pain syndrome. No greater improvements in shoulder pain were observed. This study found that the inclusion of 2 sessions of TrP-DN into an exercise program was effective for improving shoulder pain-related disability at short-, medium-, and long-term; however, no greater

  17. Arthroscopic subacromial decompression is effective in selected patients with shoulder impingement syndrome.

    Science.gov (United States)

    Magaji, S A; Singh, H P; Pandey, R K

    2012-08-01

    A total of 92 patients with symptoms for over six months due to subacromial impingement of the shoulder, who were being treated with physiotherapy, were included in this study. While continuing with physiotherapy they waited a further six months for surgery. They were divided into three groups based on the following four clinical and radiological criteria: temporary benefit following steroid injection, pain in the mid-arc of abduction, a consistently positive Hawkins test and radiological evidence of impingement. Group A fulfilled all four criteria, group B three criteria and group C two criteria. A total of nine patients improved while waiting for surgery and were excluded, leaving 83 who underwent arthroscopic subacromial decompression (SAD). The new Oxford shoulder score was recorded pre-operatively and at three and 12 months post-operatively. A total of 51 patients (group A) had a significant improvement in the mean shoulder score from 18 (13 to 22) pre-operatively to 38 (35 to 42) at three months (p < 0.001). The mean score in this group was significantly better than in group B (21 patients) and C (11 patients) at this time. At one year patients in all groups showed improvement in scores, but patients in group A had a higher mean score (p = 0.01). At one year patients in groups A and B did better than those in group C (p = 0.01). Arthroscopic SAD is a beneficial intervention in selected patients. The four criteria could help identify patients in whom it is likely to be most effective.

  18. 9. Painful shoulder complaints.

    Science.gov (United States)

    Huygen, Frank; Patijn, Jacob; Rohof, Olav; Lataster, Arno; Mekhail, Nagy; van Kleef, Maarten; Van Zundert, Jan

    2010-01-01

    Painful shoulder complaints have a high incidence and prevalence. The etiology is not always clear. Clinical history and the active and passive motion examination of the shoulder are the cornerstones of the diagnostic process. Three shoulder tests are important for the examination of shoulder complaints: shoulder abduction, shoulder external rotation, and horizontal shoulder adduction. These tests can guide the examiner to the correct diagnosis. Based on this diagnosis, in most cases, primarily a conservative treatment with nonsteroidal anti-inflammatory drugs possibly in combination with manual and/or exercise therapy can be started. When conservative treatment fails, injection with local anesthetics and corticosteroids can be considered. In the case of frozen shoulder, a continuous cervical epidural infusion of local anesthetic and small doses of opioids or a pulsed radiofrequency treatment of the nervus suprascapularis can be considered.

  19. Association of Bicipital Peritendinous Effusion with Subacromial Impingement: A Dynamic Ultrasonographic Study of 337 Shoulders.

    Science.gov (United States)

    Chang, Ke-Vin; Wu, Wei-Ting; Özçakar, Levent

    2016-12-12

    Bicipital peritendinous effusion (BPE) is the most common biceps tendon abnormality and can be related to various shoulder ultrasonographic findings. Since the association of BPE with subacromial impingement is unclear, our study aimed to explore its association with the dynamic subacromial impingement test during ultrasound (US) imaging. We included 337 shoulders referred for US examinations and quantified the amount of BPE. Effusion more than 1 mm in thickness was considered a positive finding. A comparison of three grades of subacromial impingement, adjusted by patient demographics, static sonographic shoulder pathology, and physical findings, by using multivariate regression models revealed that the odds ratio of subacromial impingement (with 95% confidence intervals) in the presence of BPE was 6.54 (3.21-13.32) in grade 1, 6.93 (3.05-15.76) in grade 2 and 3.18 (1.48-6.80) in grade 3. An increase in age, subdeltoid bursitis, full-thickness supraspinatus tendon tear, and shoulder stiffness were also associated with BPE. Since our study demonstrated a positive association of BPE with all grades of impingement, a US dynamic subacromial impingement test is suggested when BPE is present. Future prospective studies are needed to identify changes in BPE after treatment.

  20. Kinesiology taping does not alter shoulder strength, shoulder proprioception, or scapular kinematics in healthy, physically active subjects and subjects with Subacromial Impingement Syndrome.

    Science.gov (United States)

    Keenan, Karen A; Akins, Jonathan S; Varnell, Michelle; Abt, John; Lovalekar, Mita; Lephart, Scott; Sell, Timothy C

    2017-03-01

    To examine the effect of kinesiology tape (KT) on shoulder strength, proprioception, and scapular kinematics in healthy and Subacromial Impingement Syndrome (SAIS) subjects. Placebo-controlled quasi-experimental study. Research laboratory. A total of 30 physically active subjects participated. Ten healthy subjects with no previous history of shoulder pathology received KT on the dominant shoulder. Twenty subjects with shoulder pain for a minimum of two weeks and presenting with clinical signs of impingement were allotted to receive KT (n = 10) or placebo taping (PT, n = 10) on the involved shoulder. All participants were tested pre- and post-application. Shoulder internal/external rotation (IR/ER) strength was assessed with isokinetic dynamometry (average peak torque/body weight). Shoulder IR/ER proprioception was assessed through threshold to detect passive motion (mean absolute error in degrees). Scapular position at 90° and 120° of shoulder abduction during arm raising/lowering were assessed using a 3D motion analysis system. No significant within group or between group differences were demonstrated for any measure. Taping does not appear to aid/impair shoulder strength, shoulder proprioception, or scapular kinematics. Future research should explore if the effects of KT are time-dependent and similar in other pathologies. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial

    Science.gov (United States)

    Arias-Buría, José L.; Truyols-Domínguez, Sebastián; Valero-Alcaide, Raquel; Salom-Moreno, Jaime; Atín-Arratibel, María A.; Fernández-de-las-Peñas, César

    2015-01-01

    Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions). Shoulder pain (NPRS) and disability (DASH) were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention. PMID:26649058

  2. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial.

    Science.gov (United States)

    Arias-Buría, José L; Truyols-Domínguez, Sebastián; Valero-Alcaide, Raquel; Salom-Moreno, Jaime; Atín-Arratibel, María A; Fernández-de-Las-Peñas, César

    2015-01-01

    Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions). Shoulder pain (NPRS) and disability (DASH) were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P percutaneous electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention.

  3. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    José L. Arias-Buría

    2015-01-01

    Full Text Available Objective. To compare effects of ultrasound- (US- guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n=17 group or exercise (n=19 group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions. Shoulder pain (NPRS and disability (DASH were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P<0.01: individuals receiving US-guided percutaneous electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention.

  4. Diagnostic Accuracy of Clinical Examination and Imaging Findings for Identifying Subacromial Pain.

    Directory of Open Access Journals (Sweden)

    Angela Cadogan

    Full Text Available The diagnosis of subacromial pathology is limited by the poor accuracy of clinical tests for specific pathologies. The aim of this study was to estimate the diagnostic accuracy of clinical examination and imaging features for identifying subacromial pain (SAP defined by a positive response to diagnostic injection, and to evaluate the influence of imaging findings on the clinical diagnosis of SAP.In a prospective, diagnostic accuracy design, 208 consecutive patients presenting to their primary healthcare practitioner for the first time with a new episode of shoulder pain were recruited. All participants underwent a standardized clinical examination, shoulder x-ray series and diagnostic ultrasound scan. Results were compared with the response to a diagnostic block of xylocaineTM injected into the SAB under ultrasound guidance using ≥80% post-injection reduction in pain intensity as the positive anaesthetic response (PAR criterion. Diagnostic accuracy statistics were calculated for combinations of clinical and imaging variables demonstrating the highest likelihood of a PAR. A PAR was reported by 34% of participants. In participants with no loss of passive external rotation, combinations of three clinical variables (anterior shoulder pain, strain injury, absence of symptoms at end-range external rotation (in abduction demonstrated 100% specificity for a PAR when all three were positive (LR+ infinity; 95%CI 2.9, infinity. A full-thickness supraspinatus tear on ultrasound increased the likelihood of a PAR irrespective of age (specificity 98% (95%CI 94, 100; LR+ 6.2; 95% CI 1.5, 25.7. Imaging did not improve the ability to rule-out a PAR.Combinations of clinical examination findings and a full-thickness supraspinatus tear on ultrasound scan can help confirm, but not exclude, the presence of subacromial pain. Other imaging findings were of limited value for diagnosing SAP.

  5. Ultrasound-guided shoulder injections in the treatment of subacromial bursitis.

    Science.gov (United States)

    Chen, Max J L; Lew, Henry L; Hsu, Tsz-Ching; Tsai, Wen-Chung; Lin, Wei-Ching; Tang, Simon F T; Lee, Ya-Chen; Hsu, Rex C H; Chen, Carl P C

    2006-01-01

    To investigate the treatment effectiveness between ultrasound-guided and blind injection techniques in the treatment of subacromial bursitis. A total of 40 patients with sonographic confirmation of subacromial bursitis were recruited into this study. These patients were divided into blind and ultrasound-guided injection groups. The shoulder abduction range of motion was compared before injections and 1 wk after the completion of injections in both groups. The shoulder abduction range of motion before injection in the blind injection group was 71.03 +/- 12.38 degrees and improved to 100 +/- 18.18 degrees 1 wk after the injection treatments. However, the improvement did not reveal significant statistical differences (P > 0.05). The shoulder abduction range of motion before injection in the ultrasound-guided injection group was 69.05 +/- 14.72 degrees and improved to 139.29 +/- 20.14 degrees 1 wk after the injection treatments (P subacromial bursa. The ultrasound-guided injection technique can result in significant improvement in shoulder abduction range of motion as compared with the blind injection technique in treating patients with subacromial bursitis.

  6. [Leading symptom shoulder pain].

    Science.gov (United States)

    Wittke, R

    2003-09-25

    Pain in the shoulder should prompt a systematic clinical examination that adheres closely to the functional anatomy. The basic examination of the shoulder joint comprises active and passive movements and isometric resistance tests with the aid of which external and internal rotation and abduction/adduction can be investigated. The results of these tests provide the physician with a "pattern of findings" which unequivocally identifies the pain-triggering structure. Accordingly, shoulder pain can be classified into four categories as proposed by Cyriax. As treatment, intra-articular injections of corticoids or local anesthetics as determined by findings, where necessary supported by physiotherapeutic measures. Rupture of a tendon, in particular in the case of an active patient, is an indication for surgery.

  7. Prevalence of Propionibacterium acnes in the glenohumeral compared with the subacromial space in primary shoulder arthroscopies.

    Science.gov (United States)

    Patzer, Thilo; Petersdorf, Sabine; Krauspe, Ruediger; Verde, Pablo Emilio; Henrich, Birgit; Hufeland, Martin

    2018-01-18

    We hypothesized that the prevalence of Propionibacterium acnes in patients undergoing primary shoulder arthroscopy is equal in the glenohumeral space compared with the subacromial space. Patients aged 18 years or older with shoulder arthroscopies were included. The exclusion criteria were prior shoulder operations, complete rotator cuff tears, systemic inflammatory diseases, tumors, shoulder injections within 6 months of surgery, and antibiotic therapy within 14 days preoperatively. After standardized skin disinfection with Kodan Tinktur Forte Gefärbt, a skin swab was taken at the posterior portal. Arthroscopy was performed without cannulas, prospectively randomized to start either in the glenohumeral space or in the subacromial space, with direct harvesting of a soft-tissue biopsy specimen. Sample cultivation was conducted according to standardized criteria for bone and joint aspirate samples and incubated for 14 days. Matrix-assisted laser desorption-ionization time-of-flight spectrometry was used for specimen identification in positive culture results. The study prospectively included 115 consecutive patients with normal C-reactive protein levels prior to surgery (54.8% men; mean age, 47.2 ± 14.6 years). P acnes was detected on the skin after disinfection in 36.5% of patients, in the glenohumeral space in 18.9%, and in the subacromial space in 3.5% (P = .016). The prevalence of P acnes is significantly higher in the glenohumeral space compared with the subacromial space in primary shoulder arthroscopies. The results do not confirm the contamination theory but also cannot clarify whether P acnes is a commensal or enters the joint hematologically or even lymphatically or via an unknown pathway. Despite standardized surgical skin disinfection, P acnes can be detected in skin swab samples in more than one-third of patients. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  8. Sleep position and shoulder pain.

    Science.gov (United States)

    Zenian, John

    2010-04-01

    The overuse theory for musculoskeletal joint pain cannot explain adequately the occurrence of shoulder pain in those who do not engage in activities that involve repeated and stressful use of the shoulder since the percentage of the painful right shoulders usually does not match the percentage of dominant right arms in such individuals. An alternative hypothesis is presented to propose that shoulder pain is caused by postural immobility in the decubitus or side position during sleep. Prolonged pressure on the shoulder caused by the weight of the thorax can produce enough damage to cause subsequent shoulder pain. In order to test this hypothesis, a preliminary study was carried out to compare the laterality of shoulder pain with the laterality of sleep position. The calculated laterality ratios for sleep position and shoulder pain were found to be strikingly similar, suggesting a causal relationship between the two phenomena. However, the prevalence of shoulder pain in the general population was found to be smaller than the percentage of the time people would spend sleeping in the decubitus position. This discrepancy could be explained by the idea that in order for shoulder pain to develop subjects may have to spend longer times in the same decubitus position before changing to another position than the average person would. Additional evidence from published clinical studies also supports the postural theory of shoulder pain. More studies can be done to test this hypothesis by focusing on the sleep habits of patients with shoulder pain. According to the present hypothesis shoulder pain should for the most part occur on the side that the patient preferred to sleep on before the onset of shoulder pain. The postural theory of shoulder pain provides the possibility for a new and noninvasive method to treat shoulder pain by the modification of posture during sleep. (c) 2009 Elsevier Ltd. All rights reserved.

  9. Subacromial impingement syndrome and pain: protocol for a randomised controlled trial of exercise and corticosteroid injection (the SUPPORT trial).

    Science.gov (United States)

    Roddy, Edward; Zwierska, Irena; Hay, Elaine M; Jowett, Sue; Lewis, Martyn; Stevenson, Kay; van der Windt, Danielle; Foster, Nadine E

    2014-03-14

    Subacromial impingement syndrome is the most frequent cause of shoulder problems which themselves affect 1 in 3 adults. Management commonly includes exercise and corticosteroid injection. However, the few existing trials of exercise or corticosteroid injection for subacromial impingement syndrome are mostly small, of poor quality, and focus only on short-term results. Exercise packages tend to be standardised rather than individualised and progressed. There has been much recent interest in improving outcome from corticosteroid injections by using musculoskeletal ultrasound to guide injections. However, there are no high-quality trials comparing ultrasound-guided and blind corticosteroid injection in subacromial impingement syndrome. This trial will investigate how to optimise the outcome of subacromial impingement syndrome from exercise (standardised advice and information leaflet versus physiotherapist-led exercise) and from subacromial corticosteroid injection (blind versus ultrasound-guided), and provide long-term follow-up data on clinical and cost-effectiveness. The study design is a 2x2 factorial randomised controlled trial. 252 adults with subacromial impingement syndrome will be recruited from two musculoskeletal Clinical Assessment and Treatment Services at the primary-secondary care interface in Staffordshire, UK. Participants will be randomised on a 1:1:1:1 basis to one of four treatment groups: (1) ultrasound-guided subacromial corticosteroid injection and a physiotherapist-led exercise programme, (2) ultrasound-guided subacromial corticosteroid injection and an advice and exercise leaflet, (3) blind subacromial corticosteroid injection and a physiotherapist-led exercise programme, or (4) blind subacromial corticosteroid injection and an advice and exercise leaflet. The primary intention-to-treat analysis will be the mean differences in Shoulder Pain and Disability Index (SPADI) scores at 6 weeks for the comparison between injection interventions and at

  10. Shoulder Pain After Thoracic Surgery

    DEFF Research Database (Denmark)

    Blichfeldt-Eckhardt, Morten R; Andersen, Claus; Ørding, Helle

    2017-01-01

    OBJECTIVES: To study the time course of ipsilateral shoulder pain after thoracic surgery with respect to incidence, pain intensity, type of pain (referred versus musculoskeletal), and surgical approach. DESIGN: Prospective, observational cohort study. SETTING: Odense University Hospital, Denmark...... for musculoskeletal involvement (muscle tenderness on palpation and movement) with follow-up 12 months after surgery. Clinically relevant pain was defined as a numeric rating scale score>3. Of the 60 patients included, 47 (78%) experienced ipsilateral shoulder pain, but only 25 (42%) reported clinically relevant...... shoulder pain. On postoperative day 4, 19 patients (32%) still suffered shoulder pain, but only 4 patients (7%) had clinically relevant pain. Four patients (8%) still suffered shoulder pain 12 months after surgery. In 26 patients (55%), the shoulder pain was classified as referred versus 21 patients (45...

  11. Increased IL-1beta expression and myofibroblast recruitment in subacromial bursa is associated with rotator cuff lesions with shoulder stiffness.

    Science.gov (United States)

    Ko, Jih-Yang; Wang, Feng-Sheng; Huang, Hsuan-Ying; Wang, Ching-Jen; Tseng, Shin-Ling; Hsu, Chin

    2008-08-01

    We evaluated whether proinflammatory cytokine expression and myofibroblast recruitment in subacromial bursa was linked to rotator cuff lesions with shoulder stiffness. We analyzed expressions of IL-1beta, IL-6, and TNF-alpha in subacromial bursa and joint fluid collected from 14 patients with cuff tears with stiffness as a study group (Group I) and 14 patients with rotator cuff tears without shoulder stiffness as a control group (Group II) using real-time RT-PCR, immunohistochemistry, and ELISA. Myofibroblast apoptosis in subacromial bursa was analyzed using terminal deoxynucleotidyl transferase -mediated deoxyuridine triphosphate-biotin nick end-labeling (TUNEL) and alpha-smooth muscle actin immunofluorescence staining. Shoulder function was evaluated using the Constant score. Group I had higher mRNA expression (p bursa and IL-1beta levels in joint fluid were correlated with a preoperative deficit in shoulder motion (p bursa in rotator cuff lesions are linked to shoulder stiffness.

  12. The activity pattern of shoulder muscles in subjects with and without subacromial impingement

    DEFF Research Database (Denmark)

    Diederichsen, Louise Pyndt; Nørregaard, Jesper; Dyhre-Poulsen, Poul

    2009-01-01

    Altered shoulder muscle activity is frequently believed to be a pathogenetic factor of subacromial impingement (SI) and therapeutic interventions have been directed towards restoring normal motor patterns. Still, there is a lack of scientific evidence regarding the changes in muscle activity...... in patients with SI. The aim of the study was to determine and compare the activity pattern of the shoulder muscles in subjects with and without SI. Twenty-one subjects with SI and 20 healthy controls were included. Electromyography (EMG) was assessed from eight shoulder muscles from both shoulders during...... and serratus anterior muscles on the symptomatic side compared to the healthy subjects. On the asymptomatic side, the groups showed different muscle activity during external rotation. Our findings of an altered shoulder muscle activity pattern on both the symptomatic and asymptomatic side in patients indicate...

  13. The role of tendon and subacromial bursa in rotator cuff tear pain: a clinical and histopathological study.

    Science.gov (United States)

    Chillemi, Claudio; Petrozza, Vincenzo; Franceschini, Vincenzo; Garro, Luca; Pacchiarotti, Alberto; Porta, Natale; Cirenza, Mirko; Salate Santone, Francesco; Castagna, Alessandro

    2016-12-01

    To evaluate a possible association of shoulder pain with the clinical features and the histopathological changes occurring in the ruptured tendon and subacromial bursa of patients with rotator cuff tear. One hundred and eighty patients were clinically evaluated with the constant score and the visual analogue pain scale. Radiographs and MRI were performed. The chronology of the rupture, the muscle fatty degeneration according to Goutallier's scale and the tear size were evaluated. For each patient, a biopsy of the supraspinatus tendon and subacromial bursa was performed during arthroscopic rotator cuff tear repair and the specimens were histopathologically analysed. Clinically, the shoulder was more painful in females, in the presence of a chronic cuff lesion and a low Goutallier's grade (P bursa were directly associated with pain (P bursa compared with those in the rotator cuff. Considering that the bursa plays also an essential role during the healing process, this "new" role of the subacromial bursa as pain generator has important repercussions in both pharmacological and surgical treatments of rotator cuff tears. IV.

  14. The role of central sensitization in shoulder pain: A systematic literature review.

    Science.gov (United States)

    Sanchis, Marc N; Lluch, Enrique; Nijs, Jo; Struyf, Filip; Kangasperko, Maija

    2015-06-01

    Hyperexcitability of the central nervous system has been suggested to play an important role in pain experienced by patients with unilateral shoulder pain. A systematic literature review following the PRISMA guidelines was performed to evaluate the existing evidence related to the presence of central sensitization in patients with unilateral shoulder pain of different etiologies including those with chronic subacromial impingement syndrome. Studies addressing neuropathic pain (e.g., post-stroke shoulder pain) were not considered. Electronic databases PubMed, EBSCO, and Web of Science were searched to identify relevant articles using predefined keywords regarding central sensitization and shoulder pain. Articles were included till September 2013. Full-text clinical reports addressing studies of central sensitization in human adults with unilateral shoulder complaints including those diagnosed with subacromial impingement syndrome were included and screened for methodological quality by two independent reviewers. A total of 10 articles were retrieved for quality assessment and data extraction. All studies were cross-sectional (case-control) or longitudinal in nature. Different subjective and objective parameters, considered manifestations of central sensitization, were established in subjects with unilateral shoulder pain of different etiologies, including those receiving a diagnosis of subacromial impingement syndrome. Overall results suggest that, although peripheral mechanisms are involved, hypersensitivity of the central nervous system plays a role in a subgroup within the shoulder pain population. Although the majority of the literature reviewed provides emerging evidence for the presence of central sensitization in unilateral shoulder pain (including those diagnosed with subacromial impingement syndrome), our understanding of the role central sensitization plays in the shoulder pain population is still in its infancy. Future studies with high methodical quality

  15. Effectiveness of ultrasound-guided injections combined with shoulder exercises in the treatment of subacromial adhesive bursitis.

    Science.gov (United States)

    Gasparre, Giuseppe; Fusaro, Isabella; Galletti, Stefano; Volini, Silvia; Benedetti, Maria Grazia

    2012-05-01

    The aim of this study was to evaluate whether the association of exercises for the shoulder with ultrasound-guided injection into the bursa significantly improves the treatment outcome in adhesive bursitis. Two groups of 35 patients, one treated with ultrasound-guided injection (UGI) and the other one with ultrasound-guided injection and home exercise program (UGI-exercise) for 1 month, were assessed for pain and shoulder function before treatment, 1 and 3 months post-treatment. Fourteen patients in UGI group and 23 patients in the UGI-exercises group were completely free of pain after 1 month (p = 0.031). At 3 months' follow-up, patients in the UGI-exercise group showed a significant improvement with respect to the other group (p = 0.005). No differences were found in function assessment. The UGI combined with shoulder exercises in the treatment of subacromial adhesive bursitis is effective to ensure a more frequent complete pain relief in the medium term.

  16. Risk of subacromial shoulder disorder in airport baggage handlers

    DEFF Research Database (Denmark)

    Møller, Sanne Pagh; Brauer, Charlotte; Mikkelsen, Sigurd

    2017-01-01

    at Copenhagen Airport in 1990-2012, and a cohort of unskilledotherwise employed men answered a survey.Self-reported information on work tasks during employment in the airport in combination with work task specific biomechanically modelled forces in the shoulder joint was used to estimate shoulder-load. Exposure...

  17. Is exercise effective for the management of subacromial impingement syndrome and other soft tissue injuries of the shoulder? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

    Science.gov (United States)

    Abdulla, Sean Y; Southerst, Danielle; Côté, Pierre; Shearer, Heather M; Sutton, Deborah; Randhawa, Kristi; Varatharajan, Sharanya; Wong, Jessica J; Yu, Hainan; Marchand, Andrée-Anne; Chrobak, Karen; Woitzik, Erin; Shergill, Yaadwinder; Ferguson, Brad; Stupar, Maja; Nordin, Margareta; Jacobs, Craig; Mior, Silvano; Carroll, Linda J; van der Velde, Gabrielle; Taylor-Vaisey, Anne

    2015-10-01

    Exercise is a key component of rehabilitation for soft tissue injuries of the shoulder; however its effectiveness remains unclear. Determine the effectiveness of exercise for shoulder pain. We searched seven databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort and case control studies comparing exercise to other interventions for shoulder pain. We critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. We synthesized findings from scientifically admissible studies using best-evidence synthesis methodology. We retrieved 4853 articles. Eleven RCTs were appraised and five had a low risk of bias. Four studies addressed subacromial impingement syndrome. One study addressed nonspecific shoulder pain. For variable duration subacromial impingement syndrome: 1) supervised strengthening leads to greater short-term improvement in pain and disability over wait listing; and 2) supervised and home-based strengthening and stretching leads to greater short-term improvement in pain and disability compared to no treatment. For persistent subacromial impingement syndrome: 1) supervised and home-based strengthening leads to similar outcomes as surgery; and 2) home-based heavy load eccentric training does not add benefits to home-based rotator cuff strengthening and physiotherapy. For variable duration low-grade nonspecific shoulder pain, supervised strengthening and stretching leads to similar short-term outcomes as corticosteroid injections or multimodal care. The evidence suggests that supervised and home-based progressive shoulder strengthening and stretching are effective for the management of subacromial impingement syndrome. For low-grade nonspecific shoulder pain, supervised strengthening and stretching are equally effective to corticosteroid injections or multimodal care. CRD42013003928. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Which shoulder motions cause subacromial impingement? Evaluating the vertical displacement and peak strain of the coracoacromial ligament by ultrasound speckle tracking imaging.

    Science.gov (United States)

    Park, In; Lee, Hyo-Jin; Kim, Sung-Eun; Bae, Sung-Ho; Byun, Chu-Hwan; Kim, Yang-Soo

    2015-11-01

    Subacromial impingement is a common cause of shoulder pain and one cause of rotator cuff disease. We aimed to identify which shoulder motions cause subacromial impingement by measuring the vertical displacement and peak strain of the coracoacromial ligament using ultrasound speckle tracking imaging. Sixteen shoulders without shoulder disability were enrolled. All subjects were men, and the average age was 28.6 years. The vertical displacement and peak strain of the coracoacromial ligament were analyzed by the motion tracing program during the following active assisted motions (active motion controlled by the examiner): (1) forward flexion in the scapular plane, (2) horizontal abduction in the axial plane, (3) external rotation with the arm at 0° abduction (ER0), (4) internal rotation with the arm at 0° abduction (IR0), (5) internal rotation with the arm at 90° abduction (IR90), and (6) internal rotation at the back (IRB). The mean vertical displacement of the coracoacromial ligament during forward flexion (2.2 mm), horizontal abduction (2.2 mm), and IR90 (2.4 mm) was significantly greater than that during the other motions (ER0, -0.7 mm; IR0, 0.5 mm; IRB, 1.0 mm; P impingement. It is recommended that patients with impingement syndrome or a repaired rotator cuff avoid these shoulder motions. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  19. Arthroscopic subacromial decompression results in normal shoulder function after two years in less than 50% of patients

    DEFF Research Database (Denmark)

    Konradsen, Lars Aage Glud; Jensen, Claus Hjorth

    2015-01-01

    INTRODUCTION: The aim of this study was to evaluate the outcome two years after arthroscopic subacromial decompression using the Western Ontario Rotator-Cuff (WORC) index and a diagram-based questionnaire to self-assess active shoulder range of motion (ROM). METHODS: Outcomes in 80 patients...... with impingement of the shoulder undergoing arthroscopic subacromial decompression were prospectively assessed preoperatively, at three months and at two years post-operatively using the WORC index. All patients had received non-operative treatment for at least six months before undergoing surgery. Active range......, but only 45% reported near normal or normal WORC scores, and 56% presented with a reduced active ROM at two years. CONCLUSION: Arthroscopic subacromial decompression -appears effective in alleviating symptoms in patients with subacromial impingement who are resistant to conservative treatment, but can only...

  20. Shoulder pain in primary care: frozen shoulder.

    Science.gov (United States)

    Cadogan, Angela; Mohammed, Khalid D

    2016-03-01

    BACKGROUND AND CONTEXT Frozen shoulder is a painful condition that follows a protracted clinical course. We aim to review the management of patients with a diagnosis of frozen shoulder who are referred for specialist orthopaedic evaluation against existing guidelines in primary care. ASSESSMENT OF PROBLEM Referrals and clinical records were reviewed for all patients referred for orthopaedic specialist assessment who received a specialist diagnosis of frozen shoulder. Diagnostic, investigation and management practices from a regional primary health care setting in New Zealand were compared with guideline-recommended management. RESULTS Eighty patients with frozen shoulder were referred for orthopaedic evaluation in the 13 month study period, mostly from general practice. Fifteen patients (19%) were identified as having a frozen shoulder in their medical referral. Most (99%) had received previous imaging. Seven patients (12%) had received guideline recommended treatment. STRATEGIES FOR IMPROVEMENT Education of all clinicians involved in patient management is important to ensure an understanding of the long natural history of frozen shoulder and provide reassurance that outcomes are generally excellent. HealthPathways now include more information regarding diagnosis, imaging and evidence-based management for frozen shoulder. LESSONS Frozen shoulder may be under-diagnosed among patients referred for orthopaedic review. Ultrasound imaging is commonly used and may identify occult and unrelated pathology in this age-group. When managed according to clinical guidelines, patients report significant clinical and functional improvement with most reporting 80% function compared with normal after 1 year. KEYWORDS Adhesive capsulitis; bursitis; injections; practice guideline; primary health care; ultrasound.

  1. The impact of subacromial impingement syndrome on muscle activity patterns of the shoulder complex: a systematic review of electromyographic studies

    Directory of Open Access Journals (Sweden)

    Smith Toby O

    2010-03-01

    Full Text Available Abstract Background Subacromial impingement syndrome (SIS is a commonly reported cause of shoulder pain. The purpose of this study was to systematically review the literature to examine whether a difference in electromyographic (EMG activity of the shoulder complex exists between people with SIS and healthy controls. Methods Medline, CINAHL, AMED, EMBASE, and grey literature databases were searched from their inception to November 2008. Inclusion, data extraction and trial quality were assessed in duplicate. Results Nine studies documented in eleven papers, eight comparing EMG intensity and three comparing EMG onset timing, representing 141 people with SIS and 138 controls were included. Between one and five studies investigated each muscle totalling between 20 and 182 participants. The two highest quality studies of five report a significant increase in EMG intensity in upper trapezius during scaption in subjects with SIS. There was evidence from 2 studies of a delayed activation of lower trapezius in patients with SIS. There was otherwise no evidence of a consistent difference in EMG activity between the shoulders of subjects with painful SIS and healthy controls. Conclusions A difference may exist in EMG activity within some muscles, in particular upper and lower trapezius, between people with SIS and healthy controls. These muscles may be targets for clinical interventions aiding rehabilitation for people with SIS. These differences should be investigated in a larger, high quality survey and the effects of therapeutically targeting these muscles in a randomised controlled trial.

  2. Kinesio taping or just taping in shoulder subacromial impingement syndrome? A randomized, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Kocyigit, Figen; Acar, Merve; Turkmen, Mehmet Besir; Kose, Tugce; Guldane, Nezahat; Kuyucu, Ersin

    2016-10-01

    To verify effects of kinesio taping (KT) in shoulder subacromial impingement syndrome (SIS) when compared to sham taping applied in the same way with KT. Patients were randomized as group 1 (n = 21) KT group and group 2 (n = 20) sham-taping group. Taping was applied every three days, three times during the study period. We assessed all the patients at baseline, at the end of the taping period (12th day), and at one-month post-intervention. We assessed pain on the 100 mm visual analog scale (VAS). Shoulder range of motion (ROM), Constant Scores, and Nottingham Health Profile (NHP) scores were evaluated. Of the 41 participants, 13 were males (32%) and 28 were females (68%). The mean age was 45 ± 15 years (range 20-65 years). We documented a significant decrease in VAS for nocturnal pain, and Constant Score in both groups. The KT group showed additional significant change in NHP pain and physical activity scores. KT and sham taping generated similar results regarding pain and Constant Scores.

  3. Effect of dynamic humeral centring (DHC) treatment on painful active elevation of the arm in subacromial impingement syndrome. Secondary analysis of data from an RCT.

    Science.gov (United States)

    Beaudreuil, Johann; Lasbleiz, Sandra; Aout, Mounir; Vicaut, Eric; Yelnik, Alain; Bardin, Thomas; Orcel, Philippe

    2015-03-01

    The physiotherapy dynamic humeral centring (DHC) aims to prevent subacromial impingement of rotator cuff tendons during elevation of the arm. The objective of the study was to determine whether DHC acts via an effect on subacromial impingement mechanism by assessing its effect on painful elevation of the arm in subacromial impingement syndrome. This is a secondary analysis of results of a randomised controlled trial of the effectiveness of DHC. Sixty-nine patients with subacromial impingement syndrome were prospectively included. Patients and the assessor were blinded to the study hypothesis and treatment, respectively. Patients underwent DHC or non-specific mobilisation as a control for 6 weeks in 15 supervised individual outpatient sessions with home exercises. Outcomes were pain-free range of motion and presence of painful arc of the shoulder, both in active flexion and abduction of the arm at 3 months. At 3 months, pain-free range of motion, both flexion and abduction, was greater in the DHC group than in the mobilisation group. The number of patients with painful arc during flexion was decreased in the DHC group. DHC improves painful active elevation of the arm. We suggest that DHC may act via a specific effect on subacromial impingement mechanism. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Pain after shoulder arthroscopy: a prospective study on 231 cases.

    Science.gov (United States)

    Stiglitz, Y; Gosselin, O; Sedaghatian, J; Sirveaux, F; Molé, D

    2011-05-01

    Shoulder arthroscopy is reputed to be painful, but progression of postoperative pain after this type of surgery has never been described and analyzed. This study had a triple objective: the description, search for risk factors, and analysis of the long-term impact of postoperative pain. This continuous prospective series includes 231 patients who underwent arthroscopic shoulder surgery. Pain was evaluated from D-1 to D3, then at D7, D30, and 1 year. Three pain criteria were noted: visual analog scale (VAS), morphine intake, and satisfaction with pain management. Surgery was performed under general anesthesia and/or interscalene block. A local anesthetic complement was administered in one of four modes: single subacromial injection, subacromial catheter, intra-articular catheter, or no complement. The VAS values remained less than 4 out of 10 during the entire study. Immediate postoperative pain was less than preoperative pain. It was followed by a pain bounce on D1 and D2 and did not return to a level significantly lower than its preoperative value until D30. Rotator cuff repair is the most painful surgery in the first postoperative days. The main risk factor for pain is a work related accident or occupational disease, associated with higher VAS values from D1 to 1 year and greater morphine intake. There was no correlation between immediate postoperative and 1-year VAS values. Pain after shoulder arthroscopy is relatively low and the efficacy of the intervention is long-lasting in terms of pain symptom. A pain bounce appears on D1, which must be taken into account, notably in the context of outpatient surgery. The use of local anesthesia is therefore advantageous. Despite the efficacy of postoperative pain relief protocols, their effect on longer term perspective was not demonstrated. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  5. Full can test: Mechanisms of a positive test in patients with shoulder pain.

    Science.gov (United States)

    Timmons, Mark K; Yesilyaprak, Sevgi S; Ericksen, Jeff; Michener, Lori A

    2017-02-01

    The full can test is theorized to produce compressive loads on the supraspinatus tendon within the subacromial space. Characterizing the width of the subacromial outlet, scapular orientation, and shoulder pain during the full can test will improve the mechanistic understanding of the positive full can test. Cross-sectional repeated measures design. Participants with subacromial pain syndrome (n=30) were compared to a matched control group (n=30) during 2 conditions: passive support, and the full can test. The full can test was performed with the arm elevated to 90° in the scapular plane. In both conditions, measurements were taken of acromiohumeral distance with ultrasonography, scapular position using electromagnetic tracking, shoulder strength using a dynamometer, and shoulder pain with the 11-point rating scale. During the full can test, both groups had a decreased acromial humeral distance, scapular upward rotation, posterior tilt, external rotation and clavicular protraction as compared to passive support (ppain group as compared to the control group reported greater shoulder pain (ppain and reduced strength in those with subacromial pain syndrome can be explained additionally by an increase in scapular anterior tilt. These mechanistic changes may lead to tendon compression, but this cannot be verified as direct tendon compression was not measured. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Compressive cryotherapy versus ice-a prospective, randomized study on postoperative pain in patients undergoing arthroscopic rotator cuff repair or subacromial decompression.

    Science.gov (United States)

    Kraeutler, Matthew J; Reynolds, Kirk A; Long, Cyndi; McCarty, Eric C

    2015-06-01

    The purpose of this study was to compare the effect of compressive cryotherapy (CC) vs. ice on postoperative pain in patients undergoing shoulder arthroscopy for rotator cuff repair or subacromial decompression. A commercial device was used for postoperative CC. A standard ice wrap (IW) was used for postoperative cryotherapy alone. Patients scheduled for rotator cuff repair or subacromial decompression were consented and randomized to 1 of 2 groups; patients were randomized to use either CC or a standard IW for the first postoperative week. All patients were asked to complete a "diary" each day, which included visual analog scale scores based on average daily pain and worst daily pain as well as total pain medication usage. Pain medications were then converted to a morphine equivalent dosage. Forty-six patients completed the study and were available for analysis; 25 patients were randomized to CC and 21 patients were randomized to standard IW. No significant differences were found in average pain, worst pain, or morphine equivalent dosage on any day. There does not appear to be a significant benefit to use of CC over standard IW in patients undergoing shoulder arthroscopy for rotator cuff repair or subacromial decompression. Further study is needed to determine if CC devices are a cost-effective option for postoperative pain management in this population of patients. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  7. Intraarticular findings in the chronically painful shoulder. A study of 32 posttraumatic cases

    DEFF Research Database (Denmark)

    Suder, P.A.; Hougaard, K.; Frich, Lars Henrik

    1994-01-01

    32 consecutive patients suffering from chronic shoulder pain for more than 6 months after a single, nondislocating shoulder trauma were examined clinically and by special radiographs, dynamic sonography, MRI and arthroscopy. Typical complaints were pain during loading, especially during over......, but only 4 had clinical signs of shoulder instability. Diagnostic evaluation identified labral tears, partial and total rotator cuff lesions with subacromial impingement and tendinitis of the biceps tendon. Surgery was performed in 24 patients, using capsulolabral and rotator cuff reconstruction......, arthroscopic labral resection and open subacromial decompression. In conclusion, patients with chronic posttraumatic shoulder pain have intraarticular injuries, especially tears of the glenoid labrum. History, clinical findings, radiography and sonography are seldom diagnostic. MRI is valuable, particularly...

  8. Effects of Low-Load Exercise on Postneedling-Induced Pain After Dry Needling of Active Trigger Point in Individuals With Subacromial Pain Syndrome.

    Science.gov (United States)

    Salom-Moreno, Jaime; Jiménez-Gómez, Laura; Gómez-Ahufinger, Victoria; Palacios-Ceña, María; Arias-Buría, José L; Koppenhaver, Shane L; Fernández-de-Las-Peñas, César

    2017-05-05

    The application of dry needling usually is associated with postneedling-induced pain. A postneedling intervention reduce this adverse event is needed. To determine the effectiveness of low-load exercise on reducing postneedling-induced pain after dry needling of active trigger points (TrPs) in the infraspinatus muscle in subacromial pain syndrome. A 72-hour follow-up, single-blind randomized controlled trial. Urban hospitals. Individuals with subacromial pain syndrome (n = 90, 52% female, mean age: 35 ± 13 years) with active TrPs in the infraspinatus muscle. All individuals received dry needling into the infraspinatus active TrP. Then, they were divided randomly into an experimental group, which received a single bout of low-load exercise of shoulder muscles; a placebo group, which received inactive ultrasound for 10 minutes; and a control group, which did not receive any intervention. Numerical Pain Rating Scale (0-10 point) was administered postneedling, immediately postintervention (2 minutes), and 24, 48, and 72 hours after needling. Shoulder pain (Numerical Pain Rating Scale, 0-10) and disability (Disabilities of the Arm, Shoulder and Hand; Shoulder Pain and Disability Index) were assessed before and 72 hour after needling. The 5 × 3 analysis of covariance showed that the exercise group demonstrated a larger decrease in postneedling-induced pain immediately after (P = .001), 24 hours (P = .001), and 48 hours after (P = .006) than placebo or control groups. No differences were found at 72 hours (P = .03). Similar improvements in shoulder pain (P needling, irrespective of the treatment group. Low-load exercise was effective for reducing postneedling-induced pain on active TrPs in the infraspinatus muscle 24 and 48 hours after needling. The application of a postneedling intervention did not influence short-term pain and disability changes. To be determined. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc

  9. Internal- and External-Rotation Peak Toque in Little League Baseball Players With Subacromial Impingement Syndrome: Improved by Closed Kinetic Chain Shoulder Training.

    Science.gov (United States)

    Lee, Dong-Rour; Kim, Laurentius Jongsoon

    2016-08-01

    Many studies have explored closed kinetic chain (CKC) shoulder exercises (SEs) with a sling because they are safer and more effective than open-chain exercises, especially in early stages of treatment. However, the application of CKC SE in youth baseball players has rarely been attempted, although teenage baseball players also experience shoulder pain. To investigate the effects of CKC SE on the peak torque of shoulder internal rotation (IR) and external rotation (ER) in youth baseball players. Single-group pretest, posttest. Biomechanics laboratory. 23 Little League Baseball players with subacromial impingement syndrome. The CKC SE with a sling was CKC shoulder-flexion exercise, extension exercise, IR exercise, and ER exercise. This exercise regimen was conducted 2 or 3 times/wk for 8 wk. The peak torque of shoulder IR and ER was measured using an isokinetic dynamometer. Concentric shoulder rotation was performed, with 5 repetitions at an angular velocity of 60°/s and 15 at 180°/s. The IR and ER peak torque significantly increased at each angular velocity after the exercise program. In particular, the increase in IR and ER peak torque values was statistically significant at an angular velocity of 180°/s. CKC SE was effective in increasing shoulder IR and ER strength, demonstrating its potential benefits in the prevention and treatment of shoulder injury. In addition, increased IR peak torque appears to improve throwing velocity in baseball players.

  10. Isolated subacromial bursal fluid on MRI of the shoulder in symptomatic patients: correlation with arthroscopic findings

    Energy Technology Data Exchange (ETDEWEB)

    Monu, J.U.V. [Dept. of Radiology, Bowman Gray School of Medicine, Wake Forest Univ., Winston-Salem, NC (United States); Pruett, S. [Bowman Gray School of Medicine, Wake Forest Univ., Winston-Salem, NC (United States); Vanarthos, W.J. [Dept. of Radiology, Bowman Gray School of Medicine, Wake Forest Univ., Winston-Salem, NC (United States); Pope, T.L. Jr. [Dept. of Radiology, Bowman Gray School of Medicine, Wake Forest Univ., Winston-Salem, NC (United States)

    1994-10-01

    Fluid in the subacromial bursa (SAB) is a common finding on magnetic resonance (MR) images of the shoulder, and the implications of this finding have not been clarified. We retrospectively reviewed and correlated the MR features with arthroscopic findings in 21 symptomatic patients who had fluid in the SAB on MR imaging without demonstrable rotator cuff tear. Rotator cuff impingement was the most frequent surgical finding (42.9%). Other frequent surgical observations were glenbid labrum abnormality (28.6%), bursitis (19%), and supraspinatus tendinitis (14.3%). Distribution of acromial types was similar to that reported by Bigliani et al., and impingement was evenly distributed among acromial types in our study population. We conclude that in our patient population group the MR finding of isolated SAB fluid in symptomatic patients is highly likely to be associated with the finding of other abnormalities in the shoulder joint at surgery. (orig.)

  11. Steroid injection for painful shoulder: Usefulness of ultrasound-guided approach

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Min Hee [Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2004-03-15

    To evaluate the efficacy of steroid injection into the subacromial bursa and biceps tendon sheath for painful shoulders and the usefulness of ultrasound-guided approach. Seventeen shoulders of twelve patients with shoulder pain and limited motion were included, and these patient were clinically diagnosed as a painful arc syndrome. Under ultrasound guidance, steroid injection was performed into the subacormial bursa (13 cases) and biceps tendon sheath (4 cases). In 7 cases, 1 mL of steroid was used while the remaining six patients received a mixture of 1 mL of steroid and 1 ml of lidocaine. Both shoulders of two patients received 0.5 mL of steroid. The location of needle and injection duration of fluid were continuously monitored, and complications such as leakage of steroid were recorded. Medical records were reviewed for the presence of pain relief and increasing range of motion following the injection. On ultrasonogram, the needle within the subacromial bursa and biceps tendon sheath was seen as a linear echogenic structure, and injected fluid was identified. There was neither the leakage of steroid injection nor any other complications. In 16 (94%) of 17 shoulders, there was decreased intensity of shoulder pain while increased range of motion was noted in three patients following the injection. Steroid injection into the subacormial bursa and biceps tendon sheath is effective in treating shoulder pain and limited range of motion of the shoulder, and ultrasound is useful guiding method.

  12. Rotator cuff related shoulder pain: Assessment, management and uncertainties.

    Science.gov (United States)

    Lewis, Jeremy

    2016-06-01

    Rotator cuff related shoulder pain (RCRSP) is an over-arching term that encompasses a spectrum of shoulder conditions including; subacromial pain (impingement) syndrome, rotator cuff tendinopathy, and symptomatic partial and full thickness rotator cuff tears. For those diagnosed with RCRSP one aim of treatment is to achieve symptom free shoulder movement and function. Findings from published high quality research investigations suggest that a graduated and well-constructed exercise approach confers at least equivalent benefit as that derived from surgery for; subacromial pain (impingement) syndrome, rotator cuff tendinopathy, partial thickness rotator cuff (RC) tears and atraumatic full thickness rotator cuff tears. However considerable deficits in our understanding of RCRSP persist. These include; (i) cause and source of symptoms, (ii) establishing a definitive diagnosis, (iii) establishing the epidemiology of symptomatic RCRSP, (iv) knowing which tissues or systems to target intervention, and (v) which interventions are most effective. The aim of this masterclass is to address a number of these areas of uncertainty and it will focus on; (i) RC function, (ii) symptoms, (iii) aetiology, (iv) assessment and management, (v) imaging, and (vi) uncertainties associated with surgery. Although people experiencing RCRSP should derive considerable confidence that exercise therapy is associated with successful outcomes that are comparable to surgery, outcomes may be incomplete and associated with persisting and recurring symptoms. This underpins the need for ongoing research to; better understand the aetiology, improve methods of assessment and management, and eventually prevent these conditions. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association.

    Science.gov (United States)

    Diercks, Ron; Bron, Carel; Dorrestijn, Oscar; Meskers, Carel; Naber, René; de Ruiter, Tjerk; Willems, Jaap; Winters, Jan; van der Woude, Henk Jan

    2014-06-01

    Treatment of "subacromial impingement syndrome" of the shoulder has changed drastically in the past decade. The anatomical explanation as "impingement" of the rotator cuff is not sufficient to cover the pathology. "Subacromial pain syndrome", SAPS, describes the condition better. A working group formed from a number of Dutch specialist societies, joined by the Dutch Orthopedic Association, has produced a guideline based on the available scientific evidence. This resulted in a new outlook for the treatment of subacromial pain syndrome. The important conclusions and advice from this work are as follows: (1) The diagnosis SAPS can only be made using a combination of clinical tests. (2) SAPS should preferably be treated non-operatively. (3) Acute pain should be treated with analgetics if necessary. (4) Subacromial injection with corticosteroids is indicated for persistent or recurrent symptoms. (5) Diagnostic imaging is useful after 6 weeks of symptoms. Ultrasound examination is the recommended imaging, to exclude a rotator cuff rupture. (6) Occupational interventions are useful when complaints persist for longer than 6 weeks. (7) Exercise therapy should be specific and should be of low intensity and high frequency, combining eccentric training, attention to relaxation and posture, and treatment of myofascial trigger points (including stretching of the muscles) may be considered. (8) Strict immobilization and mobilization techniques are not recommended. (9) Tendinosis calcarea can be treated by shockwave (ESWT) or needling under ultrasound guidance (barbotage). (10) Rehabilitation in a specialized unit can be considered in chronic, treatment resistant SAPS, with pain perpetuating behavior. (11) There is no convincing evidence that surgical treatment for SAPS is more effective than conservature management. (12) There is no indication for the surgical treatment of asymptomatic rotator cuff tears.

  14. Sleep quality and nocturnal pain in patients with shoulder disorders.

    Science.gov (United States)

    Mulligan, Edward P; Brunette, Meredith; Shirley, Zachary; Khazzam, Michael

    2015-09-01

    Nocturnal shoulder pain resulting in poor sleep quality is a common finding in patients with shoulder disease. The purpose of this paper was to describe and to compare the sleep quality, pain, and function in adult subjects who have been diagnosed with rotator cuff disorders, osteoarthritis, or adhesive capsulitis (AC). Patients completed a clinical assessment and comprehensive questionnaire regarding their current medical health history, shoulder symptoms, and impact of their symptoms on activities of daily living and quality of sleep. The study analyzed 343 patients with an average age of 57.4 years. The mean Single Assessment Numeric Evaluation score for AC was 34%, which was significantly lower than the score for the subacromial impingement syndrome group of 53% (P = .007). The mean American Shoulder and Elbow Surgeons scale score for AC was 38, which was also significantly lower than the score for the subacromial impingement syndrome group of 51 (P = .007). There were no significant differences in pain, with mean scores ranging from 4.90 to 5.82 for diagnostic subgroups on a visual analog scale (P = .28). Sleep quality was significantly poorer in the AC group (P = .008), with a mean Pittsburgh Sleep Quality Index score of 12.07. Specific subcomponents of the Pittsburgh Sleep Quality Index that had a significant impact on sleep interruption included sleep quality, sleep duration, and habitual sleep efficiency in the AC group (P shoulder disease may have sleep-related issues, patients with adhesive capsulitis are particularly vulnerable to reduced sleep quality. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  15. Subacute effects of cervicothoracic spinal thrust/non-thrust in addition to shoulder manual therapy plus exercise intervention in individuals with subacromial impingement syndrome: a prospective, randomized controlled clinical trial pilot study.

    Science.gov (United States)

    Wright, Alexis A; Donaldson, Megan; Wassinger, Craig A; Emerson-Kavchak, Alicia J

    2017-09-01

    To determine the subacute effects of cervicothoracic spinal thrust/non-thrust in addition to shoulder non-thrust plus exercise in patients with subacromial pathology. This was a randomized, single blinded controlled trial pilot study. This trial was registered at ClinicalTrials.gov (NCT01753271) and reported according to Consolidated Standards of Reporting Trials requirements. Patients were randomly assigned to either shoulder treatment plus cervicothoracic spinal thrust/non-thrust or shoulder treatment-only group. Primary outcomes were average pain intensity (Numeric Pain Rating Scale) and physical function (Shoulder Pain and Disability Index) at 2 weeks, 4 weeks, and patient discharge. 18 patients, mean age 43.1(15.8) years satisfied the eligibility criteria and were analyzed for follow-up data. Both groups showed statistically significant improvements in both pain and function at 2 weeks, 4 weeks, and discharge. The between-group differences for changes in pain or physical function were not significant at any time point. The addition of cervicothoracic spinal thrust/non-thrust to the shoulder treatment-only group did not significantly alter improvement in pain or function in patients with subacromial pathology. Both approaches appeared to provide an equally notable benefit. Both groups improved on all outcomes and met the criteria for clinical relevance for both pain and function. 2b.

  16. Clinical anatomy of the subacromial and related shoulder bursae: A review of the literature.

    Science.gov (United States)

    Kennedy, Marion S; Nicholson, Helen D; Woodley, Stephanie J

    2017-03-01

    The subacromial bursa (SAB) is the main bursa of the shoulder. It facilitates normal movement and is also commonly involved in shoulder disorders. Other shoulder bursae have been described but their anatomy has not been well studied. Anatomical variation of shoulder bursae has been suggested and this has implications for clinical practice. This article reviews current knowledge of the normal anatomy of the SAB and related shoulder bursae. A systematic review of the English and German literature was conducted using databases and a hand search of reference lists focusing on the clinical anatomy of the SAB, coracobrachial and subcoracoid bursae and subtendinous bursa of subscapularis. Twenty-four original sources and 13 textbooks were identified. Fifteen studies described the general morphology of the shoulder bursae using cadaveric specimens, eight examined innervation, and one provided information about the blood supply of the SAB. The literature agrees that the SAB is consistent and well innervated with a lateral subdeltoid part and a variable subcoracoid portion. There is variability regarding the consistency, location, and communications of the coracobrachial and subcoracoid bursae and the superior part of the subtendinous bursa of subscapularis, and little information on their nerve and blood supply. Several bursae are present around the shoulder joint. Further research is warranted to understand the precise attachments, dimensions, and communications of the bursae, as well as their nerve and blood supply. This information will improve understanding of the clinical relevance of these bursae and inform appropriate assessment and treatment. Clin. Anat. 30:213-226, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  17. SHORT-TERM EFFECTS OF INSTRUMENT-ASSISTED SOFT TISSUE MOBILIZATION ON PAIN FREE RANGE OF MOTION IN A WEIGHTLIFTER WITH SUBACROMIAL PAIN SYNDROME.

    Science.gov (United States)

    Coviello, Joseph Paul; Kakar, Rumit Singh; Reynolds, Timothy James

    2017-02-01

    While there is limited evidence supporting the use of soft tissue mobilization techniques for Subacromial Pain Syndrome (SAPS), synonymous with subacromial impingement syndrome, previous studies have reported successful outcomes using soft tissue mobilization as a treatment technique. The purpose of this case report is to document the results of Instrument-Assisted Soft Tissue Mobilization (IASTM) for the treatment of SAPS. Diagnosis was reached based on the subject's history, tenderness to palpation, and four out of five positive tests in the diagnostic cluster. Treatment consisted of three visits where the IASTM technique was applied to the pectoral muscles as well as periscapular musculature followed by retesting pain-free shoulder flexion active range of motion (AROM) and Numerical Pain Rating Scale (NPRS) during active shoulder flexion. Scapulothoracic mobilization and stretching were performed after AROM measurement. The subject reported an NPRS of 0/10 and demonstrated improvements in pain free flexion AROM in each of the three treatment sessions post-IASTM: 85 ° to 181 °, 110 ° to 171 °, and 163 ° to 174 ° with some carryover in pain reduction and pain free AROM to the next treatment. Through three treatments, DASH score improved by 17.34%, Penn Shoulder Score improved 29%, worst NPRS decreased from 4/10 to 0/10, and a GROC score of 6. IASTM may have a beneficial acute effect on pain free shoulder flexion. In conjunction with scapulothoracic mobilizations and stretching, IASTM may improve function, decrease pain, and improve patient satisfaction. While this technique will not ameliorate the underlying pathomechanics contributing to SAPS, it may serve as a valuable tool to restore ROM and decrease pain allowing the patient to reap the full benefits of a multi-modal treatment approach. 5.

  18. A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid versus NSAID in patients with shoulder impingement syndrome.

    Science.gov (United States)

    Min, Kyong Su; St Pierre, Patrick; Ryan, Paul M; Marchant, Bryant G; Wilson, Christopher J; Arrington, Edward D

    2013-05-01

    The objective of this study was to compare the efficacy of subacromial injection of triamcinolone compared to injection of ketorolac in the treatment of external shoulder impingement syndrome. Thirty-two patients diagnosed with external shoulder impingement syndrome were included in this double-blinded randomized controlled clinical trial. Each patient was randomized into the steroid group or nonsteroidal anti-inflammatory drugs (NSAID) group. The steroid syringe contained 40 mg triamcinolone; and the NSAID syringe contained 60 mg ketorolac. Each patient was evaluated in terms of arc of motion, visual analog scale (VAS) for evaluating pain, and the UCLA (The University of California at Los Angeles) shoulder rating scale. At 1 month follow-up, both treatment arms resulted in increased range of motion and decreased pain. The steroid group decreased in active abduction while the NSAID group increased (steroid: 134°, NSAID: 151°, P = .03). The mean improvement in the UCLA shoulder rating scale at 4 weeks was 7.15 for the NSAID group and 2.13 for the steroid group (P = .03). Subgroup analysis of the UCLA scale demonstrated an increase in both forward flexion strength (P = .04) and patient satisfaction (P = .03) in the NSAID group. No significant difference could be seen in all other outcome measures. In this study, an injection of ketorolac resulted in greater improvements in the UCLA shoulder rating scale than an injection of triamcinolone at 4 weeks follow-up. While both triamcinolone and ketorolac are effective in the treatment of isolated subacromial impingement, ketorolac appears to have equivalent if not superior efficacy; all the while decreasing patient exposure to the potential side-effects of corticosteroids. Published by Mosby, Inc.

  19. SHORT‐TERM EFFECTS OF INSTRUMENT‐ASSISTED SOFT TISSUE MOBILIZATION ON PAIN FREE RANGE OF MOTION IN A WEIGHTLIFTER WITH SUBACROMIAL PAIN SYNDROME

    Science.gov (United States)

    Coviello, Joseph Paul; Reynolds, Timothy James

    2017-01-01

    Background and Purpose While there is limited evidence supporting the use of soft tissue mobilization techniques for Subacromial Pain Syndrome (SAPS), synonymous with subacromial impingement syndrome, previous studies have reported successful outcomes using soft tissue mobilization as a treatment technique. The purpose of this case report is to document the results of Instrument‐Assisted Soft Tissue Mobilization (IASTM) for the treatment of SAPS. Case Description Diagnosis was reached based on the subject's history, tenderness to palpation, and four out of five positive tests in the diagnostic cluster. Treatment consisted of three visits where the IASTM technique was applied to the pectoral muscles as well as periscapular musculature followed by retesting pain‐free shoulder flexion active range of motion (AROM) and Numerical Pain Rating Scale (NPRS) during active shoulder flexion. Scapulothoracic mobilization and stretching were performed after AROM measurement. Outcomes The subject reported an NPRS of 0/10 and demonstrated improvements in pain free flexion AROM in each of the three treatment sessions post‐IASTM: 85 ° to 181 °, 110 ° to 171 °, and 163 ° to 174 ° with some carryover in pain reduction and pain free AROM to the next treatment. Through three treatments, DASH score improved by 17.34%, Penn Shoulder Score improved 29%, worst NPRS decreased from 4/10 to 0/10, and a GROC score of 6. Discussion IASTM may have a beneficial acute effect on pain free shoulder flexion. In conjunction with scapulothoracic mobilizations and stretching, IASTM may improve function, decrease pain, and improve patient satisfaction. While this technique will not ameliorate the underlying pathomechanics contributing to SAPS, it may serve as a valuable tool to restore ROM and decrease pain allowing the patient to reap the full benefits of a multi‐modal treatment approach. Level of Evidence 5 PMID:28217425

  20. Dynamic ultrasound of the subacromial-subdeltoid bursa in patients with shoulder impingement: a comparison with normal volunteers.

    Science.gov (United States)

    Daghir, Ahmed A; Sookur, Paul A; Shah, Sachit; Watson, Martin

    2012-09-01

    The purpose of the study was to determine if the thickness of the subacromial-subdeltoid (SASD) bursa during dynamic ultrasound and on static views differs between patients with shoulder impingement syndrome and healthy volunteers. Twenty-two patients with a clinical diagnosis of shoulder impingement syndrome and 23 healthy volunteers were recruited. A subset of patients showing an immediate symptom response following intrabursal injection was identified as "injection responders". Ultrasound of the shoulder was performed on all participants using three standard static views and two dynamic views (before and after arm abduction). The thickness of both the intrabursal fluid and the superficial peribursal fat was measured on all views. The bursal thickness measurements in the two groups were compared using a t test for significance. The mean increase in SASD bursal fluid thickness following arm abduction was not statistically different among all patients (0.39 ± 0.41 mm) and controls (0.35 ± 0.32 mm), p = 0.72. The same was true comparing injection responders (0.46 ± 0.49 mm) with controls, p = 0.41. On static views, greater bursal fluid thickness was found in patients (1.01 ± 0.48 mm) compared with controls (0.67 ± 0.32 mm) when using the short axis view of the supraspinatus, p = 0.006. No statistically significant difference was found between injection responders and controls when measuring peribursal fat thickness on any view. Gathering of the SASD bursa demonstrated during dynamic ultrasound does not necessarily indicate painful impingement of the bursa as it is found to a similar degree in patients with a clinical diagnosis of impingement and healthy volunteers.

  1. Physiotherapy after subacromial decompression surgery

    DEFF Research Database (Denmark)

    Christiansen, David Høyrup; Falla, Deborah; Frost, Poul

    2015-01-01

    This paper describes the development and details of a standardised physiotherapy exercise intervention designed to address pain and disability in patients with difficulty returning to usual activities after arthroscopic decompression surgery for subacromial impingement syndrome. To develop the in...... is currently being evaluated within the framework of the Shoulder Intervention Project (ISRCTN55768749).......This paper describes the development and details of a standardised physiotherapy exercise intervention designed to address pain and disability in patients with difficulty returning to usual activities after arthroscopic decompression surgery for subacromial impingement syndrome. To develop...

  2. Effects of experimental muscle pain on shoulder-abduction force steadiness and muscle activity in healthy subjects

    DEFF Research Database (Denmark)

    Bandholm, Thomas Quaade; Rasmussen, Lars; Aagaard, Per

    2007-01-01

    We previously demonstrated that the steadiness of shoulder abduction is reduced in patients with subacromial impingement syndrome (SIS), which might be related to shoulder pain associated with the SIS. The aim of the present study was to examine the acute effects of experimental shoulder muscle...... pain on shoulder motor function in healthy subjects. The fluctuations in exerted force (force steadiness) and electromyographic (EMG) activity from eight shoulder muscles were determined during sub-maximal isometric and dynamic contractions with the shoulder abductors in nine healthy subjects (27.......7 +/- 4.2 years, mean +/- 1 SD) before, during and after experimental pain induction. Experimental pain was induced by bolus injections of 6% hypertonic saline into the supraspinatus muscle. Experimental muscle pain reduced shoulder-abduction force steadiness on average by 21% during isometric...

  3. Physical Therapists' Perceptions and Use of Exercise in the Management of Subacromial Shoulder Impingement Syndrome: Focus Group Study.

    Science.gov (United States)

    Hanratty, Catherine E; Kerr, Daniel P; Wilson, Iseult M; McCracken, Martin; Sim, Julius; Basford, Jeffrey R; McVeigh, Joseph G

    2016-09-01

    Shoulder pain resulting from subacromial impingement syndrome (SAIS) is a common problem with a relatively poor response to treatment. There is little research exploring physical therapists' perspectives on the management of the syndrome. The study objective was to investigate physical therapists' perceptions and experiences regarding the use of exercise in the treatment of patients with SAIS. This was a qualitative focus group study. Three 60- to 90-minute focus group sessions containing 6 to 8 experienced musculoskeletal physical therapists (total number=20) were conducted. Thematic content analysis was used to analyze transcripts and develop core themes and categories. Exercise was seen as key in the management of SAIS. The overarching theme was the need to "gain buy-in to exercise" at an early stage. The main subtheme was patient education. Therapists identified the need to use education about SAIS etiology to foster buy-in and "sell" self-management through exercise to the patient. They consistently mentioned achieving education and buy-in using visual tools, postural advice, and sometimes a "quick fix" of pain control. Furthermore, experienced practitioners reported including educational interventions much earlier in treatment than when they first qualified. Therapists emphasized the need for individually tailored exercises, including: scapular stabilization; rotator cuff, lower trapezius, and serratus anterior muscle strengthening; and anterior shoulder and pectoralis minor muscle stretching. Quality of exercise performance was deemed more important than the number of repetitions that the patients performed. Expanding the geographical area over which the focus groups were conducted and including therapists with less than 5 years of postgraduate experience may have strengthened the findings of this study. Experienced musculoskeletal physical therapists believe that exercise is central in treating patients with SAIS and that gaining patient buy-in to its

  4. Clinical evaluation of nonarthritic shoulder pain: Diagnosis and treatment.

    Science.gov (United States)

    Holmes, Robert E; Barfield, William R; Woolf, Shane K

    2015-07-01

    Shoulder pain and dysfunction is a complex problem frequently encountered by primary care physicians. Common nonarthritic conditions seen in the primary care setting include rotator cuff syndrome, impingement, posttraumatic stiffness, adhesive capsulitis, and instability. A thorough history and physical examination can aid in the diagnosis of many common shoulder complaints. Pain and instability are the most common shoulder complaints. Pain that is sharp or burning is commonly radicular in origin, whereas pain caused by tendinitis is often dull, diffuse, and aching. Instability is frequently found in patients with a history of dislocation, but also may occur with no prior history. Imaging modalities such as magnetic resonance imaging can be helpful for more advanced pathology. However, many common shoulder conditions can be diagnosed without imaging, and may be initially treated with a short course of rest, ice, topical analgesics, nonsteroidal anti-inflammatory drugs, directed and supervised physical therapy, and occasionally subacromial corticosteroid injections. As always, a detailed history and a thorough physical exam by a primary care physician are vital for diagnosis. When conservative measures fail, referral to an orthopaedic surgeon may be necessary for further patient management.

  5. Finnish Subacromial Impingement Arthroscopy Controlled Trial (FIMPACT): a protocol for a randomised trial comparing arthroscopic subacromial decompression and diagnostic arthroscopy (placebo control), with an exercise therapy control, in the treatment of shoulder impingement syndrome.

    Science.gov (United States)

    Paavola, Mika; Malmivaara, Antti; Taimela, Simo; Kanto, Kari; Järvinen, Teppo Ln

    2017-06-06

    Arthroscopic subacromial decompression (ASD) is the most commonly performed surgical intervention for shoulder pain, yet evidence on its efficacy is limited. The rationale for the surgery rests on the tenet that symptom relief is achieved through decompression of the rotator cuff tendon passage. The primary objective of this superiority trial is to compare the efficacy of ASD versus diagnostic arthroscopy (DA) in patients with shoulder impingement syndrome (SIS), where DA differs only by the lack of subacromial decompression. A third group of supervised progressive exercise therapy (ET) will allow for pragmatic assessment of the relative benefits of surgical versus non-operative treatment strategies. Finnish Subacromial Impingement Arthroscopy Controlled Trial is an ongoing multicentre, three-group randomised controlled study. We performed two-fold concealed allocation, first by randomising patients to surgical (ASD or DA) or conservative (ET) treatment in 2:1 ratio and then those allocated to surgery further to ASD or DA in 1:1 ratio. Our two primary outcomes are pain at rest and at arm activity, assessed using visual analogue scale (VAS). We will quantify the treatment effect as the difference between the groups in the change in the VAS scales with the associated 95% CI at 24 months. Our secondary outcomes are functional assessment (Constant score and Simple shoulder test), quality of life (15D and SF-36), patient satisfaction, proportions of responders and non-responders, reoperations/treatment conversions, all at 2 years post-randomisation, as well as adverse effects and complications. We recruited a total of 210 patients from three tertiary referral centres. We will conduct the primary analysis on the intention-to-treat basis. The study was approved by the Institutional Review Board of the Pirkanmaa Hospital District and duly registered at ClinicalTrials.gov. The findings of this study will be disseminated widely through peer-reviewed publications and

  6. Detailed Shoulder MRI Findings in Manual Wheelchair Users with Shoulder Pain

    Directory of Open Access Journals (Sweden)

    Melissa M. B. Morrow

    2014-01-01

    Full Text Available Shoulder pain and pathology are common in manual wheelchair (MWC users with paraplegia, and the biomechanical mechanism of injury is largely unknown. Establishing patterns of MRI characteristics in MWC users would help advance understanding of the mechanical etiology of rotator cuff disease, thus improving the logic for prescribed interventions. The purpose of this study was to report detailed shoulder MRI findings in a sample of 10 MWC users with anterolateral shoulder pain. The imaging assessments were performed using our standardized MRI Assessment of the Shoulder (MAS guide. The tendon most commonly torn was the supraspinatus at the insertion site in the anterior portion in either the intrasubstance or articular region. Additionally, widespread tendinopathy, CA ligament thickening, subacromial bursitis, labral tears, and AC joint degenerative arthrosis and edema were common. Further reporting of detailed shoulder imaging findings is needed to confirm patterns of tears in MWC users regarding probable tendon tear zone, region, and portion. This investigation was a small sample observational study and did not yield data that can define patterns of pathology. However, synthesis of detailed findings from multiple studies could define patterns of pathological MRI findings allowing for associations of imaging findings to risk factors including specific activities.

  7. Contributions of myofascial pain in diagnosis and treatment of shoulder pain. A randomized control trial

    Directory of Open Access Journals (Sweden)

    Gaspar-Calvo Elena

    2009-07-01

    Full Text Available Abstract Background Rotator cuff tendinopathy and subacromial impingement syndrome present complex patomechanical situations, frequent difficulties in clinical diagnosis and lack of effectiveness in treatment. Based on clinical experience, we have therefore considered the existence of another pathological entity as the possible origin of pain and dysfunction. The hypothesis of this study is to relate subacromial impingement syndrome (SIS with myofascial pain syndrome (MPS, since myofascial trigger points (MTrPs cause pain, functional limitation, lack of coordination and alterations in quality of movement, even prior to a tendinopathy. MTrPs can coexist with any degenerative subacromial condition. If they are not taken into consideration, they could perpetuate and aggravate the problem, hindering diagnosis and making the applied treatments ineffective. The aims and methods of this study are related with providing evidence of the relationship that may exist between this condition and MPS in the diagnosis and treatment of rotator cuff tendonitis and/or SIS. Method/design A descriptive transversal study will be made to find the correlation between the diagnosis of SIS and rotator cuff tendonitis, positive provocation test responses, the existence of active MTrPs and the results obtained with ultrasonography (US and Magnetic Renonance Imaging (MRI. A randomized double blinded clinical trial will be carried out in experimental conditions: A Protocolized treatment based on active and passive joint repositioning, stabilization exercises, stretching of the periarticular shoulder muscles and postural reeducation. B. The previously described protocolized treatment, with the addition of dry needling applied to active MTrPs with the purpose of isolating the efficacy of dry needling in treatment. Discussion This study aims to provide a new vision of shoulder pain, from the perspective of MPS. This syndrome can, by itself, account for shoulder pain and

  8. Contributions of myofascial pain in diagnosis and treatment of shoulder pain. A randomized control trial.

    Science.gov (United States)

    Perez-Palomares, Sara; Oliván-Blázquez, Bárbara; Arnal-Burró, Ana M; Mayoral-Del Moral, Orlando; Gaspar-Calvo, Elena; de-la-Torre-Beldarraín, M Luisa; López-Lapeña, Elena; Pérez-Benito, Marina; Ara-Loriente, Victoria; Romo-Calvo, Laura

    2009-07-24

    Rotator cuff tendinopathy and subacromial impingement syndrome present complex patomechanical situations, frequent difficulties in clinical diagnosis and lack of effectiveness in treatment. Based on clinical experience, we have therefore considered the existence of another pathological entity as the possible origin of pain and dysfunction. The hypothesis of this study is to relate subacromial impingement syndrome (SIS) with myofascial pain syndrome (MPS), since myofascial trigger points (MTrPs) cause pain, functional limitation, lack of coordination and alterations in quality of movement, even prior to a tendinopathy. MTrPs can coexist with any degenerative subacromial condition. If they are not taken into consideration, they could perpetuate and aggravate the problem, hindering diagnosis and making the applied treatments ineffective.The aims and methods of this study are related with providing evidence of the relationship that may exist between this condition and MPS in the diagnosis and treatment of rotator cuff tendonitis and/or SIS. A descriptive transversal study will be made to find the correlation between the diagnosis of SIS and rotator cuff tendonitis, positive provocation test responses, the existence of active MTrPs and the results obtained with ultrasonography (US) and Magnetic Renonance Imaging (MRI). A randomized double blinded clinical trial will be carried out in experimental conditions: A Protocolized treatment based on active and passive joint repositioning, stabilization exercises, stretching of the periarticular shoulder muscles and postural reeducation. B. The previously described protocolized treatment, with the addition of dry needling applied to active MTrPs with the purpose of isolating the efficacy of dry needling in treatment. This study aims to provide a new vision of shoulder pain, from the perspective of MPS. This syndrome can, by itself, account for shoulder pain and dysfunction, although it can coexist with real conditions involving

  9. Painful Shoulder in Swimmers: A Diagnostic Challenge.

    Science.gov (United States)

    McMaster, William C.

    1986-01-01

    This article discusses the incidence, diagnosis, and treatment of painful shoulder in swimmers, including: regional problems that can cause shoulder pain; physical, clinical, and laboratory tests for diagnostic use; and approaches to management of the problem. (Author/CB)

  10. Shoulder pain syndrome among Nigerians.

    Science.gov (United States)

    Adelowo, O O; Oguntona, S; Ojo, O

    2009-04-01

    To identify aetiological causes of shoulder pain syndrome among patients attending a rheumatology clinic, and to highlight the therapeutic options. Retrospective study. A private rheumatology clinic in Lagos, Nigeria fromJanuary 2002 to December 2006. Forty female adult patients and 26 male adult patients aged 24-79 years. Patient reported outcome in terms of pain relief and increased mobility. Sixty six subjects were seen during the study period. Females were more commonly affected and were mostly middle aged. Adhesive capsulitis was the most common condition while septic arthritis and avascular necrosis were least diagnosed 22.7% of the subjects could not, however, be categorised. Shoulder pain syndrome is common among Nigerians. Diagnosis and management are mostly based on the clinical presentations, especially considering the lack of sensitivity of plain radiographs and the high cost of more sensitive MRI. The treatment of these conditions are standard.

  11. Stretching Exercises for Shoulder Impingement Syndrome: Effects of 6-week Program on Shoulder Tightness, Pain and Disability Status.

    Science.gov (United States)

    Turgut, Elif; Duzgun, Irem; Baltaci, Gul

    2017-01-17

    Increasing soft tissue flexibility and joint mobility is one of the important aims of the shoulder impingement syndrome (SIS). The aim of this study was to investigate the effects of stretching program on posterior capsule tightness, pectoralis minor tightness, pain severity and disability status in SIS. Single-group pre-test post-test design. University outpatient clinic. Eighteen participants diagnosed with subacromial impingement syndrome (34.8 ± 9.4 years old, symptoms duration 5.8 ± 4.9 months) were included. The six-week self-stretching program for pectoralis minor, posterior capsule, levator scapula and, latissimus dorsi was performed. Posterior capsule tightness, pectoralis minor tightness, pain severity (visual analog scale), andself-reported shoulder related pain and disability status (Shoulder Pain and Disability Index) were used to assess the changes flexibility and symptoms. Comparisons showed that there was significantly less posterior capsule and pectoralis minor tightness, less pain severity on activity and at night, and less disability score reported after six-week stretching program (p pain severity at rest after stretching program performed (p > 0.05). The findings of the study showed that flexibility, pain severity and disability gains can be achieved with six-week stretching exercise training for participants with SIS. Therefore, shoulder girdle stretching exercises should be recommended to apply in early shoulder rehabilitation program.

  12. Central Hypersensitivity in Chronic Hemiplegic Shoulder Pain

    Science.gov (United States)

    Hoo, Jennifer Soo; Paul, Tracy; Chae, John; Wilson, Richard

    2013-01-01

    Objective This study aimed to examine the association of hemiplegic shoulder pain with central hypersensitivity through pressure-pain thresholds (PPT) at healthy, distant tissues. Design This study is a cross-sectional study. A total of 40 patients (n=20 hemiplegic shoulder pain (HSP), n=20 stroke without HSP) were enrolled in this study. Pressure-pain thresholds were measured at the affected deltoid and contralateral deltoid and tibialis anterior using a handheld algometer. Differences in PPTs were analyzed by Wilcoxon Rank Sum test and with linear regression analysis controlling for gender, a known confounder of PPTs. Results Subjects with hemiplegic shoulder pain had lower local PPTs than stroke control subjects when comparing the painful to dominant shoulders and comparing the non-painful shoulder and tibialis anterior to the non-dominant side controls. Similarly, those with hemiplegic shoulder pain had lower PPTs when comparing to controls in contralesional-to-contralesional comparisons as well as ipsilesional-to-ipsilesional comparisons. Conclusions Subjects with hemiplegic shoulder pain have lower local and distal PPTs than subjects without hemiplegic shoulder pain. Our study suggests that chronic shoulder pain may be associated with widespread central hypersensitivity, which has been previously found to be associated with other chronic pain syndromes. This further understanding can then help develop better treatment options for those with this hemiplegic shoulder pain. PMID:23255268

  13. An evidence-based review of current perceptions with regard to the subacromial space in shoulder impingement syndromes: Is it important and what influences it?

    Science.gov (United States)

    Mackenzie, Tanya Anne; Herrington, Lee; Horlsey, Ian; Cools, Ann

    2015-08-01

    Reduction of the subacromial space as a mechanism in the etiology of shoulder impingement syndromes is debated. Although a reduction in this space is associated with shoulder impingement syndromes, it is unclear if this observation is cause or consequence. The purposes of this descriptive review are to provide a broad perspective on the current perceptions with regard to the pathology and pathomechanics of subacromial and internal impingement syndromes, consider the role of the subacromial space in impingement syndromes, describe the intrinsic and extrinsic mechanisms considered to influence the subacromial space, and critique the level of evidence supporting these concepts. Based on the current evidence, the hypothesis that a reduction in subacromial space is an extrinsic cause of impingement syndromes is not conclusively established and the evidence permits no conclusion. If maintenance of the subacromial space is important in impingement syndromes regardless of whether it is a cause or consequence, research exploring the correlation between biomechanical factors and the subacromial space, using the later as the outcome measure, would be beneficial. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome: a nationwide Danish cohort study.

    Science.gov (United States)

    Dalbøge, Annett; Frost, Poul; Andersen, Johan Hviid; Svendsen, Susanne Wulff

    2014-11-01

    The primary aim was to examine exposure-response relationships between cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome (SIS), and to compare sex-specific exposure-response relationships. The secondary aim was to examine the time window of relevant exposures. We conducted a nationwide register study of all persons born in Denmark (1933-1977), who had at least 5 years of full-time employment. In the follow-up period (2003-2008), we identified first-time events of surgery for SIS. Cumulative exposure estimates for a 10-year exposure time window with a 1-year lag time were obtained by linking occupational codes with a job exposure matrix. The exposure estimates were expressed as, for example, arm-elevation-years in accordance with the pack-year concept of tobacco consumption. We used a multivariable logistic regression technique equivalent to discrete survival analysis. The adjusted OR (ORadj) increased to a maximum of 2.1 for arm-elevation-years, repetition-years and force-years, and to 1.5 for hand-arm-vibration-years. Sex-specific exposure-response relationships were similar for men and women, when assessed using a relative risk scale. The ORadj increased gradually with the number of years contributing to the cumulative exposure estimates. The excess fraction was 24%. Cumulative occupational shoulder exposures carried an increase in risk of surgery for SIS with similar exposure-response curves for men and women. The risk of surgery for SIS increased gradually, when the period of exposure assessment was extended. In the general working population, a substantial fraction of all first-time operations for SIS could be related to occupational exposures. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. One-year outcome of subacromial corticosteroid injection compared with manual physical therapy for the management of the unilateral shoulder impingement syndrome: a pragmatic randomized trial.

    Science.gov (United States)

    Rhon, Daniel I; Boyles, Robert B; Cleland, Joshua A

    2014-08-05

    Corticosteroid injections (CSIs) and physical therapy are used to treat patients with the shoulder impingement syndrome (SIS) but have never been directly compared. To compare the effectiveness of 2 common nonsurgical treatments for SIS. Randomized, single-blind, comparative-effectiveness, parallel-group trial. (ClinicalTrials.gov: NCT01190891). Military hospital-based outpatient clinic in the United States. 104 patients aged 18 to 65 years with unilateral SIS between June 2010 and March 2012. Random assignment into 2 groups: 40-mg triamcinolone acetonide subacromial CSI versus 6 sessions of manual physical therapy. The primary outcome was change in Shoulder Pain and Disability Index scores at 1 year. Secondary outcomes included the Global Rating of Change scores, the Numeric Pain Rating Scale scores, and 1-year health care use. Both groups demonstrated approximately 50% improvement in Shoulder Pain and Disability Index scores maintained through 1 year; however, the mean difference between groups was not significant (1.5% [95% CI, -6.3% to 9.4%]). Both groups showed improvements in Global Rating of Change scale and pain rating scores, but between-group differences in scores for the Global Rating of Change scale (0 [CI, -2 to 1]) and pain rating (0.4 [CI, -0.5 to 1.2]) were not significant. During the 1-year follow-up, patients receiving CSI had more SIS-related visits to their primary care provider (60% vs. 37%) and required additional steroid injections (38% vs. 20%), and 19% needed physical therapy. Transient pain from the CSI was the only adverse event reported. The study occurred at 1 center with patients referred to physical therapy. Both groups experienced significant improvement. The manual physical therapy group used less 1-year SIS-related health care resources than the CSI group. Cardon Rehabilitation Products through the American Academy of Orthopaedic Manual Physical Therapists.

  16. Immediate changes in pressure pain sensitivity after thoracic spinal manipulative therapy in patients with subacromial impingement syndrome: A randomized controlled study.

    Science.gov (United States)

    Kardouni, Joseph R; Shaffer, Scott W; Pidcoe, Peter E; Finucane, Sheryl D; Cheatham, Seth A; Michener, Lori A

    2015-08-01

    Thoracic SMT can improve symptoms in patients with subacromial impingement syndrome. However, at this time the mechanisms of SMT are not well established. It is possible that changes in pain sensitivity may occur following SMT. To assess the immediate pain response in patients with shoulder pain following thoracic spinal manipulative therapy (SMT) using pressure pain threshold (PPT), and to assess the relationship of change in pain sensitivity to patient-rated outcomes of pain and function following treatment. Randomized Controlled Study. Subjects with unilateral subacromial impingement syndrome (n = 45) were randomly assigned to receive treatment with thoracic SMT or sham thoracic SMT. PPT was measured at the painful shoulder (deltoid) and unaffected regions (contralateral deltoid and bilateral lower trapezius areas) immediately pre- and post-treatment. Patient-rated outcomes were pain (numeric pain rating scale - NPRS), function (Pennsylvania Shoulder Score - Penn), and global rating of change (GROC). There were no significant differences between groups in pre-to post-treatment changes in PPT (p ≥ 0.583) nor were there significant changes in PPT within either group (p ≥ 0.372) following treatment. NPRS, Penn and GROC improved across both groups (p < 0.001), but there were no differences between the groups (p ≥ 0.574). There were no differences in pressure pain sensitivity between participants receiving thoracic SMT versus sham thoracic SMT. Both groups had improved patient-rated pain and function within 24-48 h of treatment, but there was no difference in outcomes between the groups. Published by Elsevier Ltd.

  17. Is ultrasound-guided injection more effective in chronic subacromial bursitis?

    Science.gov (United States)

    Hsieh, Lin-Fen; Hsu, Wei-Chun; Lin, Yi-Jia; Wu, Shih-Hui; Chang, Kae-Chwen; Chang, Hsiao-Lan

    2013-12-01

    Although ultrasound (US)-guided subacromial injection has shown increased accuracy in needle placement, whether US-guided injection produces better clinical outcome is still controversial. Therefore, this study aimed to compare the efficacy of subacromial corticosteroid injection under US guidance with palpation-guided subacromial injection in patients with chronic subacromial bursitis. Patients with chronic subacromial bursitis were randomized to a US-guided injection group and a palpation-guided injection group. The subjects in each group were injected with a mixture of 0.5 mL dexamethasone suspension and 3 mL lidocaine into the subacromial bursa. The primary outcome measures were the visual analog scale for pain and active and passive ranges of motion of the affected shoulder. Secondary outcome measures were the Shoulder Pain and Disability Index, the Shoulder Disability Questionnaire, and the 36-item Short-Form Health Survey (SF-36). The primary outcome measures were evaluated before, immediately, 1 wk, and 1 month after the injection; the secondary outcome measures were evaluated before, 1 wk, and 1 month after the injection. Of the 145 subjects screened, 46 in each group completed the study. Significantly greater improvement in passive shoulder abduction and in physical functioning and vitality scores on the SF-36 were observed in the US-guided group. The pre- and postinjection within-group comparison revealed significant improvement in the visual analog scale for pain and range of motion, as well as in the Shoulder Pain and Disability Index, Shoulder Disability Questionnaire, and SF-36 scores, in both groups. The US-guided subacromial injection technique produced significantly greater improvements in passive shoulder abduction and in some items of the SF-36. US is effective in guiding the needle into the subacromial bursa in patients with chronic subacromial bursitis.

  18. Effectiveness of passive physical modalities for shoulder pain: systematic review by the Ontario protocol for traffic injury management collaboration.

    Science.gov (United States)

    Yu, Hainan; Côté, Pierre; Shearer, Heather M; Wong, Jessica J; Sutton, Deborah A; Randhawa, Kristi A; Varatharajan, Sharanya; Southerst, Danielle; Mior, Silvano A; Ameis, Arthur; Stupar, Maja; Nordin, Margareta; van der Velde, Gabreille M; Carroll, Linda; Jacobs, Craig L; Taylor-Vaisey, Anne L; Abdulla, Sean; Shergill, Yaadwinder

    2015-03-01

    Shoulder pain is a common musculoskeletal condition in the general population. Passive physical modalities are commonly used to treat shoulder pain. However, previous systematic reviews reported conflicting results. The aim of this study was to evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the shoulder. MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1990, to April 18, 2013. Randomized controlled trials (RCTs) and cohort and case-control studies were eligible. Random pairs of independent reviewers screened 1,470 of 1,760 retrieved articles after removing 290 duplicates. Twenty-two articles were eligible for critical appraisal. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Of those, 11 studies had a low risk of bias. The lead author extracted data from low risk of bias studies and built evidence tables. A second reviewer independently checked the extracted data. The findings of studies with a low risk of bias were synthesized according to principles of best evidence synthesis. Pretensioned tape, ultrasound, and interferential current were found to be noneffective for managing shoulder pain. However, diathermy and corticosteroid injections led to similar outcomes. Low-level laser therapy provided short-term pain reduction for subacromial impingement syndrome. Extracorporeal shock-wave therapy was not effective for subacromial impingement syndrome but provided benefits for persistent shoulder calcific tendinitis. Non-English studies were excluded. Most passive physical modalities do not benefit patients with subacromial impingement syndrome. However, low-level laser therapy is more effective than placebo or ultrasound for subacromial impingement syndrome. Similarly, shock-wave therapy is more effective than sham therapy for persistent shoulder calcific tendinitis. © 2015 American

  19. Physiotherapy and shoulder pain; Coactive collaboration, supervised exercises in patients on a waiting list for surgery, and cost-of-illness in primary care.

    OpenAIRE

    Virta, Lena

    2013-01-01

    Background: Shoulder pain is a common cause of disability and lost work days. Rotator cuff disease, impingement syndrome or subacromial pain are similar labels used to describe the most common shoulder diagnosis. Similar results after surgery and exercises supervised by physiotherapist are reported in three randomised controlled trials in hospital settings. The content of the supervised exercise programme has not been explored with qualitative scientific methods. The feasibility of the superv...

  20. Pain Management After Outpatient Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials.

    Science.gov (United States)

    Warrender, William J; Syed, Usman Ali M; Hammoud, Sommer; Emper, William; Ciccotti, Michael G; Abboud, Joseph A; Freedman, Kevin B

    2017-06-01

    Effective postoperative pain management after shoulder arthroscopy is a critical component to recovery, rehabilitation, and patient satisfaction. This systematic review provides a comprehensive overview of level 1 and level 2 evidence regarding postoperative pain management for outpatient arthroscopic shoulder surgery. Systematic review. We performed a systematic review of the various modalities reported in the literature for postoperative pain control after outpatient shoulder arthroscopy and analyzed their outcomes. Analgesic regimens reviewed include regional nerve blocks/infusions, subacromial/intra-articular injections or infusions, cryotherapy, and oral medications. Only randomized control trials with level 1 or level 2 evidence that compared 2 or more pain management modalities or placebo were included. We excluded studies without objective measures to quantify postoperative pain within the first postoperative month, subjective pain scale measurements, or narcotic consumption as outcome measures. A combined total of 40 randomized control trials met our inclusion criteria. Of the 40 included studies, 15 examined nerve blocks, 4 studied oral medication regimens, 12 studied subacromial infusion, 8 compared multiple modalities, and 1 evaluated cryotherapy. Interscalene nerve blocks (ISBs) were found to be the most effective method to control postoperative pain after shoulder arthroscopy. Increasing concentrations, continuous infusions, and patient-controlled methods can be effective for more aggressively controlling pain. Dexamethasone, clonidine, intrabursal oxycodone, and magnesium have all been shown to successfully improve the duration and adequacy of ISBs when used as adjuvants. Oral pregabalin and etoricoxib administered preoperatively have evidence supporting decreased postoperative pain and increased patient satisfaction. On the basis of the evidence in this review, we recommend the use of ISBs as the most effective analgesic for outpatient arthroscopic

  1. The application of sonography in shoulder pain evaluation and injection treatment after stroke: a systematic review.

    Science.gov (United States)

    Tao, Wu; Fu, Yu; Hai-Xin, Song; Yan, Dong; Jian-Hua, Li

    2015-09-01

    [Purpose] This review article is designed to expose the application of sonography in shoulder pain after stroke. [Methods] A range of databases was searched to identify articles that address sonography examination, with or without ultrasound guided corticosteroid injection for hemiplegic shoulder pain (HSP). The electronic databases of PubMed, CENTRAL, CINAHL, Cochrane Library, Medline were searched. [Results] According to the articles identified in our databases research, sonographic technique has potential to provide objective measurements in patients with HSP. The main sonography finding of HSP included subacromial subdeltoid (SASD) bursal effusion, tendinosis of the supraspinatus and subscapularis tendon, long head of biceps tendon sheath effusion, and shoulder subluxation. Our analysis also revealed significantly decreased pain score (VAS) and increased passive external rotation degree in the steroid injection group than control group. [Conclusion] The sonography examination is useful for HSP assessment and ultrasound guided technique is recommended for HSP injection treatment.

  2. Dexamethasone for pain after outpatient shoulder surgery

    DEFF Research Database (Denmark)

    Bjørnholdt, K. T.; Mønsted, P. N.; Søballe, Kjeld

    2014-01-01

    Background Dexamethasone has analgesic properties when given intravenously before surgery, but the optimal dose has not been determined. We hypothesised that a dose of 40 mg dexamethasone would improve analgesia after outpatient shoulder surgery compared with 8 mg. Methods A randomised, double......-blind, placebo-controlled clinical trial was conducted at Horsens Regional Hospital, Denmark. Patients scheduled for arthroscopic subacromial decompression and/or acromioclavicular joint resection as an outpatient procedure (n = 101) were randomised to receive intravenous dexamethasone 40 mg (D40), 8 mg (D8...... a dose–response relationship, increasing the dexamethasone dose from 8 to 40 mg did not improve analgesia significantly after outpatient shoulder surgery....

  3. Problem of painful shoulder in hemiparetics patients

    OpenAIRE

    Daumann, Pavla

    2013-01-01

    This bachelor thesis is focused on a painful hemiparetic shoulder as a frequently observed complication in patients suffering from stroke. Basic information about stroke, anatomy and kinematics of shoulder joint is included in a theoretical part of the thesis. The largest portion describes a pathogenesis of painful hemiparetic shoulder, its prevention and commonly used physiotherapeutic approaches. The practical part of the thesis consists of two case reports of patients with stroke suffering...

  4. Effectiveness of Shortwave Diathermy for Subacromial Impingement Syndrome and Value of Night Pain for Patient Selection: A Double-Blinded, Randomized, Placebo-Controlled Trial.

    Science.gov (United States)

    Yilmaz Kaysin, Meryem; Akpinar, Pinar; Aktas, Ilknur; Unlü Ozkan, Feyza; Silte Karamanlioglu, Duygu; Cagliyan Hartevioglu, Hulya; Vural, Nazan

    2017-09-06

    The aim of this study was to investigate the effectiveness of short wave diathermy (SWD) in patients with subacromial impingement syndrome. In this double-blinded, randomized, placebo-controlled trial, 57 patients (aged 35-65 yrs) were classified into night pain positive (NP[+]) (n = 28) and night pain negative (NP[-]) (n = 29) groups. Both groups were randomly assigned to SWD (NP[+], n = 14; NP[-], n = 14) and sham (NP[+], n = 15; NP[-], n = 14) subgroups. Visual analog scale, Constant-Murley Scale (CS), and Shoulder Disability Questionnaire (SDQ) scores were used for evaluation. There was only a significant difference in pain with activity at 1-mo (mean difference [MD], -1.65; 95% confidence interval, -3.01 to -0.28]) and 2-mo evaluations (MD, -2.1; 95% confidence interval, -3.51 to -0.69) between SWD versus sham groups. In the NP(+) SWD group, the CS pain score was significantly higher than in the NP(+) sham group at all evaluations after treatment. At 1 mo, the NP(-) SWD group showed significantly better pain, strength, total CS, and SDQ scores than the NP(-) sham group. At 2 mos, the pain, range of motion, strength, and total CS and SDQ scores were better in the NP(-) SWD group than in the NP(-) sham group (P diathermy is more effective in subacromial impingement syndrome without NP.

  5. Effectiveness of microwave diathermy on pain, functional capacity, muscle strength, quality of life, and depression in patients with subacromial impingement syndrome: a randomized placebo-controlled clinical study.

    Science.gov (United States)

    Akyol, Yesim; Ulus, Yasemin; Durmus, Dilek; Canturk, Ferhan; Bilgici, Ayhan; Kuru, Omer; Bek, Yuksel

    2012-10-01

    The aim of this clinical trial was to evaluate the effectiveness of therapeutic MD on pain, functional capacity, muscle strength, quality of life, and depression in patients with subacromial impingement syndrome (SIS). A total of 40 inpatient subjects with definite SIS were included in this study. These patients were sequentially randomized into 2 groups. Group 1 (n = 20) received therapeutic MD. Group 2 (n = 20) was served as control group and received sham MD. Superficial heat and exercise program were given to both groups. Both of the programs were performed 5 times weekly for 3 weeks. Patients were assessed before treatment (BT), after treatment (AT), and at a 1-month follow-up (F). Outcome measures included visual analogue scale, goniometry, Shoulder Pain and Disability Index, Shoulder Disability Questionnaire, shoulder isokinetic muscle testing, handgrip strength, Short Form 36, and Beck Depression Index. The patients with SIS in each group had significant improvements in pain, shoulder ROM, disability, shoulder muscles and grip strength, quality of life, and depression AT and F when compared with their initial status (P 0.05). A 2,450-MHz MD regimen showed no beneficial effects in patients with SIS, so the superficial heat and exercise program, as it is efficient, may be preferable for the treatment of SIS, alone.

  6. Effectiveness of individualized physiotherapy on pain and functioning compared to a standard exercise protocol in patients presenting with clinical signs of subacromial impingement syndrome. A randomized controlled trial.

    Science.gov (United States)

    Kromer, Thilo O; de Bie, Rob A; Bastiaenen, Caroline H G

    2010-06-09

    Shoulder impingement syndrome is a common musculoskeletal complaint leading to significant reduction of health and disability. Physiotherapy is often the first choice of treatment although its effectiveness is still under debate. Systematic reviews in this field highlight the need for more high quality trials to investigate the effectiveness of physiotherapy interventions in patients with subacromial impingement syndrome. This randomized controlled trial will investigate the effectiveness of individualized physiotherapy in patients presenting with clinical signs and symptoms of subacromial impingement, involving 90 participants aged 18-75. Participants are recruited from outpatient physiotherapy clinics, general practitioners, and orthopaedic surgeons in Germany. Eligible participants will be randomly allocated to either individualized physiotherapy or to a standard exercise protocol using central randomization. The control group will perform the standard exercise protocol aiming to restore muscular deficits in strength, mobility, and coordination of the rotator cuff and the shoulder girdle muscles to unload the subacromial space during active movements. Participants of the intervention group will perform the standard exercise protocol as a home program, and will additionally be treated with individualized physiotherapy based on clinical examination results, and guided by a decision tree. After the intervention phase both groups will continue their home program for another 7 weeks. Outcome will be measured at 5 weeks and at 3 and 12 months after inclusion using the shoulder pain and disability index and patients' global impression of change, the generic patient-specific scale, the average weekly pain score, and patient satisfaction with treatment. Additionally, the fear avoidance beliefs questionnaire, the pain catastrophizing scale, and patients' expectancies of treatment effect are assessed. Participants' adherence to the protocol, use of additional treatments

  7. Effectiveness of individualized physiotherapy on pain and functioning compared to a standard exercise protocol in patients presenting with clinical signs of subacromial impingement syndrome. A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    de Bie Rob A

    2010-06-01

    Full Text Available Abstract Background Shoulder impingement syndrome is a common musculoskeletal complaint leading to significant reduction of health and disability. Physiotherapy is often the first choice of treatment although its effectiveness is still under debate. Systematic reviews in this field highlight the need for more high quality trials to investigate the effectiveness of physiotherapy interventions in patients with subacromial impingement syndrome. Methods/Design This randomized controlled trial will investigate the effectiveness of individualized physiotherapy in patients presenting with clinical signs and symptoms of subacromial impingement, involving 90 participants aged 18-75. Participants are recruited from outpatient physiotherapy clinics, general practitioners, and orthopaedic surgeons in Germany. Eligible participants will be randomly allocated to either individualized physiotherapy or to a standard exercise protocol using central randomization. The control group will perform the standard exercise protocol aiming to restore muscular deficits in strength, mobility, and coordination of the rotator cuff and the shoulder girdle muscles to unload the subacromial space during active movements. Participants of the intervention group will perform the standard exercise protocol as a home program, and will additionally be treated with individualized physiotherapy based on clinical examination results, and guided by a decision tree. After the intervention phase both groups will continue their home program for another 7 weeks. Outcome will be measured at 5 weeks and at 3 and 12 months after inclusion using the shoulder pain and disability index and patients' global impression of change, the generic patient-specific scale, the average weekly pain score, and patient satisfaction with treatment. Additionally, the fear avoidance beliefs questionnaire, the pain catastrophizing scale, and patients' expectancies of treatment effect are assessed. Participants

  8. Comparison of Anterior and Posterior Cortico-steroid Injections for Pain Relief and Functional Improvement in Shoulder Impingement Syndrome.

    Science.gov (United States)

    Ramappa, Arun; Walley, Kempland C; Herder, Lindsay M; Iyer, Sravisht; Zurakowski, David; Hall, Amber; DeAngelis, Joseph P

    Subacromial impingement syndrome (SIS) is the most common cause of shoulder pain. Treatment options for SIS include conservative modalities such as use of nonsteroidal anti-inflammatory drugs, physical therapy, and subacromial corticosteroid injections (CSIs). Although studies have found improvement in pain, function, and range of motion after CSI, the effect of injection route (anterior or posterior) on shoulder pain in patients with SIS has not been investigated. In the study reported here, patients were randomly assigned to 2 treatment groups: anterior CSI and posterior CSI. Pain was assessed with a visual analog scale (VAS) and function with the Single Assessment Numeric Evaluation (SANE). Patients were evaluated before injection (baseline) and 1, 3, and 6 months after injection. Of the 55 patients enrolled, 25 received anterior CSI and 30 received posterior CSI. The 2 groups showed no significant difference in VAS pain at baseline or 1, 3, or 6 months after injection. SANE scores were statistically different at 3 months. Each group had significantly less pain and better function 1, 3, and 6 months after injection than at baseline. Age, sex, and body mass index did not significantly affect the efficacy of anterior or posterior CSIs. In patients with SIS, subacromial CSI reduces pain and improves function for up to 6 months. These effects are no different for anterior and posterior injection routes. As a result, clinicians should rely on their clinical acumen when selecting injection routes, as anterior and posterior are both beneficial.

  9. Methylprednisolone versus triamcinolone in painful shoulder using ultrasound-guided injection.

    Science.gov (United States)

    Chávez-López, Mario Alfredo; Navarro-Soltero, Luis Alberto; Rosas-Cabral, Alejandro; Gallaga, Adán; Huerta-Yáñez, Guillermo

    2009-01-01

    There is little evidence about the comparative efficacy of corticosteroids in the treatment of painful shoulder. The main aim was to compare the efficacy of methylprednisolone (MTP) versus triamcinolone (TMC) in the treatment of painful shoulder using an ultrasound-guided injection. Patients with painful shoulder due to subacromial bursitis and partial or full-thickness rotator cuff tears demonstrated by musculoskeletal ultrasound received a guided-injection of MTP acetate 40 mg (12 patients) or TMC acetonide 40 mg (12 patients). Range of motion and pain visual analogue scale were registered at 10 and 30 min, 1 and 2 weeks postinjection. Two weeks postinjection, both groups reported a mean improvement in range of motion (33%) and relief of pain (61%). Relief of pain of 50% or more was observed in 92% of patients in MTP group and 50% of TMC group (p = 0.02). Two months postinjection, 50% of the patients in MTP group and 25% in TMC group reported total relief of pain (p = 0.3). Patients with painful shoulder receiving an ultrasound-guided injection of MTP or TMC have a rapid and sustained overall response. Relief of pain tends to be more rapid with MTP than TMC.

  10. Diagnosing patients with longstanding shoulder joint pain

    DEFF Research Database (Denmark)

    Nørregaard, J; Krogsgaard, M R; Lorenzen, T

    2002-01-01

    OBJECTIVE: To examine the interobserver agreement of commonly used clinical tests and diagnoses in patients with shoulder pain, and the accuracy of these tests and ultrasonographic findings in comparison with arthroscopic findings. METHODS: Eighty six patients with longstanding shoulder joint pain...... lesion also showed poor agreement. Pain during muscle contraction showed moderate agreement. The agreement of clinical diagnoses was poor and the accuracy was low in comparison with arthroscopy. Ultrasonography was accurate in full thickness supraspinatus tendon tears, but inaccurate for partial tears...

  11. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial

    OpenAIRE

    José L. Arias-Buría; Sebastián Truyols-Domínguez; Raquel Valero-Alcaide; Jaime Salom-Moreno; María A. Atín-Arratibel; César Fernández-de-las-Peñas

    2015-01-01

    Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous ele...

  12. Relationship among shoulder proprioception, kinematics, and pain after stroke

    NARCIS (Netherlands)

    Niessen, M.H.M.; Veeger, H.E.J.; Meskers, C.G.M.; Koppe, P.A.; Konijnenbelt, M.H.; Janssen, T.W.J.

    2009-01-01

    Niessen MH, Veeger DH, Meskers CG, Koppe PA, Konijnenbelt MH, Janssen TW. Relationship among shoulder proprioception, kinematics, and pain after stroke. Objective: To identify a possible relationship among chronic poststroke shoulder pain (PSSP), scapular resting pose, and shoulder proprioception.

  13. Deficient Pain Modulation in Patients with Chronic Hemiplegic Shoulder Pain.

    Science.gov (United States)

    Kashi, Yafit; Ratmansky, Motti; Defrin, Ruth

    2017-11-14

    Hemiplegic shoulder pain (HSP) following stroke significantly affects the individual's function and quality of life. The mechanism of HSP is not clearly understood; hence, it is unclear why HSP resolves spontaneously or following routine care in some patients, while in others it becomes persistent. The aim was therefore to study whether HSP is associated with deficient pain modulation. Thirty post-stroke patients-16 with HSP and 14 without HSP-and 20 matched controls participated. Pain adaptation and conditioned pain modulation (CPM) were measured as indicators of pain modulation, in the affected (hemiplegic) and contralateral shoulder as well as in the affected shin among post-stroke patients, and in comparable body regions among controls. Post-stroke patients also underwent functional and physical evaluation of the shoulder. Pain adaptation was absent among HSP patients, in both the painful shoulder and the affected shin, but existed in the 2 control groups. In addition, the affected shoulder and shin among the HSP group had reduced thermal sensibility compared to the contralateral regions. CPM was similar across groups. Shoulder functional status and physical status were similar for the 2 post-stroke groups. The results suggest that HSP is associated with a lack of pain adaptation, characteristic not only of the painful shoulder but also of the affected side. Although we cannot determine whether lack of pain adaptation precedes the HSP or results from it, interventions that enhance descending pain inhibition may improve management and prevent HSP chronification. © 2017 World Institute of Pain.

  14. Physiotherapy for patients with shoulder pain in primary care: a descriptive study of diagnostic- and therapeutic management.

    Science.gov (United States)

    Karel, Y H J M; Scholten-Peeters, G G M; Thoomes-de Graaf, M; Duijn, E; van Broekhoven, J B; Koes, B W; Verhagen, A P

    2016-11-28

    Shoulder pain is one of the three main musculoskeletal complaints and more than 50% of the patients have symptoms longer than 6 months. Until now, limited data exist about the content of physiotherapy for patients with shoulder pain in primary care. Describe current physiotherapeutic diagnostic- and therapeutic management, including the use of diagnostic ultrasound, in patients with shoulder pain in primary care. A prospective cohort study in primary care physiotherapy with a 12 week follow-up. Descriptive data from physiotherapists was collected, such as: the diagnostic hypotheses after patient history and physical examination, the use of specific tests and diagnostic ultrasound, the interventions used and possible changes in treatment plan. Subacromial impingement syndrome was the most common hypothesis after patient history (48%) as well as physical examination (39%). Diagnostic ultrasound was used in 31% and of these patients the clinical diagnosis changed in 29%. Various interventions were used in all clinical diagnoses. After 12 weeks 41% of patients still received physiotherapy treatment. Patients with shoulder pain in physiotherapy practice frequently show signs of subacromial impingement syndrome. The interventions used by the physiotherapists were generally in line with the guideline for subacromial impingement syndrome however a small proportion of physiotherapists used massage and tape/bracing techniques. A large proportion of patients were still receiving treatment after 12 weeks when no improvement was observed. If treatment for patients with subacromial impingement shows no benefit patients should be referred back to the general practitioner or orthopedic surgeon. Conclusions from this study might be slightly biased because of the selection of physiotherapists. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  15. Evaluating the Effects of local Injections of Bupivacaine and Triamcinolone Acetate on Shoulder Joint Pain and Restricted Range of Motion Following Cerebrovascular Accidents

    Directory of Open Access Journals (Sweden)

    Asadollah Saadat Niaki M.D.

    2011-06-01

    Full Text Available Background: Shoulder pain is a common complication of cerebrovascular accidents. This study was conducted to assess the effects of local injections of bupivacaine and triamcinolone acetate on shoulder joint pain and on restricted range of motion following brain events. Methods: This single-blind clinical trial study included 35 patients with chronic shoulder pain (the controls and 35 patients with chronic shoulder pain due to brain events (the case group. The study was done at Imam Hossein Hospital & Gandhi Day Clinic during the year 2008-2010. The patients in the two groups received bupivacaine and triamcinolone acetate for subacromial bursa injection and suprascapular nerve block by following the protocol described by Dangoisse et al. The patients were followed up for 12 weeks and they were evaluated for pain and range of motion 1, 6, and 12 weeks after the injections.Results: The mean age of the patients was 60.9±9.07 years. Statistically significant improvements in pain score (P=0.001 and shoulder joint range of motion (P=0.001 were observed in patients with chronic shoulder pain versus patients with brain events 12 weeks after suprascapulare nerve block and subacromial bours injections by bupivacaine and triamcinolone acetate.Conclusion: Suprascapular nerve block and subacromial bursa injections of bupivacaine and triamcinolone acetate is a safe and efficacious treatment for the treatment of chronic shoulder pain and restricted range of motion but it is not efficacious or of significant value for the treatment of shoulder pain in patients with brain events.

  16. New concepts in restoring shoulder elevation in a stiff and painful shoulder patient.

    Science.gov (United States)

    Donatelli, Robert; Ruivo, R M; Thurner, Michael; Ibrahim, Mahmoud Ibrahim

    2014-02-01

    The treatment and evaluation of a stiff and painful shoulder, characteristic of adhesive capsulitis and "frozen" shoulders, is a dilemma for orthopedic rehabilitation specialists. A stiff and painful shoulder is all-inclusive of Adhesive capsulitis and Frozen Shoulder diagnoses. Adhesive capsulitis and frozen shoulder will be referred to as a stiff and painful shoulder, throughout this paper. Shoulder motion occurs in multiple planes of movement. Loss of shoulder mobility can result in significant functional impairment. The traditional treatment approach to restore shoulder mobility emphasizes mobilization of the shoulder overhead. Forced elevation in a stiff and painful shoulder can be painful and potentially destructive to the glenohumeral joint. This manuscript will introduce a new biomechanical approach to evaluate and treat patients with stiff and painful shoulders. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Impingement syndrome and pain of shoulder joint

    OpenAIRE

    Švingrová, Eva

    2014-01-01

    Name: Eva Švingrová Supervisor: Mgr. Bc. Milena Valenová Opponent: Title of bachelor thesis: Impingement syndrom and pain of shoulder joint ABSTRACT The topic of this thesis was focused on the characteristics, course and the treatment of the impingement syndrome and the other kinds of shoulder joint pain. The aim was to objectify the data from the therapy using goniometric measurements and demonstrate the possitive effect of the physiotherapy on the increased range of movement and decreased p...

  18. Accuracy of physical examination in subacromial impingement syndrome.

    Science.gov (United States)

    Silva, L; Andréu, J L; Muñoz, P; Pastrana, M; Millán, I; Sanz, J; Barbadillo, C; Fernández-Castro, M

    2008-05-01

    Shoulder pain is a common complaint, frequently caused by subacromial impingement syndrome (SIS). There are a number of physical examination (PE) manoeuvres that explore the subacromial space. MRI provides an accurate anatomic image of the subacromial space, being the current gold standard in the diagnosis of SIS. The aim of this study is to evaluate the accuracy of the PE in the diagnosis of SIS and/or subacromial-subdeltoid bursitis (SSB) confirmed by MRI. Consecutive outpatients with an episode of shoulder pain were prospectively included in the study. They were examined by a rheumatologist and, within 3 days, an MRI was done. Sensitivity, specificity, positive and negative predictive values, and accuracy of PE manoeuvres were calculated using a 2 x 2 table. Fourteen males and 16 females were included. All the tests exhibited acceptable sensitivity. As a result Yocum manoeuvre was considered the most sensitive and most accurate for SIS. With regard to SSB, the Gerber test was the most sensitive. The majority of the PE manoeuvres showed low specificity. Most PE manoeuvres identify reasonably well subacromial impingement of the shoulder, although, in general, they have low specificity. The Yocum test has the best sensitivity and precision. Our data suggest that imaging techniques should be recommended to better define shoulder lesions.

  19. Effectiveness of low-level laser therapy combined with an exercise program to reduce pain and increase function in adults with shoulder pain: a critically appraised topic.

    Science.gov (United States)

    Thornton, Aimee L; McCarty, Cailee W; Burgess, Mollie-Jean

    2013-02-01

    Shoulder pain is a common musculoskeletal condition that affects up to 25% of the general population. Shoulder pain can be caused by any number of underlying conditions including Subacromial impingement syndrome, rotator-cuff tendinitis, and biceps tendinitis. Regardless of the specific pathology, pain is generally the number 1 symptom associated with shoulder injuries and can severely affect daily activities and quality of life of patients with these conditions. Two of the primary goals in the treatment of these conditions are reducing pain and increasing shoulder range of motion (ROM). Conservative treatment has traditionally included a therapeutic exercise program targeted at increasing ROM, strengthening the muscles around the joint, proprioceptive training, or some combination of those activities. In addition, these exercise programs have been supplemented with other interventions including nonsteroidal anti-inflammatory drugs, corticosteroid injections, manual therapy, activity modification, and a wide array of therapeutic modalities (eg, cryotherapy, EMS, ultrasound). Recently, low-level laser therapy (LLLT) has been used as an additional modality in the conservative management of patients with shoulder pain. However, the true effectiveness of LLLT in decreasing pain and increasing function in patients with shoulder pain is unclear. Is low-level laser therapy combined with an exercise program more effective than an exercise program alone in the treatment of adults with shoulder pain?

  20. EFFECT OF GONG'S MOBILIZATION VERSUS MULLIGAN'S MOBILIZATION ON SHOULDER PAIN AND SHOULDER MEDIAL ROTATION MOBILITY IN FROZEN SHOULDER

    OpenAIRE

    Jyoti Rinku Dilip; Vinod Babu. K; Sai Kumar. N; Akshata Akalwadi

    2016-01-01

    Background: Frozen shoulder is a painful condition with gradual restriction of all planes of movement in the shoulder joint. The purpose of the present study is to evaluate the effect of Gong’s Mobilization versus Mulligan’s Mobilization on Shoulder pain and Shoulder Medial Rotation mobility in subjects with Frozen shoulder. Methods: An Experimental study design, 40 subjects with unilateral frozen shoulder were selected and randomized 20 subjects into each of two groups- Gong’s mobilizatio...

  1. Management of painful reverse shoulder arthroplasty.

    Science.gov (United States)

    Ekelund, Anders L

    2017-07-01

    Even though reverse shoulder arthroplasty is a very successful procedure, painful complications occur. During the initial postoperative years, the most common reasons for pain are instability, postoperative fracture of the acromion or spine, and periprosthetic infection. Later, aseptic loosening, with humeral loosening being more frequent that glenoid loosening, can be a source of pain and reduction in function. A careful patient history, clinical examination, plain radiographs, computed tomography and blood tests give an explanation for the pain in most cases. The majority of these complications can be successfully treated, maintaining a functional reverse shoulder arthroplasty. However, if all examinations are normal, it is important to remember that nonshoulder conditions such as tumour of the lung or degenerative changes of the cervical spine can give shoulder pain.

  2. MRI findings in the painful hemiplegic shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Tavora, D.G.F., E-mail: danielgurgel@sarah.b [Department of Radiology, Sarah Network of Hospitals for Rehabilitation, Fortaleza (Brazil); Gama, R.L.; Bomfim, R.C. [Department of Radiology, Sarah Network of Hospitals for Rehabilitation, Fortaleza (Brazil); Nakayama, M. [Department of Radiology, Federal University of Grande Dourados, Dourados (Brazil); Silva, C.E.P. [Department of Statistics, Sarah Network of Hospitals for Rehabilitation, Fortaleza (Brazil)

    2010-10-15

    Aim: To evaluate the magnetic resonance imaging (MRI) findings in painful hemiplegic shoulder (PHS) in hemiplegic post-stroke patients. Materials and methods: Patients with hemiplegia following their first cerebrovascular accident who were admitted to the Sarah Network of Hospitals for Rehabilitation were studied. Forty-five patients with pain in the hemiplegic shoulder and 23 post-stroke patients without shoulder pain were investigated. MRI and radiographic findings of the hemiplegic and contralateral asymptomatic shoulders were evaluated. Results: Some MRI findings were more frequent in PHS group, including synovial capsule thickening, synovial capsule enhancement, and enhancement in the rotator cuff interval. Conclusions: Adhesive capsulitis was found to be a possible cause of PHS.

  3. MRI findings in the painful hemiplegic shoulder.

    Science.gov (United States)

    Távora, D G F; Gama, R L; Bomfim, R C; Nakayama, M; Silva, C E P

    2010-10-01

    To evaluate the magnetic resonance imaging (MRI) findings in painful hemiplegic shoulder (PHS) in hemiplegic post-stroke patients. Patients with hemiplegia following their first cerebrovascular accident who were admitted to the Sarah Network of Hospitals for Rehabilitation were studied. Forty-five patients with pain in the hemiplegic shoulder and 23 post-stroke patients without shoulder pain were investigated. MRI and radiographic findings of the hemiplegic and contralateral asymptomatic shoulders were evaluated. Some MRI findings were more frequent in PHS group, including synovial capsule thickening, synovial capsule enhancement, and enhancement in the rotator cuff interval. Adhesive capsulitis was found to be a possible cause of PHS. Copyright (c) 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  4. Prediction of post-operative pain following arthroscopic subacromial decompression surgery: an observational study [v1; ref status: indexed, http://f1000r.es/9s

    Directory of Open Access Journals (Sweden)

    Anthony Davis

    2013-02-01

    Full Text Available Background: Arthroscopic shoulder surgery is increasingly performed as a day case procedure. Optimal post-operative pain relief remains a challenge due to considerable variations in the level of pain experienced between individuals. Our aim was to examine whether the preoperative electrical pain threshold was a strong predictor of elevated postoperative pain levels following arthroscopic subacromial decompression (ASD surgery. Methods: Forty consenting patients with American Society of Anesthesiologists (ASA grade 1-2 presenting for elective ASD surgery were recruited. Patients’ electrical pain thresholds were measured preoperatively using a PainMatcher® (Cefar Medical AB, Lund, Sweden device. Following surgery under general anaesthesia, the maximum pain experienced at rest and movement was recorded using a visual analogue scale until the end of postoperative day four. Results: In univariate analyses (t-test, the postoperative pain experienced (Area Under Curve was significantly greater in patients with a low pain threshold as compared with a high pain threshold at both rest (mean 12.5, S.E. 1.7 v mean 6.5, S.E.1.2. P=0.008 and on movement (mean 18.7, S.E. 1.5 v mean 14.1, S.E.1.4. P=0.031. In multivariate analyses, adjusting for additional extra analgesia, the pain experienced postoperatively was significantly greater in the low pain threshold group both at rest (mean difference 4.9, 95% CI 1.5 to 8.4, P=0.007 and on movement (mean difference 4.1, 95%CI 0.03 to 8.2, P=0.049. Conclusions: Preoperative pain threshold can predict postoperative pain level following ASD of the shoulder. Trial registration: Clinicaltrials.gov identifier: NCT01351363 Level of Evidence: II

  5. INTEGRATION BETWEEN MRI AND PHYSICAL THERAPY TO IMPROVE TREATMENT OF PATIENTS WITH SHOULDER PAIN

    Directory of Open Access Journals (Sweden)

    Awad Mohamed Elkhadir

    2016-08-01

    Full Text Available Background: Shoulder pain is the second most common musculoskeletal disorder treated by physical therapists. The cause for the shoulder pain is multifactorial. However, a specific diagnosis is crucial in the right management of shoulder dysfunction. Therefore, the aim of this study was to find out the efficacy of integrating the MRI for the accurate diagnosis and impact of this on rendering the effective physical therapy interventions in shoulder dysfunction patients. Methods: A retrospective study conducted on 14 patients who undergone an MRI with a 1.5 T unit MAGNETOM Symphony (Siemens, for their shoulder pain, where the diagnosis might be Muscle tears like, subscapularis, infraspinatus,supraspinatus and teres minor muscles; subacromial or subdeltoid bursitis and labral tears were included. All the subjects were then continued with usual physical therapy treatments for four weeks depending on their diagnosis which includes; advice, stretching, mobilization and strengthening exercises, manual therapy, massage, strapping, and electrotherapy . The outcome measures documented from the case sheet were; Visual Analogue Scale grade and passive range of motion of shoulder external / internal rotation and abduction. Results: Paired t test was used to compare the PROM between pre rehabilitation and post rehabilitation testing and the non parametric test, Mann Whitney U test was used for the comparison of VAS. All patients showed a significant improvement in VAS and PROM of abduction, internal and external rotation following physical therapy (P≤ 0.05. Conclusion: MRI is found to be a reliable method of diagnostic procedure for the shoulder pain and the integration of MRI and physical therapy to treat shoulder dysfunction leads to a better outcome.

  6. Clavicular eosinophilic granuloma causing adult shoulder pain

    Directory of Open Access Journals (Sweden)

    Lawrence R. Menendez

    2013-02-01

    Full Text Available Though rarely reported, neoplasms of the clavicle occur, and their symptoms can be mistaken for more common shoulder conditions. We present the case of a benign clavicular neoplasm, rarely seen in adults, presenting with pain, and eventual pathologic fracture in a 49 year-old. A 49 year-old male firefighter underwent arthroscopic rotator cuff repair for shoulder pain after magnetic resonance imaging revealed supraspinatus tendon tear. The patient’s pain persisted after surgery, and was described as routine until he developed severe pain after minor blunt trauma. A local Emergency Room performed the first x-rays, which revealed a pathologic fracture of the distal clavicle through a destructive lesion. The patient was referred to an orthopedic oncologist, who performed incisional biopsy, which initially diagnosed osteomyelitis. The patient was subsequently taken to surgery for debridement. Pathology then yielded the diagnosis of eosinophilic granuloma. The patient was taken back to surgery for formal curettage with open reduction and internal fixation. The patient’s pain resolved, the pathologic fracture fully healed, and the patient returned to full time work as a firefighter. Though workup for common shoulder conditions often identifies incidental benign lesions of bone, the converse can be true. Persistent pain despite intervention should raise concern for further investigation. An x-ray alone can reveal a destructive bone lesion as the source of shoulder pain.

  7. Kinematics of the contralateral and ipsilateral shoulder: A possible relationship with post-stroke shoulder pain

    NARCIS (Netherlands)

    Niessen, M.H.M.; Janssen, T.W.J.; Meskers, C.G.M.; Koppe, P.; Konijnenbelt, M.; Veeger, H.E.J.

    2008-01-01

    Objective: Post-stroke shoulder pain is a common phenomenon in hemiplegia and impedes rehabilitation. The aim of this study was to identify a possible relationship between post-stroke shoulder pain, scapula resting position and shoulder motion. Methods: Shoulder kinematics of 27 patients after

  8. Orthopaedic manual physical therapy for shoulder pain and impaired movement in a patient with glenohumeral joint osteoarthritis: a case report.

    Science.gov (United States)

    Crowell, Michael S; Tragord, Bradley S

    2015-06-01

    Case report. Comprehensive treatment strategies are needed for individuals with glenohumeral joint osteoarthritis (OA), especially when they are young and active. Prior dislocation, with or without subsequent shoulder stabilization surgery, complicates the clinical presentation and increases the risk of OA progression. The purpose of this case report was to describe an orthopaedic manual physical therapy approach used in a patient with glenohumeral joint OA who presented with shoulder pain and impaired movement. CASE DESCRIPTION A 38-year-old male military officer presented with left-shoulder pain of 2 months in duration that was unrelieved with a subacromial injection. He reported a history of anterior-inferior dislocation with subsequent stabilization surgery 15 years prior and arthroscopic subacromial decompression 2 years prior. Physical examination demonstrated painful limitations in shoulder elevation and internal/external rotation movements, stiffness with testing using accessory glides, and rotator cuff and scapular musculature weakness associated with pain. Treatment consisted of 5 sessions provided over 4 weeks. The plan of care included manual physical therapy, exercises, and progressive functional activities specifically tailored to the patient's clinical presentation. Shoulder Pain and Disability Index scores decreased from 43% to 17%, and the Patient-Specific Functional Scale average score improved from 3.0 to 7.3 out of 10. After 4 additional weeks of a home exercise program, the Shoulder Pain and Disability Index score was 4% and Patient-Specific Functional Scale average score was 9.0. Improvements in self-reported function were maintained at 6 months. Four "booster" treatment sessions were administered at 9 months, contributing to sustained outcomes through 1 year. In a young, active patient with glenohumeral joint OA, clinically meaningful short-term improvements in self-reported function and pain, maintained at 1 year, were observed with manual

  9. The influence of induced shoulder muscle pain on rotator cuff and scapulothoracic muscle activity during elevation of the arm.

    Science.gov (United States)

    Castelein, Birgit; Cools, Ann; Parlevliet, Thierry; Cagnie, Barbara

    2017-03-01

    Altered recruitment of rotator cuff and scapulothoracic muscles has been identified in patients with subacromial impingement syndrome. To date, however, the cause-consequence relationship between pain and altered muscle recruitment has not been fully unraveled. The effect of experimental shoulder pain induced by injection of hypertonic saline in the supraspinatus on the activity of the supraspinatus, infraspinatus, subscapularis, trapezius, and serratus anterior activity was investigated during the performance of an elevation task by use of muscle functional magnetic resonance imaging in 25 healthy individuals. Measurements were taken at 4 levels (C6-C7, T2-T3, T3-T4, and T6-T7) at rest and after the elevation task performed without and with experimental shoulder pain. During arm elevation, experimentally induced pain caused a significant activity reduction, expressed as reduction in T2 shift of the IS (P = .029). No significant changes in T2 shift values were found for the other rotator cuff muscles or the scapulothoracic muscles. This study demonstrates that acute experimental shoulder pain has an inhibitory effect on the activity of the IS during arm elevation. Acute experimental shoulder pain did not seem to influence the scapulothoracic muscle activity significantly. The findings suggest that rotator cuff muscle function (infraspinatus) should be a consideration in the early management of patients with shoulder pain. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  10. EVALUATION OF PAINFUL SHOULDER IN BASEBALL PLAYERS.

    Science.gov (United States)

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; do Val Sella, Guilherme; Junior, Adriano Fernando Mendes; Soares, André Lopes; Aihara, Leandro Jun; Checchia, Sérgio Luiz

    2011-01-01

    To assess the relationship between shoulder mobility and strength and the presence of pain among baseball players. Between April and July 2009, 55 baseball players were assessed by the Shoulder and Elbow Group of the School of Medical Sciences, Santa Casa de Misericórdia, São Paulo. They were all males, aged between 15 and 33 years (mean of 21); they attended an average of three training sessions per week and had been doing this sport for a mean of 10 years. 14 of the 55 players evaluated were pitchers, and 20 reported pain during the pitching motion. The mean values for lateral and medial rotation and range of motion (ROM) in the dominant shoulder were, respectively, 110 °, 61 ° and 171 °, with a statistically significant difference in relation to the non-dominant limb. Pitchers had greater gains in lateral rotation and deficits in medial rotation than did non-pitchers. Pain presented a statistically significant correlation with diminished ROM, greater length of time playing the sport and situations of "shoulder at risk". Statistically significant differences in dominant shoulder mobility were found, with increased lateral rotation, diminished medial rotation and smaller ROM, in relation to the contralateral limb. There was a statistically significant relationship between the pitcher's position and greater gain in lateral rotation and diminished medial rotation. There were statistically significant correlations between pain and diminished ROM, greater length of time playing the sport and situations of "shoulder at risk". There was a statistical tendency suggesting that players with diminished medial rotation of the dominant shoulder presented a relationship with pain.

  11. Effects of Low-Load Exercise on Post-needling Induced Pain After Dry Needling of Active Trigger Point in Individuals with Subacromial Pain Syndrome.

    OpenAIRE

    Salom Moreno, Jaime; Jiménez Gómez, Laura; Gómez Ahufinger, Victoria; Palacios Ceña, María; Arias Buría, José Luis; Koppenhaver, Shane L.; Fernández de las Peñas, César

    2017-01-01

    Background: Application of dry needling is usually associated to post-needling induced pain. Development of post-needling intervention targeting to reduce this adverse event is needed. Objective: To determine the effectiveness of low-load exercise on reducing post-needling induced-pain after dry needling of active trigger points (TrPs) in the infraspinatus muscle in subacromial pain syndrome.

  12. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain

    NARCIS (Netherlands)

    Bron, Carel; Dommerholt, J.; Stegenga, Boudewijn; Wensing, M.; Oostendorp, R.A.B.

    2011-01-01

    Background: Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment. The pathophysiological mechanisms of shoulder pain are poorly understood. Furthermore, there is little evidence supporting the effectiveness of current treatment protocols.

  13. Shoulder pain in primary care--part 2: predictors of clinical outcome to 12 months.

    Science.gov (United States)

    Laslett, Mark; Steele, Michael; Hing, Wayne; McNair, Peter; Cadogan, Angela

    2015-01-01

    Identify predictor variables and models for clinical outcomes for primary care shoulder pain patients to 12 months follow-up. A non-randomized audit with measures of pain and disability at 3 weeks, 3, 6 and 12 months. Of 208 patients, 161 agreed to participate with 96.9, 98.1, 87.0 and 83.9% follow-up at 3 weeks, 3, 6 and 12 months respectively. Treatment consisted of exercise and manual therapy-based physiotherapy and corticosteroid injection under specified selection criteria. Potentially useful baseline variables were evaluated in univariate logistic regressions with the dependent variables determined by SPADI Questionnaire at 3 weeks, 3, 6 and 12 months. Variables associated (p-value ≤ 0.2) were retained for potential inclusion within multiple logistic regression analyses. Pain not improved by rest, intermittent pain, lower pain intensity with physical tests and absence of subacromial bursa pathology on ultrasound at the 3-week follow-up, constant pain and lower pain intensity with physical tests are predictors of excellent outcomes at the 3-month follow- up. Worse baseline pain and disability, no history of asthma, pain better with rest, better physical functioning, greater fear avoidance, male gender, no history of pain in the opposite shoulder, pain referred below the elbow, sleep disturbed by pain, smaller waist circumference, lower pain intensity with physical tests are factors predictive of excellent outcomes at the 12-month follow-up. Only higher pain intensity with physical tests was associated with a poor clinical outcome. Predictive models for clinical outcomes in primary-care patients with shoulder pain were achieved for excellent clinical outcomes, successfully classifying 70-90% of cases.

  14. Risk of surgery for subacromial impingement syndrome in relation to neck-shoulder complaints and occupational biomechanical exposures: a longitudinal study.

    Science.gov (United States)

    Svendsen, Susanne Wulff; Dalbøge, Annett; Andersen, Johan Hviid; Thomsen, Jane Frølund; Frost, Poul

    2013-11-01

    The aim of this longitudinal study was to evaluate the risk of surgery for subacromial impingement syndrome (SIS) in relation to neck-shoulder complaints and occupational biomechanical shoulder exposures. The study was based on the Musculoskeletal Research Database at the Danish Ramazzini Centre. We linked baseline questionnaire information from 1993-2004 on neck-shoulder complaints, job titles, psychosocial work factors, body mass index, and smoking with register information on first-time surgery for SIS from 1996-2008. Biomechanical exposure measures were obtained from a job exposure matrix based on expert judgment. We applied multivariable Cox regression. During 280 125 person-years of follow-up among 37 402 persons, 557 first-time operations for SIS occurred. Crude surgery rates increased from 1.1 to 2.5 per 1000 person-years with increasing shoulder load. Using no neck-shoulder complaints and low shoulder load at baseline as a reference, no neck-shoulder complaints and high shoulder load showed an adjusted hazard ratio (HR(adj)) of 2.55 [95% confidence interval (95% CI) 1.59-4.09], while neck-shoulder complaints in combination with high shoulder load showed an HR(adj) of 4.52 (95% CI 2.87-7.13). Subanalyses based on 18 856 persons showed an HR(adj) of 5.40 (95% CI 2.88-10.11) for complaints located specifically in the shoulder in combination with high shoulder load. Based on these findings, persons with neck-shoulder and especially shoulder complaints in combination with high shoulder load seem an obvious target group for interventions aimed at reducing exposures to prevent surgery for SIS.

  15. Acupuncture and rehabilitation of the painful shoulder: study protocol of an ongoing multicentre randomised controlled clinical trial [ISRCTN28687220

    Directory of Open Access Journals (Sweden)

    Jimenez Carmen

    2005-10-01

    Full Text Available Abstract Background Although the painful shoulder is one of the most common dysfunctions of the locomotor apparatus, and is frequently treated both at primary healthcare centres and by specialists, little evidence has been reported to support or refute the effectiveness of the treatments most commonly applied. According to the bibliography reviewed, physiotherapy, which is the most common action taken to alleviate this problem, has not yet been proven to be effective, because of the small size of sample groups and the lack of methodological rigor in the papers published on the subject. No reviews have been made to assess the effectiveness of acupuncture in treating this complaint, but in recent years controlled randomised studies have been made and these demonstrate an increasing use of acupuncture to treat pathologies of the soft tissues of the shoulder. In this study, we seek to evaluate the effectiveness of physiotherapy applied jointly with acupuncture, compared with physiotherapy applied with a TENS-placebo, in the treatment of painful shoulder caused by subacromial syndrome (rotator cuff tendinitis and subacromial bursitis. Methods/design Randomised controlled multicentre study with blind evaluation by an independent observer and blind, independent analysis. A study will be made of 465 patients referred to the rehabilitation services at participating healthcare centres, belonging to the regional public health systems of Andalusia and Murcia, these patients presenting symptoms of painful shoulder and a diagnosis of subacromial syndrome (rotator cuff tendinitis and subacromial bursitis. The patients will be randomised into two groups: 1 experimental (acupuncture + physiotherapy; 2 control (TENS-placebo + physiotherapy; the administration of rescue medication will also be allowed. The treatment period will have a duration of three weeks. The main result variable will be the change produced on Constant's Shoulder Function Assessment (SFA Scale

  16. Subacromial space in adult patients with thoracic hyperkyphosis and in healthy volunteers.

    Science.gov (United States)

    Gumina, Stefano; Di Giorgio, Giantony; Postacchini, Franco; Postacchini, Roberto

    2008-02-01

    The assumption that subacromial space decreases in patients with thoracic hyperkyphosis arises from sporadic and personal observations. The purpose of this study was to compare width of subacromial space calculated on radiographs and CT scans of a high number of patients with thoracic hyperkyphosis that registered on exams of healthy volunteers. We measured the subacromial space, using Petersson's method, on radiographs of 47 patients with idiopathic or acquired thoracic hyperkyphosis and of 175 healthy shoulder volunteers. Both groups were further distinguished considering gender and age. Females with hyperkyphosis were also divided in two subgroups: those with a kyphotic curve of less (24 patients) or more (19 patients) than 50 degrees , respectively. Subacromial space of all patients and of 21 volunteers was also evaluated using CT. Acromio-humeral space was less wide in patients with hyperkyphosis with respect to coeval volunteers of the same gender; in females and in subjects older than 60. Subacromial width of females with hyperkyphosis whose curve was more than 50 degrees was significantly narrower (phyperkyphosis greater than 50 degrees had a subacromial space narrower than that measured in patients with a less severe kyphosis. This suggests that subacromial width is directly related to severity of thoracic kyphosis. Because hyperkyphosis of patients with osteoporotic vertebral fractures may worsen over the time, subacromial decompression could give only temporary shoulder pain relief.

  17. Magnetic resonance imaging of abnormal shoulder pain following influenza vaccination

    Energy Technology Data Exchange (ETDEWEB)

    Okur, Gokcan [Etimesgut Military Hospital, Department of Radiology, Ankara (Turkey); Chaney, Kimberly A. [Presence St. Joseph Hospital, Department of Radiology, Elgin, IL (United States); Lomasney, Laurie M. [Loyola University Medical Center, Department of Radiology, Maywood, IL (United States)

    2014-09-15

    The influenza vaccine is increasingly available to the general public and mandated by many employers in the United States. The prevalence of post-vaccination complications is likely on the rise. Complications are well known to general clinicians, but are under-reported in the imaging literature. We present four cases of post-vaccination shoulder pain with magnetic resonance imaging (MRI) findings. An intrasubstance fluid-like signal in deep muscular and/or tendinous structures was the most common finding on MRI of these four cases. Focal bone marrow signal within the humeral head and inflammatory changes in the subacromial/subdeltoid bursa were also observed. The most likely reason for a humeral intraosseous edema-like signal was presumed injection of vaccine substance directly into osseous structures that might lead to focal osteitis. In the published literature, there is little emphasis on the imaging of local injection site complications accompanying influenza vaccination. We intended to increase familiarity of MRI findings in the setting of prolonged or severe clinical symptoms following influenza vaccination through the imaging findings of these four cases. (orig.)

  18. Shoulder function and work disability after decompression surgery for subacromial impingement syndrome: a randomised controlled trial of physiotherapy exercises and occupational medical assistance.

    Science.gov (United States)

    Svendsen, Susanne W; Christiansen, David H; Haahr, Jens Peder; Andrea, Linda C; Frost, Poul

    2014-06-21

    Surgery for subacromial impingement syndrome is often performed in working age and postoperative physiotherapy exercises are widely used to help restore function. A recent Danish study showed that 10% of a nationwide cohort of patients retired prematurely within two years after surgery. Few studies have compared effects of different postoperative exercise programmes on shoulder function, and no studies have evaluated workplace-oriented interventions to reduce postoperative work disability. This study aims to evaluate the effectiveness of physiotherapy exercises and occupational medical assistance compared with usual care in improving shoulder function and reducing postoperative work disability after arthroscopic subacromial decompression. The study is a mainly pragmatic multicentre randomised controlled trial. The trial is embedded in a cohort study of shoulder patients referred to public departments of orthopaedic surgery in Central Denmark Region. Patients aged ≥18-≤63 years, who still have shoulder symptoms 8-12 weeks after surgery, constitute the study population. Around 130 participants are allocated to: 1) physiotherapy exercises, 2) occupational medical assistance, 3) physiotherapy exercises and occupational medical assistance, and 4) usual care. Intervention manuals allow individual tailoring. Primary outcome measures include Oxford Shoulder Score and sickness absence due to symptoms from the operated shoulder. Randomisation is computerised with allocation concealment by randomly permuted block sizes. Statistical analyses will primarily be performed according to the intention-to-treat principle. The paper presents the rationale, design, methods, and operational aspects of the Shoulder Intervention Project (SIP). SIP evaluates a new rehabilitation approach, where physiotherapy and occupational interventions are provided in continuity of surgical episodes of care. If successful, the project may serve as a model for rehabilitation of surgical shoulder

  19. Pain Management Strategies in Shoulder Arthroplasty.

    Science.gov (United States)

    Codding, Jason L; Getz, Charles L

    2018-01-01

    Pain control in total shoulder arthroplasty demands a multidisciplinary approach with collaboration between patients, surgeon, and anesthetist. A multimodal approach with preemptive medication, regional blockade, local anesthetics, and a combination of acetaminophen, nonsteroidal antiinflammatory drugs, tramadol, and gabapentinoids postoperatively leads to pain control and patient satisfaction. Assessment of patients' expectations constitutes a vital aspect of the preoperative patient evaluation. Educating and psychologically preparing patients reduces postoperative pain. Patients with anxiety and depression, preoperative narcotic use, and medical comorbidities are at an increased risk for suboptimal pain control. Minimizing narcotic use decreases opioid-related adverse effects and facilitates productive rehabilitation efforts. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Relation Between Subacromial Bursitis on Ultrasonography and Efficacy of Subacromial Corticosteroid Injection in Rotator Cuff Disease: A Prospective Comparison Study.

    Science.gov (United States)

    Lee, Doo-Hyung; Hong, Ji Yeon; Lee, Michael Young; Kwack, Kyu-Sung; Yoon, Seung-Hyun

    2017-05-01

    To evaluate the correlations between subacromial bursitis (bursal thickening and effusion) on ultrasonography and its response to subacromial corticosteroid injection in patients with rotator cuff disease. Prospective, longitudinal comparison study. University-affiliated tertiary care hospital. Patients with rotator cuff disease (N=69) were classified into 3 groups based on ultrasonographic findings; (1) normative bursa group (group 1, n=23): bursa and effusion thickness 2mm and effusion thickness 2mm. A single subacromial injection with 20mg of triamcinolone acetonide. Visual analog scale (VAS) of shoulder pain, Shoulder Disability Questionnaire (SDQ), angles of active shoulder range of motion (flexion, abduction, external rotation, and internal rotation), and bursa and effusion thickness at pre- and posttreatment at week 8. There were no significant differences between the 3 groups in demographic characteristics pretreatment. Groups 2 and 3 showed a significant difference compared with group 1 in changes on the VAS and abduction; group 3 showed a significant difference compared with group 1 in changes of the SDQ, internal rotation, and external rotation; and all groups showed significant differences when compared with each other (groups 1 and 3, 2 and 3, and 1 and 2) in changes of thickness. A patient with ultrasonographic observation of subacromial bursitis, instead of normative bursa, can expect better outcome with subacromial corticosteroid injection. Therefore, we recommend a careful selection of patients using ultrasonography prior to injection. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  1. Shoulder Impingement Syndromes: Implications on Physical Therapy Examination and Intervention

    Science.gov (United States)

    2005-01-01

    A painful shoulder presents challenges in examination, diagnosis and intervention for the physical therapist because of the complexity of the structures involved. A common cause of shoulder pain is shoulder impingement syndrome. This was first described as a condition in which the soft tissues of the subacromial space were chronically entrapped and compressed between the humeral head and the subacromial arch. This definition does not account for the myriad potential causes of shoulder impingement conditions, as forms of impingement other than subacromial soft tissue compression may explain different symptomatic shoulder injuries. This paper describes shoulder impingement syndromes that have been hypothesized, identified and analyzed in the literature. Physical Therapy examination and intervention for these syndromes are also discussed. PMID:25792938

  2. The Maastricht Ultrasound Shoulder pain trial (MUST: Ultrasound imaging as a diagnostic triage tool to improve management of patients with non-chronic shoulder pain in primary care

    Directory of Open Access Journals (Sweden)

    Cals Jochen WL

    2011-07-01

    Full Text Available Abstract Background Subacromial disorders are considered to be one of the most common pathologies affecting the shoulder. Optimal therapy for shoulder pain (SP in primary care is yet unknown, since clinical history and physical examination do not provide decisive evidence as to the patho-anatomical origin of the symptoms. Optimal decision strategies can be furthered by applying ultrasound imaging (US, an accurate method in diagnosing SP, demonstrating a clear relationship between diagnosis and available therapies. Yet, the clinical cost-effectiveness of applying US in the management of SP in primary care has not been studied. The aim of this paper is to describe the design and methods of a trial assessing the cost-effectiveness of ultrasound imaging as a diagnostic triage tool to improve management of primary care patients with non-chronic shoulder pain. Methods/Design This randomised controlled trial (RCT will involve 226 adult patients with suspected subacromial disorders recruited by general practitioners. During a Qualification period of two weeks, patients receive care as usual as advised by the Dutch College of General Practitioners, and patients are referred for US. Patients with insufficient improvement qualify for the RCT. These patients are then randomly assigned to the intervention or the control group. The therapies used in both groups are the same (corticosteroid injections, referral to a physiotherapist or orthopedic surgeon except that therapies used in the intervention group will be tailored based on the US results. Ultrasound diagnosed disorders include tendinopathy, calcific tendinitis, partial and full thickness tears, and subacromial bursitis. The primary outcome is patient-perceived recovery at 52 weeks, using the Global Perceived Effect questionnaire. Secondary outcomes are disease specific and generic quality of life, cost-effectiveness, and the adherence to the initial applied treatment. Outcome measures will be assessed

  3. Imaging Evaluation of Nonacute Shoulder Pain.

    Science.gov (United States)

    Tuite, Michael J; Small, Kirstin M

    2017-09-01

    A variety of radiographic views have been described in the literature for the initial imaging of nonacute shoulder pain. Multiple articles have also discussed the best next imaging test if radiographs do not show the diagnosis, especially the use of unenhanced MRI, MR arthrography, CT arthrography, and ultrasound. The purpose of this article is to examine the evidence for the most helpful radiographic views and the best imaging test after radiographs for different clinical presentations of chronic shoulder pain. The recommended radiographic views and best next imaging test after the radiograph depends on the clinical diagnosis. Ultrasound is generally preferred over MRI for evaluating chronic rotator cuff pain, whereas MR arthrography, preferably with abducted and externally rotated images, is most accurate for imaging chronic symptoms from a suspected labral tear or instability.

  4. EVALUATION OF PAINFUL SHOULDER IN BASEBALL PLAYERS

    OpenAIRE

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; do Val Sella, Guilherme; Junior, Adriano Fernando Mendes; Soares, André Lopes; Aihara, Leandro Jun; Checchia, Sérgio Luiz

    2011-01-01

    Objective: To assess the relationship between shoulder mobility and strength and the presence of pain among baseball players. Methods: Between April and July 2009, 55 baseball players were assessed by the Shoulder and Elbow Group of the School of Medical Sciences, Santa Casa de Miseric?rdia, S?o Paulo. They were all males, aged between 15 and 33 years (mean of 21); they attended an average of three training sessions per week and had been doing this sport for a mean of 10 years. Results: 14 of...

  5. Evaluation and management of shoulder pain in skeletally immature athletes

    OpenAIRE

    Patel, Dilip R.; Breisach, Stephen

    2017-01-01

    Shoulder pain in young athletes generally is a result of poor sports technique and overuse. A number intrinsic causes of shoulder pain have been identified. Pain may also be referred to shoulder area from cervical spine, neck and chest pathology. Overuse stress injury of the proximal humeral physis is important to recognize early in order to prevent later complications. Shoulder impingement syndrome is a general term used to describe multiple underlying lesions and relatively uncommon in youn...

  6. Secondary Subacromial Impingement after Valgus Closing-Wedge Osteotomy for Proximal Humerus Varus

    Directory of Open Access Journals (Sweden)

    Hirotaka Sano

    2015-01-01

    Full Text Available A 31-year-old construction worker had been suffering from both the motion pain and the restriction of elevation in his right shoulder due to severe varus deformity of humeral neck, which occurred after proximal humeral fracture. The angle for shoulder flexion and abduction was restricted to 50 and 80 degrees, respectively. Valgus closing-wedge osteotomy followed by the internal fixation using a locking plate was carried out at 12 months after injury. Postoperatively, the head-shaft angle of the humerus improved from 65 to 138 degrees. Active flexion and abduction angles improved from 80 to 135 degrees and from 50 to 135 degrees, respectively. However, the patient complained from a sharp pain with a clicking sound during shoulder abduction even after removal of the locking plate. Since subacromial steroid injection temporarily relieved his shoulder pain, we assumed that the secondary subacromial impingement was provoked after osteotomy. Thus, arthroscopic subacromial decompression was carried out at 27 months after the initial operation, which finally relieved his symptoms. In the valgus closing-wedge osteotomy, surgeons should pay attention to the condition of subacromial space to avoid causing the secondary subacromial impingement.

  7. mri evaluation of patients with shoulder pain at three imaging ...

    African Journals Online (AJOL)

    Background: Shoulder pain is a common reason for visiting a physician. It is the third most common cause of musculoskeletal complaint after low back pain and cervical pain in the USA. No data is available on MRI findings among our local population with shoulder pain despite having an MRI machine in our country since ...

  8. Evaluation and management of shoulder pain in skeletally immature athletes

    Science.gov (United States)

    Breisach, Stephen

    2017-01-01

    Shoulder pain in young athletes generally is a result of poor sports technique and overuse. A number intrinsic causes of shoulder pain have been identified. Pain may also be referred to shoulder area from cervical spine, neck and chest pathology. Overuse stress injury of the proximal humeral physis is important to recognize early in order to prevent later complications. Shoulder impingement syndrome is a general term used to describe multiple underlying lesions and relatively uncommon in young athletes. In adolescent athletes, glenohumeral instability is an important underlying pathomechanical basis for shoulder pain. Other less frequent causes reviewed here include atraumatic osteolysis of the distal clavicle, long thoracic and suprascapular neuropathies. PMID:28795009

  9. Evaluation and management of shoulder pain in skeletally immature athletes.

    Science.gov (United States)

    Patel, Dilip R; Breisach, Stephen

    2017-07-01

    Shoulder pain in young athletes generally is a result of poor sports technique and overuse. A number intrinsic causes of shoulder pain have been identified. Pain may also be referred to shoulder area from cervical spine, neck and chest pathology. Overuse stress injury of the proximal humeral physis is important to recognize early in order to prevent later complications. Shoulder impingement syndrome is a general term used to describe multiple underlying lesions and relatively uncommon in young athletes. In adolescent athletes, glenohumeral instability is an important underlying pathomechanical basis for shoulder pain. Other less frequent causes reviewed here include atraumatic osteolysis of the distal clavicle, long thoracic and suprascapular neuropathies.

  10. Kinematics of the contralateral and ipsilateral shoulder: A possible relationship with post-stroke shoulder pain

    OpenAIRE

    Niessen, M.H.M.; Janssen, T.W.J.; Meskers, C.G.M.; Koppe, P.; Konijnenbelt, M.; Veeger, H.E.J.

    2008-01-01

    Objective: Post-stroke shoulder pain is a common phenomenon in hemiplegia and impedes rehabilitation. The aim of this study was to identify a possible relationship between post-stroke shoulder pain, scapula resting position and shoulder motion. Methods: Shoulder kinematics of 27 patients after stroke (17 men) were compared with 10 healthy age-matched control subjects. Using an electromagnetic tracking device, the kinematics of both the contralateral and ipsilateral (i.e. paretic and non-paret...

  11. Arthroscopic Finding of an Extra-Articular Loose Body in the Subacromial Space: Case Report Presentation and Literature Review.

    Science.gov (United States)

    Hartelius, Carl; Apostolopoulos, Alexandros P; Zaman, Tariq

    2016-01-01

    Loose bodies are pieces of soft tissue that run free within a body cavity, typically in the synovium; loose bodies outside of synovial cavities are very rare. This case study demonstrates such an instance occurring in the subacromial space, which is especially unusual. We report on it coupled with an analysis of the literature of known cases that have occurred previously. A 55-year old right-hand-dominant female patient presented with left shoulder pain. She had injured her left shoulder 7 yr previously and had achieved adequate pain and symptomatic control with physiotherapy. A magnetic resonance imaging scan demonstrated subacromial subdeltoid bursitis with a large subacromial spur, a bulky acromioclavicular (AC) joint, and a partial tear of the supraspinatous tendon. The patient subsequently underwent shoulder arthroscopy for subacromial decompression and AC joint excision. Arthroscopy demonstrated a suspected impingement of the rotator cuff in the subacromial space, bursitis, and a prominent acromion that limited the subacromial space (bigliani, type III), but during the procedure a detached white mass was discovered in the subacromial bursa. After histological analysis, the mass showed osteocartilagenous tissue, consistent with a loose body. Following the procedure, there were no complications, and the patient's symptoms gradually resolved. Extraarticular loose bodies are extremely rare, especially in the subacromial bursa. Reported cases have all been associated with either traumatic or degenerative shoulder pathology, and the diagnosis was commonly established incidentally on arthroscopy. Cases were managed with removal during the same procedure. Arthroscopic removal of loose bodies and bursa debridement, good options for treatment of loose bodies in the subacromial space, can result in good function.

  12. Subacromial impingement in patients with whiplash injury to the cervical spine

    Directory of Open Access Journals (Sweden)

    Giddins Grey E

    2008-06-01

    Full Text Available Abstract Background Impingement syndrome and shoulder pain have been reported to occur in a proportion of patients following whiplash injuries to the neck. In this study we aim to examine these findings to establish the association between subacromial impingement and whiplash injuries to the cervical spine. Methods and results We examined 220 patients who had presented to the senior author for a medico-legal report following a whiplash injury to the neck. All patients were assessed for clinical evidence of subacromial impingement. 56/220 patients (26% had developed shoulder pain following the injury; of these, 11/220 (5% had clinical evidence of impingement syndrome. Only 3/11 patients (27% had the diagnosis made prior to evaluation for their medico-legal report. In the majority, other clinicians had overlooked the diagnosis. The seatbelt shoulder was involved in 83% of cases (p Conclusion After a neck injury a significant proportion of patients present with shoulder pain, some of whom have treatable shoulder pathology such as impingement syndrome. The diagnosis is, however, frequently overlooked and shoulder pain is attributed to pain radiating from the neck resulting in long delays before treatment. It is important that this is appreciated and patients are specifically examined for signs of subacromial impingement after whiplash injuries to the neck. Direct seatbelt trauma to the shoulder is one possible explanation for its aetiology.

  13. Adhesive capsulitis of the shoulder: pain intensity and distribution.

    Science.gov (United States)

    Candela, V; Giannicola, G; Passaretti, D; Venditto, T; Gumina, S

    2017-12-01

    Papers regarding adhesive capsulitis (AC) of the shoulder focused on etiology, epidemiology, diagnosis, and treatment; until now, information on shoulder pain characteristics is still scarce. Our aim was to analyze pain intensity and distribution in patients with AC. The study group was composed of 278 (133M-145F) consecutive patients with AC. After diagnosis, shoulder pain distribution was assessed through an upper limb pain map and pain intensity through a visual analog scale. Patients were distinguished on the basis of gender, age, time elapsed from onset of symptoms, and severity of functional limitation. Data were submitted to statistical analysis. Intensity of shoulder pain caused by AC was higher in females (p pain arose from more than 3 months suffered a lower intensity of shoulder pain. Furthermore, pain intensity was higher in the most severe form of AC (active forward flexion Pain was localized predominantly on the anterior aspect of the shoulder (dermatomes C5-C6) and rarely extended beyond the distal third of the arm. No differences were found in pain distribution between male and female, between patients with pain from less or more than 3 months and between different levels of AC severity (p > 0.05). Shoulder pain due to AC may be influenced by gender and severity of functional limitation. AC pain distribution principally involves anterior aspect of the shoulder with downward extension of the arm until its distal third. Level IV.

  14. Subacromial impingement syndrome caused by a voluminous subdeltoid lipoma.

    Science.gov (United States)

    Murray, Jean-Christophe; Pelet, Stéphane

    2014-01-01

    Subacromial impingement syndrome is a clinical diagnosis encompassing a spectrum of possible etiologies, including subacromial bursitis, rotator cuff tendinopathy, and partial- to full-thickness rotator cuff tears. This report presents an unusual case of subdeltoid lipoma causing extrinsic compression and subacromial impingement syndrome. The patient, a 60-year-old man, presented to our institution with a few years' history of nontraumatic, posteriorly localized throbbing pain in his right shoulder. Despite a well-followed 6-months physiotherapy program, the patient was still suffering from his right shoulder. The MRI scan revealed a well-circumscribed 6 cm × 2 cm × 5 cm homogenous lesion compatible with a subdeltoid intermuscular lipoma. The mass was excised en bloc, and subsequent histopathologic examination confirmed a benign lipoma. At 6-months follow-up, the patient was asymptomatic with a complete return to his activities. Based on this case and a review of the literature, a subacromial lipoma has to be included in the differential diagnosis of a subacromial impingement syndrome refractory to nonoperative treatment. Complementary imaging modalities are required only after a failed conservative management to assess the exact etiology and successfully direct the surgical treatment.

  15. Subacromial Impingement Syndrome Caused by a Voluminous Subdeltoid Lipoma

    Directory of Open Access Journals (Sweden)

    Jean-Christophe Murray

    2014-01-01

    Full Text Available Subacromial impingement syndrome is a clinical diagnosis encompassing a spectrum of possible etiologies, including subacromial bursitis, rotator cuff tendinopathy, and partial- to full-thickness rotator cuff tears. This report presents an unusual case of subdeltoid lipoma causing extrinsic compression and subacromial impingement syndrome. The patient, a 60-year-old man, presented to our institution with a few years' history of nontraumatic, posteriorly localized throbbing pain in his right shoulder. Despite a well-followed 6-months physiotherapy program, the patient was still suffering from his right shoulder. The MRI scan revealed a well-circumscribed 6 cm × 2 cm × 5 cm homogenous lesion compatible with a subdeltoid intermuscular lipoma. The mass was excised en bloc, and subsequent histopathologic examination confirmed a benign lipoma. At 6-months follow-up, the patient was asymptomatic with a complete return to his activities. Based on this case and a review of the literature, a subacromial lipoma has to be included in the differential diagnosis of a subacromial impingement syndrome refractory to nonoperative treatment. Complementary imaging modalities are required only after a failed conservative management to assess the exact etiology and successfully direct the surgical treatment.

  16. Posterior shoulder tightness and rotator cuff strength assessments in painful shoulders of amateur tennis players

    Directory of Open Access Journals (Sweden)

    Freddy B. Marcondes

    2013-04-01

    Full Text Available BACKGROUND: Previous studies have shown a relationship between shoulder posterior capsule tightness and shoulder pain in overhead athletes. However, this relationship has not been studied in tennis players. OBJECTIVES: Assessment of the shoulder range of motion (ROM, strength and posterior capsule tightness of skilled amateur tennis players who had complaints of dominant shoulder pain in comparison with tennis players without pain. METHOD: Forty-nine skilled amateur tennis players were distributed in 2 groups: Control Group (n=22 and Painful Group (n=27. The first group was composed of asymptomatic subjects, and the second was composed of subjects with shoulder pain on the dominant side. These groups were evaluated to determine the dominant and non-dominant shoulder ROM (internal and external rotation, isometric shoulder strength (internal and external rotation and posterior shoulder tightness by blind evaluators. RESULTS: The ANOVA results indicated significant differences between the groups in the dominant shoulder ROM, posterior capsule tightness, external rotation strength and strength ratio (p<0.05. The intragroup analysis (dominant versus non-dominant in the Painful Group displayed a significant difference for ROM, posterior capsule tightness and external rotation strength (p<0.05. CONCLUSIONS: The tennis players with pain in the dominant shoulder presented greater posterior capsule tightness, internal rotation deficit (ROM, external rotation gain (ROM and deficits in external rotation strength than the tennis players without pain.

  17. A specific exercise strategy reduced the need for surgery in subacromial pain patients.

    Science.gov (United States)

    Hallgren, Hanna C Björnsson; Holmgren, Theresa; Oberg, Birgitta; Johansson, Kajsa; Adolfsson, Lars E

    2014-10-01

    A programme based on eccentric exercises for treating subacromial pain was in a previous study found effective at 3-month follow-up. The purposes of the present study were to investigate whether the results were maintained after 1 year and whether the baseline Constant-Murley score, rotator cuff status and radiological findings influenced the outcome. 97 patients on the waiting list for arthroscopic subacromial decompression had been randomised to a specific exercise programme or unspecific exercises (controls). After 3 months of exercises, the patients were asked whether they still wanted surgery and this option was available until a 1-year follow-up. 1 year after inclusion or 1 year after surgery, the number of patients who decided to have surgery in each group was compared. The choice of surgery was related to the baseline Constant-Murley score, ultrasound and radiographs taken at inclusion. All patients had improved significantly (p<0.0001) in the Constant-Murley score at the 1-year follow-up. Significantly more patients in the control group decided to have surgery (63%) than those in the specific exercise group (24%; p<0.0001). Patients who decided to have surgery had a significantly lower baseline Constant-Murley score and more often a full-thickness tear. Patients with partial tears did not differ from those with intact tendons. The positive short-term results of specific exercises were maintained after 1 year, and this exercise strategy reduces the need for surgery. Full-thickness tear and a low baseline Constant-Murley score appear to be a predictive marker for a less good outcome. Clinical trials NCT01037673. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain

    OpenAIRE

    Wensing Michel; Stegenga Boudewijn; Dommerholt Jan; Bron Carel; Oostendorp Rob AB

    2011-01-01

    Abstract Background Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment. The pathophysiological mechanisms of shoulder pain are poorly understood. Furthermore, there is little evidence supporting the effectiveness of current treatment protocols. Although myofascial trigger points (MTrPs) are rarely mentioned in relation to shoulder pain, they may present an alternative underlying mechanism, which would provide new treatment target...

  19. Painful shoulder. Introduction into fundamental facts and problems

    Energy Technology Data Exchange (ETDEWEB)

    Hartl, P.W.

    1987-10-19

    The painful shoulder syndrome is very common. Diagnosis and differential diagnosis may be difficult. Shoulder pain may be caused by local processes or systemic diseases or can be referred. Periarthritis humeroscapularis (frozen shoulder) is the most common cause of painful shoulder syndrome. Biomechanical factors concerning the rotator cuff are involved in the etiopathogenesis of these pain syndromes. The therapy of frozen shoulder includes physical treatment, antirheumatic drugs, or X-ray treatment. Surgical measures may become necessary. In the course of rheumatoid arthritis the shoulder may be involved. Milwaukee-shoulder-syndrome has been described recently in crystal deposit diseases. Shoulder pain may be referred by mechanical irritations of nerve roots in the course of degenerative lesions of the cervical spine and also in the course of internal diseases of the heart, the lungs, or the gastrointestinal tract. In cases of shoulder pain without pathological data from arthrological, radiological or laboratory studies, one should always consider localized fibromyalgia in the shoulder-neck-region. The precise diagnosis of shoulder pain is an important prerequisite for treatment, the success of which should not be judged as pessimistic as it has been commonly done in the past.

  20. Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders.

    Science.gov (United States)

    Struyf, Filip; Lluch, Enrique; Falla, Deborah; Meeus, Mira; Noten, Suzie; Nijs, Jo

    2015-02-01

    Shoulder pain is often a challenging clinical phenomenon because of the potential mismatch between pathology and the perception of pain. Current evidence clearly emphasizes an incomplete understanding of the nature of shoulder pain. Indeed, the effective diagnosis and treatment of shoulder pain should not only rely upon a detailed knowledge of the peripheral pathologies that may be present in the shoulder, but also on current knowledge of pain neurophysiology. To assess and treat shoulder pain, a comprehensive understanding of the way in which pain is processed is essential. This review reflects modern pain neurophysiology to the shoulder and aims to answer the following questions: why does my shoulder hurt? What is the impact of shoulder pain on muscle function? What are the implications for the clinical examination of the shoulder? And finally, what are the clinical implications for therapy? Despite the increasing amount of research in this area, an in-depth understanding of the bidirectional nociception-motor interaction is still far from being achieved. Many questions remain, especially related to the treatment of nociception-motor interactions.

  1. Posterior shoulder tightness and rotator cuff strength assessments in painful shoulders of amateur tennis players.

    Science.gov (United States)

    Marcondes, Freddy B; de Jesus, Julio F; Bryk, Flavio F; de Vasconcelos, Rodrigo A; Fukuda, Thiago Y

    2013-01-01

    Previous studies have shown a relationship between shoulder posterior capsule tightness and shoulder pain in overhead athletes. However, this relationship has not been studied in tennis players. Assessment of the shoulder range of motion (ROM), strength and posterior capsule tightness of skilled amateur tennis players who had complaints of dominant shoulder pain in comparison with tennis players without pain. Forty-nine skilled amateur tennis players were distributed in 2 groups: Control Group (n=22) and Painful Group (n=27). The first group was composed of asymptomatic subjects, and the second was composed of subjects with shoulder pain on the dominant side. These groups were evaluated to determine the dominant and non-dominant shoulder ROM (internal and external rotation), isometric shoulder strength (internal and external rotation) and posterior shoulder tightness by blind evaluators. The ANOVA results indicated significant differences between the groups in the dominant shoulder ROM, posterior capsule tightness, external rotation strength and strength ratio (pPainful Group displayed a significant difference for ROM, posterior capsule tightness and external rotation strength (ppain in the dominant shoulder presented greater posterior capsule tightness, internal rotation deficit (ROM), external rotation gain (ROM) and deficits in external rotation strength than the tennis players without pain.

  2. Ultrasound and magnetic resonance findings and correlation in hemiplegic patients with shoulder pain.

    Science.gov (United States)

    Doğun, Asuman; Karabay, İlkay; Hatipoğlu, Cem; Özgirgin, Neşe

    2014-01-01

    The aim of this study was to evaluate the ultrasonography (US) and MRI findings in hemiplegic patients with shoulder pain and investigate the correlation between them. It is not possible for these patients to fully perform active range of motion (ROM) and stress tests, so imaging methods take center stage in diagnosis and treatment planning. A total of 68 hemiplegic patients with shoulder pain attending the inpatient rehabilitation program were included in the study. MRI and US results from the patient files were recorded. The frequency of each pathology identified by US and MRI was determined. The distribution of MRI and US findings was investigated to see whether there was a statistical difference between the correlation of MRI and US results. The mean (SD) age of the patients was 63.7 (8.3) years and the mean (SD) duration of hemiplegia was 49 (8.9) days. According to the MRI results, glenohumeral and acromioclavicular joint degeneration was found in 77.9% and 79.7% of the patients, respectively; subacromial-subdeltoid bursitis in 80.9%; fluid increase in the joint space in 41.2%; supraspinatus tendinitis in 36.8%; and supraspinatus partial rupture in 33.8%. Shoulder US findings were supraspinatus tendinitis in 54.4%, acromioclavicular joint degeneration in 26.5%, bicipital tendinitis in 20.6%, and subacromial-subdeltoid bursitis in 19.1%. There was a statistically significant difference between MRI and US findings. The results were not compatible with each other (P ≯ .05), and these findings were not consistent with each other since the kappa coefficient was under 0.40 for all these results. Although US is recommended as the first method in determining shoulder pathologies in hemiplegic patients, we suggest that MRI should be used as the first choice in hemiplegic patients with shoulder pain. MRI and US findings were not consistent, and US is dependent on the experience of the operator. MRI should be the first choice in cases where the diagnosis will affect

  3. Intertester reliability of a classification system for shoulder pain.

    Science.gov (United States)

    Carter, Tom; Hall, Hamilton; McIntosh, Greg; Murphy, John; MacDougall, Janice; Boyle, Christina

    2012-03-01

    To describe and determine the intertester reliability of a newly developed classification system of shoulder syndrome recognition. Intertester reliability study. Fourteen primary care physiotherapy clinics. Two hundred and fifty-five patients with shoulder pain. Inclusion criterion: presence of shoulder pain aring within the glenohumeral or associated joints and structures. previous shoulder surgery, surgical candidates, recognised malignancy, systemic illness, or concurrent cervical pain and/or radiculopathy. Examiners were 55 physiotherapists who were arranged in pairs; each patient received two independent and blinded assessments, one by each of the paired physiotherapists. This shoulder classification approach contains three main clinical syndromes: Pattern 1 (impingement pain), Pattern 2 (acromioclavicular joint pain) and Pattern 3 (shoulder pain: frozen shoulder, glenohumeral arthritis, massive cuff tear, subscapularis tear, painful laxity, post-traumatic instability, internal derangement). Percentage agreement and Cohen's kappa coefficient. The mean age of patients was 46.6 years (standard deviation 16.3, range 16 to 86), and 57% were male. Physiotherapists agreed on the pattern of shoulder pain for 205 of the 255 shoulders assessed (agreement rate 80%); the kappa coefficient was 0.664 (95% confidence interval 0.622 to 0.706; Pshoulder pain. The kappa coefficient denotes good reproducibility. Copyright © 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  4. Relation between shoulder proprioception, kinematics and pain after stroke

    NARCIS (Netherlands)

    Niessen, M. H M; Veeger, H. E J; Meskers, C.G.; Koppe, P.A.; Konijnenbelt, M.H.; Janssen, T. W J

    2010-01-01

    Purpose: To identify a possible relationship between chronic Post-Stroke Shoulder Pain (PSSP), scapular resting pose and shoulder proprioception. Methods: A total of 21 inpatients with stroke and 10 healthy control subjects were included and kinematics and proprioception of both shoulders were

  5. SHOULDER JOINT PAIN: APPROACHES TO DIAGNOSIS AND TREATMENT

    Directory of Open Access Journals (Sweden)

    N. A. Shostak

    2014-07-01

    Full Text Available The paper presents main approaches to the differential diagnosis of shoulder joint pathology and describes the major nosological entities of shoulder diseases. It gives data on the possibility of using nanotechnologies in optimizing the management of a patient with chronic shoulder joint pain syndrome.

  6. Muscle shortening manoeuvre reduces pain and functional impairment in shoulder impingement syndrome: clinical and ultrasonographic evidence.

    Science.gov (United States)

    Melchiorre, Daniela; Maresca, Marco; Bracci, Riccardo; Ravaschio, Andrea; Valiensi, Bruno; Casale, Roberto; Bandinelli, Francesca; Candelieri, Antonio; Maddali Bongi, Susanna; Porta, Francesco; Innocenti, Massimo; Carulli, Christian; Matucci Cerinic, Marco

    2014-01-01

    To evaluate the short-term efficacy of muscle shortening manoeuvre (MSM), by inducing an increase in strength of the shoulder muscles, for the treatment of shoulder impingement syndrome (SIS). Sixty subjects (mean age: 58.6 years) with SIS were assigned to one of 3 different treatment interventions: 1) MSM: a series of fast accelerations in the upward direction was applied to the upper limb that was also submitted to forces acting in the opposite direction (added mass); 2) traditional physiotherapeutic technique: scapulothoracic gliding; 3) simple traction: the added mass was applied to the limb without the series of fast accelerations. Pain intensity, Neer's impingement sign, range of motion and muscle strength were assessed. Ultrasound (US) examination was performed before, immediately after and 30 days after each treatment to study the width of the subacromial-subdeltoid bursa, long biceps tendon sheath and acromioclavicular joint. Impingement was evaluated by dynamic examination. After treatment with MSM, pain was significantly reduced (p<0.001), Neer's impingement sign was negative, range of motion and muscle strength were increased. US examination showed that the widths of the subacromial-subdeltoid bursa (p<0.001), long biceps tendon sheath (p<0.001) and acromioclavicular joint (p<0.001) were significantly reduced; impingement was no more detected. After 30 days, improvement in clinical and US findings was maintained. In the two control groups, no significant changes were observed after treatment. Clinical and US findings demonstrate that MSM, by inducing an increase in muscle strength, is effective in the short-term treatment of SIS.

  7. Myofascial origin of shoulder pain: a literature review.

    Science.gov (United States)

    Sergienko, Stanislav; Kalichman, Leonid

    2015-01-01

    Shoulder pain is a common problem imposing a considerable burden on the affected person and society. Since interventions targeting traditional musculoskeletal conditions are usually only moderately effective, myofascial origin can be suggested as an alternative possible source of shoulder pain. To examine current evidence associated with myofascial origin of shoulder pain, with emphasis on diagnosis, prevalence and treatment efficacy. PubMed, Google Scholar and PEDro databases were searched from inception until December 2013 for terms relating to myofascial pain in the shoulder area. Two studies showed a high reliability of the following diagnostic characteristics during palpation: presence or absence of the taut band, spot tenderness, jump sign, pain recognition and referred pain sensation. Three prevalence studies showed a significant greater number of active myofascial trigger points (MTrPs) on the painful shoulder side. Reduced muscle strength, accelerated muscle fatigue, inconsistent muscle activation pattern under load and reduced antagonist reciprocal inhibition were found in subjects with latent MTrPs in four observational studies. Six interventional studies demonstrated the effectiveness of dry needling, myofascial manipulation, ischemic compression, laser therapy and multimodal treatment. MTrPs in shoulder muscles is a common condition among patients with shoulder complaints and can be reliably diagnosed by palpation. The reviewed interventions seem to be effective in reducing pain, increasing range of motion and improving function of the painful shoulder. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Chronic shoulder pain: part I. Evaluation and diagnosis.

    Science.gov (United States)

    Burbank, Kelton M; Stevenson, J Herbert; Czarnecki, Gregory R; Dorfman, Justin

    2008-02-15

    Shoulder pain is defined as chronic when it has been present for longer than six months. Common conditions that can result in chronic shoulder pain include rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. Rotator cuff disorders include tendinopathy, partial tears, and complete tears. A clinical decision rule that is helpful in the diagnosis of rotator cuff tears includes pain with overhead activity, weakness on empty can and external rotation tests, and a positive impingement sign. Adhesive capsulitis can be associated with diabetes and thyroid disorders. Clinical presentation includes diffuse shoulder pain with restricted passive range of motion on examination. Acromioclavicular osteoarthritis presents with superior shoulder pain, acromioclavicular joint tenderness, and a painful cross-body adduction test. In patients who are older than 50 years, glenohumeral osteoarthritis usually presents as gradual pain and loss of motion. In patients younger than 40 years, glenohumeral instability generally presents with a history of dislocation or subluxation events. Positive apprehension and relocation are consistent with the diagnosis. Imaging studies, indicated when diagnosis remains unclear or management would be altered, include plain radiographs, magnetic resonance imaging, ultrasonography, and computed tomography scans. Plain radiographs may help diagnose massive rotator cuff tears, shoulder instability, and shoulder arthritis. Magnetic resonance imaging and ultrasonography are preferred for rotator cuff disorders. For shoulder instability, magnetic resonance imaging arthrogram is preferred over magnetic resonance imaging.

  9. Central Pain Processing in Patients with Shoulder Pain: A Review of the Literature.

    Science.gov (United States)

    Noten, Suzie; Struyf, Filip; Lluch, Enrique; D'Hoore, Marika; Van Looveren, Eveline; Meeus, Mira

    2017-02-01

    Shoulder pain is a common health problem in which changes in shoulder structure cannot always explain the patient's perceived pain. Central sensitization (CS) might play a role in a subgroup of these patients. The literature was systematically reviewed to address the role of CS in patients with shoulder pain. Electronic databases PubMed and Web of Knowledge were searched for relevant studies. Eighteen full-text articles were included, methodological quality was scored, and information was extracted. Studies were clustered on those studying patients with musculoskeletal (MSK) shoulder pain and those studying patients with hemiplegic shoulder pain (HSP). In particular, quantitative sensory testing revealed hyperalgesia for pressure pain in the MSK group, whereas these results were inconsistent in patients with HSP. Conditioned pain modulation was reduced in patients with MSK shoulder pain, but functioned normally in the HSP group. This review has shown that great progress has been made toward a better understanding of neurophysiologic pain mechanisms in patients with shoulder pain. The presence of generalized mechanical hyperalgesia, allodynia, and impaired conditioned pain modulation in patients with MSK shoulder pain indicates the involvement of the central nervous system. Widespread somatosensory abnormalities observed in patients with HSP could suggest a central origin for their shoulder pain and predispose patients with HSP to develop CS, although results are inconsistent. Additional research is required adopting different assessment methods (especially dynamic methods) to establish the role of CS in patients with shoulder pain. © 2016 World Institute of Pain.

  10. Surgical Release of the Pectoralis Minor Tendon for Scapular Dyskinesia and Shoulder Pain.

    Science.gov (United States)

    Provencher, Matthew T; Kirby, Hannah; McDonald, Lucas S; Golijanin, Petar; Gross, Daniel; Campbell, Kevin J; LeClere, Lance; Sanchez, George; Anthony, Shawn; Romeo, Anthony A

    2017-01-01

    Pectoralis minor (PM) tightness has been linked to pain and dysfunction of the shoulder joint secondary to anterior tilt and internal rotation of the scapula, thus causing secondary impingement of the subacromial space. To describe outcomes pertaining to nonoperative and operative treatment via surgical release of the PM tendon for pathologic PM tightness in an active population. Case series; Level of evidence, 4. Over a 3-year period, a total of 46 patients were enrolled (mean age, 25.5 years; range, 18-33 years). Inclusion criteria consisted of symptomatic shoulder pain, limited range of overhead motion, inability to participate in overhead lifting activities, and examination findings consistent with scapular dysfunction secondary to a tight PM with tenderness to palpation of the PM tendon. All patients underwent a lengthy physical therapy and stretching program (mean, 11.4 months; range, 3-23 months), which was followed by serial examinations for resolution of symptoms and scapular tilt. Of the 46 patients, 6 (13%) were unable to adequately stretch the PM and underwent isolated mini-open PM release. Outcomes were assessed with scapula protraction measurements and pain scales as well as American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) scores. Forty of the 46 patients (87%) resolved the tight PM and scapular-mediated symptoms with a dedicated therapy program (pre- and posttreatment mean outcome scores: 58 and 91 [ASES], 50 and 90 [SANE], 4.9 and 0.8 [VAS]; P shoulder symptoms after surgical release of the PM. Additional research is necessary to evaluate the long-term efficacy of isolated PM treatment.

  11. Ultrasound assessment of new onset bilateral painful shoulder in patients with polymyalgia rheumatica and rheumatoid arthritis.

    Science.gov (United States)

    Ruta, Santiago; Rosa, Javier; Navarta, David A; Saucedo, Carla; Catoggio, Luis J; Monaco, Ricardo García; Soriano, Enrique R

    2012-09-01

    The aim of our study was to investigate by ultrasound (US) the anatomical structures affected during a new episode of bilateral painful shoulder in patients with polymyalgia rheumatica (PMR) and rheumatoid arthritis (RA) and to compare the findings between these two conditions. PMR and RA patients complaining of new onset bilateral painful shoulder were included. Subjects without any known rheumatic condition with a new onset unilateral painful shoulder were assessed as a control group. US evaluation includes the depiction subacromial-subdeltoid (SAD) bursitis, long head biceps (LHB) tenosynovitis and/or gleno-humeral (GH) synovitis. Thirty patients with PMR, 30 with RA, and 60 controls were included for a total of 60 shoulders per group. Unilateral SAD bursitis and LHB tenosynovitis were significantly more frequent in patients with PMR when compared to those with RA (p < 0.0001 and p < 0.01, respectively) and controls (p < 0.001 and p < 0.01, respectively). Unilateral GH synovitis was more common in RA than in PMR and controls (p < 0.05 and p < 0.01, respectively). Bilateral SAD bursitis was significantly more frequent in patients with PMR than in those with RA (p < 0.01) as was bilateral LHB tenosynovitis (p < 0.01). No significant differences were found in bilateral GH synovitis. US-detected periarticular inflammatory involvement more frequently in PMR both unilaterally and bilaterally and intra-articular inflammatory involvement was commonly in RA but only unilaterally.

  12. Force steadiness, muscle activity, and maximal muscle strength in subjects with subacromial impingement syndrome

    DEFF Research Database (Denmark)

    Bandholm, Thomas; Rasmussen, Lars; Aagaard, Per

    2006-01-01

    physically active in spite of shoulder pain and nine healthy matched controls were examined to determine isometric and isokinetic submaximal shoulder-abduction force steadiness at target forces corresponding to 20%, 27.5%, and 35% of the maximal shoulder abductor torque, and maximal shoulder muscle strength......We investigated the effects of the subacromial impingement syndrome (SIS) on shoulder sensory-motor control and maximal shoulder muscle strength. It was hypothesized that both would be impaired due to chronic shoulder pain associated with the syndrome. Nine subjects with unilateral SIS who remained...... (MVC). Electromyographic (EMG) activity was assessed using surface and intramuscular recordings from eight shoulder muscles. Force steadiness was impaired in SIS subjects during concentric contractions at the highest target force level only, with muscle activity largely unaffected. No between...

  13. Comparison of the Efficacy of Local Corticosteroid Injection and Physical Therapy on Pain Severity, Joint Range of Motion and Muscle Strength in Patients with Shoulder Impingement Syndrome Referred to Rasool-e-Akram Medical Center from April 2008 to September 2009

    Directory of Open Access Journals (Sweden)

    Hosein Farahini

    2011-11-01

    Full Text Available Backgrounds: Subacromial impingement is a common cause of shoulder pain and many patients with this condition recover with conservative management. The most commonly used modalities of nonoperative treatment include activity modification, anti-inflammatory medication and subacromial injection of steroid and ultrasound and physical therapy programs. This study assessed the value of physiotherapy versus subacromial corticosteroid injection in patients with shoulder impingement syndrome (SIS. Methods: Seventy three patients with SIS enrolled in the study and treated through physiotherapy (n=37 and subacromial corticosteroid injection (n=36. Two follow-up sessions accomplished at the end of 4th week and 3rd month of treatment respectively. Results: Corticosteroid injection caused dramatic improvement in the painful state (p<0.0001 and sleep dysfunction score (p=0.039 in the first follow-up. However, physiotherapy showed significantly better results regarding patients’ pain score (p=0.016 and their shoulder join range of motions (p=0.017 and p=0.029 for the abduction and extension, respectively in their second follow-up. Conclusion: Our study results showed that subacromial corticosteroid injection primarily resulted in more improvement in the impingement symptoms. However, with the long-term follow-up the results were better for the physiotherapy. These results suggest that patients should not undergo surgery before having conservative treatment.

  14. [Case-control study on shoulder pain caused by hook palte for the treatment of acromioclavicular joint dislocation].

    Science.gov (United States)

    Yang, Ying-guo; Cai, Xiao-bing; Wang, Xiao-min; Zhu, Yong-gan; Pan, He-yong

    2015-06-01

    To explore causes of shoulder pain and propose prevention measures in treating acromioclavicular joint dislocation. From January 2005 to January 2013, 86 patients with acromioclavicular joint dislocation (Tossy III) were treated with hook plate fixation, and were divided into two groups. Bsaed on recovery of shoulder function mostly, the patients who suffered from rest pain, motion pain were named as shoulder pain group, while the patients without pain were named as painless group. In shoulder pain group, there were 21 cases including 15 males and and 6 females ranging the age from 22 to 62 years old with an average of (40.6±11.2) years old. There were 8 cases were on the left side and 13 cases were on the right side. In painless group, there were 65 cases including 36 males and and 29 females ranging the age from 19 to 65 years old with an average of (40.0±11.3) years old. There were 33 cases were on the left side and 32 cases were on the right side. The time from injury to operation ranged from 3 h to 8 d with an average of 34.6 h. Shoulder function of all patients were normal before injuried. Postoperative pain, activity of daily living (ADL), range of motion, deltoid muscle strength were compared. Anteflexion,rear protraction, abduction and upthrow of shoulder joint were also compared. Postoperative complications between two groups were observed and compared. All patients were followed up from 12 to 48 months with an average of 18.5 months. Constant-Murley score were used to evaluate clinical efficacy at the least following up, and 13 cases got an excellent results, 5 moderate, 2 good and 1 poor in shoulder pain group ; while 61 cases were obtained excellent results, 3 moderate and 1 good in painless group. There were significantly differences between two groups in Constant-Murley score and activity of shoulder joint (Pshoulder pain group, 3 cases were disconnected, 1 case occurred stress fracture, 9 cases were subacromial impingement syndrome, 5 cases

  15. Does scapular positioning predict shoulder pain in recreational overhead athletes?

    Science.gov (United States)

    Struyf, F; Nijs, J; Meeus, M; Roussel, N A; Mottram, S; Truijen, S; Meeusen, R

    2014-01-01

    The objective of this prospective study is to investigate possible scapular related risk factors for developing shoulder pain. Therefore, a 2-year follow-up study in a general community sports centre setting was conducted. A sample of convenience of 113 recreational overhead athletes (59 women and 54 men) with a mean age of 34 (17-64; SD 12) years were recruited. At baseline, visual observation for scapular dyskinesis, measured scapular protraction, upward scapular rotation and dynamic scapular control were evaluated. 22% (n=25) of all athletes developed shoulder pain during the 24 months following baseline assessment. The Mean Shoulder Disability Questionnaire (SDQ) score for the painful shoulders was 34.8 (6.3-62.5; SD 17.4). None of the scapular characteristics predicted the development of shoulder pain. However, the athletes that developed shoulder pain demonstrated significantly less upward scapular rotation at 45° (p=0.010) and 90° (p=0.016) of shoulder abduction in the frontal plane at baseline in comparison to the athletes that remained pain-free. In conclusion, although these scapular characteristics are not of predictive value for the development of shoulder pain, this study increases our understanding of the importance of a scapular upward rotation assessment among recreational overhead athletes. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Evaluation and management of shoulder pain in primary care clinics.

    Science.gov (United States)

    House, Jeff; Mooradian, Arshag

    2010-11-01

    Shoulder pain is a frequent clinical problem facing primary care physicians. Despite its common occurrence, many clinicians are unfamiliar with the diagnosis and treatment of many common shoulder ailments. Because therapy for most shoulder disorders can be made at the initial consultation, a good history and physical remain paramount. The purpose of this paper is to review the basic approach to diagnosis and management of shoulder pain. It will summarize a pragmatic approach to the initial history, with particular attention to differentiating extrinsic and intrinsic etiologies. Physical exam techniques for evaluating shoulder pain will be reviewed, including provocation testing for specific disorders. Specific disorders covered include supraspinatus tendonitis, subdeltoid bursitis, frozen shoulder, biceps tendonitis, and acromioclavicular (AC) joint arthritis.

  17. Unrecognized shoulder disorders in treatment of cervical spondylosis presenting neck and shoulder pain.

    Science.gov (United States)

    Jo, Hyun-Jin; Shin, Myung-Hoon; Hur, Jung-Woo; Kim, Jin-Sung; Ryu, Kyeong-Sik; Park, Chun-Kun

    2012-09-01

    Cervical spondylosis and shoulder disorders share with neck and shoulder pain. Differentiating between the two can be challenging and patient with combined pathologies is less likely to have pain improvement even after successful cervical operation. We investigated clinical characteristics of the patients who were diagnosed as cervical spondylosis however, were turned out to have shoulder disorders or the patients whose pain was solely originated from shoulder. Between January 2008 and October 2009, the patients presenting neck and shoulder pain with diagnosis of cervical spondylosis were enrolled. Among them, the patients who met following inclusion criteria were grouped into shoulder disorder group and the others were into cervical spondylosis group. Inclusion criteria were as follows. (1) To have residual or unresponsive neck and shoulder pain despite of optimal surgical treatment due to concomitant shoulder disorders. (2) When the operation was cancelled for the reason that shoulder and neck pain was proved to be related with unrecognized shoulder disorders. The authors retrospectively reviewed and compared clinical characteristics, level of pathology, diagnosis of cervical spondylosis and shoulder disorders. A total of 96 patients were enrolled in this study. Shoulder disorder group was composed of 15 patients (15.8%) and needed additional orthopedic treatment. Cervical spondylosis group was composed of 81 patients (84.2%). There was no significant differences in mean age, sex ratio and major diagnosis in both shoulder disorder and cervical spondylosis group (p=0.33, 0.78, and 0.68 respectively). However, the distribution of pathologic levels was found to be significantly different (p=0.03). In shoulder disorder group, the majority of lesions (15 of 19 levels, 78.9%) were located at the level of C4-5 (36.8%) and C5-6 (42.1%). On the other hand, in cervical spondylosis group, C5-6 (39.0%) and C6-7 (37.1%) were the most frequently observed level of lesions (80

  18. Does acromioplasty result in favorable clinical and radiologic outcomes in the management of chronic subacromial pain syndrome? A double-blinded randomized clinical trial with 9 to 14 years' follow-up.

    Science.gov (United States)

    Kolk, Arjen; Thomassen, Bregje J W; Hund, Hajo; de Witte, Pieter Bas; Henkus, Hans-Erik; Wassenaar, Willem G; van Arkel, Ewoud R A; Nelissen, Rob G H H

    2017-08-01

    The treatment effect of acromioplasty for chronic subacromial pain syndrome (SAPS) on long-term shoulder function and rotator cuff deterioration has still to be determined. This study aimed to determine the long-term clinical and radiologic treatment effect of arthroscopic acromioplasty in patients with chronic SAPS. In this double-blind, randomized clinical trial, 56 patients with chronic SAPS (median age, 47 years; age range, 31-60 years) were randomly allocated to arthroscopic bursectomy alone or to bursectomy combined with acromioplasty and were followed up for a median of 12 years. The primary outcome was the Constant score. Secondary outcomes included the Simple Shoulder Test, visual analog scale (VAS) for pain, VAS for shoulder functionality, and rotator cuff integrity assessed with magnetic resonance imaging or ultrasound. A total of 43 patients (77%) were examined at a median of 12 years' follow-up. Intention-to-treat analysis at 12 years' follow-up did not show a significant additional treatment effect of acromioplasty on bursectomy alone in improvement in Constant score (5 points; 95% confidence interval, -5.1 to 15.6), Simple Shoulder Test score, VAS score for pain, or VAS score for shoulder function. The prevalence of rotator cuff tears was not significantly different between the bursectomy group (17%) and acromioplasty group (10%). There were no relevant additional effects of arthroscopic acromioplasty on bursectomy alone with respect to clinical outcomes and rotator cuff integrity at 12 years' follow-up. These findings bring the effectiveness of acromioplasty into question and may support the idea of a more conservative approach in the initial treatment of SAPS. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  19. Assessment of dynamic humeral centering in shoulder pain with impingement syndrome: a randomised clinical trial.

    Science.gov (United States)

    Beaudreuil, Johann; Lasbleiz, Sandra; Richette, Pascal; Seguin, Gérard; Rastel, Christine; Aout, Mounir; Vicaut, Eric; Cohen-Solal, Martine; Lioté, Frédéric; de Vernejoul, Marie-Christine; Bardin, Thomas; Orcel, Philippe

    2011-09-01

    Treatment for degenerative rotator cuff disease of the shoulder includes physiotherapy. Dynamic humeral centering (DHC) aims at preventing subacromial impingement, which contributes to the disease. The goal of this study was to assess the effectiveness of DHC. 69 patients with shoulder pain and impingement syndrome were prospectively included in a single-centre randomised trial with a 12-month follow-up. Patients and assessor were blinded to the study hypothesis and treatment, respectively. DHC and non-specific mobilisation as control were performed for 6 weeks, in 15 supervised individual outpatient sessions, and patients performed daily home exercises. The planned primary outcome was the Constant score including subscores for pain, activity, mobility and strength at 3 months. Secondary outcomes were the Constant score and subscores at 12 months, and medication use for pain at 3 and 12 months. The DHC group did not differ from the control group in the total Constant score at 3 months. However, the DHC group showed a higher Constant subscore for pain (12.2 (SD 2.8) vs 9.9 (2.9), least square means difference 2.1, 95% CI 0.7 to 3.5, p=0.004). At 3 months, the DHC group also showed a higher rate of no medication use (96.7% vs 71%, proportional difference 25.7, 95% CI 3.7 to 51.9, p=0.012). There was no other intergroup difference. There was no difference in the total Constant score between DHC and controls. However, pain was improved at 3 months after DHC. The differences found in subscores for pain should be explored in future studies. Trial registration clinicaltrials.gov Identifier: NCT 01022775.

  20. Shoulder Strength and Physical Activity Predictors of Shoulder Pain in People With Paraplegia From Spinal Injury: Prospective Cohort Study

    Science.gov (United States)

    Hatchett, Patricia; Eberly, Valerie J.; Lighthall Haubert, Lisa; Conners, Sandy; Requejo, Philip S.

    2015-01-01

    Background Shoulder joint pain is a frequent secondary complaint for people following spinal cord injury (SCI). Objective The purpose of this study was to determine predictors of shoulder joint pain in people with paraplegia. Methods/Design A 3-year longitudinal study was conducted. Participants were people with paraplegia who used a manual wheelchair for at least 50% of their mobility and were asymptomatic for shoulder pain at study entry. Participants were classified as having developed shoulder pain if they experienced an increase of ≥10 points on the Wheelchair User's Shoulder Pain Index in the 3-year follow-up period. Measurements of maximal isometric shoulder torques were collected at study entry (baseline), 18 months, and 3 years. Daily activity was measured using a wheelchair odometer, and self-reported daily transfer and raise frequency data were collected by telephone every 6 weeks. Results Two hundred twenty-three participants were enrolled in the study; 39.8% developed shoulder pain over the 3-year follow-up period. Demographic variables and higher activity levels were not associated with shoulder pain onset. Baseline maximal isometric torque (normalized by body weight) in all shoulder muscle groups was 10% to 15% lower in participants who developed shoulder pain compared with those who remained pain-free. Lower shoulder adduction torque was a significant predictor of shoulder pain development (log-likelihood test=11.38), but the model explained only 7.5% of shoulder pain onset and consequently is of limited clinical utility. Limitations Time since SCI varied widely among participants, and transfer and raise activity was measured by participant recall. Conclusions Participants who developed shoulder pain had decreased muscle strength, particularly in the shoulder adductors, and lower levels of physical activity prior to the onset of shoulder pain. Neither factor was a strong predictor of shoulder pain onset. PMID:25721123

  1. Shoulder Strength and Physical Activity Predictors of Shoulder Pain in People With Paraplegia From Spinal Injury: Prospective Cohort Study.

    Science.gov (United States)

    Mulroy, Sara J; Hatchett, Patricia; Eberly, Valerie J; Haubert, Lisa Lighthall; Conners, Sandy; Requejo, Philip S

    2015-07-01

    Shoulder joint pain is a frequent secondary complaint for people following spinal cord injury (SCI). The purpose of this study was to determine predictors of shoulder joint pain in people with paraplegia. A 3-year longitudinal study was conducted. Participants were people with paraplegia who used a manual wheelchair for at least 50% of their mobility and were asymptomatic for shoulder pain at study entry. Participants were classified as having developed shoulder pain if they experienced an increase of ≥10 points on the Wheelchair User's Shoulder Pain Index in the 3-year follow-up period. Measurements of maximal isometric shoulder torques were collected at study entry (baseline), 18 months, and 3 years. Daily activity was measured using a wheelchair odometer, and self-reported daily transfer and raise frequency data were collected by telephone every 6 weeks. Two hundred twenty-three participants were enrolled in the study; 39.8% developed shoulder pain over the 3-year follow-up period. Demographic variables and higher activity levels were not associated with shoulder pain onset. Baseline maximal isometric torque (normalized by body weight) in all shoulder muscle groups was 10% to 15% lower in participants who developed shoulder pain compared with those who remained pain-free. Lower shoulder adduction torque was a significant predictor of shoulder pain development (log-likelihood test=11.38), but the model explained only 7.5% of shoulder pain onset and consequently is of limited clinical utility. Time since SCI varied widely among participants, and transfer and raise activity was measured by participant recall. Participants who developed shoulder pain had decreased muscle strength, particularly in the shoulder adductors, and lower levels of physical activity prior to the onset of shoulder pain. Neither factor was a strong predictor of shoulder pain onset. © 2015 American Physical Therapy Association.

  2. Inflammatory genes and psychological factors predict induced shoulder pain phenotype.

    Science.gov (United States)

    George, Steven Z; Parr, Jeffrey J; Wallace, Margaret R; Wu, Samuel S; Borsa, Paul A; Dai, Yunfeng; Fillingim, Roger B

    2014-10-01

    The pain experience has multiple influences, but little is known about how specific biological and psychological factors interact to influence pain responses. The current study investigated the combined influences of genetic (pro-inflammatory) and psychological factors on several preclinical shoulder pain phenotypes. An exercise-induced shoulder injury model was used, and a priori selected genetic (IL1B, TNF/LTA region, and IL6 single nucleotide polymorphisms (SNP)) and psychological (anxiety, depression symptoms, pain catastrophizing, fear of pain, and kinesiophobia) factors were included as the predictors of interest. The phenotypes were pain intensity (5-d average and peak reported on numerical rating scale), upper extremity disability (5-d average and peak reported on the Quick Disabilities of the Arm, Shoulder and Hand instrument), and duration of shoulder pain (d). After controlling for age, sex, and race, the genetic and psychological predictors were entered separately as main effects and interaction terms in regression models for each pain phenotype. Results from the recruited cohort (n = 190) indicated strong statistical evidence for the interactions between 1) TNF/LTA SNP rs2229094 and depression symptoms for average pain intensity and duration and 2) IL1B two SNP diplotype and kinesiophobia for average shoulder pain intensity. Moderate statistical evidence for prediction of additional shoulder pain phenotypes included interactions of kinesiophobia, fear of pain, or depressive symptoms with TNF/LTA rs2229094 and IL1B. These findings support the combined predictive ability of specific genetic and psychological factors for shoulder pain phenotypes by revealing novel combinations that may merit further investigation in clinical cohorts to determine their involvement in the transition from acute to chronic pain conditions.

  3. Pain management of hemiplegic shoulder pain post stroke in patients from Nanjing, China

    Science.gov (United States)

    Zhu, Yi; Su, Bin; Li, Ning; Jin, Hongzhu

    2013-01-01

    We selected 106 hemiplegic patients with shoulder pain hospitalized after stroke from three hospitals in Nanjing, China between February 2007 and January 2012. All patients had complete clinical data sets and accounted for 45.5% of the inpatients because of stroke. Results showed that the number of patients with hemiplegic shoulder pain post stroke increased yearly, attacking mainly males 50–69 years of age. Of 106 patients, there were 60 cases (56.6%) of adhesive capsulitis, 19 (17.9%) of shoulder subluxation, 14 (13.2%) of complex regional pain syndrome, and 13 (12.6%) of central pain. The main symptoms were shoulder pain (100%), limit of shoulder mobility (98.1%), and adhesion of the scapula (56.6%). MRI of the shoulder showed tendon and ligament lesions (57.1%) and rotator cuff tear (38.1%). 53.8% of central pain was related to the thalamus, in addition to the basal ganglia, brain stem, and cerebellopontine angle. Shoulder pain, upper limb motor function, and function independence were significantly improved after comprehensive rehabilitation. In particular, electroacupuncture based on basic physical therapy exhibited efficacy on shoulder tion and complex regional pain syndrome. Multiple linear regression results showed a negative relationship of efficacy of pain management with the attack period of shoulder pain, involvement of the posterior limb of the internal capsule, and duration between onset and rehabilitation treatment, but a positive correlation with pain-related education, pain regression period, and pain diagnosis. PMID:25206549

  4. Arthroscopic treatment for synovial chondromatosis of the subacromial bursa associated with partial rotator cuff tear.

    Science.gov (United States)

    Xu, Caiqi; Yang, Xingguang; Zhao, Jinzhong

    2015-02-01

    Synovial chondromatosis is characterized by benign synovial proliferation that leads to chondral or osteochondral foci formation. In this case report, a right-handed female suffered from progressively worsening pain and limited mobility of forward elevation, abduction and external rotation in her right shoulder. A shoulder arthroscopy was conducted, during which, thickened bursal synovium and several loose bodies were observed, associated with bursal side tear of rotator cuff. A thorough synovectomy, subacromial debridement and acromioplasty were conducted. The pathological findings were consistent with synovial chondromatosis. After systematic rehabilitation, the patient had relief of shoulder pain and full range of motions in 14-months follow-up. Case report, Level IV.

  5. Protocol for Shoulder function training reducing musculoskeletal pain in shoulder and neck: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Mortensen Ole S

    2011-01-01

    Full Text Available Abstract Background Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use. Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions treated by physical therapists. The exact mechanism of neck pain is rarely revealed by clinical examination and the treatment has varied from passive rest to active treatments. Active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area. Our study investigates the effect of the latter approach. Methods/Design A randomized controlled trial of 10 weeks duration is currently being conducted. Employed office workers with severe neck-shoulder pain are randomized to 3 × 20 min shoulder function training with training supervision or to a reference group receiving advice to stay physically active. Shoulder function training primarily focuses on the serratus anterior and lower trapezius muscle with only minimal activation the upper trapezius. An announcement was sent to the administrative section of the university including jobs characterized by intensive computer work. The first 100 positive replies entered the study. Among these inclusion criteria were pain intensity in the neck/shoulder of at least 3 on a 0-9 scale. Exclusion criteria were cardiovascular disease, trauma, hypertension, or serious chronic disease. Before and after the intervention period the participants replied to a questionnaire about musculoskeletal disorders and work disability, and underwent a standardized clinical examination of the neck and shoulder girdle. Further, on a weekly basis the participants log pain intensity of the neck and shoulder during the previous week. The primary outcome measure is pain in the neck and shoulders at week 10 based on the weekly pain registration and results

  6. EFFECT OF GONG'S MOBILIZATION VERSUS MULLIGAN'S MOBILIZATION ON SHOULDER PAIN AND SHOULDER MEDIAL ROTATION MOBILITY IN FROZEN SHOULDER

    Directory of Open Access Journals (Sweden)

    Jyoti Rinku Dilip

    2016-02-01

    Full Text Available Background: Frozen shoulder is a painful condition with gradual restriction of all planes of movement in the shoulder joint. The purpose of the present study is to evaluate the effect of Gong’s Mobilization versus Mulligan’s Mobilization on Shoulder pain and Shoulder Medial Rotation mobility in subjects with Frozen shoulder. Methods: An Experimental study design, 40 subjects with unilateral frozen shoulder were selected and randomized 20 subjects into each of two groups- Gong’s mobilization and Mulligan’s mobilization respectively. Gong’s group received the Gong’s mobilization technique with conventional therapy while Mulligan’s group received Mulligan’s mobilization along with conventional therapy. The duration of intervention was 5 treatment sessions per week for two weeks. Outcome measures such as shoulder medial rotation was measured using a Goniometer and pain was measured using a VAS scale before and after two weeks of intervention. Results: Analysis using Independent ‘t’ test and Mann Whitney U test found that there is statistically significant difference p<0.000 when pre to post interventions means were compared within the groups. When post intervention means were compared between the Gong’s and Mulligan’s groups there was no statistically significant difference in Active and Passive Range of Shoulder Medial Rotation but there was statistically significant difference in VAS when compared between the groups. Conclusion: It is concluded that both Gong’s mobilization with conventional therapy and Mulligan’s mobilization with conventional therapy are effective in improving Shoulder Medial Rotation Mobility in Frozen Shoulder. However Gong’s mobilization shown greater percentage of effect in reducing pain and Mulligan’s Mobilization shown greater percentage in improving ROM.

  7. [Painful hemiplegic shoulder in stroke patients: causes and management].

    Science.gov (United States)

    Murie-Fernández, M; Carmona Iragui, M; Gnanakumar, V; Meyer, M; Foley, N; Teasell, R

    2012-05-01

    The hemiplegic shoulder pain is common after a stroke. Its appearance brings pain and limits daily living activities as well as participation in specific Neuro-rehabilitation programs. All this leads to a worse functional outcome. Good management of patients can reduce both the frequency and intensity of shoulder pain, improving functional outcome. We conducted a literature search of various databases between 1980 and 2008. The articles were evaluated using the PEDro scoring system. Five evidence levels were established for the conclusions. Shoulder subluxation, occurs at an early stage after stroke and is associated with subluxation of the shoulder joint and spasticity (mainly subscapularis and pectoralis). Slings prevent subluxation of the shoulder. It is preferable to move within a lower range of motion and without aggression to prevent the occurrence of shoulder pain. The injection of corticosteroids does not improve pain and range of motion in hemiplegic patients, while botulinum toxin combined with physical therapy appears to reduce hemiplegic shoulder pain. Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  8. Risk factors for volleyball-related shoulder pain and dysfunction.

    Science.gov (United States)

    Reeser, Jonathan C; Joy, Elizabeth A; Porucznik, Christina A; Berg, Richard L; Colliver, Ethan B; Willick, Stuart E

    2010-01-01

    To identify risk factors for volleyball-related shoulder pain and dysfunction. Cross-sectional, observational. National championship sporting event. Competitors at the 2006 National Intramural & Recreational Sports Association Collegiate Club Volleyball Championship competition were invited to volunteer for the study. A total of 422 athletes returned questionnaires, of whom 276 also underwent a structured physical examination. Study participants provided information on any history of volleyball-related shoulder pain or dysfunction. The simple shoulder test (SST) and a visual analog scale permitted subjects to quantify the extent of their perceived functional limitation. Subjects also were invited to undergo a physical examination in which dynamic scapular positioning, glenohumeral range of motion, shoulder girdle strength, and core stability were assessed. Standard statistical methods of comparison and tests of association were used to identify risk factors for shoulder pain among participating volleyball athletes. Approximately 60% of participants reported a history of shoulder problems. Attackers and "jump" servers were more likely to have shoulder problems than setters, defensive specialists, and "float" servers. Nearly half of the athletes who reported shoulder problems perceived some associated functional limitation, with female athletes providing lower SST scores than male athletes (9.0 versus 10.1, P = .001). Athletes reporting shoulder pain and dysfunction were more likely to have SICK scapula scores of 3 or greater (P = .010). Participants who demonstrated core instability also had greater SICK scapula scores (3.9 versus 2.9, P = .038), and were more likely to report a history of shoulder problems (chi2 = 8.83, P = .032). Although the authors observed a significant mean left-right difference of 8.9 degrees in available glenohumeral internal rotation among participating athletes, this deficit was not associated with shoulder problems. However, there was an

  9. Inflammatory Genes and Psychological Factors Predict Induced Shoulder Pain Phenotype

    Science.gov (United States)

    George, Steven Z.; Parr, Jeffrey J.; Wallace, Margaret R.; Wu, Samuel S.; Borsa, Paul A.; Dai, Yunfeng; Fillingim, Roger B.

    2014-01-01

    Purpose The pain experience has multiple influences but little is known about how specific biological and psychological factors interact to influence pain responses. The current study investigated the combined influences of genetic (pro-inflammatory) and psychological factors on several pre-clinical shoulder pain phenotypes. Methods An exercise-induced shoulder injury model was used, and a priori selected genetic (IL1B, TNF/LTA region, IL6 single nucleotide polymorphisms, SNPs) and psychological (anxiety, depressive symptoms, pain catastrophizing, fear of pain, kinesiophobia) factors were included as the predictors of interest. The phenotypes were pain intensity (5-day average and peak reported on numerical rating scale), upper-extremity disability (5-day average and peak reported on the QuickDASH instrument), and duration of shoulder pain (in days). Results After controlling for age, sex, and race, the genetic and psychological predictors were entered separately as main effects and interaction terms in regression models for each pain phenotype. Results from the recruited cohort (n = 190) indicated strong statistical evidence for the interactions between 1) TNF/LTA SNP rs2229094 and depressive symptoms for average pain intensity and duration and 2) IL1B two-SNP diplotype and kinesiophobia for average shoulder pain intensity. Moderate statistical evidence for prediction of additional shoulder pain phenotypes included interactions of kinesiophobia, fear of pain, or depressive symptoms with TNF/LTA rs2229094 and IL1B. Conclusion These findings support the combined predictive ability of specific genetic and psychological factors for shoulder pain phenotypes by revealing novel combinations that may merit further investigation in clinical cohorts, to determine their involvement in the transition from acute to chronic pain conditions. PMID:24598699

  10. Effects of shoulder stabilization exercise on pain and functional recovery of shoulder impingement syndrome patients.

    Science.gov (United States)

    Park, Sang-In; Choi, Yong-Kyu; Lee, Jung-Ho; Kim, Young-Min

    2013-11-01

    [Purpose] This study examined the effects of scapular stabilization exercises immediately after surgery on pain and function in patients diagnosed with shoulder impingement syndrome. [Subjects] The subjects were assigned by random sampling to an experimental group (n=15) to which stabilization exercise was applied and a control group (n=15) to which ordinary physical treatment was applied. [Methods] To evaluate the degree of pain, a 100 mm visual analogue scale (VAS) was used. The Constant-Murley Scale (CMS) was used to evaluate the functions of the shoulder joints. To determine the range of motion, a goniometer was used to measure range of shoulder motion. The simple shoulder test (SST) was used to determine the condition of the shoulder joints of the subjects. [Results] There were significant differences in all the items of the experimental group. The results of comparison of the therapeutic effect in the experimental and control groups revealed significant differences in active abduction, passive abduction, VAS, SST, and the CMS, except for pain. [Conclusion] The results suggest that shoulder stabilization exercise positively affects pain alleviation and functional recovery in shoulder impingement patients.

  11. Distribution of the axillary nerve to the subacromial bursa and the area around the long head of the biceps tendon.

    Science.gov (United States)

    Nasu, H; Nimura, A; Yamaguchi, K; Akita, K

    2015-09-01

    Patients with a shoulder disorder often complain of pain on the anterior or lateral aspect of the shoulder. Such pain has been thought to originate from the suprascapular nerve. However, taking into consideration the distinctive course of the axillary nerve, the axillary nerve is likely to supply branches to the structure around the shoulder joint. This study was conducted to clarify the division, course, and distribution of the branches which originate from the axillary nerve and innervate structures around the shoulder joint. The division, course, and distribution of the branches which originate from the axillary nerve and innervate structures around the shoulder joint were examined macroscopically by dissecting 20 shoulders of 10 adult Japanese cadavers. The thin branches from the anterior branch of the axillary nerve were distributed to the subacromial bursa and the area around the long head of the biceps tendon. The branches from the main trunk of the axillary nerve or the branch to the teres minor muscle were distributed to the infero-posterior part of the shoulder joint. The pain on the anterior or lateral aspect of the shoulder, which has been thought to originate from the suprascapular nerve, might be related to the thin branches which originate from the axillary nerve and innervate the subacromial bursa and the area around the long head of the biceps tendon. These results would be useful to consider the cause of the shoulder pain or to prevent the residual pain after the biceps tenodesis.

  12. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Donatsky, Anders Meller; Bjerrum, Flemming; Gögenür, Ismayil

    2013-01-01

    BACKGROUND: Laparoscopic cholecystectomy (LC) is the treatment of choice for symptomatic cholecystolithiasis. Despite the many advantages over open surgery, many patients complain about referred pain to the shoulder during the postoperative course. The purpose of this review was to evaluate...... different intraoperative surgical methods to minimize shoulder pain (SP). METHODS: A search of the literature was conducted using PubMed, Excerpta Medica Database (EMBASE), and Cochrane database of systematic reviews. Eligibility criteria were: randomized clinical trials or meta-analysis evaluating...

  13. Effects of manual therapy on shoulder pain in office workers

    OpenAIRE

    Go, Seong-Uk; Lee, Byoung-Hee

    2016-01-01

    [Purpose] The purpose of this study was to determine the effects of manual therapy on shoulder pain in office workers. [Subjects and Methods] Subjects included 38 office workers who were randomly divided into two groups: a manual therapy group of 19 subjects and a shoulder stabilization exercise group of 19 subjects. All subjects underwent evaluation of the pressure pain threshold in the splenius capitis and upper, middle, and lower trapezius muscles on both sides. The manual therapy used in ...

  14. Arthroscopic Resection of The Distal Clavicle With Concomitant Subacromial Decompression: A Case Series

    Directory of Open Access Journals (Sweden)

    HZ Chan

    2014-07-01

    Full Text Available Shoulder impingement syndrome and acromioclavicular joint osteoarthritis often occur simultaneously and easily missed. Kay et al. reported excellent results with combined arthroscopic subacromial decompression and resection of the distal end of the clavicle in patients with both disorders. Arthroscopic treatment of these disorders produces more favourable results than open procedures. We report two patients who were not responding to conservative management and were treated with direct arthroscopic distal clavicle excision and subacromial decompression in single setting. Both patients gained good postoperative outcome in terms of pain score, function and strength improvement assessed objectively with visual analogue score (VAS and University of California Los Angeles Score (UCLA.

  15. Arthroscopic treatment of bony loose bodies in the subacromial space.

    Science.gov (United States)

    Li, Wei; Xiao, De-Ming; Jiang, Chang-Qing; Zhang, Wen-Tao; Lei, Ming

    2015-01-01

    Multiple bony loose bodies in the subacromial space caused form cartilage or bone cells and continue to grow. A 58-year-old man with two-year history of swelling and pain of the right shoulder. He had no history of tuberculosis and rheumatoid arthritis. Magnetic resonance (MR) images showed some bony loose bodies in the subacromial space. The removal of loose bodies and bursa debridement were performed arthroscopically. Histological diagnosis of them was synovitis with fibrous bodies. Extra-articular loose bodies is extremely rare, especially in the subacromial space, which maybe originated in the proliferative synovial bursa. Most authors recommend open removal to relive the pain, but there were choice to apply arthroscopy to remove them. The mechanism of formation of bony loose bodies is not clear, may be associated with synovial cartilage metaplasia. Arthroscopic removal of loose bodies and bursa debridement is a good option for treatment of the loose body in the subacromial space, which can receive good function. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  16. Protocol for Shoulder function training reducing musculoskeletal pain in shoulder and neck: a randomized controlled trial

    DEFF Research Database (Denmark)

    Andersen, Christoffer H; Andersen, Lars L; Mortensen, Ole S

    2011-01-01

    ABSTRACT: BACKGROUND: Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use. Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions...... treated by physical therapists. The exact mechanism of neck pain is rarely revealed by clinical examination and the treatment has varied from passive rest to active treatments. Active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct...... training of the painful area. Our study investigates the effect of the latter approach. METHODS/DESIGN: A randomized controlled trial of 10 weeks duration is currently being conducted. Employed office workers with severe neck-shoulder pain are randomized to 3 × 20 min shoulder function training...

  17. Psychosocial work factors and shoulder pain in hotel room cleaners.

    Science.gov (United States)

    Burgel, Barbara J; White, Mary C; Gillen, Marion; Krause, Niklas

    2010-07-01

    Hotel room cleaners have physically demanding jobs that place them at high risk for shoulder pain. Psychosocial work factors may also play a role in shoulder pain, but their independent role has not been studied in this group. Seventy-four percent (941 of 1,276) of hotel room cleaners from five Las Vegas hotels completed a 29-page survey assessing health status, working conditions, and psychosocial work factors. For this study, 493 of the 941 (52%) with complete data for 21 variables were included in multivariate logistic regression analyses. Fifty-six percent reported shoulder pain in the prior four weeks. Room cleaners with effort-reward imbalance (ERI) were three times as likely to report shoulder pain (OR 2.99, 95% CI 1.95-4.59, P = 0.000) even after adjustment for physical workload and other factors. After adjustment for physical workload, job strain and iso-strain were not significantly associated with shoulder pain. ERI is independently associated with shoulder pain in hotel room cleaners even after adjustment for physical workload and other risk factors. 2010 Wiley-Liss, Inc.

  18. Shoulder pain in primary care: diagnostic accuracy of clinical examination tests for non-traumatic acromioclavicular joint pain.

    Science.gov (United States)

    Cadogan, Angela; McNair, Peter; Laslett, Mark; Hing, Wayne

    2013-05-01

    Despite numerous methodological flaws in previous study designs and the lack of validation in primary care populations, clinical tests for identifying acromioclavicular joint (ACJ) pain are widely utilised without concern for such issues. The aim of this study was to estimate the diagnostic accuracy of traditional ACJ tests and to compare their accuracy with other clinical examination features for identifying a predominant ACJ pain source in a primary care cohort. Consecutive patients with shoulder pain were recruited prospectively from primary health care clinics. Following a standardised clinical examination and diagnostic injection into the subacromial bursa, all participants received a fluoroscopically guided diagnostic block of 1% lidocaine hydrochloride (XylocaineTM) into the ACJ. Diagnostic accuracy statistics including sensitivity, specificity, predictive values, positive and negative likelihood ratios (LR+ and LR-) were calculated for traditional ACJ tests (Active Compression/O'Brien's test, cross-body adduction, localised ACJ tenderness and Hawkins-Kennedy test), and for individual and combinations of clinical examination variables that were associated with a positive anaesthetic response (PAR) (P≤0.05) defined as 80% or more reduction in post-injection pain intensity during provocative clinical tests. Twenty two of 153 participants (14%) reported an 80% PAR. None of the traditional ACJ tests were associated with an 80% PAR (P0.05). Five clinical examination variables (repetitive mechanism of pain onset, no referred pain below the elbow, thickened or swollen ACJ, no symptom provocation during passive glenohumeral abduction and external rotation) were associated with an 80% PAR (Ppain of non-traumatic onset, traditional ACJ tests were of limited diagnostic value. Combinations of other history and physical examination findings were able to more accurately identify injection-confirmed ACJ pain in this cohort.

  19. Painful shoulder? Remote clinical management of a Field Guide with shoulder pain and loss of shoulder function in Antarctica

    Directory of Open Access Journals (Sweden)

    Gareth Jones

    2017-06-01

    Full Text Available We report the case of a female Field Guide based at the British Antarctic Survey’s Rothera Science Research Station on Adelaide Island, Antarctica who independently contacted a physiotherapist specialising in climbing related injuries (GJ located in the UK. for a second opinion. The Field Guide was experiencing significant work difficulties due to shoulder pain and subsequent loss of function particularly in overhead activities. The case raises important issues about the medical management of Field Guides operating in extreme environments and remote locations

  20. Sonography of the painful shoulder: role of the operator's experience

    Energy Technology Data Exchange (ETDEWEB)

    Corroller, Thomas Le; Cohen, Michel; Champsaur, Pierre [Hopital Sainte-Marguerite, Service d' Imagerie Medicale, Marseille (France); Aswad, Richard [Clinique Juge, Service de Chirurgie Orthopedique, Marseille (France); Pauly, Vanessa [Hopital Sainte-Marguerite, D.I.M., Marseille (France)

    2008-11-15

    The aim of our study was to determine the role of the operator's experience in the sonographic evaluation of the painful shoulder and to validate assumptions about its technical performance in routine practice. Two radiologists, respectively standard and expert sonographic operators, independently and prospectively scanned 65 patients with clinical suspicion of rotator cuff lesion. Magnetic resonance arthrography was the reference standard. The sensitivity of the expert ultrasound operator was 95.3% for full-thickness rotator cuff tears (41/43), 70.6% for partial-thickness tears (12/17), 64.3% for intratendinous tears (9/14), 100% for abnormality of the long head of biceps tendon (seven of seven), 88.9% for supraspinatus tendinosis (16/18), 96.4% for subacromial bursa abnormalities (53/55), and 91.7%for acromioclavicular joint osteoarthritis (33/36). The two sonographic operators were in very good agreement about full-thickness rotator cuff tears ({kappa}=0.90), supraspinatus tendinosis ({kappa} =0.80), abnormalities of the long head of biceps tendon ({kappa}=0.84), subacromial bursa abnormalities ({kappa}=0.89), and acromioclavicular osteoarthritis ({kappa}=0.81). The agreement was only moderate for partial-thickness tears ({kappa}=0.63) and intratendinous tears ({kappa}=0.57). Our results show that in moderately experienced hands as in experts' hands, sonography has a low level of interobserver variability for full-thickness rotator cuff tears. Considering partial-thickness and intratendinous rotator cuff tears, our data suggest that interobserver variability is higher. (orig.)

  1. The role of sensitization in musculoskeletal shoulder pain.

    Science.gov (United States)

    Borstad, John; Woeste, Christopher

    2015-01-01

    Peripheral and central sensitization are neurophysiological processes that can prolong painful conditions. Painful shoulder conditions are often persistent, perhaps due to the presence of sensitization. This manuscript summarizes six studies that have evaluated those with musculoskeletal shoulder pain for the presence of sensitization. All six manuscripts report evidence of peripheral sensitization, while central sensitization was described in five of the studies. The chronicity of symptoms in subjects who were included in the studies is probably influencing this finding. The primary somatosensory test used to assess sensitization in these studies was Pressure Pain Threshold, a test for lowered nociceptive thresholds. It appears that peripheral sensitization manifests consistently in those with musculoskeletal shoulder pathology, probably due to the inflammatory processes related to tissue injury. Central sensitization, while not universally present, was reported in a majority of the manuscripts. Because central sensitization is thought to be a key step on the pathway to chronic pain, evidence for its presence in those with shoulder pain is significant. Clinicians should expect the presence of sensitization with shoulder pathology and make appropriate choices about interventions so as not to exacerbate pain.

  2. The role of sensitization in musculoskeletal shoulder pain

    Directory of Open Access Journals (Sweden)

    John Borstad

    2015-08-01

    Full Text Available Introduction: Peripheral and central sensitization are neurophysiological processes that can prolong painful conditions. Painful shoulder conditions are often persistent, perhaps due to the presence of sensitization.Method:This manuscript summarizes six studies that have evaluated those with musculoskeletal shoulder pain for the presence of sensitization.Results:All six manuscripts report evidence of peripheral sensitization, while central sensitization was described in five of the studies. The chronicity of symptoms in subjects who were included in the studies is probably influencing this finding. The primary somatosensory test used to assess sensitization in these studies was Pressure Pain Threshold, a test for lowered nociceptive thresholds.Discussion:It appears that peripheral sensitization manifests consistently in those with musculoskeletal shoulder pathology, probably due to the inflammatory processes related to tissue injury. Central sensitization, while not universally present, was reported in a majority of the manuscripts. Because central sensitization is thought to be a key step on the pathway to chronic pain, evidence for its presence in those with shoulder pain is significant. Clinicians should expect the presence of sensitization with shoulder pathology and make appropriate choices about interventions so as not to exacerbate pain.

  3. Risk factors for shoulder and elbow pain in youth baseball players.

    Science.gov (United States)

    Matsuura, Tetsuya; Iwame, Toshiyuki; Suzue, Naoto; Arisawa, Kokichi; Sairyo, Koichi

    2017-05-01

    This study sought to quantify the 1-year cumulative incidence of shoulder and elbow pain among youth baseball players and identify risk factors associated with the occurrence of shoulder and elbow pain. In total, 900 youth baseball players (aged 7-11 years) were enrolled in a 1-year prospective follow-up study. One year later, the players were asked whether they had experienced episodes of shoulder or elbow pain and the following risk factors for such pain were investigated: age, position, length of baseball experience, training hours per week, and history of shoulder or elbow pain. Data for the groups with and without shoulder or elbow pain were analyzed using multivariate logistic regression models. Episodes of shoulder pain were reported by 18.3% of players and episodes of elbow pain were reported by 35.2% of players. Multivariate analysis showed that shoulder pain was associated with pitcher position, catcher position, longer training hours per week, and history of shoulder and elbow pain, and that elbow pain was associated with age, pitcher position, catcher position, longer training hours per week, and history of elbow pain. Length of baseball experience was not associated with shoulder or elbow pain. History of elbow pain, pitcher position, catcher position, and longer training hours per week were associated with both types of pain. History of shoulder pain was associated with shoulder pain but not elbow pain. Age was associated with elbow pain but not shoulder pain.

  4. Efficacy and safety of a subacromial continuous ropivacaine infusion for post-operative pain management following arthroscopic rotator cuff surgery: A protocol for a randomised double-blind placebo-controlled trial

    Directory of Open Access Journals (Sweden)

    Bell Simon N

    2008-04-01

    Full Text Available Abstract Background Major shoulder surgery often results in severe post-operative pain and a variety of interventions have been developed in an attempt to address this. The continuous slow infusion of a local anaesthetic directly into the operative site has recently gained popularity but it is expensive and as yet there is little conclusive evidence that it provides additional benefits over other methods of post-operative pain management. Methods/Design This will be a randomised, placebo-controlled trial involving 158 participants. Following diagnostic arthroscopy, all participants will undergo arthroscopic subacromial decompression with or without rotator cuff repair, all operations performed by a single surgeon. Participants, the surgeon, nurses caring for the patients and outcome assessors will be blinded to treatment allocation. All participants will receive a pre-incision bolus injection of 20 mls of ropivacaine 1% into the shoulder and an intra-operative intravenous bolus of parecoxib 40 mg. Using concealed allocation participants will be randomly assigned to active treatment (local anaesthetic ropivacaine 0.75% or placebo (normal saline administered continuously into the subacromial space by an elastomeric pump at 5 mls per hour post-operatively. Patient controlled opioid analgesia and oral analgesics will be available for breakthrough pain. Outcome assessment will be at 15, 30 and 60 minutes, 2, 4, 8, 12, 18 and 24 hours, and 2 or 4 months for decompression or decompression plus repair respectively. The primary end point will be average pain at rest over the first 12-hour post-operative period on a verbal analogue pain score. Secondary end points will be average pain at rest over the second 12-hour post-operative period, maximal pain at rest over the first and second 12-hour periods, amount of rescue medication used, length of inpatient stay and incidence of post-operative adhesive capsulitis. Discussion The results of this trial will

  5. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain

    Science.gov (United States)

    2011-01-01

    Background Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment. The pathophysiological mechanisms of shoulder pain are poorly understood. Furthermore, there is little evidence supporting the effectiveness of current treatment protocols. Although myofascial trigger points (MTrPs) are rarely mentioned in relation to shoulder pain, they may present an alternative underlying mechanism, which would provide new treatment targets through MTrP inactivation. While previous research has demonstrated that trained physiotherapists can reliably identify MTrPs in patients with shoulder pain, the percentage of patients who actually have MTrPs remains unclear. The aim of this observational study was to assess the prevalence of muscles with MTrPs and the association between MTrPs and the severity of pain and functioning in patients with chronic non-traumatic unilateral shoulder pain. Methods An observational study was conducted. Subjects were recruited from patients participating in a controlled trial studying the effectiveness of physical therapy on patients with unilateral non-traumatic shoulder pain. Sociodemographic and patient-reported symptom scores, including the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, and Visual Analogue Scales for Pain were compared with other studies. To test for differences in age, gender distribution, and education level between the current study population and the populations from Dutch shoulder studies, the one sample T-test was used. One observer examined all subjects (n = 72) for the presence of MTrPs. Frequency distributions, means, medians, standard deviations, and 95% confidence intervals were calculated for descriptive purposes. The Spearman's rank-order correlation (ρ) was used to test for association between variables. Results MTrPs were identified in all subjects. The median number of muscles with MTrPs per subject was 6 (active MTrPs) and 4 (latent MTr

  6. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain.

    Science.gov (United States)

    Bron, Carel; Dommerholt, Jan; Stegenga, Boudewijn; Wensing, Michel; Oostendorp, Rob A B

    2011-06-28

    Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment. The pathophysiological mechanisms of shoulder pain are poorly understood. Furthermore, there is little evidence supporting the effectiveness of current treatment protocols. Although myofascial trigger points (MTrPs) are rarely mentioned in relation to shoulder pain, they may present an alternative underlying mechanism, which would provide new treatment targets through MTrP inactivation. While previous research has demonstrated that trained physiotherapists can reliably identify MTrPs in patients with shoulder pain, the percentage of patients who actually have MTrPs remains unclear. The aim of this observational study was to assess the prevalence of muscles with MTrPs and the association between MTrPs and the severity of pain and functioning in patients with chronic non-traumatic unilateral shoulder pain. An observational study was conducted. Subjects were recruited from patients participating in a controlled trial studying the effectiveness of physical therapy on patients with unilateral non-traumatic shoulder pain. Sociodemographic and patient-reported symptom scores, including the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, and Visual Analogue Scales for Pain were compared with other studies. To test for differences in age, gender distribution, and education level between the current study population and the populations from Dutch shoulder studies, the one sample T-test was used. One observer examined all subjects (n = 72) for the presence of MTrPs. Frequency distributions, means, medians, standard deviations, and 95% confidence intervals were calculated for descriptive purposes. The Spearman's rank-order correlation (ρ) was used to test for association between variables. MTrPs were identified in all subjects. The median number of muscles with MTrPs per subject was 6 (active MTrPs) and 4 (latent MTrPs). Active MTrPs were most

  7. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain

    Directory of Open Access Journals (Sweden)

    Wensing Michel

    2011-06-01

    Full Text Available Abstract Background Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment. The pathophysiological mechanisms of shoulder pain are poorly understood. Furthermore, there is little evidence supporting the effectiveness of current treatment protocols. Although myofascial trigger points (MTrPs are rarely mentioned in relation to shoulder pain, they may present an alternative underlying mechanism, which would provide new treatment targets through MTrP inactivation. While previous research has demonstrated that trained physiotherapists can reliably identify MTrPs in patients with shoulder pain, the percentage of patients who actually have MTrPs remains unclear. The aim of this observational study was to assess the prevalence of muscles with MTrPs and the association between MTrPs and the severity of pain and functioning in patients with chronic non-traumatic unilateral shoulder pain. Methods An observational study was conducted. Subjects were recruited from patients participating in a controlled trial studying the effectiveness of physical therapy on patients with unilateral non-traumatic shoulder pain. Sociodemographic and patient-reported symptom scores, including the Disabilities of the Arm, Shoulder, and Hand (DASH Questionnaire, and Visual Analogue Scales for Pain were compared with other studies. To test for differences in age, gender distribution, and education level between the current study population and the populations from Dutch shoulder studies, the one sample T-test was used. One observer examined all subjects (n = 72 for the presence of MTrPs. Frequency distributions, means, medians, standard deviations, and 95% confidence intervals were calculated for descriptive purposes. The Spearman's rank-order correlation (ρ was used to test for association between variables. Results MTrPs were identified in all subjects. The median number of muscles with MTrPs per subject was 6 (active

  8. Coracoid syndrome: a neglected cause of anterior shoulder pain.

    Science.gov (United States)

    Gigante, Antonio; Bottegoni, Carlo; Barbadoro, Pamela

    2016-01-01

    the present prospective open-label study was designed to gain further insights into a condition thought to constitute a neglected but not uncommon syndrome characterized by anterior shoulder pain and tenderness to palpation over the apex of the coracoid process, not related to rotator cuff or pectoralis minor tendinopathy, long head of the biceps tendon disorders, or instability. The aim was to clarify its prevalence, clinical characteristics, differential diagnosis and response to corticosteroid injections. patients with primary anterior shoulder pain precisely reproduced by deep pressure on the apex of the coracoid process were recruited. Patients with clinical or instrumental signs of other shoulder disorders were excluded. Patients were given an injection of triamcinolone acetonide 40 mg/ml 1 ml at the coracoid trigger point. They were evaluated after 15, 30 and 60 days and at 2 years using Equal Visual Analog Scale (EQ-VAS) and the Italian version of the Simple Shoulder Test (SST). between January 1 and December 31 2010, we treated 15 patients aged 26-66 years. The majority were women (86.67%). At 15 days, 6 (40%) patients reported complete resolution of their symptoms, while 9 (60%) complained of residual symptoms and received another injection. At 30 days, 14 (93.33%) patients were pain-free and very satisfied. At 2 years, the 14 patients who had been asymptomatic at 30 days reported that they had experienced no further pain or impaired shoulder function. The analysis of variance for repeated measures showed a significant effect of time on EQ-VAS and SST scores. the present study documents the existence, and characteristics, of a "coracoid syndrome" characterized by anterior shoulder pain and tenderness to palpation over the apex of the coracoid process and showed that the pain is usually amenable to steroid treatment. This syndrome should be clearly distinguished from anterior shoulder pain due to other causes, in order to avoid inappropriate conservative

  9. [New options in the treatment of painful shoulder syndrome].

    Science.gov (United States)

    Esparza Miñana, J M; Londoño Parra, M; Villanueva Pérez, V L; De Andrés Ibáñez, J

    2012-01-01

    Shoulder pain is a common complaint in clinical practice in Primary Care and affects 20% of the general population. The usual form of treatment is based on NSAIDs, rest, rehabilitation and, as an alternative, a local injection into the joint. There are also radiofrequency techniques on the suprascapular nerve in the cases of refractory pain to these therapies. Radiofrequency can be used in two ways: Conventional Radiofrequency, using high temperatures to the target tissue with the aim of producing a thermal neurolysis and Pulsed Radiofrequency where the temperatures are lower and produces a temporary non-destructive blockage; the latter being the most common technique in the management of shoulder pain. Although the analgesic mechanism of action of Radiofrequency is unknown, recent studies have shown that it is safe, effective and Lasting. Radiofrequency of the suprascapular nerve is a valid, effective and with few complications in the treatment of shoulder pain refractory to other therapies.

  10. A little-known cause of painful shoulder: os acromiale

    Energy Technology Data Exchange (ETDEWEB)

    Granieri, G.F.; Bacarini, L. [Dipartimento di Radiologia Clinica, Ospedale Regionale, Treviso (Italy)

    1998-02-01

    The incidental discovery of an `os acromiale` might explain some cases of `painful shoulder`: this is what we have observed in three patients. The purpose of our article is to underline the relevance of the axillary roentgenogram of the shoulder for the correct diagnosis of this anomaly. In all patients the radiographic examination was performed using a computed radiography system; moreover we performed a computed tomographic examination of the acromioclavicular portion of the shoulders with three-dimensional reconstructions. (orig.) With 3 figs., 6 refs.

  11. [Evaluation of ear acupressure on painful shoulder syndrome: case study].

    Science.gov (United States)

    Zanelatto, Ana Paula

    2013-01-01

    The Painful Shoulder Syndrome (PSS) is defined as pain and functional limitation resulting from impairment of static and dynamic structures of the shoulder, such as ligaments, capsule and muscles. It is one of the most common and disabling of the musculoskeletal system in the general population with prevalence estimated between 15-25%. This study aimed to evaluate the results of auricular acupressure when used as therapy in the treatment of chronic pain secondary to SOD, and the analgesic effect and therapeutic satisfactory and the estimated time of treatment. To obtain the objective was to perform a case study was to intervene with auricular acupressure beads and crystals as an indicator of the outcome questionnaire Penn Shoulder Score (PSS - Brazil). Data were analyzed qualitatively and quantitatively. We conclude that auriculotherapy is an important therapeutic technique, because the study showed an improvement in the total score of the PSS - Brazil at 34.3%.

  12. [Implementation of preoperative physiotherapy and recovery after shoulder impingement surgery].

    Science.gov (United States)

    Vuorenmaa, Mirja; Häkkinen, Arja; Paloneva, Juha; Kiviranta, Ilkka; Kautiainen, Hannu; Marjo, Oikari; Ylinen, Jari

    2011-01-01

    Subacromial impingement syndrome is a common orthopedic condition. Patients operated due to shoulder impingement (n=104) were sent a questionnaire inquiring rehabilitation procedures before and after surgery, pain and shoulder function. Response rate was 68%, mean age of the patients was 53 years. Before surgery, 50% of the patients had received physiotherapy. The symptoms disappeared after surgery in the majority of the patients. However, 13% of the patients had significant shoulder pain (VAS over 30 mm) one year postoperatively and 15% had considerable functional deficit. To avoid unnecessary operations for shoulder impingement proper conservative treatment must be provided before surgery.

  13. The Effect of the Modified Lateral Suprascapular Block on Shoulder Function in Patients With Chronic Shoulder Pain.

    Science.gov (United States)

    Dorn, Christian; Rumpold-Seitlinger, Gudrun; Farzi, Sylvia; Auer, Johann; Bornemann-Cimenti, Helmar

    2015-12-01

    Suprascapular nerve block (SSNB) is commonly used in pain therapy for patients with chronic shoulder pain. The effect of SSNB on shoulder function has, however, not been investigated so far. If in shoulder function, i.e. the range of motion is increased after application of the nerve block, it can be expected that subsequent physiotherapy, besides being less painful, is also more effective in terms of restoring shoulder mobility. Our aim was to evaluate the effect of SSNB on shoulder function, in patients with chronic shoulder pain. Patients were evaluated using the Constant-Murley Score (CMS) and number rating scale values for pain. The SSN was blocked using the Feigl approach, with 5 ml ropivacaine 0.5%. Shoulder function and pain were assessed 60 minutes and 24 hours after the block. Totally, 20 patients completed the study. The CMS and pain scores significantly improved after the block. The use of the modified lateral SSNB of Feigl significantly reduces pain and increases shoulder function, in chronic shoulder pain.

  14. The immediate effects of diacutaneous fibrolysis on pain and mobility in patients suffering from painful shoulder: a randomized placebo-controlled pilot study.

    Science.gov (United States)

    Barra, M E; López, C; Fernández, G; Murillo, E; Villar, E; Raya, L

    2011-04-01

    To describe the immediate effects of diacutaneous fibrolysis on pain and mobility in patients suffering from painful shoulder, and to assess the ability of the placebo technique to blind participants to group allocation. A double-blind before-after randomized placebo-controlled pilot study. Two public centres of Primary Health Care of the Spanish National Health System. Fifty patients (29 women, 21 men) with a diagnosis of painful shoulder of subacromial origin were included. Participants were randomly allocated to one of two groups. The intervention group (N = 25) was actually treated with diacutaneous fibrolysis, while the placebo group (N = 25) was treated with placebo diacutaneous fibrolysis. Active range of motion (flexion, abduction, extension, external and internal rotation) and pain intensity in the hand-behind-back position were measured. Participants were also asked about their perception in terms of comfort of the technique and results obtained. Between-groups differences were significant in flexion (mean 11.4 degrees; 95% confidence interval (CI) 5.7-17.1), abduction (mean 7.2 degrees; 95% CI 2.0-12.5) and internal rotation movements (mean 3.1 cm; 95% CI 0.1-6.1). There were no significant differences between groups in pain intensity, extension or external rotation movements. The placebo technique showed its ability to blind participants to group allocation. None of the participants suffered any adverse effects from diacutaneous fibrolysis. Diacutaneous fibrolysis may be an effective and safe therapeutic option to improve active range of motion in patients suffering from painful shoulder.

  15. Obesity-Related Adipokines Predict Patient-Reported Shoulder Pain

    Directory of Open Access Journals (Sweden)

    Rajiv Gandhi

    2013-12-01

    Full Text Available Background/Aims: Increasingly, an inflammatory modulating effect of adipokines within synovial joints is being recognized. To date, there has been no work examining a potential association between the presence of adipokines in the shoulder and patient-reported outcomes. This study undertakes an investigation assessing these potential links. Methods: 50 osteoarthritis patients scheduled for shoulder surgery completed a pre-surgery questionnaire capturing demographic information including validated, patient-reported function (Disabilities of the Arm, Shoulder, and Hand questionnaire and pain (Short Form McGill Pain Questionnaire measures. Synovial fluid (SF samples were analyzed for leptin, adiponectin, and resistin levels using Milliplex MAP assays. Linear regression modeling was used to assess the association between adipokine levels and patient-reported outcomes, adjusted for age, sex, BMI, and disease severity. Results: 54% of the cohort was female (n = 27. The mean age (SD of the sample was 62.9 (9.9 years and the mean BMI (SD was 28.1 (5.4 kg/m2. From regression analyses, greater SF leptin and adiponectin levels, but not regarding resistin, were found to be associated with greater pain (p Conclusions: The identified association between shoulder-derived SF leptin and adiponectin and shoulder pain is likely explained by the pro-inflammatory characteristics of the adipokines and represents potentially important therapeutic targets.

  16. Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials.

    Science.gov (United States)

    Haik, M N; Alburquerque-Sendín, F; Moreira, R F C; Pires, E D; Camargo, P R

    2016-09-01

    To summarise the current evidence regarding the effectiveness of physical therapy on pain, function and range of motion in individuals with subacromial pain syndrome (SAPS). Systematic review. PubMed, Web of Science, CINAHL, Cochrane, Embase, Lilacs, Ibecs and Scielo databases. Randomised controlled trials (RCTs) investigating physical therapy modalities for SAPS on pain, function/disability or range of motion were included. 64 high-quality RCTs were included. Exercise therapy provided high evidence of being as effective as surgery intervention and better than no treatment or placebo treatment to improve pain, function and range of motion in the short, mid and long terms. The combination of mobilisation and exercises provided high evidence to decrease pain and improve function in the short term. There is limited evidence for improvements on the outcomes with the isolated application of manual therapy. High level of evidence was synthesised regarding the lack of beneficial effects of physical resources such as low-level laser, ultrasound and pulsed electromagnetic field (PEMF) on pain, function or range of motion in the treatment of SAPS. There is limited evidence for microwave diathermy and transcutaneous electrical nerve stimulation. There is moderate evidence to no benefits with taping in the short term. Effects of diacutaneous fibrolysis and acupuncture are not well established yet. Exercise therapy should be the first-line treatment to improve pain, function and range of motion. The addition of mobilisations to exercises may accelerate reduction of pain in the short term. Low-level laser therapy, PEMF and taping should not be recommended. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. Optimism Moderates the Influence of Pain Catastrophizing on Shoulder Pain Outcome: A Longitudinal Analysis.

    Science.gov (United States)

    Coronado, Rogelio A; Simon, Corey B; Lentz, Trevor A; Gay, Charles W; Mackie, Lauren N; George, Steven Z

    2017-01-01

    Study Design Secondary analysis of prospectively collected data. Background An abundance of evidence has highlighted the influence of pain catastrophizing and fear avoidance on clinical outcomes. Less is known about the interaction of positive psychological resources with these pain-associated distress factors. Objective To assess whether optimism moderates the influence of pain catastrophizing and fear avoidance on 3-month clinical outcomes in patients with shoulder pain. Methods Data from 63 individuals with shoulder pain (mean ± SD age, 38.8 ± 14.9 years; 30 female) were examined. Demographic, psychological, and clinical characteristics were obtained at baseline. Validated measures were used to assess optimism (Life Orientation Test-Revised), pain catastrophizing (Pain Catastrophizing Scale), fear avoidance (Fear-Avoidance Beliefs Questionnaire physical activity subscale), shoulder pain intensity (Brief Pain Inventory), and shoulder function (Pennsylvania Shoulder Score function subscale). Shoulder pain and function were reassessed at 3 months. Regression models assessed the influence of (1) pain catastrophizing and optimism and (2) fear avoidance and optimism. The final multivariable models controlled for factors of age, sex, education, and baseline scores, and included 3-month pain intensity and function as separate dependent variables. Results Shoulder pain (mean difference, -1.6; 95% confidence interval [CI]: -2.1, -1.2) and function (mean difference, 2.4; 95% CI: 0.3, 4.4) improved over 3 months. In multivariable analyses, there was an interaction between pain catastrophizing and optimism (β = 0.19; 95% CI: 0.02, 0.35) for predicting 3-month shoulder function (F = 16.8, R2 = 0.69, Poptimism lessened the influence of pain catastrophizing on function. There was no evidence of significant moderation of fear-avoidance beliefs for 3-month shoulder pain (P = .090) or function (P = .092). Conclusion Optimism decreased the negative influence of pain

  18. Force steadiness, muscle activity, and maximal muscle strength in subjects with subacromial impingement syndrome.

    Science.gov (United States)

    Bandholm, Thomas; Rasmussen, Lars; Aagaard, Per; Jensen, Bente Rona; Diederichsen, Louise

    2006-11-01

    We investigated the effects of the subacromial impingement syndrome (SIS) on shoulder sensory-motor control and maximal shoulder muscle strength. It was hypothesized that both would be impaired due to chronic shoulder pain associated with the syndrome. Nine subjects with unilateral SIS who remained physically active in spite of shoulder pain and nine healthy matched controls were examined to determine isometric and isokinetic submaximal shoulder-abduction force steadiness at target forces corresponding to 20%, 27.5%, and 35% of the maximal shoulder abductor torque, and maximal shoulder muscle strength (MVC). Electromyographic (EMG) activity was assessed using surface and intramuscular recordings from eight shoulder muscles. Force steadiness was impaired in SIS subjects during concentric contractions at the highest target force level only, with muscle activity largely unaffected. No between-group differences in shoulder MVC were observed. The present data suggest that shoulder sensory-motor control is only mildly impaired in subjects with SIS who are able to continue with upper body physical activity in spite of shoulder pain. Thus, physical activity should be continued by patients with SIS, if possible, to avoid the loss in neural and muscle functions associated with inactivity.

  19. Risk of surgery for subacromial impingement syndrome in relation to neck-shoulder complaints and occupational biomechanical exposures

    DEFF Research Database (Denmark)

    Svendsen, Susanne Wulff; Dalbøge, Annett; Andersen, JH

    2013-01-01

    at the Danish Ramazzini Centre. We linked baseline questionnaire information from 1993-2004 on neck-shoulder complaints, job titles, psychosocial work factors, body mass index, and smoking with register information on first-time surgery for SIS from 1996-2008. Biomechanical exposure measures were obtained from...

  20. Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial

    OpenAIRE

    Stegenga Boudewijn; Dommerholt Jan; de Gast Arthur; Bron Carel; Wensing Michel; Oostendorp Rob AB

    2011-01-01

    Abstract Background Shoulder pain is a common musculoskeletal problem that is often chronic or recurrent. Myofascial trigger points (MTrPs) cause shoulder pain and are prevalent in patients with shoulder pain. However, few studies have focused on MTrP therapy. The aim of this study was to assess the effectiveness of multimodal treatment of MTrPs in patients with chronic shoulder pain. Methods A single-assessor, blinded, randomized, controlled trial was conducted. The intervention group receiv...

  1. Shoulder pain and concomitant hand oedema among stroke patients with pronounced arm paresis

    Science.gov (United States)

    2013-01-01

    Background The aim of this prospective study was to identify clinical factors associated with the development of shoulder pain in stroke patients with pronounced arm paresis. Methods At stroke onset, 485 patients were initially assessed in 2007–2009. Sixty-three patients with pronounced arm paresis completed the study, and 21 of these developed shoulder pain. Clinical findings were recorded fortnightly by the attending physiotherapist during hospital stay. Results Hand oedema on the paretic side was more common in patients developing shoulder pain compared with those who did not develop shoulder pain. The onset of shoulder pain was associated with concomitant hand oedema. High NIHSS score was associated with developing shoulder pain. Patients with a history of shoulder pain developed pain earlier than those without previous shoulder pain. Patients with haemorrhagic stroke were significantly more prone to developing shoulder pain. Conclusions One-third of the stroke patients with pronounced arm paresis developed shoulder pain. Concomitant hand oedema seems to be an additional symptom of shoulder injury. Patients with low general status are more vulnerable to develop post-stroke shoulder pain. PMID:24765589

  2. Shoulder pain and concomitant hand oedema among stroke patients with pronounced arm paresis.

    Science.gov (United States)

    Isaksson, Mats; Johansson, Lars; Olofsson, Ingrid; Eurenius, Eva

    2013-12-01

    The aim of this prospective study was to identify clinical factors associated with the development of shoulder pain in stroke patients with pronounced arm paresis. At stroke onset, 485 patients were initially assessed in 2007-2009. Sixty-three patients with pronounced arm paresis completed the study, and 21 of these developed shoulder pain. Clinical findings were recorded fortnightly by the attending physiotherapist during hospital stay. Hand oedema on the paretic side was more common in patients developing shoulder pain compared with those who did not develop shoulder pain. The onset of shoulder pain was associated with concomitant hand oedema. High NIHSS score was associated with developing shoulder pain. Patients with a history of shoulder pain developed pain earlier than those without previous shoulder pain. Patients with haemorrhagic stroke were significantly more prone to developing shoulder pain. One-third of the stroke patients with pronounced arm paresis developed shoulder pain. Concomitant hand oedema seems to be an additional symptom of shoulder injury. Patients with low general status are more vulnerable to develop post-stroke shoulder pain.

  3. Treatment of myofascial trigger points in patients with chronic shoulder pain : a randomized, controlled trial

    NARCIS (Netherlands)

    Bron, Carel; de Gast, Arthur; Dommerholt, Jan; Stegenga, Boudewijn; Wensing, Michel; Oostendorp, Rob A. B.

    2011-01-01

    Background: Shoulder pain is a common musculoskeletal problem that is often chronic or recurrent. Myofascial trigger points (MTrPs) cause shoulder pain and are prevalent in patients with shoulder pain. However, few studies have focused on MTrP therapy. The aim of this study was to assess the

  4. Effects of Proprioceptive Neuromuscular Facilitation and Mulligan Concepts on the Pain, Functional Level and Quality of Life on Subacromial Impingement Syndrome

    OpenAIRE

    Karaku?, Sinem; Gelecek, Nihal; Ye?ilyaprak, Sevgi Sevi

    2014-01-01

    Objectives: The purpose of the study was to investigate the effects of Proprioceptif Neuromuscular Facilitation (PNF) and Mulligan concepts on the pain, functional level and quality of life in the patients with subacromial impingement syndrome (SIS). Methods: This study was carried out on 40 patients (26 females, 14 males), mean age 50,3?1,13 years, who had been diagnosed as SIS admitted to the physical therapy and rehabilitation clinic. Before the beginning measurements all the patients were...

  5. Quadrilateral space syndrome: a rare cause of shoulder pain.

    Science.gov (United States)

    Cormier, P J; Matalon, T A; Wolin, P M

    1988-06-01

    The authors report a case of quadrilateral space syndrome in a baseball pitcher. The diagnosis was made by means of subclavian arteriography performed with the arm in abduction and external rotation. This entity is a rare cause of shoulder pain caused by occlusion of the posterior humeral circumflex artery in the quadrilateral space.

  6. Calcifying supracoracoid bursitis as a cause of chronic shoulder pain.

    Science.gov (United States)

    Mens, J; van der Korst, J K

    1984-01-01

    A case of chronic shoulder pain is reported with marked limitation of both active and passive elevations and a normal range of motion of the glenohumeral joint. X-ray examination demonstrated cloudy calcification in the coracoclavicular region, presumably indicating calcifying supracoracoid bursitis. Images PMID:6497468

  7. Effects of manual therapy on shoulder pain in office workers.

    Science.gov (United States)

    Go, Seong-Uk; Lee, Byoung-Hee

    2016-09-01

    [Purpose] The purpose of this study was to determine the effects of manual therapy on shoulder pain in office workers. [Subjects and Methods] Subjects included 38 office workers who were randomly divided into two groups: a manual therapy group of 19 subjects and a shoulder stabilization exercise group of 19 subjects. All subjects underwent evaluation of the pressure pain threshold in the splenius capitis and upper, middle, and lower trapezius muscles on both sides. The manual therapy used in the study was designed to include soft-tissue mobilization, prone thoracic mobilization, prone selected thoracic mobilization, cervical mobilization, and thoracic manipulation. Both groups underwent training of two 40-minute sessions per week for 6 weeks. [Results] After the intervention, both groups showed significantly increased pressure pain thresholds in the splenius capitis and upper, middle, and lower trapezius muscles on both sides. The manual therapy group showed greater improvements than did the shoulder stabilization exercise group in the splenius capitis on both sides, left upper trapezius, middle trapezius on both sides, and right lower trapezius. [Conclusion] The results of this study suggest that manual therapy for shoulder pain is feasible and suitable for office workers and may be useful in clinical rehabilitation.

  8. A prospective study of shoulder pain in primary care: Prevalence of imaged pathology and response to guided diagnostic blocks

    Directory of Open Access Journals (Sweden)

    McNair Peter J

    2011-05-01

    Full Text Available Abstract Background The prevalence of imaged pathology in primary care has received little attention and the relevance of identified pathology to symptoms remains unclear. This paper reports the prevalence of imaged pathology and the association between pathology and response to diagnostic blocks into the subacromial bursa (SAB, acromioclavicular joint (ACJ and glenohumeral joint (GHJ. Methods Consecutive patients with shoulder pain recruited from primary care underwent standardised x-ray, diagnostic ultrasound scan and diagnostic injections of local anaesthetic into the SAB and ACJ. Subjects who reported less than 80% reduction in pain following either of these injections were referred for a magnetic resonance arthrogram (MRA and GHJ diagnostic block. Differences in proportions of positive and negative imaging findings in the anaesthetic response groups were assessed using Fishers test and odds ratios were calculated a for positive anaesthetic response (PAR to diagnostic blocks. Results In the 208 subjects recruited, the rotator cuff and SAB displayed the highest prevalence of pathology on both ultrasound (50% and 31% respectively and MRA (65% and 76% respectively. The prevalence of PAR following SAB injection was 34% and ACJ injection 14%. Of the 59% reporting a negative anaesthetic response (NAR for both of these injections, 16% demonstrated a PAR to GHJ injection. A full thickness tear of supraspinatus on ultrasound was associated with PAR to SAB injection (OR 5.02; p p p p ≤ 0.05. Conclusions Rotator cuff and SAB pathology were the most common findings on ultrasound and MRA. Evidence of a full thickness supraspinatus tear was associated with symptoms arising from the subacromial region, and a biceps tendon sheath effusion and an intact rotator cuff were associated with an intra-articular GHJ pain source. When combined with clinical information, these results may help guide diagnostic decision making in primary care.

  9. Biomechanical measures in participants with shoulder pain: Intra-rater reliability.

    Science.gov (United States)

    Michener, Lori A; Elmore, Kevin A; Darter, Benjamin J; Timmons, Mark K

    2016-04-01

    Biomechanical measures are used to characterize the mechanisms of treatment for shoulder pain. The objective was to characterize test-retest reliability and measurement error of shoulder surface electromyographic(sEMG) and kinematic measures. Individuals(n = 12) with subacromial pain syndrome were tested at 2 visits. Five repetitions of shoulder scapular plane elevation were performed while collecting sEMG of the upper trapezius(UT), middle trapezius(MT), lower trapezius(LT), serratus anterior(SA) middle-deltoid, and infraspinatus muscles during ascending and descending phases. Simultaneously, electromagnetic sensors measured 3-dimensional kinematics of scapular internal/external rotation, upward/downward rotation, posterior/anterior tilt, and clavicular elevation/depression and clavicular protraction/retraction. Kinematic and sEMG variables were reduced for the total phase of ascending and descending elevation (30°-120°, 120°-30°), at 30° intervals for sEMG, and at every 30° discrete kinematic angle. The intraclass correlation coefficients(ICC) ranged from 0.08 to 0.99 for sEMG and 0.23-0.95 for kinematics. Correspondingly, the standard error of the measurement(SEM) and minimal detectable change(MDC) for sEMG measures varied from 2.3% to 103.8% of a reference contraction(REF-contraction). For kinematics, the SEM and MDC varied from 1.4° to 5.9°. Between-day reliability was good to very good, except for scapular internal/external rotation kinematics, and sEMG for the LT, UT, and SA. sEMG error values were highest (>25%REF-contraction) for most of the LT, UT, and SA variables. Kinematic error values indicate changes or differences of 2°-3° are meaningful, except for upward/downward rotation and internal/external rotation with MDCs of 4°-6°. Generally, data from the total phase of movement had better reliability and lower error than the data from sEMG interval or kinematic discrete angles. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Acromioclavicular osteoarthritis: a common cause of shoulder pain.

    Science.gov (United States)

    Menge, Travis J; Boykin, Robert E; Bushnell, Brandon D; Byram, Ian R

    2014-05-01

    Osteoarthritis of the acromioclavicular joint is a frequent cause of shoulder pain and can result in significant debilitation. It is the most common disorder of the acromioclavicular joint and may arise from a number of pathologic processes, including primary (degenerative), posttraumatic, inflammatory, and septic arthritis. Patients often present with nonspecific complaints of pain located in the neck, shoulder, and/or arm, further complicating the clinical picture. A thorough understanding of the pertinent anatomy, disease process, patient history, and physical examination is crucial to making the correct diagnosis and formulating a treatment plan. Initial nonoperative management is aimed at relieving pain and restoring function. Typical treatments include anti-inflammatory medications, physical therapy, and injections. Patients who continue to exhibit symptoms after appropriate nonsurgical treatment may be candidates for operative resection of the distal clavicle through either open or arthroscopic techniques.

  11. Validity of an Alternate Hand Behind Back Shoulder Range of Motion Measurement in Patients With Shoulder Pain and Movement Dysfunction.

    Science.gov (United States)

    Satpute, Kiran H; Hall, Toby; Adanani, Aditi

    2018-02-23

    The purpose of this study was to determine the criterion-related validity of a novel method of measuring hand behind back (HBB) shoulder range of motion (ROM) for evaluating pain and disability in people with shoulder pain and movement impairment. This cross-sectional study design evaluated shoulder ROM, pain, fear-avoidance beliefs, and disability in 60 people (aged 35-70 years, 31 male) with chronic unilateral shoulder dysfunction (mean duration 15.73 weeks). Shoulder HBB ROM was measured with a bubble inclinometer in a manner that did not require the patient to disrobe. Correlations were sought between HBB ROM and other shoulder movements, as well as scores recorded on the Shoulder Pain and Disability Index (SPADI), visual analogue scale for pain, Fear Avoidance Beliefs Questionnaire (FABQ), and duration of symptoms. Restriction of HBB movement was significantly correlated with SPADI total disability score (r = 0.39, P shoulder movements. These findings suggest that this novel method of measuring HBB ROM could be used as a functional outcome measure in the evaluation of patients with shoulder disorders. This method could be considered as an additional or alternative where there are challenges in measuring HBB because of restrictions in undressing a patient, such as for cultural reasons. Copyright © 2018. Published by Elsevier Inc.

  12. Evidence that central sensitisation is present in patients with shoulder impingement syndrome and influences the outcome after surgery.

    Science.gov (United States)

    Gwilym, S E; Oag, H C L; Tracey, I; Carr, A J

    2011-04-01

    Impingement syndrome in the shoulder has generally been considered to be a clinical condition of mechanical origin. However, anomalies exist between the pathology in the subacromial space and the degree of pain experienced. These may be explained by variations in the processing of nociceptive inputs between different patients. We investigated the evidence for augmented pain transmission (central sensitisation) in patients with impingement, and the relationship between pre-operative central sensitisation and the outcomes following arthroscopic subacromial decompression. We recruited 17 patients with unilateral impingement of the shoulder and 17 age- and gender-matched controls, all of whom underwent quantitative sensory testing to detect thresholds for mechanical stimuli, distinctions between sharp and blunt punctate stimuli, and heat pain. Additionally Oxford shoulder scores to assess pain and function, and PainDETECT questionnaires to identify 'neuropathic' and referred symptoms were completed. Patients completed these questionnaires pre-operatively and three months post-operatively. A significant proportion of patients awaiting subacromial decompression had referred pain radiating down the arm and had significant hyperalgesia to punctate stimulus of the skin compared with controls (unpaired t-test, p shoulder pain associated with impingement. Also, if patients had relatively high levels of central sensitisation pre-operatively, as indicated by higher levels of punctate hyperalgesia and/or referred pain, the outcome three months after subacromial decompression was significantly worse.

  13. Comparison of shoulder rotation range of motion in professional tennis players with and without history of shoulder pain.

    Science.gov (United States)

    Moreno-Pérez, Victor; Moreside, Janice; Barbado, David; Vera-Garcia, Francisco J

    2015-04-01

    A glenohumeral internal rotation deficit of the dominant shoulder relative to the non-dominant shoulder (GIRD) is considered a risk factor for shoulder injury in overhead athletes. The aim of this study was to investigate whether professional tennis players with a history of self-reported shoulder pain show differences in rotation range of motion (ROM) of the dominant and non-dominant shoulder compared to asymptomatic controls. Forty-seven professional tennis players belonging to the Association of Tennis Professionals World Tour took part in the study: 19 with shoulder pain history and 28 without. Passive shoulder ROM was measured using a process of photography and software calculation of angles. The dominant shoulder had reduced internal rotation (IR) ROM and total rotation ROM, and increased external rotation (ER) ROM compared to the non-dominant side. These differences did not correlate significantly with years of tennis practice, years of professional play, nor the players' age. However, glenohumeral rotation ROMs correlated negatively with the duration of tennis practice and players' age. Although tennis players with shoulder pain history showed less IR ROM in both shoulders compared with the no-pain group, no significant differences between groups were found for ER ROM, side-to-side ROM asymmetries, years of tennis practice or years of professional play. In professional tennis players, limited IR ROM rather than a GIRD, seems to be associated with shoulder pain history, duration of tennis practice and the players' age, when compared to a similar cohort with no history of shoulder pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Comparison of risk factors for shoulder pain and rotator cuff syndrome in the working population.

    Science.gov (United States)

    Bodin, Julie; Ha, Catherine; Chastang, Jean-François; Descatha, Alexis; Leclerc, Annette; Goldberg, Marcel; Imbernon, Ellen; Roquelaure, Yves

    2012-07-01

    To compare risk factors for shoulder pain without and with rotator cuff syndrome (RCS). A total of 3,710 workers of a French region were randomly included in the cross-sectional study between 2002 and 2005. Personal and occupational risk factors were assessed during a physical examination and by a self-administered questionnaire. Multinomial logistic modeling was used for the following outcomes: no shoulder pain and no RCS (reference), shoulder pain without RCS (called "shoulder pain") and RCS, separately for men and women. The prevalence rates of "shoulder pain" for men and women were 28.0% and 31.1%, respectively, and the prevalence rates of RCS were 6.6% and 8.5%, respectively. In men, "shoulder pain" and RCS were associated with age, high-perceived physical exertion, and arm abduction. Automatic work pace and low supervisor support were associated with "shoulder pain," and high psychological demand and low skill discretion with RCS. In women, "shoulder pain" and RCS were associated with age, repetitiveness of tasks, and low supervisor support. High perceived physical exertion and exposure to cold temperatures were associated with "shoulder pain." Age was more strongly associated with RCS than with shoulder pain without RCS for both genders. Biomechanical and psychosocial factors were associated with "shoulder pain" and RCS and differed between genders. Copyright © 2011 Wiley Periodicals, Inc.

  15. Dynamic enhanced MRI of the subacromial bursa: correlation with arthroscopic and histological findings

    Energy Technology Data Exchange (ETDEWEB)

    Matsuzaki, S. [Dept. of Radiology, Osaka Kosei-nenkin Hospital (Japan); Yoneda, M. [Shoulder and Sports Medicine Service, Osaka Kosei-nenkin Hospital, Osaka City, Osaka (Japan); Kobayashi, Y. [Dept. of Pathology, Osaka Kosei-nenkin Hospital (Japan); Fukushima, S. [Dept. of Orthopaedic Surgery, Sapporo Tokeidai Hospital, Osaka (Japan); Wakitani, S. [Dept. of Orthopaedic Surgery, Shinsyu Univ., Matsumato (Japan)

    2003-09-01

    Objective: To assess dynamic MRI with Gd-DTPA enhancement for evaluating inflammatory changes in the subacromial bursa. Design and patients: We detected the signal intensity changes in dynamic MRI of the subacromial bursa, and confirmed these macroscopically by arthroscopy and histologically. The signal intensity was measured using built-in software, and the enhancement ratio (E ratio) was calculated from dynamic MR images. In addition, as a parameter of the rate of the increase in the signal intensity from 0 to 80 s, the mean increase per second in the E ratio was obtained as the coefficient of enhancement (CE). The correlation was studied of the E ratio and CE with the arthroscopic findings (redness, villous formation, thickening and adhesion), and of the E ratio and CE with the histological findings (capillary proliferation, papillary hyperplasia, fibrosis and inflammatory cell infiltration) of the subacromial bursa. Of patients with shoulder pain, this study included those with rotator cuff injury; patients with rheumatoid arthritis or pitching shoulder disorders were excluded. There were 27 patients (15 men, 12 women) ranging in age from 25 to 73 years (mean 49.1 years). Dynamic MRI of the shoulder was also performed on the healthy side of 10 patients and in five normal young volunteers. Results and conclusions: Changes in signal intensity on dynamic MRI were measured in the subacromial bursa. The E ratio (80 s) and CE (0-80 s) were significantly correlated with redness and villous formation as arthroscopic findings, positively correlated with capillary proliferation and papillary hyperplasia as histological findings (p < 0.05), and negatively correlated with fibrosis as a histological finding (p < 0.05) in the subacromial bursa. The patterns of dynamic curves were well correlated with the bursoscopic and histological findings of the synovium of the subacromial bursa. Dynamic MRI appears to correlate with inflammatory activity of synovium of the subacromial

  16. [Effectiveness of physiotherapy on painful shoulder impingement syndrome].

    Science.gov (United States)

    Gomora-García, Mónica; Rojano-Mejía, David; Solis-Hernández, José Luis; Escamilla-Chávez, Carolina

    2016-01-01

    Painful shoulder impingement syndrome is one of the first reasons for care in rehabilitation centres. As the evidence regarding the effectiveness of physical measures as adjuvant treatment is limited, the aim of this study was to determine the effectiveness of physiotherapy on shoulder pain. A retrospective and analytical study was conducted using the medical records of patients with shoulder pain who attended in a rehabilitation centre from October 2010 to September 2011. The demographic and clinical data were collected, and the clinical improvement was determined as: complete, incomplete, or no improvement. Chi squared was used to determine whether there were differences between the different modalities of physiotherapy, as well as the level of improvement. The study included a total of 181 patients, with a mean age of 54.3 years, and a mean of 4.6 months of onset of pain. The physiotherapy treatments included: warm compresses plus interferential current (60.2%), and warm compresses plus ultrasound (17.1%). Just over half (53.6%) obtained a moderate recovery, 36.4% slight improvement, and 9.9% no improvement. No significant differences were found between the different forms of therapy. The supervised rehabilitation program consists of 9 sessions of physiotherapy. A functional improvement of 90% was obtained, without finding any statistical differences between the therapies used. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  17. Experimental Pain Responses Support Peripheral and Central Sensitization in Patients with Unilateral Shoulder Pain

    Science.gov (United States)

    Coronado, Rogelio A.; Simon, Corey B.; Valencia, Carolina; George, Steven Z.

    2013-01-01

    Objective The aims of this study were to 1) examine the pattern of experimental pain responses in the affected and non-affected extremities in patients with shoulder pain and 2) explore the intra-individual association between sensitization states derived from experimental pain testing. Methods Experimental pain responses from 58 patients with shoulder pain (17 females, ages 18 to 52) were compared to those from 56 age- and sex-matched healthy volunteers (16 females, ages 21 to 58). Experimental pain responses included pressure pain threshold (PPT), thermal pain threshold and tolerance, and suprathreshold heat pain response (SHPR). Comparisons were made between the affected and non-affected extremity of clinical participants and the average response of extremities in healthy participants. Peripheral and central sensitization indexes were computed for clinical participants using standardized scores and percentile cut-offs based on the data from the healthy control sample. Experimental pain responses in clinical participants observed beyond the 25th and 75th percentile of healthy control sample responses were used for investigation of intra-individual association of sensitization states. Results PPT on the affected side acromion and masseter of clinical participants were diminished compared to their non-affected side (p shoulder pain present with variable patterns of peripheral and central sensitization. Conclusions Collectively, experimental pain responses supported peripheral and central sensitization in response to pressure and thermal stimuli. No clear association was made between individuals exhibiting peripheral or central sensitization and suggests heterogeneity in pain processing in this clinical population. PMID:23619203

  18. Shoulder orthoses for the prevention and reduction of hemiplegic shoulder pain and subluxation: systematic review.

    Science.gov (United States)

    Nadler, M; Pauls, Mmh

    2017-04-01

    To determine whether shoulder orthoses prevent or reduce gleno-humeral subluxation and hemiplegic shoulder pain. OVID SP, MEDLINE, AMED, CINAHL, PEDro and the Cochrane Central Register of Controlled Trials. We included: randomised or quasi-randomised controlled trials, controlled before and after studies and observational studies. Two reviewers independently screened, critically appraised papers using the PEDro tool, and extracted data. A descriptive synthesis was performed as there were insufficient data for meta-analysis. Eight studies were included, totalling 186 participants: One randomised controlled trial with 41 participants, one quasi-randomised with 14 participants, one before and after controlled study with 40 participants and five observational studies with 91 participants met the inclusion criteria. Findings suggest that applying an orthosis to an already subluxed shoulder immediately reduced vertical subluxation on X-ray but improvements were not maintained when orthosis was removed. Orthoses with both proximal and distal attachments improved shoulder pain in the majority of stroke patients when worn for four weeks (starting several days or weeks post-stroke). There was no increase in adverse effects of contracture, spasticity or hand oedema when compared to no orthosis. Orthoses were generally well-tolerated and most patients rated the orthosis as comfortable to wear. Observational studies suggest that orthoses reduce vertical subluxation whilst in-situ. Available evidence from heterogeneous studies after stroke suggests that orthoses may reduce pain and are well-tolerated with prolonged use. No studies have tested whether subluxation and pain can be prevented by immediate post-stroke application of orthoses.

  19. Dominant vs. non-dominant shoulder morphology in volleyball players and associations with shoulder pain and spike speed.

    Science.gov (United States)

    Challoumas, Dimitrios; Artemiou, Andreas; Dimitrakakis, Georgios

    2017-01-01

    The aims of our study were to compare the dominant (DOM) and non-dominant (NDOM) shoulders of high-level volleyball athletes and identify possible associations of shoulder adaptations with spike speed (SS) and shoulder pathology. A total of 22 male volleyball players from two teams participating in the first division of the Cypriot championship underwent clinical shoulder tests and simple measurements around their shoulder girdle joints bilaterally. SS was measured with the use of a sports speed radar. Compared with the NDOM side, the DOM scapula was more lateralised, the DOM dorsal capsule demonstrated greater laxity, the DOM dorsal muscles stretching ability was compromised, and the DOM pectoralis muscle was more lengthened. Players with present or past DOM shoulder pain demonstrated greater laxity in their DOM dorsal capsule, tightening of their DOM inferior capsule, and lower SS compared with those without shoulder pain. Dorsal capsule measurements bilaterally were significant predictors of SS. None of the shoulder measurements was associated with team roles or infraspinatus atrophy, while scapular lateralisation was more pronounced with increasing years of experience, and scapular antetilting was greater with increasing age. Adaptations of the DOM shoulder may be linked to pathology and performance. We describe simple shoulder measurements that may have the potential to predict chronic shoulder injury and become part of injury prevention programmes. Detailed biomechanical and large prospective studies are warranted to assess the validity of our findings and reach more definitive conclusions.

  20. Two Cases of Subacromial Bursitis with Many Loose Bodies as a Cause of Rheumatoid Arthritis

    OpenAIRE

    砂川, 融; 杉村, 功; 堀, 司郎; 村岡, 博; 有田, 淳

    1989-01-01

    Rice bodies caused by T.B. and R.A. in joints are relatively common and reported, but in bursa are rare. We experienced two cases of subacromial bursitis with many rice bodies :one is a 53-year-old female and the other is a 62-year-old male. They were suffering from rheumatoid arthritis for years, and complained of swelling of the shoulder joint, but had no pain and no remarkable limitation of range of motion of the shoulder joint. We resected the bursa containing a lot of rice bodies operati...

  1. Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain

    DEFF Research Database (Denmark)

    Andersen, Lars L; Hansen, Klaus; Mortensen, Ole S

    2011-01-01

    Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults...... with nonspecific neck/shoulder pain....

  2. Incidence of shoulder pain after neck dissection: a clinical explorative study for risk factors

    NARCIS (Netherlands)

    Dijkstra, P. U.; van Wilgen, P. C.; Buijs, R. P.; Brendeke, W.; de Goede, C. J.; Kerst, A.; Koolstra, M.; Marinus, J.; Schoppink, E. M.; Stuiver, M. M.; van de Velde, C. F.; Roodenburg, J. L.

    2001-01-01

    It is the purpose of this study to determine the incidence of shoulder pain and restricted range of motion of the shoulder after neck dissection, and to identify risk factors for the development of shoulder pain and restricted range of motion. Clinical patients who underwent a neck dissection

  3. Incidence of shoulder pain after neck dissection : A clinical explorative study for risk factors

    NARCIS (Netherlands)

    Dijkstra, PU; van Wilgen, PC; Brendeke, W; de Goede, CJT; Kerst, A; Koolstra, M; Marinus, J; Schoppink, EM; Stuiver, MM; van de Velde, CF; Roodenburg, JLN

    2001-01-01

    Background. It is the purpose of this study to determine the incidence of shoulder pain and restricted range of motion of the shoulder after neck dissection, and to identify risk factors for the development of shoulder pain and restricted range of motion. Methods. Clinical patients who underwent a

  4. RE: Underlying Pathology and Associated Factors of Hemiplegic Shoulder Pain (Letter to the Editor)

    NARCIS (Netherlands)

    Roosink, M.; Renzenbrink, Gerbert J.; Geurts, Alexander C.H.; IJzerman, Maarten Joost

    Poststroke shoulder pain or hemiplegic shoulder pain (HSP) is a complex type of pain that has been the topic of many literature reviews. Traditionally, HSP is viewed as a nociceptive pain. Nonetheless, both the clinical features and the underlying mechanisms may show similarities to other types of

  5. [Shoulder pain as the first sign of disseminated lung cancer].

    Science.gov (United States)

    Stenqvist, Charlotte; Majed, Ahmad

    2013-01-28

    The diagnosis of non-small cell lung cancer is in 50% of the cases not made until the metastatic stage. Distant metastases commonly involve the adrenal glands, the liver, the bones and the central nervous system. Metastases are very rarely seen in skeletal muscles. We report a case with a 47-year-old man, who suffered from strong pain in his right shoulder. The symptoms turned out to be the initial presentation of a disseminated lung cancer. A magnetic resonance scan showed skeletal muscle metastases to m. subscapularis and m. infraspinatus. Metastases to skeletal muscles are rare but should be kept in mind as part of the differential diagnosis in cases where atypical shoulder pain is the only symptom.

  6. Shoulder Pain and Cycle to Cycle Kinematic Spatial Variability during Recovery Phase in Manual Wheelchair Users: A Pilot Investigation

    OpenAIRE

    Jayaraman, Chandrasekaran; Moon, Yaejin; Rice, Ian M.; Hsiao Wecksler, Elizabeth T.; Beck, Carolyn L.; Sosnoff, Jacob J.

    2014-01-01

    Wheelchair propulsion plays a significant role in the development of shoulder pain in manual wheelchair users (MWU). However wheelchair propulsion metrics related to shoulder pain are not clearly understood. This investigation examined intra-individual kinematic spatial variability during semi-circular wheelchair propulsion as a function of shoulder pain in MWU. Data from 10 experienced adult MWU with spinal cord injury (5 with shoulder pain; 5 without shoulder pain) were analyzed in this stu...

  7. Chronic shoulder pain in the community: a syndrome of disability or distress?

    OpenAIRE

    Badcock, L; Lewis, M.; Hay, E; McCarney, R; Croft, P

    2002-01-01

    Objectives: To investigate two questions in a community based population of people with chronic shoulder pain. Firstly, does chronic pain lead to impaired psychological health over time? Secondly, how does restriction of daily activity influence pain perception and psychological health?

  8. Periarthritis of the shoulder-MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Hirano, Mako; Nomura, Kazutoshi; Hashimoto, Noburo; Fukumoto, Tetsuya; Oshima, Suguru; Katahira, Kazuhiro [Kumamoto National Hospital (Japan)

    1997-09-01

    We examined MRI findings in patients with periarthritis of the shoulder. We excluded cuff tears, calcified tendinitis, instability of the shoulder, fracture and impingement syndrome of young patients. Subjects comprised 36 cases, 38 shoulders (25 men and 11 women), with an average age of 59.1 years (42-75). Scanning was performed on a Gyroscan T5-II 0.5-T (Philips). T1-weighted and T2-weighted sequences in the coronal oblique plane, T2-weighted sequences in the coronal sagittal plane and horizontal plane were taken. Twelve shoulders showed some change in the humeral heads. Degeneration of the rotator cuff was observed in 15 shoulders. Joint fluid collection was observed in the gleno-humeral joints of 15 shoulders, in the subacromial bursa of 11 shoulders and in the acromio-clavicular joints of 7 shoulders. Twenty four shoulders had fluid collection in the sheath of the long head of the biceps long tendon. Localized high signal area was observed around the inferior pouch in 11 shoulders. We studied the relationship between MRI findings and clinical symptoms. There was no significant relationship but the shoulders with night pain and severe contractures had a higher positive rate of joint fluid collection on MRI than the shoulders without night pain and with less contractures. (author)

  9. Computer mouse use predicts acute pain but not prolonged or chronic pain in the neck and shoulder

    DEFF Research Database (Denmark)

    Gerster, Mette; Grimstrup, S; Lassen, C F

    2008-01-01

    BACKGROUND: Computer use may have an adverse effect on musculoskeletal outcomes. This study assessed the risk of neck and shoulder pain associated with objectively recorded professional computer use. METHODS: A computer programme was used to collect data on mouse and keyboard usage and weekly...... not influence reports of acute or prolonged pain. A few psychosocial factors predicted the risk of prolonged pain. CONCLUSIONS: Most computer workers have no or minor neck and shoulder pain, few experience prolonged pain, and even fewer, chronic neck and shoulder pain. Moreover, there seems...... followed by three consecutive weeks with a high pain score); and (3) chronic pain (reported pain or discomfort lasting more than 30 days and "quite a lot of trouble" during the past 12 months). RESULTS: Risk for acute neck pain and shoulder pain increased linearly by 4% and 10%, respectively, for each...

  10. Preoperative physical therapy treatment did not influence postoperative pain and disability outcomes in patients undergoing shoulder arthroscopy: a prospective study

    Directory of Open Access Journals (Sweden)

    Valencia C

    2016-07-01

    contrast, age, pain intensity, disability, and pain-associated psychological factors did not differ between pre-op PT treatment groups (P>0.05. Subacromial bursectomies were more commonly performed in patients having pre-op PT treatment (P<0.05. Pre-op PT treatment did not influence length of post-op PT treatment and did not affect 3-month and 6-month pain intensity and disability outcomes. Differences in distribution of pre-op PT for males and females and subacromial bursectomy did not influence 3-month or 6-month postsurgical outcomes. Conclusion: Receiving pre-op PT treatment did not influence post-op PT treatment or pain and disability outcomes at 3 months and 6 months. This prospective cohort study provides no evidence of benefit for pre-op PT on post-op PT treatment or postsurgical outcomes. Females or patients receiving certain surgical procedures are more likely to undergo pre-op PT treatment. However, these differences did not influence postoperative outcomes in this cohort. Keywords: preoperative physical therapy, postoperative pain, postoperative disability, shoulder arthroscopy

  11. The cost of shoulder pain at work : variation in work tasks and good job opportunities are essential for prevention

    NARCIS (Netherlands)

    Bongers, P.M.

    2001-01-01

    Shoulder pain is widespread and imposes a considerable burden on the affected person and society. Women seem to have more shoulder problems than men, and the frequency of shoulder pain increases with age. Smoking and previous trauma are associated with shoulder pain. A recent systematic review of

  12. Case study of physiotherapy treatment of a patient after arthroscopic for subacromial decompression

    OpenAIRE

    Hiršová, Pavlína

    2013-01-01

    Title: Case study of physiotherapy treatment of a patient after arthroscopic for subacromial decompression The objective of this bachelor thesis is introduction with theme of physiotherapy of shoulder joint after arthroscopy for subacromial decompression. The thesis is divided in two main parts. The first (general) part describes anatomy, kinesiology and biomechanics of shoulder girdle briefly. There is also the reference of pathology in subacromial space and arthroscopic method description. ...

  13. The clinical and sonographic effects of kinesiotaping and exercise in comparison with manual therapy and exercise for patients with subacromial impingement syndrome: a preliminary trial.

    Science.gov (United States)

    Kaya, Derya Ozer; Baltaci, Gul; Toprak, Ugur; Atay, Ahmet Ozgur

    2014-01-01

    The purpose of this study was to compare the effects of manual therapy with exercise to kinesiotaping with exercise for patients with subacromial impingement syndrome. Randomized clinical before and after trial was used. Fifty-four patients diagnosed as having subacromial impingement syndrome who were referred for outpatient treatment were included. Eligible patients (between 30 and 60 years old, with unilateral shoulder pain) were randomly allocated to 2 study groups: kinesiotaping with exercise (n = 28) or manual therapy with exercise (n = 26). In addition, patients were advised to use cold packs 5 times per day to control for pain. Visual analog scale for pain, Disability of Arm and Shoulder Questionnaire for function, and diagnostic ultrasound assessment for supraspinatus tendon thickness were used as main outcome measures. Assessments were applied at the baseline and after completing 6 weeks of related interventions. At the baseline, there was no difference between the 2 group characteristics (P > .05). There were significant differences in both groups before and after treatment in terms of pain decrease and improvement of Disability of Arm and Shoulder Questionnaire scores (P .05). The only difference between the groups was at night pain, resulting in favor of the kinesiotaping with exercise group (P < .05). For the group of subjects studied, no differences were found between kinesiotaping with exercise and manual therapy with exercise. Both treatments may have similar results in reducing pain and disability in subacromial impingement in 6 weeks. Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  14. The Responsiveness and Interpretability of the Shoulder Pain and Disability Index

    NARCIS (Netherlands)

    Thoomes-de Graaf, Marloes; Scholten-Peeters, Wendy; Duijn, Edwin; Karel, Yasmaine; de Vet, Henrica C W; Koes, Bart; Verhagen, Arianne

    2017-01-01

    Study Design Clinical measurement study; prospective cohort design. Background Shoulder pain is a common disorder and treatment is most often focused on a reduction of pain and functional disabilities. Several reviews have encouraged the use of the Shoulder Pain and Disability Index (SPADI) to

  15. Posterior instability of the shoulder with secondary impingement in elite golfers.

    Science.gov (United States)

    Hovis, W David; Dean, Mark T; Mallon, William J; Hawkins, Richard J

    2002-01-01

    Shoulder injuries in golf are related to the biomechanics of the golf swing and typically occur in the lead arm at the top of the back swing. We report a newly recognized entity in a series of elite golfers: posterior glenohumeral instability associated with subacromial impingement. Retrospective review. Eight elite golfers were treated between March 1991 and July 1998 for pain occurring in the nondominant, lead shoulder at the top of the back swing. Posterior instability was diagnosed in all eight patients; six of the eight also demonstrated signs of subacromial impingement. Initial treatment consisted of rehabilitation. For patients in whom rehabilitation failed, surgery was performed. Two patients improved with nonoperative treatment and returned to play immediately. Six patients underwent shoulder arthroscopy with posterior thermal capsulorrhaphy. Four of the six also underwent arthroscopic subacromial decompression. The six surgically treated patients returned to play at an average 4 months after surgery. At an average 4.5 years of follow-up, all eight patients were playing at their previous level of competitive play. One patient had complications that led to the need for subsequent arthroscopic subacromial decompression; she eventually returned to competitive play. Clinicians should be aware of posterior shoulder instability and the associated secondary diagnosis of rotator cuff impingement as a possible cause of shoulder pain in elite golfers.

  16. Shoulder pain -- a common problem in world-class badminton players.

    Science.gov (United States)

    Fahlström, Martin; Yeap, Joo Seng; Alfredson, Håkan; Söderman, Kerstin

    2006-06-01

    Badminton is a sport that requires a lot of over-shoulder motion, with the shoulder in abduction/external rotation. This questionnaire study on 188 international top-level badminton players during the World Mixed Team Championships showed that previous or present shoulder pain on the dominant side was reported by 52% of the players. Previous shoulder pain was reported by 37% of the players and on-going shoulder pain by 20% of the players. There were no significant differences in the prevalence of shoulder pain between men and women. The majority of the shoulder pain had started gradually. The pain was usually associated with shoulder activity, and stiffness was a common, associated symptom. Furthermore, the shoulder pain was associated with consequences such as sleeping disturbances, changes in training and competition habits, and it also affected activities of daily living. The majority of the players had sought medical advice and had been given different kinds of treatment. The study showed that shoulder pain is a common and significant problem in world-class badminton players, and the consequences are most likely of importance for their training and playing capacity.

  17. A manual physical therapy approach versus subacromial corticosteroid injection for treatment of shoulder impingement syndrome: a protocol for a randomised clinical trial

    Science.gov (United States)

    Boyles, Robert E; Cleland, Joshua A; Brown, David L

    2011-01-01

    Introduction Corticosteroid injections (CSI) are a recommended and often-used first-line intervention for shoulder impingement syndrome (SIS) in primary care and orthopaedic settings. Manual physical therapy (MPT) offers a non-invasive approach with negligible risk for managing SIS. There is limited evidence to suggest significant long-term improvements in pain, strength and disability with the use of MPT, and there are conflicting reports from systematic reviews that question the long-term efficacy of CSI. Specifically, the primary objective is to compare the effect of CSI and MPT on pain and disability in subjects with SIS at 12 months. Design This pragmatic randomised clinical trial will be a mixed-model 2×5 factorial design. The independent variables are treatment (MPT and CSI) and time with five levels from baseline to 1 year. The primary dependent variable is the Shoulder Pain and Disability Index, and the secondary outcome measures are the Global Rating of Change and the Numeric Pain Rating Scale. For each ANOVA, the hypothesis of interest will be the two-way group-by-time interaction. Methods and analysis The authors plan to recruit 104 participants meeting established impingement criteria. Following examination and enrolment, eligible participants will be randomly allocated to receive a pragmatic approach of either CSI or MPT. The MPT intervention will consist of six sessions, and the CSI intervention will consist of one to three sessions. All subjects will continue to receive usual care. Subjects will be followed for 12 months. Dissemination and ethics The protocol was approved by the Madigan Army Medical Center Institutional Review Board. The results may have an impact on clinical practice guidelines. This study was funded in part by the Orthopaedic Physical Therapy Products Grant through the American Academy of Orthopaedic Manual Physical Therapists. Trial Registration http://clinicaltrials.gov/ NCT01190891. PMID:22021870

  18. Suprascapular block in the therapy of chronic pain in the shoulder and the shoulder joint: Suprascapular block

    Directory of Open Access Journals (Sweden)

    Palibrk Ivan

    2016-01-01

    Full Text Available Introduction: Chronic pain in the shoulder and the shoulder joint is a very common pathology in modern human population. The etiology of chronic pain is often unknown, although the trauma, degenerative diseases, inflammation, tumors and neurological disease appear as common etiologic factors. Patients with this pain had a significantly reduced quality of life.1,2 Method: During the two years, twelve patients diagnosed painful shoulder syndrome. Eleven of the twelve patients involved in the study had started physical therapy. Under the physical treatment pain intensity decreased, but not completely. Hand had reduced mobility. We applied a suprascapular block. We used 1 ml (7 mg betamethasone. Results: Suprascapular block was applied to the eleven patients in physical therapy. After three days of application, the pain was significantly reduced, by 50% in seven patients. Mobility of the hand was greatly improved. In three of the remaining four patients the block was repeated after one month. The pain was significantly smaller after that. Physical therapy is done all the time. Conclusion: The treatment of chronic pain in the shoulder and the shoulder joint is multidisciplinary. In some cases, the use of corticosteroids suprascapular block is very useful.

  19. Prevalence of shoulder pain in Swedish flatwater kayakers and its relation to range of motion and scapula stability of the shoulder joint.

    Science.gov (United States)

    Johansson, Anette; Svantesson, Ulla; Tannerstedt, Jörgen; Alricsson, Marie

    2016-01-01

    Few studies have investigated the incidence of injuries in kayakers. The aim was to study the prevalence of shoulder pain in competitive flatwater kayakers and to evaluate any differences in range of motion or scapula stability of the shoulder joint among kayakers with or without the history of shoulder pain. Thirty-one kayakers were participated in the study, and a questionnaire including background data was used. Shoulder range of motion was measured with a goniometer, and the participants were observed for scapula dyskinesis in flexion and abduction. Of the participating kayakers, 54.8% (n = 17) had experienced shoulder pain. Kayakers who had experienced shoulder pain showed a significantly lower degree of internal rotational range of motion versus kayakers with no reported shoulder pain, with a mean degree of internal rotation in the right shoulder 49.3 vs. 60.0 (P = 0.017) and the left shoulder 51.9 vs. 66.0 (P = 0.000). Kayakers who had experienced shoulder pain were also observed with a scapular dyskinesis (n = 15 of 17 kayakers) to a significantly higher degree (P = 0.001) than kayakers with no reported shoulder pain. Findings suggest that screening for scapular dyskinesis and testing for rotational range of motion in the shoulder joint is essential in order to treat and maybe prevent shoulder pain in kayakers.

  20. Adhesion of the subacromial bursa may cause subacromial impingement in patients with rotator cuff tears: pressure measurements in 18 patients.

    Science.gov (United States)

    Machida, Akitoshi; Sugamoto, Kazuomi; Miyamoto, Takashi; Inui, Hiroaki; Watanabe, Tetsu; Yoshikawa, Hideki

    2004-02-01

    In order to determine whether adhesion of the subacromial bursa leads to impingement, we measured the subacromial contact pressures before and after release of adhesion of this bursa. 18 shoulders with cuff tears and adhesion of the subacromial bursa were evaluated in 8 male and 10 female patients, of mean age 62 (53-71) years and who had no particular limitation of shoulder motion. We recorded subacromial pressures using a very sensitive film inserted under the acromion during surgery. In passive scapular plane elevation (scaption) at 100 degrees, the mean subacromial contact pressure and area declined from 1.43 (SD 0.23) MPa before release to 1.14 (SD 0.35) MPa after release (p bursa increases impingement between the acromion and the insertion of rotator cuff tendons.

  1. Motion and Pain Relief Remain 23 Years After Manipulation Under Anesthesia for Frozen Shoulder

    National Research Council Canada - National Science Library

    Vastamäki, Heidi; Vastamäki, Martti

    2013-01-01

    Manipulation under anesthesia (MUA) as treatment for idiopathic frozen shoulder increases motion, provides pain relief, and restores function, but it is unclear whether the improvements persist long...

  2. Effect of Targeted Strength, Endurance, and Coordination Exercise on Neck and Shoulder Pain Among Fighter Pilots

    DEFF Research Database (Denmark)

    Lange, Britt; Toft, Palle; Myburgh, Corrie

    2013-01-01

    : To explore in Danish F-16 pilots: (1) the effect on neck and shoulder pain of a 24-week training intervention including targeted training of the deep neck muscles; (2) selected clinical signs and symptoms at baseline; (3) the prevalence and intensity of neck and shoulder pain.......: To explore in Danish F-16 pilots: (1) the effect on neck and shoulder pain of a 24-week training intervention including targeted training of the deep neck muscles; (2) selected clinical signs and symptoms at baseline; (3) the prevalence and intensity of neck and shoulder pain....

  3. Pain management of hemiplegic shoulder pain post stroke in patients from Nanjing, China

    OpenAIRE

    Zhu, Yi; Su, Bin; Li, Ning; Jin, Hongzhu

    2013-01-01

    We selected 106 hemiplegic patients with shoulder pain hospitalized after stroke from three hospitals in Nanjing, China between February 2007 and January 2012. All patients had complete clinical data sets and accounted for 45.5% of the inpatients because of stroke. Results showed that the number of patients with hemiplegic shoulder pain post stroke increased yearly, attacking mainly males 50–69 years of age. Of 106 patients, there were 60 cases (56.6%) of adhesive capsulitis, 19 (17.9%) of sh...

  4. The effect of traditional wet cupping on shoulder pain and neck pain: A pilot study.

    Science.gov (United States)

    Arslan, Müzeyyen; Gökgöz, Nurcan; Dane, Şenol

    2016-05-01

    Wet cupping therapy (WCT) is a traditional complementary method recommended to decrease the symptoms of a lot of diseases and used in the treatment of pain syndromes. In this pilot study, the possible effects of wet cupping therapy on nonspecific neck and upper shoulder pain were investigated. Sixty one eligible volunteer participants with nonspecific neck and upper shoulder pain for at least 3 months were allocated. The Numeric Rating Scale (NRS) was used to assess pain scores. Pain scores were recorded before and after wet cupping therapy. The mean scores of neck pain in study group were 7.02 (SD = 1.8) before and 3.70 (SD = 2.2) after cupping therapy. The decrease of pain scores between pre- and post-test was statistically significant (p < 0.05). It can be stated that WCT has potential therapeutic effect in nonspecific neck and upper shoulder pain. Future full-scale randomized controlled trials will be needed to provide firm evidence of the effectiveness of this intervention. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Shoulder functional assessments in persons with chronic neck/shoulder pain and healthy subjects: Reliability and effects of movement repetition.

    Science.gov (United States)

    Lomond, Karen V; Côté, Julie N

    2011-01-01

    Obtaining reliable functional capacity measures from injured workers is an essential part of the return to work (RTW) process. The present study compares shoulder functional outcomes between healthy individuals and others with neck/shoulder pain, assesses reliability and examines the influence of repetitive movements on shoulder function. Subjects performed trials of flexion and abduction active range of motion (ROM), and cumulative power output (PO) in a pushing/pulling task on the Baltimore Therapeutic Equipment Simulator II in two consecutive sessions. Tasks were assessed before and after performing a repetitive arm task, during which heart rate (HR) was recorded, until scoring 8 on the Borg CR-10 scale or on a 11-point numeric rating scale (NRS) for pain. Persons with chronic neck/shoulder pain (intensity ≥ 3/10 for > 3 months) (n = 16) and an age- and sex-matched control group (n = 16). Functional shoulder measures demonstrated strong inter-session reliability, except PO in the pain group. Average repetitive task duration was shorter in the pain group (4 min vs. 7 min). The protocol detected both pain- and time-related impairments, with HR and PO being sensitive to movement duration and ROM to pain.

  6. Variability of peak shoulder force during wheelchair propulsion in manual wheelchair users with and without shoulder pain.

    Science.gov (United States)

    Moon, Y; Jayaraman, C; Hsu, I M K; Rice, I M; Hsiao-Wecksler, E T; Sosnoff, J J

    2013-01-01

    Manual wheelchair users report a high prevalence of shoulder pain. Growing evidence shows that variability in forces applied to biological tissue is related to musculoskeletal pain. The purpose of this study was to examine the variability of forces acting on the shoulder during wheelchair propulsion as a function of shoulder pain. Twenty-four manual wheelchair users (13 with pain, 11 without pain) participated in the investigation. Kinetic and kinematic data of wheelchair propulsion were recorded for 3 min maintaining a constant speed at three distinct propulsion speeds (fast speed of 1.1 m/s, a self-selected speed, and a slow speed of 0.7 m/s). Peak resultant shoulder forces in the push phase were calculated using inverse dynamics. Within individual variability was quantified as the coefficient of variation of cycle to cycle peak resultant forces. There was no difference in mean peak shoulder resultant force between groups. The pain group had significantly smaller variability of peak resultant force than the no pain group (Ppain in manual wheelchair users. © 2013.

  7. Assessment of painful total shoulder arthroplasty using computed tomography arthrography.

    Science.gov (United States)

    Mallo, Gregory C; Burton, Lauren; Coats-Thomas, Margaret; Daniels, S David; Sinz, Nathan J; Warner, Jon J P

    2015-10-01

    This study assessed the accuracy of computed tomography (CT) arthrography when evaluating glenoid component stability in the setting of postarthroplasty shoulder pain. We retrospectively reviewed all patients presenting to the clinic during a 5.5-year period to identify those with a painful shoulder arthroplasty more than 1 year after the index procedure. We excluded reverse and hemiarthroplasty procedures, patients with a clearly identifiable cause for pain, such as rotator cuff insufficiency or gross component loosening as seen on plain radiographs, and those with culture-positive aspiration. There were 14 patients with suspected glenoid component loosening but inconclusive plain radiographs. Each of the 14 patients underwent a CT arthrogram that was evaluated by the senior author (J.J.P.W.) for the presence or absence of contrast material underneath the polyethylene component. Operative reports and surgical videos from subsequent arthroscopy were reviewed to assess glenoid component stability as determined by direct arthroscopic visualization. CT arthrography suggested glenoid component loosening in 8 of 14 patients (57.1%), and arthroscopic inspection identified loosening in 10 of 14 patients (71.4%). In 3 of 10 patients (30%), CTA suggested a well-fixed glenoid component, but gross loosening was identified during arthroscopy. In this study, CTA yielded a sensitivity of 70%, a specificity of 75%, a positive predictive value of 87.5%, and a negative predictive value of 50.0%. CTA had a low negative predictive value (50%), and therefore, the prediction of component stability based on the absence of contrast between the glenoid component and the bone-cement interface does not always reflect true stability. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  8. Shoulder arthroscopy

    Science.gov (United States)

    ... inflammation and pain in your shoulder. Surgery for shoulder instability: If you have a torn labrum, the surgeon ... torn or damaged cartilage ring (labrum) or ligaments Shoulder instability, in which the shoulder joint is loose and ...

  9. Shoulder pain among high-level volleyball players and preseason features.

    Science.gov (United States)

    Forthomme, Benedicte; Wieczorek, Valerie; Frisch, Anne; Crielaard, Jean-Michel; Croisier, Jean-Louis

    2013-10-01

    The main goal of this prospective study was to identify the most significant intrinsic risk factors for shoulder pain by measuring strength developed by shoulder rotators and by carrying out various morphostatic assessments. Sixty-six players (mean ± SD age = 24 ± 5 yr) were recruited from nine volleyball teams from the first and second divisions (34 men and 32 women) to participate in the study. Before the start of the volleyball season, all the participants completed a preseason questionnaire and underwent both a bilateral isokinetic evaluation of the shoulders and morphostatic measurements. During the subsequent 6 months of the competition period, the players reported through a weekly questionnaire any shoulder pain experienced. During the ongoing season, 23% (15 of 66 players) of the volleyball players experienced dominant shoulder pain. Interestingly, participants who reported a history of dominant shoulder pain were found to have nine times higher risk of suffering further pain in their dominant shoulder. The eccentric maximal strength developed by the internal and external rotators was found to represent a protective factor in the volleyball players (respective odds ratios = 0.946, P = 0.01 and 0.94, P = 0.05). No risk factors were found among the shoulder morphostatic measurements. In our study, the evaluation of shoulder rotator muscle strength through isokinetic assessment, especially eccentric mode, appeared to be the most contributing parameter to identify risk factors for shoulder pain. This evaluation should allow to better identify players at risk.

  10. What is the effect of a shoulder-strengthening program to prevent shoulder pain among junior female team handball players?

    Science.gov (United States)

    Sommervold, Maria; Østerås, Håvard

    2017-01-01

    Excessively high stresses are applied to the shoulder joint of handball players, mainly caused by overhead throwing. Shoulder pain is a significant problem among junior female team handball players and both male and female top-level team handball players in Norway. A randomized selection was performed among the best female junior teams (J 16) in the Trøndelag region of Norway in the 2014-2015 season. Three teams were randomized to the intervention group and three teams to the control group. Players in the intervention group (n=53) participated in a seven-month, three-times-a-week shoulder-muscle strength-training program, while those in the control group (n=53) participated in a comparable handball training, but did not conduct any specific strength training during the season. A strength-training program had no effect on the prevention of shoulder pain. Overall, the players reported shoulder pain, but graded the pain low on visual analog scale (VAS). Both the intervention group and the control group reported pain under 1 on VAS at baseline and posttest, and there was no significant difference within or between the groups when it came to the intensity of pain reported on VAS. A significant difference (phandball. The intervention group was significantly stronger (phandball players.

  11. A prospective study of work related factors and physical exercise as predictors of shoulder pain.

    Science.gov (United States)

    Miranda, H; Viikari-Juntura, E; Martikainen, R; Takala, E P; Riihimäki, H

    2001-08-01

    To evaluate the effects of work related and individual factors as well as physical activity and sports on the incidence and persistence of shoulder pain among forestry workers. Workers in a large Finnish forestry company replied to a questionnaire (a modified version of the Nordic questionnaire) on musculoskeletal pain and its possible risk factors for 4 consecutive years 1992-5. This 1 year follow up study covers the time 1994-5. Year 1994 was chosen as baseline because in that year the questionnaire contained for the first time more detailed questions about different sports. The response rate in 1995 was 90%. The effects of the predictors on 1 year incidence and persistence of shoulder pain were studied with multivariate logistic regression modelling. At baseline, 2094 subjects had been free of shoulder pain during the preceding 12 months. After 1 year, 14% (n=285) reported having mild or severe shoulder pain. Higher age, obesity, and mental stress as well as physically strenuous work and working with trunk forward flexed or with a hand above shoulder level increased the risk of incident shoulder pain. Of the different sports activities, dancing increased the risk of incident pain whereas jogging decreased the risk significantly. Of those 419 workers who had severe shoulder pain at baseline, 55% (n=230) still had severe pain 1 year later. Higher age, overload at work, and working with a hand above shoulder level increased the risk of persistent severe shoulder pain whereas cross country skiing and general sports activity decreased the risk. Our results support the current view that shoulder pain is the result of many factors, including occupational and individual factors. In this longitudinal study, physical work with a heavy load, awkward work postures, mental stress, and obesity were the risk factors at which preventive measures could be aimed. As a new finding, physical exercise had more protective than impairing effects on the shoulders.

  12. Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life

    NARCIS (Netherlands)

    Renzenbrink, Gerbert J.; IJzerman, Maarten Joost

    2004-01-01

    Objective: To evaluate the effect of percutaneous neuromuscular electrical stimulation (P-NMES) of the shoulder muscles on shoulder pain intensity and health-related quality of life in chronic hemiplegia. Design: Prospective, open label design. Setting: The outpatient services of a large teaching

  13. Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion.

    Science.gov (United States)

    Louw, Adriaan; Puentedura, Emilio J; Reese, Dave; Parker, Paula; Miller, Terra; Mintken, Paul E

    2017-10-01

    To determine the effects of a brief single component of the graded motor imagery (GMI) sequence (mirror therapy) on active range of motion (AROM), pain, fear avoidance, and pain catastrophization in patients with shoulder pain. Single-blind case series. Three outpatient physical therapy clinics. Patients with shoulder pain and limited AROM (N=69). Patients moved their unaffected shoulder through comfortable AROM in front of a mirror so that it appeared that they were moving their affected shoulder. We measured pain, pain catastrophization, fear avoidance, and AROM in 69 consecutive patients with shoulder pain and limited AROM before and immediately after mirror therapy. There were significant differences in self-reported pain (P=.014), pain catastrophization (Pshoulder flexion AROM immediately postmirror therapy (Ppain, pain catastrophization, fear avoidance, and shoulder flexion AROM in patients presenting with shoulder pain with limited AROM. The immediate changes may allow a quicker transition to multimodal treatment, including manual therapy and exercise in these patients. Further studies, including randomized controlled trials, are needed to investigate these findings and determine longer-term effects. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  14. A comparison of isometric, isotonic concentric and isotonic eccentric exercises in the physiotherapy management of subacromial pain syndrome/rotator cuff tendinopathy: study protocol for a pilot randomised controlled trial.

    Science.gov (United States)

    Kinsella, Rita; Cowan, Sallie M; Watson, Lyn; Pizzari, Tania

    2017-01-01

    Subacromial pain syndrome (SPS) involving rotator cuff tendinopathy is a common cause of shoulder pain and disability. Evidence suggests that structured physiotherapy may be as effective as surgery in this condition with significant improvements demonstrated in trials involving scapular retraining, rotator cuff strengthening and flexibility exercises. Most published programs typically utilise isotonic concentric and/or eccentric strengthening modes. Recently, immediate analgesic effects and muscle strength gains following heavy-load isometric exercises in lower limb tendinopathy conditions have been observed. It is pertinent to ascertain whether such outcomes can be replicated in SPS/rotator cuff tendinopathy. The primary aim of this study is to establish the feasibility of undertaking a full-scale randomised controlled trial (RCT) that compares the effects of isometric, isotonic concentric and isotonic eccentric rotator cuff contractions when used as part of a semi-standardised exercise-based physiotherapy program in patients diagnosed with SPS. The secondary aim is to explore potential trends or treatment effects of the exercise intervention. Thirty-six participants diagnosed with SPS will be randomised to one of three intervention groups and undergo a one-on-one exercise-based physiotherapy intervention, involving scapular and rotator cuff muscle retraining and strengthening. Each group will utilise a different mode of rotator cuff strengthening-isometric, isotonic concentric or isotonic eccentric. Rotator cuff tendon responses to isometric loading are not yet established in the literature; hence, individualised, progressive loading will be used in this pilot study in accordance with symptoms. The intervention will involve two phases: during Phase 1 (weeks 1-6) participants undertake the active group-specific physiotherapy treatment; in Phase 2 (weeks 6-12), they undertake a progressive, but no longer group-specific exercise program. To determine feasibility, an

  15. AN 80-YEAR-OLD WOMAN WITH LEFT SHOULDER PAIN

    Directory of Open Access Journals (Sweden)

    KHOO SB

    2010-01-01

    Full Text Available This case history illustrates the real life experience and dilemma of an 80-year-old woman in pursuit of medical care for her left shoulder pain. Points for discussion range from clinical features of Pancoast tumor, importance of pain management, good principles of Family Medicine and Palliative care to ethical issues of conspiracy of silence, limited treatment plan and palliative versus curative radiotherapy treatment without a known biopsy report. This paper provides opportunity for analysis of a real complex clinical situation, application of medical knowledge to problem solving in clinical practice and relevant topics for discussions. (For anonymity sake, the names of patient, doctors, general and private hospitals are not mentioned.The aim of this paper is solely for continuous medical education without any intention to ridicule any party.

  16. Influence of frequency and duration of strength training for effective management of neck and shoulder pain

    DEFF Research Database (Denmark)

    Andersen, Christoffer H; Andersen, Lars Louis; Gram, Bibi

    2012-01-01

    BACKGROUND: Specific strength training can reduce neck and shoulder pain in office workers, but the optimal combination of exercise frequency and duration remains unknown. This study investigates how one weekly hour of strength training for the neck and shoulder muscles is most effectively...... distributed. METHODS: A total of 447 office workers with and without neck and/or shoulder pain were randomly allocated at the cluster-level to one of four groups; 1×60 (1WS), 3×20 (3WS) or 9×7 (9WS) min a week of supervised high-intensity strength training for 20 weeks, or to a reference group without...... training (REF). Primary outcome was self-reported neck and shoulder pain (scale 0-9) and secondary outcome work disability (Disability in Arms, Shoulders and Hands (DASH)). RESULTS: The intention-to-treat analysis showed reduced neck and right shoulder pain in the training groups after 20 weeks compared...

  17. Chloroma (Granulocytic sarcoma: An unusual cause of shoulder pain in chronic myeloid leukemia; a diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Sachin Upadhyay

    2014-01-01

    Full Text Available At one point or another in their lives, most people will experience some degree of shoulder pain. It may be secondary to a variety of underlying pathology. We report a case of shoulder pain caused by a granulocytic sarcoma (chloroma in chronic myeloid leukemia (CML patient misdiagnosed initially as synovitis. Although granulocytic sarcoma has many classic musculoskeletal manifestations, to our knowledge, a case of CML concurrent with chloroma of the shoulder joint has not been reported in the literature. We must not forget that the shoulder pain arising from granulocytic sarcoma may be the initial presenting feature of underlying hematological malignancy such as CML.

  18. Subdeltoid lipoma: a case with symptoms mimicking glenohumeral instability and subacromial impingement.

    Science.gov (United States)

    Ui, Michimasa; Ogawa, Kiyohisa

    2010-06-09

    Lipoma is the most frequently occurring benign soft tissue tumor in the shoulder and the axillary region in middle-aged and older persons, yet few such lipoma cases have been associated with clinical symptoms. A 38-year-old right-handed man presented with an enlarged feeling and a painful back-and-forth popping in his left shoulder. Although moderate tenderness of the subacromial bursa and bicipital groove existed, an obvious impingement sign was absent. Also not evidenced were signs of neurological deficits, limited range of motion, or any physical findings suggestive of instability. Magnetic resonance imaging showed a homogenous tumor in the subdeltoid that was isointense relative to the subcutaneous fat and fluid collection in the hypertrophic subacromial bursa. As the tumor was considered from the clinical and imaging findings to be attributable to all clinical symptoms, it was resected en bloc with a satisfactory result. Histopathologically, the tumor showed typical features of a simple lipoma. To our knowledge, the present case is the first of a subdeltoid intermuscular lipoma of which mechanism developing symptoms was preoperatively surmised from imaging. The symptom-mimicking shoulder instability was assumed to be produced by the back-and-forth snapping of the lipoma beneath the deltoid muscle. The mechanism for developing the subacromial impingement-like symptom was surmised to derive from the middle deltoid fibers pressuring the lipoma to push up into the subacromial space. This case is presented to emphasize the careful reading of imaging in considering the pathomechanism of the attributing symptoms. Copyright 2010, SLACK Incorporated.

  19. Subacromial Impingement Syndrome Caused by a Voluminous Subdeltoid Lipoma

    OpenAIRE

    Jean-Christophe Murray; Stéphane Pelet

    2014-01-01

    Subacromial impingement syndrome is a clinical diagnosis encompassing a spectrum of possible etiologies, including subacromial bursitis, rotator cuff tendinopathy, and partial- to full-thickness rotator cuff tears. This report presents an unusual case of subdeltoid lipoma causing extrinsic compression and subacromial impingement syndrome. The patient, a 60-year-old man, presented to our institution with a few years' history of nontraumatic, posteriorly localized throbbing pain in his right sh...

  20. Shoulder pain in adolescent athletes: prevalence, associated factors and its influence on upper limb function.

    Science.gov (United States)

    Oliveira, Valéria M A de; Pitangui, Ana C R; Gomes, Mayra R A; Silva, Hítalo A da; Passos, Muana H P Dos; Araújo, Rodrigo C de

    Sports that require the constant use of an upper limb demand the maximum kinetic chain efficiency in this segment. Immaturity of the musculoskeletal system, followed by failure in motor skills can expose adolescents to major reports of pain complaints, particularly for the shoulder. To evaluate the prevalence of shoulder pain in adolescent athletes and identify possible factors associated with the complaint. A total of 310 athletes, of both sexes and aged between 10 and 19 years old participated on this study. The subjects filled out a questionnaire with personal, sports and upper limb function (Quick-DASH) questions. We evaluated the height, body mass, shoulder rotation range and stability of the upper limb using the CKCUES-test. The association between pain and the variables was analyzed using multilevel modeling logistic regression. We used the Mann-Whitney test for comparing between pain and function. The prevalence of shoulder pain was 43.5%. Athletes between 15 and 19 years, handball and judo practitioners, are 1.86, 2.14 and 3.07 more likely to report shoulder pain, respectively, when compared with other sports and ages. Shoulder pain reduced function scores (pShoulder pain is highly prevalent and is associated especially with older adolescent athletes of handball and judo, and affects the levels of function and the range of the shoulder. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  1. Shoulder Pain in Cases of Spinal Injury: Influence of the Position of the Wheelchair Seat

    Science.gov (United States)

    Giner-Pascual, Manuel; Alcanyis-Alberola, Modesto; Millan Gonzalez, Luis; Aguilar-Rodriguez, Marta; Querol, Felipe

    2011-01-01

    The objective of this study was to determine the relationship between shoulder pain and the position of the seat of a wheelchair relative to the ground and to determine the relationship between shoulder pain and structural damage. A transversal study of a patient cohort of 140 patients with grade A and B spinal cord injuries below the T1 vertebra,…

  2. Trajectories of musculoskeletal shoulder pain after spinal cord injury : Identification and predictors

    NARCIS (Netherlands)

    Eriks-Hoogland, Inge E.; Hoekstra, Trynke; de Groot, Sonja; Stucki, Gerold; Post, Marcel W.; van der Woude, Lucas H.

    Objective/Background: Although shoulder pain is a problem in up to 86% of persons with a spinal cord injury (SCI), so far, no studies have empirically identified longitudinal patterns (trajectories) of musculoskeletal shoulder pain after SCI. The objective of this study was: (1) to identify distinct

  3. Trajectories of musculoskeletal shoulder pain after spinal cord injury: Identification and predictors.

    NARCIS (Netherlands)

    Eriks-Hoogland, I.E.; Hoekstra, T.; de Groot, S.; Stucki, G.; Post, M.W.; van der Woude, L.H.

    2014-01-01

    Objective/ Background: Although shoulder pain is a problem in up to 86% of persons with a spinal cord injury (SCI), so far, no studies have empirically identified longitudinal patterns (trajectories) of musculoskeletal shoulder pain after SCI. The objective of this study was: (1) to identify

  4. Shoulder tip pain: an under-reported complication of ventriculoperitoneal shunt.

    LENUS (Irish Health Repository)

    Lim, C

    2012-02-03

    Ventriculoperitoneal (VP) shunt insertion is the commonest form of treatment for hydrocephalus. Shoulder tip pain after VP shunt insertion is unusual and has only recently been reported. We present a case of excruciating shoulder tip pain due to diaphragmatic irritation after VP shunt insertion.

  5. Core domain and outcome measurement sets for shoulder pain trials are needed: Systematic review of physical therapy trials

    NARCIS (Netherlands)

    M.J. Page (Matthew J.); J.E. McKenzie (Joanne E.); S.E. Green (Sally E.); D.E. Beaton (Dorcas E.); N.B. Jain (Nitin B.); M. Lenza (Mario); A.P. Verhagen (Arianne P.); S. Surace (Stephen); J. Deitch (Jessica); R. Buchbinder (Rachelle)

    2015-01-01

    textabstractObjectives To explore the outcome domains and measurement instruments reported in published randomized controlled trials of physical therapy interventions for shoulder pain (rotator cuff disease, adhesive capsulitis, or nonspecific shoulder pain). Study Design and Setting We included

  6. Trajectories of musculoskeletal shoulder pain after spinal cord injury: Identification and predictors

    Science.gov (United States)

    Eriks-Hoogland, Inge E.; Hoekstra, Trynke; de Groot, Sonja; Stucki, Gerold; Post, Marcel W.; van der Woude, Lucas H.

    2014-01-01

    Objective/Background Although shoulder pain is a problem in up to 86% of persons with a spinal cord injury (SCI), so far, no studies have empirically identified longitudinal patterns (trajectories) of musculoskeletal shoulder pain after SCI. The objective of this study was: (1) to identify distinct trajectories of musculoskeletal shoulder pain in persons with SCI, and (2) to determine possible predictors of these trajectories. Design/Methods Multicenter, prospective cohort study in 225 newly injured persons with SCI. Outcome Measure Shoulder pain was assessed on five occasions up to 5 years after discharge. Latent class growth mixture modeling was used to identify the distinct shoulder pain trajectories. Results Three distinct shoulder pain trajectories were identified: (1) a “No or Low pain” trajectory (64%), (2) a “High pain” (30%) trajectory, and (3) a trajectory with a “Decrease of pain” (6%). Compared with the “No or Low pain” pain trajectory, the “High pain” trajectory consisted of more persons with tetraplegia, shoulder pain before injury, limited shoulder range of motion (ROM), lower manual muscle test scores, or more spasticity at t1. Multiple logistic regression analysis showed two significant predictors for the “High pain” trajectory (as compared with the “No or Low pain” trajectory): having a tetraplegia (odds ratio (OR) = 3.2; P = 0.002) and having limited shoulder ROM (OR = 2.8; P = 0.007). Conclusion Shoulder pain in people with SCI follows distinct trajectories. At risk for belonging to the “High pain” trajectory are persons with tetraplegia and those with a limited shoulder ROM at start of active rehabilitation. PMID:24621031

  7. Comparison between ultrasound and plain X-ray in evaluating the cause of shoulder pain.

    Science.gov (United States)

    Salek, K M; Mannan, M; Chowdhury, A Z; Haque, M A; Kaiser, M S; Nabi, S; Ferdousee, R A; Paul, B K; Ahmed, S M; Khan, M; Begum, M

    2011-01-01

    Painful shoulder is a common painful condition among patients. Apart from acute traumatic lesions such as fractures, dislocations, contusions, sprains and ruptured tendons, 85 to 90% of painful shoulders are due to adhesive capsulitis, acute or chronic calcific tendinitis, bursitis, bicipital tendinitis and lesions of the musculotendinous cuff. Arthritis is the cause of less than 5% of painful shoulders. For evaluating conditions of shoulder joint, X-ray has been regarded as only method of choice for long time. Magnetic resonance imaging (MRI) is an alternative procedure but the cost limits its utilization especially in Bangladesh. Ultrasonography is an effective imaging modality in the evaluation of both rotator and non-rotator cuff disorders. Because of low cost and availability, it can be an alternative procedure for the diagnosis of painful shoulder. The present study was conducted to assess ultrasonography as a useful modality in evaluating cases of shoulder pain and to compare the findings with X-ray findings. Thirty two patients with shoulder pain were evaluated by X-ray and Ultrasonography (USG). Clinical diagnosis was done for correlation. To identify the cause of shoulder pain, 100% patients were found normal in plain X-ray. On Ultrasonography (USG) 12.5% patients had displaced long head of biceps, 21.9% had biceps tendinitis, and 3.1% had bursitis. In the assessment of shoulder pathology, USG had a sensitivity of 73.3%, specificity of 88.2%, Positive predictive value (PPV) of 84.6%, Negative predictive value (NPV) of 78.9% and an accuracy of 81.3%. USG is a useful modality for evaluation the shoulder joint in case of painful shoulder even plain X-ray is non conclusive.

  8. Effect of scapular function training on chronic pain in the neck/shoulder region

    DEFF Research Database (Denmark)

    Andersen, Christoffer H; Andersen, Lars L; Zebis, Mette K

    2014-01-01

    PURPOSE: Neck and shoulder complaints are common among employees in occupations characterized by intensive computer use. Treatment has varied from passive rest to active treatments and active treatments have often been divided into either training of the painful area or the surrounding musculature...... while minimizing direct training of the upper trapezius-is effective in reducing pain in adults with chronic non-specific pain in the neck/shoulder region. METHODS: 47 office workers with chronic non-specific pain in the neck/shoulder region were randomized to 10 weeks 3 × 20 min SFT with training...... supervision or to a control group. At baseline and at follow-up the participants were tested for maximum isometric shoulder strength by a blinded tester. Further, once a week participants reported pain intensity of the neck/shoulder during the previous week. RESULTS: In intention-to-treat analysis neck...

  9. Subacromial impingement syndrome

    NARCIS (Netherlands)

    Umer, M.; Qadir, I.; Azam, M.

    2012-01-01

    Subacromial impingement syndrome (SAIS) represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a

  10. What is the effect of a shoulder-strengthening program to prevent shoulder pain among junior female team handball players?

    Directory of Open Access Journals (Sweden)

    Sommervold M

    2017-03-01

    Full Text Available Maria Sommervold, Håvard Østerås Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU, Trondheim, Norway Background: Excessively high stresses are applied to the shoulder joint of handball players, mainly caused by overhead throwing. Shoulder pain is a significant problem among junior female team handball players and both male and female top-level team handball players in Norway.Method: A randomized selection was performed among the best female junior teams (J 16 in the Trøndelag region of Norway in the 2014–2015 season. Three teams were randomized to the intervention group and three teams to the control group. Players in the intervention group (n=53 participated in a seven-month, three-times-a-week shoulder-muscle strength-training program, while those in the control group (n=53 participated in a comparable handball training, but did not conduct any specific strength training during the season. Results: A strength-training program had no effect on the prevention of shoulder pain. Overall, the players reported shoulder pain, but graded the pain low on visual analog scale (VAS. Both the intervention group and the control group reported pain under 1 on VAS at baseline and posttest, and there was no significant difference within or between the groups when it came to the intensity of pain reported on VAS. A significant difference (p<0.048 was found between the groups on the sport-specific part of the quick-Disability of the Arm, Shoulder and Hand (DASH form, but it did not fulfill the minimal demand to change and the players scored it low, something that indicates little functional problems when it comes to team handball. The intervention group was significantly stronger (p<0.008 on the push-ups test compared to the control group on the posttest. The intervention group increased the number of push-ups from 3.1 to 6.4, while the control group went from 2.3 to 3.6. Aside from this, there were no

  11. Do subacromial ultrasonography findings predict efficacy of intra-bursal injection? Prospective study in 39 patients.

    Science.gov (United States)

    Bouju, Y; Bouilleau, L; Dubois de Montmarin, G; Bacle, G; Favard, L

    2014-12-01

    Ultrasonography has become an investigation of choice in the management of shoulder pain. The objective of this study was to determine whether the efficacy of subacromial-subdeltoid bursa injection correlated with the ultrasound findings. We prospectively recruited patients who were seen between November 2012 and November 2013 for subacromial pain and whose rotator cuff was either intact or showed a full-thickness tear less than 1cm in length. A standardised physical examination of the shoulder was followed immediately by static and dynamic ultrasonography, intra-bursal injection of lidocaine, and a repetition of the same physical examination. Recorded ultrasonography features were the appearance of the bursa, shape of the coraco-acromial ligament, and bursal deformation induced by passage under the coraco-acromial ligament during dynamic imaging. A response to the injection was defined as greater than 75% improvements in at least three of the physical examination parameters. We included 39 patients with a mean age of 56.7 years. Ultrasonography showed abnormalities of the bursa in 30 patients, including 1 with an intra-bursal effusion, 10 with thickening, and 19 with both. Deformation of the bursa under the coraco-acromial ligament was noted in 26 patients. The proportions of patients with bursal effusion and with bursal thickening were similar in the 20 responders and 19 non-responders. Neither were any significant differences found for coraco-acromial ligament shape or bursal deformation under the ligament. No correlation was found between ultrasonography findings and the efficacy of a local anaesthetic injection into the subacromial bursa. These findings suggest that ultrasound abnormalities may constitute mere physiological changes, in keeping with earlier studies in asymptomatic individuals. Thus, subacromial impingement may be currently overdiagnosed. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  12. Manipulative therapy for shoulder pain and disorders: expansion of a systematic review.

    Science.gov (United States)

    Brantingham, James W; Cassa, Tammy Kay; Bonnefin, Debra; Jensen, Muffit; Globe, Gary; Hicks, Marian; Korporaal, Charmaine

    2011-06-01

    The purpose of this study was to conduct a systematic review on manual and manipulative therapy (MMT) for common shoulder pain and disorders. A search of the literature was conducted using the Cumulative Index of Nursing Allied Health Literature; PubMed; Manual, Alternative, and Natural Therapy Index System; Physiotherapy Evidence Database; and Index to Chiropractic Literature dating from January 1983 to July 7, 2010. Search limits included the English language and human studies along with MeSH terms such as manipulation, chiropractic, osteopathic, orthopedic, musculoskeletal, physical therapies, shoulder, etc. Inclusion criteria required a shoulder peripheral diagnosis and MMT with/without multimodal therapy. Exclusion criteria included pain referred from spinal sites without a peripheral shoulder diagnosis. Articles were assessed primarily using the Physiotherapy Evidence Database scale in conjunction with modified guidelines and systems. After synthesis and considered judgment scoring were complete, with subsequent participant review and agreement, evidence grades of A, B, C, and I were applied. A total of 211 citations were retrieved, and 35 articles were deemed useful. There is fair evidence (B) for the treatment of a variety of common rotator cuff disorders, shoulder disorders, adhesive capsulitis, and soft tissue disorders using MMT to the shoulder, shoulder girdle, and/or the full kinetic chain (FKC) combined with or without exercise and/or multimodal therapy. There is limited (C) and insufficient (I) evidence for MMT treatment of minor neurogenic shoulder pain and shoulder osteoarthritis, respectively. This study found a level of B or fair evidence for MMT of the shoulder, shoulder girdle, and/or the FKC combined with multimodal or exercise therapy for rotator cuff injuries/disorders, disease, or dysfunction. There is a fair or B level of evidence for MMT of the shoulder/shoulder girdle and FKC combined with a multimodal treatment approach for shoulder

  13. The unstable painful shoulder (UPS) as a cause of pain from unrecognized anteroinferior instability in the young athlete.

    Science.gov (United States)

    Boileau, Pascal; Zumstein, Matthias; Balg, Frederic; Penington, Scott; Bicknell, Ryan T

    2011-01-01

    The etiology of shoulder pain in the overhead athlete is often difficult to determine. This study hypothesized that (1) instability can present in a purely painful form, without any apparent history of instability, but with anatomic lesions indicative of instability, termed unstable painful shoulder (UPS), and that (2) arthroscopic shoulder stabilization is effective. The study evaluated 20 patients (mean age, 22 ± 8 years) at a mean of 38 months postoperatively (range, 24-69 months). Inclusion criteria were painful shoulder with lesions indicative of instability on imaging or at surgery, minimum 2-year follow-up. Exclusion criteria were recognized instability, other associated pathologies, and previous shoulder surgery. Patients were young, hyperlax athletes who complained of deep, anterior shoulder pain and denied any instability. Pain was reproduced with the arm in an anterior apprehension position and relieved by a relocation test; however, no actual apprehension was experienced. Patients often had glenohumeral laxity and hyperlaxity. Lesions indicative of instability confirmed that at least 1 unapparent shoulder subluxation occurred. The Rowe, Walch-Duplay, and University of California, Los Angeles scores improved significantly (P Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  14. Balance ability and postural stability among patients with painful shoulder disorders and healthy controls.

    Science.gov (United States)

    Baierle, Tobias; Kromer, Thilo; Petermann, Carmen; Magosch, Petra; Luomajoki, Hannu

    2013-10-02

    In therapeutic settings, patients with shoulder pain often exhibit deficient coordinative abilities in their trunk and lower extremities. The aim of the study was to investigate 1) if there is a connection between shoulder pain and deficits in balance ability and postural stability, 2) if pain intensity is related to balance ability and postural stability, and 3) if there is a connection between body mass index (BMI) and balance ability and postural stability. In this case-control study, patients (n = 40) with pathological shoulder pain (> 4 months) were matched with a healthy controls (n = 40) and were compared with regard to their balance ability and postural stability. Outcome parameters were postural stability, balance ability and symmetry index which were measured using the S3-Check system. In addition, the influence of shoulder pain intensity and BMI on the outcome parameters was analysed. Patients with shoulder pain showed significantly worse results in measurements of postural stability right/left (p shoulder pain group. There was no correlation between pain intensity and measurements of balance ability or postural stability. Likewise, no correlation between BMI and deficiencies in balance ability and postural stability was established. Patients with pathological shoulder pain (> 4 months) have deficiencies in balance ability and postural stability; however the underlying mechanisms for this remain unclear. Neither pain intensity nor BMI influenced the outcome parameters. Patients with shoulder pain shift their weight to the affected side. Further research is needed to determine if balance training can improve rehabilitation results in patients with shoulder pathologies.

  15. Association between Neck/Shoulder Pain and Trapezius Muscle Tenderness in Office Workers

    DEFF Research Database (Denmark)

    Brandt, Mikkel; Sundstrup, Emil; Jakobsen, Markus D.

    2014-01-01

    the previous three months on a scale of 0–10 and palpable tenderness of the upper trapezius muscle on a scale of “no tenderness,” “some tenderness,” or “severe tenderness.” Odds ratios for tenderness as a function of neck/shoulder pain intensity were determined using cumulative logistic regression controlled......Background. Neck/shoulder pain is a common musculoskeletal disorder among adults.The pain is often assumed to be related to muscular tenderness rather than serious chronic disease. Aim. To determine the association between neck/shoulder pain intensity and trapezius muscle tenderness in office...... interval 1.70 to 2.04). Conclusion. In office workers, a strong association between perceived neck/shoulder pain intensity and trapeziusmuscle tenderness exists.The present study provides reference values of pain intensity among office workers with no, some, and severe tenderness of the trapezius muscle....

  16. Comparison of 3-Dimensional Shoulder Complex Kinematics in Individuals With and Without Shoulder Pain, Part 2: Glenohumeral Joint

    Science.gov (United States)

    LAWRENCE, REBEKAH L.; BRAMAN, JONATHAN P.; STAKER, JUSTIN L.; LAPRADE, ROBERT F.; LUDEWIG, PAULA M.

    2015-01-01

    STUDY DESIGN Cross-sectional. OBJECTIVES To compare differences in glenohumeral joint angular motion and linear translations between symptomatic and asymptomatic individuals during shoulder motion performed in 3 planes of humerothoracic elevation. BACKGROUND Numerous clinical theories have linked abnormal glenohumeral kinematics, including decreased glenohumeral external rotation and increased superior translation, to individuals with shoulder pain and impingement diagnoses. However, relatively few studies have investigated glenohumeral joint angular motion and linear translations in this population. METHODS Transcortical bone pins were inserted into the scapula and humerus of 12 a symptomatic and 10 symptomatic participants for direct bone-fixed tracking using electromagnetic sensors. Glenohumeral joint angular positions and linear translations were calculated during active shoulder flexion, abduction, and scapular plane abduction. RESULTS Differences between groups in angular positions were limited to glenohumeral elevation, coinciding with a reduction in scapulothoracic upward rotation. Symptomatic participants demonstrated 1.4 mm more anterior glenohumeral translation between 90° and 120° of shoulder flexion and an average of 1 mm more inferior glenohumeral translation throughout shoulder abduction. CONCLUSION Differences in glenohumeral kinematics exist between symptomatic and a symptomatic individuals. The clinical implications of these differences are not yet understood, and more research is needed to understand the relationship between abnormal kinematics, shoulder pain, and pathoanatomy. PMID:25103132

  17. Concurrent Peripheral Pathologies and Complex Regional Pain Syndrome Type 1 as Contributors to Acute Post-Stroke Shoulder Pain: A Case Report

    Directory of Open Access Journals (Sweden)

    Seyed Majid Akhavan Hejazi

    2012-04-01

    Full Text Available Post-stroke shoulder pain is associated with either a peripheral or central pathology. However, most of the time, it is challenging to establish a cause-and-effect relationship between the suggested pathology and shoulder pain reported. We report a 66 year-old man who developed a right hemiplegic shoulder pain two months post stroke with initial investigations suggestive of peripheral pathologies. Pharmacological and non-pharmacological treatment did not improve his shoulder pain. Later he developed complex regional pain syndrome (CRPS of the right hand and the initial shoulder pain subsequently relieved following resolution of the CRPS.

  18. Concurrent peripheral pathologies and complex regional pain syndrome type 1 as contributors to acute post-stroke shoulder pain: a case report.

    Science.gov (United States)

    Akhavan Hejazi, Seyed Majid; Mazlan, Mazlina

    2012-01-01

    Post-stroke shoulder pain is associated with either a peripheral or central pathology. However, most of the time, it is challenging to establish a cause-and-effect relationship between the suggested pathology and shoulder pain reported. We report a 66 year-old man who developed a right hemiplegic shoulder pain two months post stroke with initial investigations suggestive of peripheral pathologies. Pharmacological and non-pharmacological treatment did not improve his shoulder pain. Later he developed complex regional pain syndrome (CRPS) of the right hand and the initial shoulder pain subsequently relieved following resolution of the CRPS. © 2012 Tehran University of Medical Sciences. All rights reserved.

  19. High Prevalence of Nontraumatic Shoulder Pain in a Regional Sample of Female High School Volleyball Athletes

    Science.gov (United States)

    Frisch, Kayt E.; Clark, Jacob; Hanson, Chad; Fagerness, Chris; Conway, Adam; Hoogendoorn, Lindsay

    2017-01-01

    Background: Shoulder pain is becoming increasingly problematic in young players as volleyball gains popularity. Associations between repetitive motion and pain and overuse injury have been observed in other overhand sports (most notably baseball). Studies of adult athletes suggest that there is a shoulder pain and overuse problem present in volleyball players, but minimal research has been done to establish rates and causes in juvenile participants. Purpose: To establish rates of shoulder pain, regardless of whether it resulted in a loss of playing time, in female high school volleyball players. A secondary goal was to determine whether high repetition volumes correlated with an increased likelihood of experiencing pain. Study Design: Descriptive epidemiology study. Methods: A self-report survey focusing on the prevalence of pain not associated with a traumatic event in female high school youth volleyball players was developed. Survey questions were formulated by certified athletic trainers, experienced volleyball coaches, and biomechanics experts. Surveys were received from 175 healthy, active high school volleyball players in Iowa, South Dakota, and Minnesota. Results: Forty percent (70/175) of active high school volleyball players remembered experiencing shoulder pain not related to traumatic injury, but only 33% (23/70) reported taking time off to recover from the pain. Based on these self-reported data, activities associated with significantly increased risk of nontraumatic shoulder pain included number of years playing competitive volleyball (P = .01) and lifting weights out of season (P = .001). Players who reported multiple risk factors were more likely to experience nontraumatic shoulder pain. Conclusion: When using time off for recovery as the primary injury criterion, we found that the incidence of shoulder pain is more than twice as high as the incidence of injury reported by previous studies. Findings also indicated that the incidence of shoulder pain

  20. High Prevalence of Nontraumatic Shoulder Pain in a Regional Sample of Female High School Volleyball Athletes.

    Science.gov (United States)

    Frisch, Kayt E; Clark, Jacob; Hanson, Chad; Fagerness, Chris; Conway, Adam; Hoogendoorn, Lindsay

    2017-06-01

    Shoulder pain is becoming increasingly problematic in young players as volleyball gains popularity. Associations between repetitive motion and pain and overuse injury have been observed in other overhand sports (most notably baseball). Studies of adult athletes suggest that there is a shoulder pain and overuse problem present in volleyball players, but minimal research has been done to establish rates and causes in juvenile participants. To establish rates of shoulder pain, regardless of whether it resulted in a loss of playing time, in female high school volleyball players. A secondary goal was to determine whether high repetition volumes correlated with an increased likelihood of experiencing pain. Descriptive epidemiology study. A self-report survey focusing on the prevalence of pain not associated with a traumatic event in female high school youth volleyball players was developed. Survey questions were formulated by certified athletic trainers, experienced volleyball coaches, and biomechanics experts. Surveys were received from 175 healthy, active high school volleyball players in Iowa, South Dakota, and Minnesota. Forty percent (70/175) of active high school volleyball players remembered experiencing shoulder pain not related to traumatic injury, but only 33% (23/70) reported taking time off to recover from the pain. Based on these self-reported data, activities associated with significantly increased risk of nontraumatic shoulder pain included number of years playing competitive volleyball (P = .01) and lifting weights out of season (P = .001). Players who reported multiple risk factors were more likely to experience nontraumatic shoulder pain. When using time off for recovery as the primary injury criterion, we found that the incidence of shoulder pain is more than twice as high as the incidence of injury reported by previous studies. Findings also indicated that the incidence of shoulder pain may be correlated with volume of previous volleyball experience.

  1. Soft Tissue Mobilization and PNF Improve Range of Motion and Minimize Pain Level in Shoulder Impingement

    OpenAIRE

    Al Dajah, Salameh Bweir

    2014-01-01

    [Purpose] The aim of this study was to evaluate the effects of soft tissue mobilization and PNF on pain level, and shoulder ROM in patients with shoulder impingement syndrome. [Subjects and Methods] Thirty patients with painful and limited glenohumeral ROM activities were selected. The subjects were randomly assigned to an experimental group (n=15), which received treatment consisting of soft tissues mobilization and the PNF technique. The control group received an ultrasound treatment. Pain ...

  2. [The painful hemiplegic shoulder: effects of exercises program according to Bobath].

    Science.gov (United States)

    Gialanella, B; Benvenuti, P; Santoro, R

    2004-01-01

    To verify whether a shoulder exercises program according to Bobath reduced the shoulder pain in hemiplegic patients. We studied a total of 20 patients with pain shoulder. Ten patients are assigned to group R (submitted to rehabilitation) and ten to group R+E (submitted to rehabilitation and shoulder exercises program according to Bobath). Shoulder exercises program was self-performed by the patients after training in occupational rehabilitation unit. The assessment of patients was performed at admission to hospital, at discharge and three months after discharge. Shoulder pain (VAS), shoulder range of motion, disability (FIM), motor function (Fugl-Meyer scale) and spasticity (Ashworth scale) of paretic arm were evaluated in all patients. VAS was similar in both groups at admission and decreased in group R+E at discharge without reaching significant differences (p=0.253). On the contrary, VAS and Shoulder range of motion improved statistically in group R+E (p=0.0001, pBobath reduces shoulder pain of patients with hemiplegia if it is performed daily and for a long period of time.

  3. Pathological Fracture of Clavicle Following Sub-Acromial Decompression-Infraclavicular Compartment Syndrome?

    Directory of Open Access Journals (Sweden)

    S Mukhopadhyay

    2009-11-01

    Full Text Available A 34-year-old factory worker presented with pain and weakness of the left shoulder following a fall on ice on her left shoulder. An ultrasound scan of the shoulder taken 4 months after injury showed small partial articular surface tear of the supraspinatus tendon. Ten days following subacromial decompression she suffered a pathological fracture of her left clavicle. MRI, CT, and isotope bone scans showed no evidence of malignancy or infection but a collection of fluid was noted underlying the clavicle communicating to the acromioclavicular joint. Ultrasound scan guided aspiration of 20 millilitres of bloodstained fluid underlying the clavicle resulted in gradual recovery and adequate healing of the fracture.

  4. Role of radiographs in shoulder pathology: a clinical review

    Directory of Open Access Journals (Sweden)

    Hershkovich O

    2014-07-01

    Full Text Available Oded Hershkovich,1–3,* Shachar Shapira,1–3,* Yaron Sela,1,3 Itamar B Botser1,31Department of Orthopedic Surgery, Chaim Sheba Medical Center, 2Medical Corps, Israeli Defense Forces, Tel Hashomer, 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel*SS and OH contributed equally to this workAbstract: Shoulder pain is a very common complaint, and affects as many as 20% of all people at some point during their lives. Despite the availability of more advanced imaging modalities, X-ray remains the first imaging test to be performed in the investigation of any shoulder pain. However, with their increasing availability, ultrasound and magnetic resonance imaging have in recent years become first-line techniques for the diagnostic imaging of the shoulder. Moreover, ultrasound of the shoulder is increasingly performed in lieu of radiography. Nevertheless, many patients who visit a shoulder specialist for their pain are referred by a family physician or community orthopedist without an X-ray having ever been performed. Shoulder pain can be caused by many conditions, including rotator cuff tears, calcification within the tendons of the rotator cuff, stiff shoulder, subacromial impingement, space-occupying lesions, degenerative changes, and rheumatoid arthritis. This paper reviews various types of shoulder injury and the radiographic symptomatology of each, with the goal of encouraging the use of radiography by demonstrating the importance of this basic tool in the diagnostic process for these injuries.Keywords: shoulder, pain, pathology, imaging, radiographs

  5. Neck-shoulder pain and depressive symptoms: a cohort study with a 7-year follow-up.

    Science.gov (United States)

    Mäntyselkä, Pekka; Lupsakko, Taina; Kautiainen, Hannu; Vanhala, Mauno

    2010-02-01

    The presence of neck-shoulder pain as a predictor of depression is not widely studied. To analyse the association of neck-shoulder pain at baseline with depressive symptomatology after a 7-year follow-up. A total of 604 subjects who had not had depressive symptomatology at baseline participated in 7-year follow-up survey. The number of subjects with depressive symptomatology (Beck Depression Score10) after 7-year follow-up were measured in three groups - subjects without neck-shoulder pain, with infrequent neck-shoulder pain and with daily neck-shoulder pain at baseline. A total of 77 (13%) participants had developed depressive symptomatology by the follow-up. Prevalence of depressive symptomatology in follow-up in subjects without neck-shoulder pain, with infrequent neck-shoulder pain and with daily neck-shoulder pain at baseline pain was 9.5%, 11.2% and 28.4%. In multivariate logistic regression analysis odds for having depressive symptomatology in daily neck-shoulder pain subjects was almost three fold higher (OR, 2.64, 95% CI, 1.27-5.48) compared to those without neck-shoulder pain. Frequent neck-shoulder pain is a preceding symptom for the depressive symptomatology in adults.

  6. Clinical and sonographic risk factors for hemiplegic shoulder pain: A longitudinal observational study.

    Science.gov (United States)

    Kim, Yeo Hyung; Jung, Sung Jin; Yang, Eun Joo; Paik, Nam Jong

    2014-01-01

    To identify baseline risk factors associated with hemiplegic shoulder pain during the first 6 months after a stroke and to investigate changes in these risk factors over time. Longitudinal observational study. A total of 94 patients with first-ever unilateral stroke lesion within 1 month after stroke. Clinical, radiological and sonographic evaluations were performed at baseline. Hemiplegic shoulder pain was assessed at 1, 3 and 6 months post-stroke. Associations between baseline factors and hemiplegic shoulder pain during the first 6 months and hemiplegic shoulder pain at 1, 3 and 6 months poststroke were analysed. Poor arm motor function, indicated by a poor National Institutes of Health Stroke Scale item 5 score (odds ratio (OR) = 3.0; 95% confidence interval (CI) = 1.1-7.7) and the presence of supraspinatus tendon pathology (OR = 4.2; 95% CI = 1.4-12.9), were associated with hemiplegic shoulder pain. While patients with adhesive capsulitis, glenohumeral subluxation, or long head of biceps tendon effusion showed a higher prevalence of hemiplegic shoulder pain at 1 month after stroke, those with supraspinatus tendon pathology showed a higher prevalence at 3 and 6 months. Patients at high risk of hemiplegic shoulder pain with severe arm paralysis and supraspinatus tendon pathology require more careful attention during the rehabilitation period.

  7. Painful and painless shoulder magnetic resonance imaging comparisons in hemodialysis patients and correlation with clinical findings.

    Science.gov (United States)

    Turk, Ayla Caglıyan; Fıdan, Nurdan; Ozcan, Oguzhan; Ozdemır, Ferda; Tomak, Leman; Ozkurt, Sultan; Sahın, Fusun

    2016-05-20

    Shoulder pain is frequently observed in haemodialysis patients. To compare haemodialysis patients with or without shoulder pain in terms of shoulder motion ranges, β2 microglobulin levels and magnetic resonance imaging findings. Forty-three patients undergoing dialysis were enrolled, of which 23 patients had explicit shoulder pain at night, which appeared during dialysis. Range of joint motion and impingement tests were evaluated. β 2 microglobulin value was recorded. MRI was used to evaluate rotator cuff tendons for thickness, homogeneity, integrity and presence of effusion. Ranges of motion were significantly lower in the painful shoulder group. Supraspinatus tendon thickness and the number of areas with effusion were higher in the painful group. There was a positive correlation between the β 2 microglobulin level and supraspinatus (r:0.352 ppain (r:0.351 ppain and shoulder motion ranges. Shoulder pain in dialysis patients can be related with tendon thickness and effusion. While the β 2 microglobulin level affects tendon thickness, it has no relation to pain and movement constraint.

  8. Enhanced-MRI and ultrasound evaluation of painful shoulder in patients after stroke: a pilot study.

    Science.gov (United States)

    Pompa, Alessandra; Clemenzi, Alessandro; Troisi, Elio; Di Mario, Marco; Tonini, Angelo; Pace, Luca; Casillo, Paolo; Cuccaro, Alessandro; Grasso, Maria Grazia

    2011-01-01

    Epidemiological and radiological studies have previously been performed to identify the possible causes of hemiplegic shoulder pain (HSP). Many different etiologies have been postulated, though no clear correlations have emerged, and a multifactorial pathogenesis of HSP has been proposed. Recently, two MRI-based studies have described different shoulder findings as possible causes of pain in chronic stroke survivors. The aim of this study was to describe the structural abnormalities of the painful shoulder in the first months after stroke by ultrasound and enhanced MRI. The secondary aims were to identify possible predisposing factors for HSP and to evaluate its impact on motor recovery. One hundred and fifty-three first-time stroke patients, admitted to the Santa Lucia Foundation for rehabilitation, were investigated for HSP. Twenty-five stroke patients with HSP and 16 stroke patients without shoulder pain were included. An ultrasound evaluation and enhanced shoulder MRI were performed for all the patients. Among the shoulder abnormalities detected by both imaging studies, only capsulitis, which was detected by enhanced shoulder MRI in 88% of the HSP patients, was independently associated with pain (p pain intensity as expressed by the VAS score (p pain. Adhesive capsulitis was found to be a possible cause of HSP. However, MRI, which is more expensive than other diagnostic tools, may be considered the gold standard tool for understanding the etiology of HSP. Copyright © 2011 S. Karger AG, Basel.

  9. Effect of interferential current stimulation in management of hemiplegic shoulder pain.

    Science.gov (United States)

    Suriya-amarit, Duangporn; Gaogasigam, Chitanongk; Siriphorn, Akkradate; Boonyong, Sujitra

    2014-08-01

    To study the immediate effects of interferential current stimulation (IFC) on shoulder pain and pain-free passive range of motion (PROM) of the shoulder in people with hemiplegic shoulder pain (HSP). Double-blind, placebo-controlled clinical trial. Institutional physical therapy clinic, neurologic rehabilitation center. A population-based sample of people with HSP (N=30) was recruited. Participants were divided into 2 groups--an IFC group and a placebo group--by using a match-paired method (age, sex, and Brunnstrom motor recovery stage). In the IFC group, participants received IFC for 20 minutes with an amplitude-modulated frequency at 100 Hz in vector mode. The current intensity was increased until the participants felt a strong tingling sensation. Pain intensity and pain-free PROM of the shoulder until the onset of pain were measured at baseline and immediately after treatment. Participants reported a greater reduction in pain during the most painful movement after treatment with IFC than with placebo (Ppain-free PROM than the placebo group in shoulder flexion (Ppain during movement and also increases the pain-free PROM of the shoulder in people with HSP. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  10. Inter-examiner reproducibility of clinical tests and criteria to identify subacromial impingement syndrome

    DEFF Research Database (Denmark)

    Vind, Mikkel; Bogh, Søren Bie; Larsen, Camilla Marie

    2011-01-01

    Abstract Introduction A specific algorithm has been proposed for classifying impingement related shoulder pain in athletes with overhead activity. Data on the inter-examiner reproducibility of the suggested clinical tests and criteria and their mutual dependencies for identifying subacromial...... was followed, consisting of a training, an overall agreement and a study phase. To proceed to the study phase, an overall agreement of 0.80 was required. In total 10, 20 and 44 subjects were included in the three phases, respectively. The case prevalence in the study phase was 50%. The inclusion criterion...... reproducibility in clinical practice, as well as the validity of the tests and criteria for SIS....

  11. Celecoxib effectively treats patients with acute shoulder tendinitis/bursitis.

    Science.gov (United States)

    Petri, Michelle; Hufman, Stephen L; Waser, Gregory; Cui, Harry; Snabes, Michael C; Verburg, Kenneth M

    2004-08-01

    Shoulder tendinitis and subacromial bursitis are acute, painful inflammatory musculoskeletal conditions that may recur as a result of overuse. We investigated the efficacy of celecoxib in managing patients with acute shoulder tendinitis/bursitis. In this double blind, placebo controlled, parallel group study, patients with acute onset shoulder tendinitis and/or subacromial bursitis were randomized to receive one of: celecoxib 400 mg followed by 200 mg bid, naproxen 500 mg bid, or placebo bid for 14 days. The primary measure of efficacy was the mean reduction in Maximum Pain Intensity at Rest, measured using a 100 mm visual analog scale, from baseline to Days 7 and 14. Of the 306 patients randomized to treatment, 254 completed the study. On Day 7, the mean reduction from baseline in Maximum Pain Intensity at Rest was significantly greater in the celecoxib group compared with the placebo group (-27.7 +/- 2.75 mm vs -18.4 +/- 2.63 mm, respectively; p subacromial bursitis.

  12. The consequences of shoulder pain intensity on quality of life and community participation in paraplegic wheelchair users

    Directory of Open Access Journals (Sweden)

    Nulle A.

    2012-10-01

    Full Text Available Background/Objective: Shoulder overuse due weight-bearing loads – wheelchair propulsion and transfers – are supposed to cause shoulder pain in active wheelchair users. Consequently, shoulder pain has been found to have a high prevalence in the spinal cord-injured population. Severity of pain levels in individuals with spinal cord injury has been shown to impact quality of life. Aim of this study was to describe the consequences of shoulder pain intensity on quality of life, physical activity, and community activities in spinal cord-injured paraplegic wheelchair users. Materials and Methods: It was a qualitative, analytical one moment study where was involved persons after spinal cord injury below Th1 with lower paraplegia, who used manually operated wheelchairs for mobility at least 50% of the time. Main outcomes measure: SF-36textregistered Health Survey, Physical Activity Scale for Individuals With Physical Disabilities, Community Activities Checklist, Wheelchair User’s Shoulder Pain Index, Functional Independence Measure, Goniometry for shoulder joint. Results and analysis: 40 participants (9 female, 31 male after spinal cord injury (SCI, mean age – 30,8 years, one to twenty years after spinal cord injury. 20 participants had pain in shoulder, 20 participants without pain in shoulder. The intensity of shoulder pain was not related to duration of SCI or the duration of shoulder pain. Shoulder pain intensity scores were inversely related to quality of life. There was a moderate, inverse relationship between shoulder pain intensity and physical activity. There was no relationship, however, between shoulder pain intensity and community activities. The level of community activity was positively related to quality of life. Conclusions: Persons with spinal cord injury who reported lower subjective quality of life and physical activity scores experienced significantly higher levels of shoulder pain. Shoulder pain intensity did not relate to

  13. Risk factors for incident neck and shoulder pain in hospital nurses.

    Science.gov (United States)

    Smedley, J; Inskip, H; Trevelyan, F; Buckle, P; Cooper, C; Coggon, D

    2003-11-01

    To assess the incidence and risk factors for neck and shoulder pain in nurses. A longitudinal study of neck and shoulder pain was carried out in female nurses at two hospitals in England. Personal and occupational risk factors were assessed at baseline. The self reported incidence of symptoms in the neck and shoulder region was ascertained at three-monthly intervals over two years. A Cox regression model was used to estimate hazard ratios (HRs) for incident neck/shoulder pain during follow up in nurses who had been pain free for at least one month at baseline. The baseline response rate was 56%. Of 903 women who were pain free at baseline, 587 (65%) completed at least one follow up while still in the same job. During an average of 13 months, 34% of these (202 women) reported at least one episode of neck/shoulder pain. The strongest predictor of pain in the neck/shoulder was previous history of the symptom (HRs up to 3.3). For physical exposures at work, the highest risks (HRs up to 1.7) were associated with specific patient handling tasks that involved reaching, pushing, and pulling. Nurses who reported low mood or stress at baseline were more likely to develop neck/shoulder pain later (HR 1.5). Workplace psychosocial factors (including job demands, satisfaction, and control) were not associated with incident neck/shoulder symptoms. Neck/shoulder pain is common among hospital nurses, and patient handling tasks that involve reaching and pulling are the most important target for risk reduction strategies.

  14. Does the acromiohumeral distance matter in chronic rotator cuff related shoulder pain?

    Science.gov (United States)

    Navarro-Ledesma, Santiago; Struyf, Filip; Labajos-Manzanares, Maria Teresa; Fernandez-Sanchez, Manuel; Morales-Asencio, Jose Miguel; Luque-Suarez, Alejandro

    2017-06-01

    The relation between acromiohumeral distance (AHD) and severity of pain, disability and range of movement (ROM) in patients with chronic rotator cuff related shoulder pain (RCRSP) has not been reported. The aim of this study was to investigate the level of association between AHD measured by ultrasonography and pain-disability and shoulder range of movement (ROM), in patients suffering from chronic RCRSP. As a secondary objective, the determination of the intrarater reliability of AHD at both 0 and 60 degrees of shoulder elevation was carried out. This was a cross-sectional study. A sample comprised of 97 patients with chronic RCSRP symptoms was recruited from three different primary care centres. Acromio-humeral distance (AHD) measured by ultrasonography at 0 and 60 degrees of shoulder elevation, shoulder pain-function (SPADI) and range of movement (ROM) were taken. There was no correlation between AHD at 0° (-0,215), and at 60° (-0,148), with SPADI. No correlations were found with AHD and shoulder ROM at both 0 and 60°. Intrarater reliability was excellent for AHD at 0 and 60°. There was a small association between AHD and shoulder pain and function, as well as with shoulder ROM, in patients with chronic RCRSP. Hence, clinicians should consider other possibilities rather than focusing their therapies only in increasing AHD when patients with chronic RCRSP are treated. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Acromion Types and Role of Corticosteroid with Shoulder Impingement Syndrome.

    Science.gov (United States)

    Akram, Muhammad; Shah Gillani, Syed Faraz Ul Hassan; Farooqi, Faheem Mubashir; Awais, Syed Muhammad

    2016-12-01

    To determine the association between shoulder impingement and morphological characteristics of acromion and the role of sub-acromial injection of methylprednisolone in the short-term treatment for relieving pain and improve functional disability of these patients. A descriptive study. Department of Orthopedic Surgery and Traumatology Unit-I (DOST-I), Mayo Hospital, Lahore, between November 2013 to June 2014. All patients presented in OPD with shoulder pain were included as subjects and evaluated by clinical test and categorised using X-ray scapula Y-view. Patients with impingement syndrome were correlated with Bigliani types and offered intra-lesional injection into sub-acromial space with 2ml of xylocaine 2% and 40 mg of methylprednisolone using 22 gauge needle. The effectiveness was assessed in terms of relieving pain and good functional outcomes; and rotator cuff tear was clinically assessed among impingement positive patient. The pain was assessed using visual analogue score before and after the administration of the injection. Demographic variables for frequencies and their associations were analysed using SPSS version 20.0. Significance level was p shoulder impingement. Most had moderate pain. Thirty-four patients required intralesional steroid, which relieved the pain in 31 of them. Shoulder impingement syndrome without tear of rotator cuff tendon was found in younger age group between 40 to 45 years, which was relieved by intralesional corticosteroid administration. These patients had type II (curved) acromion, according to Bigliani classification.

  16. Home exercises and supervised exercises are similarly effective for people with subacromial impingement: a randomised trial

    Directory of Open Access Journals (Sweden)

    Fredrik Granviken

    2015-07-01

    Full Text Available Question: Are there different effects of home exercises and supervised exercises on pain and disability for people with subacromial impingement? Design: Randomised trial with two treatment arms, concealed allocation, blinded assessment of some outcomes, and intention-to-treat analysis. Participants: Forty-six patients with subacromial impingement were recruited from an interdisciplinary outpatient clinic of physical medicine and rehabilitation at a university hospital in Norway. Intervention: The home exercise group had one supervised exercise treatment followed by exercises at home for 6 weeks. The supervised exercise group had up to 10 supervised exercise treatments in addition to home exercises for 6 weeks. Outcome measures: The primary outcome was the Shoulder Pain and Disability Index (SPADI. Secondary outcome variables were: average pain during the past week, the Fear Avoidance Beliefs Questionnaire, participant satisfaction with treatment, active range of motion, work status and clinical shoulder tests. Pain was assessed weekly and all outcomes were assessed at 6 weeks. Participants were free to seek ongoing treatment of their choice until 26 weeks, when the SPADI was assessed again. Results: While both groups improved considerably, the groups did not differ significantly on the SPADI after the intervention at 6 weeks (0 points, 95% CI –14 to 14 or when followed up at 26 weeks (–2 points, 95% CI –21 to 17. There were no between-group differences for pain at any time. The remaining outcomes also did not differ significantly, except for the clinical tests of shoulder impingement. In the supervised exercise group, 11 out of 23 participants had two or more positive tests, compared to 18 out of 21 in the home exercise group. Conclusion: Supervision of more than the first session of a 6-week exercise regimen did not cause significant differences in pain and disability in people with subacromial impingement. Trial registration: NCT01257113

  17. Shoulder Pain among Rehabilitated Spinal Cord Injured Persons Using Manually Propelled Wheelchairs in the Gaza Strip: A Survey

    OpenAIRE

    Ziad Al Hawamdah; Jadallah M El-Shafie; Khamis El Essi; Sami I Zaqout

    2012-01-01

    Shoulder pain among paraplegic persons has negative effects on their lives. The prevalence of shoulder pain among persons with spinal cord injury (SCI) varies from 30% to 70% in different studies and may be related to repetitive use of the shoulder during self-care and wheelchair-related activities. Purpose: This study focused on the prevalence of shoulder pain and examined its effects on activities of daily living and social participation, and on functional, work and recreational or athletic...

  18. Subacromial osteochondroma: A rare cause of impingement syndrome

    OpenAIRE

    Çıtlak, Atilla; Akgün, Ulaş; Bulut, Tugrul; Aslan, Cihan; Mete, Berna Dirim; Şener, Muhittin

    2014-01-01

    Introduction Subacromial impingement syndrome is one of the most common disorders of shoulder. Scapula is a very rare site for osteochondromas, and osteochondromas arising under the acromion cause impingement syndrome. Presentation of case We presented 34-year old female patient with subacromial impingement syndrome secondary to osteochondroma. She had received conservative treatment several times in other clinics. The osteochondroma causing impingement was not diagnosed. Physical examination...

  19. Bilateral bony fusion around the supraspinatus muscle inducing muscle hypoplasia and shoulder pain

    Energy Technology Data Exchange (ETDEWEB)

    Son, YeNa; Jin, Wook; Park, So Young [Kyung Hee University Hospital at Gangdong, Department of Radiology, 892, Dongnam-ro, Gangdong-gu, Seoul (Korea, Republic of); Ryu, Kyung Nam; Park, Ji Seon [Kyung Hee University Hospital, Department of Radiology, 23 Kyunghee-daero, Dongdaemun-gu, Seoul (Korea, Republic of)

    2017-03-15

    We describe the case of a 30-year-old man who developed chronic bilateral shoulder pain that relapsed and remitted over the course of 1 year. The patient was diagnosed with congenital shoulder fusion anomalies. The right shoulder showed anomalous accessory articulation between the distal third of the clavicle and the acromion along with normal articulation of the shoulder on CT. At the left shoulder, bony fusions were present between the distal portion of the clavicle, the acromion, and the coracoid process, and between the coracoid process, upper portion of the glenoid, and upper body of the scapula, which formed a bony canal and was responsible for hypoplasia of the supraspinatus muscle on CT and MRI. To our knowledge, this is the first description of such congenital shoulder anomalies with extreme bony fusion and is an illustrative example of how imaging may be used to differentiate fusion from other congenital abnormalities of the shoulder to aid diagnosis. (orig.)

  20. Long-term prognosis for neck-shoulder pain and disorders

    DEFF Research Database (Denmark)

    Jakobsen, Emma Lise Thorlund; Biering, Karin; Kærgaard, Anette

    2017-01-01

    -shoulder pain at baseline and neck-shoulder pain at follow-up (OR 8.2;95% CI 3.5 to 19.2). Associations between neck-shoulder disorders and pain at baseline and limited physical functioning at follow-up had ORs of 5.0 (95% CI 1.5 to 16.1) and 2.2 (95% CI 1.1 to 4.6), respectively. In women still working in 2008...... to examine associations between neck-shoulder pain and disorders at baseline and neck-shoulder pain and physical functioning at follow-up. RESULTS: We found an association between neck-shoulder disorders at baseline and neck-shoulder pain at follow-up (OR 5.9;95% CI 1.9 to 17.7), and between neck...... examination at baseline in 243 female sewing machine operators and by questionnaire 14 years later. During follow-up, information on comorbidity and job exposures was obtained from registers and by linking register-based D-ISCO 88 codes with a job exposure matrix. Logistic regression analyses were performed...

  1. Massage Therapy for Neck and Shoulder Pain: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Ling Jun Kong

    2013-01-01

    Full Text Available Objective. To evaluate the effectiveness of massage therapy (MT for neck and shoulder pain. Methods. Seven English and Chinese databases were searched until December 2011 for randomized controlled trials (RCTs of MT for neck and shoulder pain. The methodological quality of RCTs was assessed based on PEDro scale. The meta-analyses of MT for neck and shoulder pain were performed. Results. Twelve high-quality studies were included. In immediate effects, the meta-analyses showed significant effects of MT for neck pain (standardised mean difference, SMD, 1.79; 95% confidence intervals, CI, 1.01 to 2.57; P<0.00001 and shoulder pain (SMD, 1.50; 95% CI, 0.55 to 2.45; P=0.002 versus inactive therapies. And MT showed short-term effects for shoulder pain (SMD, 1.51; 95% CI, 0.53 to 2.49; P=0.003. But MT did not show better effects for neck pain (SMD, 0.13; 95% CI, −0.38 to 0.63; P=0.63 or shoulder pain (SMD, 0.88; 95% CI, −0.74 to 2.51; P=0.29 than active therapies. In addition, functional status of the shoulder was not significantly affected by MT. Conclusion. MT may provide immediate effects for neck and shoulder pain. However, MT does not show better effects on pain than other active therapies. No evidence suggests that MT is effective in functional status.

  2. A cross-sectional study examining shoulder pain and disability in Division I female swimmers.

    Science.gov (United States)

    Harrington, Shana; Meisel, Corinne; Tate, Angela

    2014-02-01

    The prevalence of shoulder pain in the competitive swimming population has been reported to be as high as 91%. Female collegiate swimmers have a reported shoulder-injury rate 3 times greater than their male counterparts. There has been little information on how to best prevent shoulder pain in this population. The purpose of this study was to examine if differences exist in shoulder range of motion, upper-extremity strength, core endurance, and pectoralis minor length in NCAA Division I female swimmers with and without shoulder pain and disability. NCAA Division I females (N = 37) currently swimming completed a brief survey that included the pain subscale of the Penn Shoulder Score (PSS) and the sports/performing arts module of the Disabilities of the Arm, Shoulder, and Hand (DASH) Outcome Measure. Passive range of motion for shoulder internal rotation (IR) and external rotation (ER) at 90° abduction was measured using a digital inclinometer. Strength was measured using a handheld dynamometer for scapular depression and adduction, scapular adduction, IR, and ER. Core endurance was assessed using the side-bridge and prone-bridge tests. Pectoralis minor muscle length was assessed in both a resting and a stretched position using the PALM palpation meter. All measures were taken on the dominant and nondominant arms. Participants were classified as positive for pain and disability if the following 2 criteria were met: The DASH sports module score was >6/20 points and the PSS strenuous pain score was ≥4/10. If these criteria were not met, participants were classified as negative for pain and disability. Significant differences were found between the 2 groups on the dominant side for pectoralis muscle length at rest (P = .003) and stretch (P = .029). The results provide preliminary evidence regarding an association between a decrease in pectoralis minor length and shoulder pain and disability in Division I female swimmers.

  3. Measurement variability of quantitative sensory testing in persons with post-stroke shoulder pain.

    Science.gov (United States)

    Lindgren, Ingrid; Ekstrand, Elisabeth; Brogårdh, Christina

    2016-04-28

    To evaluate the measurement variability of quantitative sensory testing (QST) in persons with post-stroke shoulder pain. A test-retest design. Twenty-three persons with post-stroke shoulder pain (median age 65 years). Thermal detection thresholds (cold and warm), pain thresholds (cold and heat) and mechanical pain thresholds (pressure and pin prick) were assessed twice in both arms, 2-3 weeks apart. Measurement variability was analysed with the intraclass correlation coefficient (ICC2.1), the change in mean (đ) with 95% confidence interval (logarithmic scales), and the relative standard error of measurement (SEM%; re-transformed scales). The ICCs for thermal thresholds ranged from 0.48 to 0.89 in the affected (painful) arm and from 0.50 to 0.63 in the unaffected arm, and for mechanical pain thresholds from 0.66 to 0.90 in both arms. No systematic changes in the mean (đ) were found. The SEM% ranged from 4% to 10% for thermal detection and heat pain thresholds, and from 17% to 42% for cold pain and mechanical pain thresholds in both arms. QST measurements, especially cold pain thresholds and mechanical pain thresholds, vary in persons with post-stroke shoulder pain. Before QST can be used routinely to evaluate post-stroke shoulder pain, a test protocol with decreased variability needs to be developed.

  4. PERBANDINGAN ANTARA KOMBINASI LATIHAN STABILISASI BAHU DAN TRAKSI HUMERUS KE INFERIOR DENGAN KOMBINASI LATIHAN FUNGSIONAL BAHU DAN TRAKSI HUMERUS KE INFERIOR DALAM MENURUNKAN DISABILITAS BAHU DAN LENGAN PADA SUBACROMIAL IMPINGEMENT SYNDROME MAHASISWA AKAD

    Directory of Open Access Journals (Sweden)

    Mawaddah -

    2015-08-01

    Full Text Available Shoulder impingement causing interference on the motion of the shoulder joint activities and result in functional activity disorder. These injuries usually are caused by faulty movement, overuse, poor posture, occupational factors and trauma. This will cause a burden on one part of the body and cause imbalances in anatomy, which will eventually lead to disruption of the body that experienced work. This study aimed to investigate the effect of functional shoulder exercise and traction humerus to inferior with shoulder stabilization exercises and traction humerus to inferior to the decline in the shoulder and arm disabilities in subacromial impingement syndrome. This research method was experimental clinical trials with pre test and post test group design. Population student Academy Physiotherapy Widya Husada Semarang, which consists of 3 men and 12 women, aged between 18-21 years, divided into two groups. Group I was given Shoulder Stabilization exercises and Traction humerus to Inferior (n=7 and group II Functional Shoulder Exercise and Traction humerus to Inferior (n=8. This research was conducted for 3 weeks. Measurement of the value of disability shoulder and arm by using the Shoulder Pain and Disability Index (SPADI. The test results on the group I average value pre 34.17, SB = 6.31, and the average value of post 11.54, SB = 4.02, p = 0.001 found significant differences obtained test results paired sample t-test, and testing group II average value pre 40.18, SB = 3.53, and the average value of post 7.82, SB = 1.57, p = 0.001 found significant differences obtained test results paired sample t-test. Comparison of Group I and II, p = 0.005 there were significant differences, test results obtained independent sample t-test. Conclusions: The combination of shoulder stabilization exercises and traction humerus to inferior can reduce disability shoulder and arm on subacromial impingement syndrome. The combination functional shoulder exercise and

  5. Eccentric training for shoulder abductors improves pain, function and isokinetic performance in subjects with shoulder impingement syndrome: a case series.

    Science.gov (United States)

    Camargo, Paula R; Avila, Mariana A; Alburquerque-Sendín, Francisco; Asso, Naoe A; Hashimoto, Larissa H; Salvini, Tania F

    2012-01-01

    Conservative treatments have been proposed for people with shoulder impingement syndrome (SIS), such as strengthening of the rotator cuff and scapular muscles and stretching of the soft tissues of the shoulder. However, there is a lack of studies analyzing the effectiveness of eccentric training in the treatment of SIS. To evaluate the effects of eccentric training for shoulder abductors on pain, function, and isokinetic performance during concentric and eccentric abduction of the shoulder in subjects with SIS. Twenty subjects (7 females, 34.2 SD 10.2 years, 1.7 SD 0.1 m, 78.0 SD 16.3 kg) with unilateral SIS completed the study protocol. Bilateral isokinetic eccentric training at 60º/s for shoulder abductors was performed for six consecutive weeks, twice a week, on alternate days. For each training day, three sets of 10 repetitions were performed with a 3-minute rest period between the sets for each side. The range of motion trained was 60° (ranging from 80° to 20°). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate functional status and symptoms of the upper limbs. Peak torque, total work and acceleration time were measured during concentric and eccentric abduction of the arm at 60º/s and 180º/s using an isokinetic dynamometer. DASH scores, peak torque, total work and acceleration time improved (pshoulder abductors improves physical function of the upper limbs in subjects with SIS.

  6. The potential role of angiogenesis in the development of shoulder pain, shoulder dysfunction, and lymphedema after breast cancer treatment

    Directory of Open Access Journals (Sweden)

    Mafu TS

    2018-01-01

    Full Text Available Trevor S Mafu,1 Alison V September,1 Delva Shamley2 1Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, 2Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Abstract: Shoulder morbidity is a well-documented sequela of breast cancer treatment, which includes various manifestations such as pain, reduced range of motion, and lymphedema, among others. The multifactorial nature of such morbidities has long been appreciated, and research on reliable risk predictors of development thereof still continues. Previous studies have demonstrated the potential of different types of physical therapy to treat such shoulder problems, and the integration of such interventions into routine care for breast cancer survivors is a requirement in most high-income countries. Although patients at risk for developing shoulder problems would most likely benefit from posttreatment physical therapy, currently, there is no gold standard for identifying this patient group. This is particularly important in low- and middle-income countries where scarce monetary resources need to be directed specifically to those most in need. Modulators of the angiogenesis pathway have been implicated in noncancer shoulder conditions such as rotator cuff disease, adhesive capsulitis, and tendon injuries. The present review summarizes the role of angiogenesis in the development of shoulder morbidity among breast cancer survivors and sets forth the rationale for our belief that angiogenesis signaling may help explain a proportion of the reported clinical variability noted in the development of shoulder pain and dysfunction and upper-limb lymphedema after breast cancer treatment. Keywords: angiogenesis, shoulder dysfunction, cytokines, polymorphism, breast cancer therapy

  7. Physical capacity in relation to low back, neck or shoulder pain in a working population

    NARCIS (Netherlands)

    Hamberg-van Reenen, H.H.; Ariens, G.A.M.; Blatter, B.M.; Twisk, J.W.; van Mechelen, W.; Bongers, P.M.

    2006-01-01

    Aims: To investigate the longitudinal relation between physical capacity (isokinetic lifting strength, static endurance of the back, neck, and shoulder muscles, and mobility of the spine) and low back, neck, and shoulder pain. Methods: In this prospective cohort study, 1789 Dutch workers

  8. Migration of calcium deposits into subacromial-subdeltoid bursa and into humeral head as a rare complication of calcifying tendinitis: sonography and imaging.

    Science.gov (United States)

    Della Valle, Valeria; Bassi, Emilio Maria; Calliada, Fabrizio

    2015-09-01

    Calcifying tendinitis of the shoulder is a common condition characterized by the deposition of calcium, predominantly hydroxyapatite crystals, in the rotator cuff. A rare complication of this condition is the migration of calcium deposits from tendons, usually the supraspinatus, into the subacromial-subdeltoid bursa or into the humeral greater tuberosity. These complications are responsible for intense acute shoulder pain and functional disability. Patient anamnesis and clinical symptoms must be considered to make the diagnosis, but imaging, particularly sonography, is often necessary, showing a typical presentation related to the locations of calcium deposits. We present sonographic and other imaging features of subacromial-subdeltoid bursitis and humeral osteitis related to the migration of calcium.

  9. Persistent of Neck/Shoulder Pain among Computer Office Workers with Specific Attention to Pain Expectation, Somatization Tendency, and Beliefs.

    Science.gov (United States)

    Sadeghian, Farideh; Raei, Mehdi; Amiri, Mohammad

    2014-09-01

    Neck and shoulder pains are the prevalent complaints among computer office workers. The purpose of this study was to assess the relationship of somatization tendency, expectation of pain, mental health and beliefs about causation of pain with persistence of neck/shoulder pains among computer office workers. This research is a kind of prospective cohort study with 1-year follow-up. It has done among all eligible computer office workers of Shahroud universities (n = 182) in 2008-2009 and 1-year later. Data were collected using the Cultural and Psychosocial Influences on Disability questionnaire. Multiple logistic regression analysis was used to analyze the data through SPSS (P somatization tendency P = 0.01, (OR = 6.5, 95% CI: 1.6-27.4). Pain expectation and somatization tendency recognized as associated risk factors of persistent neck/shoulder pain among computer operators. This confirmed some other similar studies on work-related musculoskeletal disorders in Europe countries in recent years.

  10. Observational Scapular Dyskinesis: Known-Groups Validity in Patients With and Without Shoulder Pain.

    Science.gov (United States)

    Plummer, Hillary A; Sum, Jonathan C; Pozzi, Federico; Varghese, Rini; Michener, Lori A

    2017-08-01

    Study Design Cross-sectional. Background The scapular dyskinesis test (SDT) has demonstrated reliability and validity, but its utility for clinical decision making is unclear. Objectives To characterize the prevalence of scapular dyskinesis in participants with and without shoulder pain, and to determine the influence of blinding to the presence of shoulder pain on prevalence of scapular dyskinesis. Methods Participants (n = 135), 67 with shoulder pain and 68 healthy controls, were included in this study. The SDT was performed by 2 examiners, from a total of 21 physical therapists. The second examiner was blinded to the participant's presence of shoulder pain. The SDT involved participants performing 5 repetitions of shoulder flexion and abduction, while the clinician observed for scapular dyskinesis, as characterized by scapular winging or dysrhythmia. Dyskinesis was rated as normal, subtle, or obvious. Ratings were collapsed into 2 groups, dyskinesis (subtle and obvious) and no dyskinesis (normal), as recommended by expert consensus. Results There were no significant differences for scapular dyskinesis prevalence between the shoulder pain group and control group during the SDT in abduction (shoulder pain, 67.2%; 95% confidence interval [CI]: 0.55, 0.77 and control group, 52.9%; 95% CI: 0.41, 0.64; P = .09) or flexion (shoulder pain, 67.2%; 95% CI: 0.55, 0.77 and control group, 61.8%; 95% CI: 0.50, 0.72; P = .51). There were significant differences (P ≤001) between the examiners' SDT ratings in the shoulder pain group. The unblinded examiner reported a higher prevalence when testing the involved shoulder for dyskinesis in flexion (blinded, 67.7%; 95% CI: 0.56, 0.78 and unblinded, 80%; 95% CI: 0.69, 0.88) and during abduction (blinded, 66.2%; 95% CI: 0.54, 0.76 and unblinded, 78.5%; 95% CI: 0.67, 0.87). Conclusion Scapular dyskinesis as assessed with the SDT is not more prevalent in those with shoulder pain. Rating was influenced by an examiner's knowledge of

  11. Randomized trial of trigger point acupuncture treatment for chronic shoulder pain: a preliminary study.

    Science.gov (United States)

    Itoh, Kazunori; Saito, Shingo; Sahara, Shunsaku; Naitoh, Yuki; Imai, Kenji; Kitakoji, Hiroshi

    2014-04-01

    There is evidence for the efficacy of acupuncture treatment for chronic shoulder pain, but it remains unclear which acupuncture modes are most effective. We compared the effect of trigger point acupuncture (TrP), with that of sham (SH) acupuncture treatments, on pain and shoulder function in patients with chronic shoulder pain. The participants were 18 patients (15 women, 3 men; aged 42-65 years) with nonradiating shoulder pain for at least 6 months and normal neurological findings. The participants were randomized into two groups, each receiving five treatment sessions. The TrP group received treatment at trigger points for the muscle, while the other group received SH acupuncture treatment on the same muscle. Outcome measures were pain intensity (visual analogue scale, VAS) and shoulder function (Constant-Murley Score: CMS). After treatment, pain intensity between pretreatment and 5 weeks after TrP decreased significantly (pShoulder function also increased significantly between pretreatment and 5 weeks after TrP (pshoulder pain. Copyright © 2014. Published by Elsevier B.V.

  12. Clinical and functional profile of patients with the Painful Shoulder Syndrome (PSS).

    Science.gov (United States)

    Dias, Daniela; Matos, Marcos; Daltro, Carla; Guimarães, Armênio

    2008-01-01

    The Painful Shoulder Syndrome (PSS) is characterized by varying degrees of pain and functional limitation. The aim of this study is to describe the clinical and functional profile of these patients. 136 patients undergoing clinical treatment for PSS were evaluated by a questionnaire regarding the following variables: sex, age, occupation, affected shoulder and its dominance, image diagnosis, pain location, intensity and characteristics, physical activity involving the shoulder, preferential position of upper limbs during occupational activity, limitation of movements during activities o daily living, and job absenteeism. 74.3% of the patients were women (pshoulder was affected most frequently (58.8%) and dominant (91.9%). Rotator cuff tear was the most frequent shoulder pathology (75.4%). Treatment was sought more commonly in the chronic stage of pain (61.0%). Pain, moderate in intensity, predominated in males (54.3%) and severe pain was more frequent in females (47.5%), restricted to the shoulder in 44.1% and worsening at night (50%). The upper limbs were used more frequently below shoulder level during usual daily activities (68.4%), and limitation of movements was present mainly in women (63.4%, p=0.017). Rotator cuff tear is the most frequent cause of PSS. PSS produces pain and functional limitation, especially in women.

  13. Rehabilitative ultrasound measurement of trapezius muscle contractile states in people with mild shoulder pain.

    Science.gov (United States)

    O'Sullivan, Cliona; McCarthy Persson, Ulrik; Blake, Catherine; Stokes, Maria

    2012-04-01

    The utility of rehabilitative ultrasound imaging (RUSI) for assessing trapezius muscle contractile characteristics was investigated by examining whether muscle thickness changes during contraction (CT) differed between people with and without mild shoulder pain. In 18 subjects with mild shoulder pain (aged 28±8 years) and 18 matched controls, trapezius muscle thickness change was measured in prone at rest at 0° and during isometric CTs at 90° and 120° of shoulder abduction. Images were taken at four sites using a real-time ultrasound scanner (7-MHz linear transducer, 40 mm footprint). Percentage change in muscle thickness from rest was calculated. Differences between painful and non-painful shoulders and participant groups were examined by analysis of variance (ANOVA) and t-tests. There were no significant differences between groups or sides in trapezius muscle thickness change during CT. There was no significant difference in trapezius muscle resting thickness (RT) between painful and non-painful shoulders in the same subjects. Contractile ability of the trapezius muscle, assessed using RUSI was not impaired in subjects with mild shoulder pain during the test manoeuvres used. Further research is warranted involving patients with different severity of symptoms, using other test manoeuvres before RUSI can be advocated for assessing scapular muscle dysfunction. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Risk factors associated with shoulder pain and disability across the lifespan of competitive swimmers.

    Science.gov (United States)

    Tate, Angela; Turner, Gregory N; Knab, Sarah E; Jorgensen, Colbie; Strittmatter, Andrew; Michener, Lori A

    2012-01-01

    The prevalence of shoulder pain among competitive swimmers is high, but no guidelines exist to reduce shoulder injuries. Elucidating differences between swimmers with and without shoulder pain can serve as a basis for the development of a program to prevent shoulder injury that might lead to pain and dysfunction. To determine whether physical characteristics, exposure, or training variables differ between swimmers with and without shoulder pain or disability. Cross-sectional study. Multisite swimming centers. A total of 236 competitive female swimmers aged 8 to 77 years. Participants completed the Penn Shoulder Score and underwent testing of core endurance, range of motion, muscle force production, and pectoralis minor muscle length and the Scapular Dyskinesis Test. Swimmers were grouped by age for analysis: ages 8 to 11 years (n = 42), 12 to 14 years (n = 43), 15 to 19 years (high school, n = 84), and 23 to 77 years (masters, n = 67). Comparisons were made between groups with and without pain and disability using independent t tests for continuous data and χ² analyses and Fisher exact tests for categorical data. Nine (21.4%) swimmers aged 8 to 11 years, 8 (18.6%) swimmers aged 12 to 14 years, 19 (22.6%) high school swimmers, and 13 (19.4%) masters swimmers had shoulder pain and disability. Differences that were found in 2 or more age groups between athletes with and without shoulder pain and disability included greater swimming exposure, a higher incidence of previous traumatic injury and patient-rated shoulder instability, and reduced participation in another sport in the symptomatic groups (P trapezius and internal rotation, shorter pectoralis minor and latissimus, participation in water polo, and decreased core endurance were found in symptomatic females in single varying age groups (P stretching, strengthening, and core endurance training.

  15. Postoperative shoulder pain after laparoscopic hysterectomy with deep neuromuscular blockade and low-pressure pneumoperitoneum

    DEFF Research Database (Denmark)

    Madsen, Matias Vested; Istre, Olav; Staehr-Rye, Anne K

    2016-01-01

    BACKGROUND: Postoperative shoulder pain remains a significant problem after laparoscopy. Pneumoperitoneum with insufflation of carbon dioxide (CO2) is thought to be the most important cause. Reduction of pneumoperitoneum pressure may, however, compromise surgical visualisation. Recent studies......-pressure pneumoperitoneum (12 mmHg) and moderate NMB (single bolus of rocuronium 0.3 mg kg with spontaneous recovery) would reduce the incidence of shoulder pain and improve recovery after laparoscopic hysterectomy. DESIGN: A randomised, controlled, double-blinded study. SETTING: Private hospital in Denmark. PARTICIPANTS...... was the incidence of shoulder pain during 14 postoperative days. Secondary endpoints included area under curve VAS scores for shoulder, abdominal, incisional and overall pain during 4 and 14 postoperative days; opioid consumption; incidence of nausea and vomiting; antiemetic consumption; time to recovery...

  16. Subacromial impingement syndrome

    OpenAIRE

    Masood Umer; Irfan Qadir; Mohsin Azam

    2012-01-01

    Subacromial impingement syndrome (SAIS) represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate. However, the etiology is multi-factorial, and it has been attributed to both extrinsic and intrinsic mechanisms. Management includes physical therapy, injections, and, for some patient...

  17. Shoulder tip pain after laparoscopic surgery analgesia by collateral meridian acupressure (shiatsu) therapy: a report of 2 cases.

    Science.gov (United States)

    Yeh, Chun-Chang; Ko, Shan-Chi; Huh, Billy K; Kuo, Chang-Po; Wu, Ching-Tang; Cherng, Chen-Hwan; Wong, Chih-Shung

    2008-01-01

    This article describes 2 cases of collateral meridian acupressure (shiatsu) therapy (CMAT) for treatment of shoulder tip pain after laparoscopic cholecystectomy (LC). Both cases showed marked pain relief with reduction of skin temperature (1 degrees C) of the affected shoulder after CMAT. A 32- and a 53-year-old female presented with right shoulder tip pain after LC surgery. The repeated dose of intravenous ketorolac 30 mg and meperidine 50 mg did not improve the pain. Because of persistent pain and episodes of nausea and vomiting after intravenous nonsteroidal anti-inflammatory drugs and opioid medications, patients refused to take more analgesics, and we were consulted for pain management. After informed written consent obtained, CMAT was performed using acupoints located on the contralateral (left) kidney meridian to treat affected (right) shoulder pain. Postoperatively, patients' pain intensity was measured using a numeric pain scale. The infrared thermography of shoulder tip was obtained before and after the CMAT. Both patients reported immediate pain relief after the CMAT, with pain scores decreased from 5 to 1 of 10 and 5 to 0 of 10, respectively. Moreover, the local skin temperature of affected shoulders were significantly decreased in both patients after the CMAT. Similarly, the temperature difference between patients' affected and nonpainful shoulders were also significant after the CMAT. The results of these 2 cases suggest that the CMAT may be effective in reducing patients' post-LC shoulder tip pain without medication. An associated reduction of skin temperature of the painful shoulder with CMAT warrants further investigation.

  18. Case Reports: Unusual Cause of Shoulder Pain in a Collegiate Baseball Player

    OpenAIRE

    Ligh, Cassandra A.; Schulman, Brian L.; Safran, Marc R.

    2009-01-01

    The objective of reporting this case was to introduce a unique cause of shoulder pain in a high-level Division I NCAA collegiate baseball player. Various neurovascular causes of shoulder pain have been described in the overhead athlete, including quadrilateral space syndrome, thoracic outlet syndrome, effort thrombosis, and suprascapular nerve entrapment. All of these syndromes are uncommon and frequently are missed as a result of their rarity and the need for specialized tests to confirm the...

  19. Is there evidence in favor of surgical interventions for the subacromial impingement syndrome?

    Science.gov (United States)

    Tashjian, Robert Z

    2013-09-01

    To investigate the effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome (SIS). Using terms including randomized controlled trial (RCT), shoulder impingement syndrome, rotator cuff impingement, and interventions, the Cochrane Library, PubMed, Embase, PEDro, and CINAHL were searched up to February 2009. Relevant systematic reviews and RCTs in any language that included patients with SIS that was not caused by systemic disease or acute trauma; that evaluated surgical or postsurgical treatment for SIS; that reported outcomes of pain, function, or recovery; and that had a follow-up of ≥ 2 weeks, were selected by 2 independent reviewers and confirmed by consensus. Data on the study population, interventions, outcome measures, and length of follow-up (6 months) were extracted. Two reviewers assessed the methods of the RCTs that were included in reviews other than Cochrane reviews and in RCTs published more recently, rating RCTs that met 6 of 12 Furlan criteria as high quality. The effectiveness of the intervention was rated as moderate, limited, or no evidence, depending on the consistency and quality of the evidence. The included studies were 11 RCTs from a Cochrane review, an additional 2 RCTs that reported on the effectiveness of surgery for SIS, and 3 further RCTs that reported on postsurgical interventions. The quality of the studies was generally poor (10/11 RCTs in the Cochrane review had a high risk of bias; and 3 of the additional RCTs were rated moderate to low quality). Arthroscopic or open subacromial decompression compared with physiotherapy or exercise was investigated in 3 trials. No evidence for differences between the treatments in pain, function, or time to recovery was found in the short, medium, or long term. Five comparisons of arthroscopic versus open subacromial decompression showed no differences in pain or shoulder function scores at any follow-up assessment. One study found no difference in short- or

  20. Does hemiplegic shoulder pain share clinical and sensory characteristics with central neuropathic pain? A comparative study.

    Science.gov (United States)

    Zeilig, Gabi; Rivel, Michal; Doron, Dana; Defrin, Ruth

    2016-10-01

    Hemiplegic shoulder pain (HSP) is a common poststroke complication and is considered to be a chronic pain syndrome. It is negatively correlated with the functional recovery of the affected arm and the quality of life of the individual. It also leads to a longer length of stay in rehabilitation. Today, there is no consensus as to the underlying mechanism causing HSP, making the syndrome difficult to treat. The aim of this study was to compare the clinical and sensory profile of individuals with HSP to that of individuals with established central neuropathic pain (CNP) in order to identify common features and the presence of neuropathic components in HSP. Cross sectional controlled study. Outpatient rehabilitation clinics. Sixteen chronic HSP patients and 18 chronic CNP patients with spinal cord injury (SCI-CNP). The chronic pain characteristics, thresholds of thermal and tactile sensations and presence of pathological sensations were compared between groups, and between painful and pain free body regions within groups. Correlations were calculated between HSP intensity and sensory and musculoskeletal characteristics. Patients with HSP and patients with SCI-CNP had similar decrease of thermal sensibility in the painful compared to intact body regions and both groups presented similar rates of pathological sensations in painful regions. HSP and SCI-CNP differed however, in the quality of pain and aggravating factors. Significant correlations were found between HSP intensity and heat-pain threshold, presence of subluxation and spasticity. The similarities between HSP and SCI-CNP and the altered spinothalamic function and sensitization suggest that HSP has neuropathic components in its mechanism. Nevertheless, the unique features of HSP point towards additional possible mechanisms. The use of specific therapy options for neuropathic pain should be considered when treating patients with HSP.

  1. Psychophysical and Patient Factors as Determinants of Pain, Function and Health Status in Shoulder Disorders.

    Science.gov (United States)

    Uddin, Zakir; MacDermid, Joy C; Moro, Jaydeep; Galea, Victoria; Gross, Anita R

    2016-01-01

    To estimate the extent to which psychophysical quantitative sensory test (QST) and patient factors (gender, age and comorbidity) predict pain, function and health status in people with shoulder disorders. To determine if there are gender differences for QST measures in current perception threshold (CPT), vibration threshold (VT) and pressure pain (PP) threshold and tolerance. A cross-sectional study design. MacHAND Clinical Research Lab at McMaster University. 34 surgical and 10 nonsurgical participants with shoulder pain were recruited. Participants completed the following patient reported outcomes: pain (Numeric Pain Rating, Pain Catastrophizing Scale, Shoulder Pain and Disability Index) and health status (Short Form-12). Participants completed QST at 4 standardized locations and then an upper extremity performance-based endurance test (FIT-HaNSA). Pearson r's were computed to determine the relationships between QST variables and patient factors with either pain, function or health status. Eight regression models were built to analysis QST's and patient factors separately as predictors of either pain, function or health status. An independent sample t-test was done to evaluate the gender effect on QST. Greater PP threshold and PP tolerance was significantly correlated with higher shoulder functional performance on the FIT-HANSA (r =0.31-0.44) and lower self-reported shoulder disability (r = -0.32 to -0.36). Higher comorbidity was consistently correlated (r =0.31-0.46) with more pain, and less function and health status. Older age was correlated to more pain intensity and less function (r =0.31-0.57). In multivariate models, patient factors contributed significantly to pain, function or health status models (r 2 =0.19-0.36); whereas QST did not. QST was significantly different between males and females [in PP threshold (3.9 vs . 6.2, p shoulder disorders.

  2. [Functional results of type A botulinum toxin versus oral anti-inflammatory agents in the rehabilitation of painful shoulder syndrome caused by rotator cuff lesion].

    Science.gov (United States)

    Becerril, Bautista P; Negrete-Corona, J; Chávez-Hinojosa, E

    2014-01-01

    Rotator cuff conditions are characterized by unspecific signs, as well as anatomic alterations and symptoms. They have a multifactorial etiology and may include everything from tendinitis to massive, full thickness tears of the rotator cuff tendon that compromise the normal biomechanics of the involved shoulder. They usually occur in people over 40 years of age but lesions resulting from trauma may vary according to the mechanism of injury and are not directly related with the age at onset of symptoms. Vascular factors have been described as related with rotator cuff tendon damage in conditions affecting the microcirculation. However, recent studies have not proven that the tendon under direct observation shows hypovascularity. Type A botulinum toxin acts by blocking the release of acetylcholine in the neuromuscular plate; in the joints it releases capsular tension and reduces proinflammatory factors such as interleukin-1 (IL-1). There are only a few papers on its intraarticular benefit; in muscle and tendon groups it not only has a muscle relaxant effect, but several publications support its utility for pain management. It has been widely used in the rehabilitation of this group of patients at low doses. Material and methods: Prospective, investigational and longitudinal study involving the follow-up of 24 patients with a diagnosis of painful shoulder syndrome proven clinically and with imaging tests, and caused by rotator cuff lesions. The patients either did not meet the criteria for immediate surgical repair or had already undergone such a repair. Type A botulinum toxin was applied to 12 patients in the subacromial space around the rotator cuff conjoint tendon, as well as in the painful spots and in the muscle contracture in the shoulder. The total dose of Type A botulinum toxin was 200 IU. The control group, also composed of 12 patients, was given a COX-2 oral antiinflammatory agent for 6 weeks (Celecoxib, 100 mg BID). Both groups followed a pre

  3. Can scapular and humeral head position predict shoulder pain in adolescent swimmers and non-swimmers?

    Science.gov (United States)

    McKenna, Leanda; Straker, Leon; Smith, Anne

    2012-12-01

    The aims of this study were to determine whether scapular and humeral head position can predict the development of shoulder pain in swimmers, whether those predictors were applicable to non-swimmers and the annual rate of shoulder pain in adolescent swimmers and non-swimmers. Forty-six adolescent swimmers and 43 adolescent non-swimmers were examined prospectively with a questionnaire and anthropometric measures. The questionnaire examined demographic and training variables. Anthropometric measures examined the distances between the T7 spinous process and the inferior scapula (Inferior Kibler) and T3 spinous process and the medial spine of the scapula (Superior Kibler), humeral head position in relation to the acromion using palpation, BMI and chest width. Shoulder pain was re-assessed 12 months later by questionnaire. Shoulder pain in swimmers was best predicted by a larger BMI (OR = 1.48, P = 0.049), a smaller Inferior Kibler distance in abduction (e.g. OR = 0.90, P = 0.009) and a smaller horizontal distance between the anterior humeral head and the anterior acromion (OR = 0.76, P = 0.035). These variables were not significantly predictive of shoulder pain in non-swimmers. Annual prevalence of shoulder pain was 23.9% in swimmers and 30.8% in non-swimmers (χ(2) = 0.50, P = 0.478).

  4. Costs of shoulder pain in primary care consulters: a prospective cohort study in The Netherlands

    Directory of Open Access Journals (Sweden)

    van Tulder Maurits W

    2006-11-01

    Full Text Available Abstract Background Shoulder pain is common in primary care, and has an unfavourable outcome in many patients. Information on the costs associated with health care use and loss of productivity in patients with shoulder pain is very scarce. The objective of this study was to determine shoulder pain related costs during the 6 months after first consultation in general practice Methods A prospective cohort study consisting of 587 patients with a new episode of shoulder pain was conducted with a follow-up period of 6 months. Data on costs were collected by means of a cost diary during 6 months. Results 84% of the patients completed all cost diaries. The mean consumption of direct health care and non-health related care was low. During 6 months after first consultation for shoulder pain, the mean total costs a patient generated were €689. Almost 50% of this total concerned indirect costs, caused by sick leave from paid work. A small proportion (12% of the population generated 74% of the total costs. Conclusion The total costs in the 6 months after first consultation for shoulder pain in primary care, mostly generated by a small part of the population, are not alarmingly high.

  5. Effect of pain-free range exercise on shoulder pain and range of motion in an amateur skier.

    Science.gov (United States)

    Yoo, Won-Gyu

    2016-12-01

    [Purpose] This study prescribed pain-free range exercises for a female amateur skier who complained of limitations in her shoulder range of motion, and pain caused by protective spasms; the tester evaluated the effects of such exercise on pain. [Subject and Methods] A 23-year-old female who complained of pain of 3 weeks in duration in the right glenohumoral and scapulothoracic joints was enrolled. [Results] After pain-free range exercises, the visual analog pain score was 2 and the shoulder flexion and abduction angles improved compared to the initial values. [Conclusion] Thus, this study suggests muscle-strengthening exercises within the pain-free range, rather than simple pain treatments, as therapy for acute muscle injuries in skiers.

  6. Patterns of shoulder pain during a 14-year follow-up: results from a longitudinal population study in Norway

    Science.gov (United States)

    Grotle, Margreth; Natvig, Bård

    2014-01-01

    Background Population studies have reported that shoulder pain is the third most frequently reported musculoskeletal pain. Long duration, pain intensity and high level of disability predict persistent complaints. The present study aimed to describe the prevalence of shoulder pain in a general population and follow this over a long period (1990 to 2004). The objective was also to describe the stability of shoulder pain and patterns of co-occurrence with neck and upper back pain. Methods Data were obtained from a self-reported questionnaire in a population in Ullensaker muncipality, north-east of Oslo. The Standard Nordic Questionnaire was sent in 1990, 1994 and 2004 to inhabitants belonging to six birth cohorts from 1918–20 to 1968–70. Results The 1-year prevalence of shoulder pain was 46.7% (95% CI, 44.9% to 48.6%) in 1990, 48.7% (95% CI, 46.8% to 50.5%) in 1994, and 55.2% (95% CI, 53.5% to 56.9%) in 2004. Approximately three-quarters of the persons with shoulder pain at one given time also reported shoulder pain at the next follow-up. Conclusions Prevalence of shoulder pain during a 14-year period was high and slightly increasing. Shoulder pain was reported most frequently in co-occurrence with neck pain. Classification models should include neck pain as well as other co-occurring pain sites. PMID:27582957

  7. Effects of Kinesio taping for stroke patients with hemiplegic shoulder pain: A double-blind, randomized, placebo-controlled study.

    Science.gov (United States)

    Huang, Yen-Chang; Chang, Kwang-Hwa; Liou, Tsan-Hon; Cheng, Chau-Wei; Lin, Li-Fong; Huang, Shih-Wei

    2017-03-06

    To investigate the effects of Kinesio taping for stroke patients with hemiplegic shoulder pain. Double-blind, placebo-controlled clinical trial. Twenty-one stroke patients with hemiplegic shoulder pain within 6 months of stroke onset in the rehabilitation ward of a medical university hospital in Taiwan. A 3-week intervention involving a conventional rehabilitation protocol and therapeutic Kinesio taping was conducted with an experimental group of 11 stroke patients. A control group of 10 stroke patients underwent an identical conventional rehabilitation programme and sham Kinesio taping on the hemiplegic shoulder. Numerical rating scale scores, Shoulder Pain and Disability Index, ultrasound findings and pain-free passive range of motion of the affected shoulder, were evaluated before and after the intervention. Mann-Whitney test was used to compare within-group continuous variables before and after the intervention. Wilcoxon signed-rank test was used to analyse the differences and changes in values between study and control groups. There was no statistical difference in demographic variables between the 2 groups. Both groups showed improvement in passive range of motion of the shoulder, (mean numerical rating scale 2.36 (standard deviation (SD) 1.03)), and mean Shoulder Pain and Disability Index (16.64 (SD 2.62)) after the intervention (p pain-free passive ROM, and ultrasound findings for the shoulder after 3 weeks of treatment. Concerning the variables changes, the therapeutic Kinesio taping group showed more improvement in the numerical rating scale (p = 0.008), shoulder flexion (p = 0.008), external rotation (p = 0.006), internal rotation (p = 0.040), and Shoulder Pain and Disability Index (p shoulder pain can experience greater reductions in Shoulder Pain and Disability Index, pain, and improvement in shoulder flexion, external, and internal rotation after 3 weeks of Kinesio taping intervention compared with sham Kinesio taping. Kinesio taping may be an

  8. [Diagnostic value of a predictive model for complete ruptures of the rotator cuff associated to subacromial impingement].

    Science.gov (United States)

    Águila-Ledesma, I R; Córdova-Fonseca, J L; Medina-Pontaza, O; Núñez-Gómez, D A; Calvache-García, C; Pérez-Atanasio, J M; Torres-González, R

    2017-01-01

    Pathology related to the rotator cuff remains among the most prevalent musculoskeletal diseases. There is an increasing need for imaging studies (MRI, US, arthroscopy) to test the diagnostic performance of the medical history and physical examination. To prove the diagnostic value of a clinical-radiographic predictive model to find complete ruptures of the rotator cuff. Descriptive, observational, prospective, transversal and analytical study. Fifty-five patients with preoperative shoulder pain were evaluated with 13 predictive variables: age > 50 years, nocturnal pain, muscle weakness, clinical signs of Neer, Hawkins, Jobe, external rotation lag (ERLS), belly-press, bear hug, and lift-off, radiographic measurement of subacromial space, acromial index and critical shoulder angle. Sensitivity, specificity, and positive and negative predictive values were measured in each variable, comparing the results of each one against the postoperative findings. Of the 55 patients evaluated, 42 had a complete rupture of the rotator cuff in the postoperative period. The eight variables with a higher diagnostic value were selected and a ROC curve was performed, providing an area under the curve of 0.88. This predictive model uses eight variables (age > 50 years, nocturnal pain, muscle weakness, Jobe, Hawkins, ERLS, subacromial space ≤ 6 mm, and critical shoulder angle > 35°), which together add the predictive value of 0.88 (AUC) to diagnose complete ruptures of the supraspinatus tendon.

  9. Implementation of neck/shoulder exercises for pain relief among industrial workers: A randomized controlled trial

    Science.gov (United States)

    2011-01-01

    Background Although leisure-time physical activity is important for health, adherence to regular exercise is challenging for many adults. The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise. This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers. Methods Cluster-randomized controlled trial involving 537 adults from occupations with high prevalence of neck and shoulder pain (industrial production units). Participants were randomized to 20 weeks of high-intensity strength training for the neck and shoulders three times a week (n = 282) or a control group receiving advice to stay physically active (n = 255). The strength training program followed principles of progressive overload and periodization. The primary outcome was changes in self-reported neck and shoulder pain intensity (scale 0-9). Results 85% of the participants followed the strength training program on a weekly basis. In the training group compared with the control group, neck pain intensity decreased significantly (-0.6, 95% CI -1.0 to -0.1) and shoulder pain intensity tended to decrease (-0.2, 95% CI -0.5 to 0.1, P = 0.07). For pain-cases at baseline (pain intensity > = 3) the odds ratio - in the training group compared with the control group - for being a non-case at follow-up (pain intensity < 3) was 2.0 (95% CI 1.0 to 4.2) for the neck and 3.9 (95% CI 1.7 to 9.4) for the shoulders. Conclusion High-intensity strength training relying on principles of progressive overload can be successfully implemented at industrial workplaces, and results in significant reductions of neck and shoulder pain. Trial registration NCT01071980. PMID:21936939

  10. Myofascial triggerpoint release (MTR) for treating chronic shoulder pain: A novel approach.

    Science.gov (United States)

    Gordon, Christopher-Marc; Andrasik, Frank; Schleip, Robert; Birbaumer, Niels; Rea, Massimiliano

    2016-07-01

    This study comprehensively evaluated a myofascial triggerpoint release (MTR) technique for shoulder pain. Twenty-three (from an initial sample of 25) patients experiencing shoulder pain received MTR, in four 10-min sessions over a period of 2 weeks, applied exclusively on the more painful shoulder, with assessments being recorded both before and after treatment (and for pain at 1 and 13 months). Measures of stiffness and elasticity were collected to monitor the process of therapy, while subjective measures of pain and objective measures of pressure pain thresholds tracked primary outcomes. Secondary outcomes focused on suffering, stress, and quality of life. A statistically significant decrease in stiffness and increase in elasticity was observed post intervention for the treated side only, while pressure pain thresholds improved on the untreated side as well. Reports of pain significantly decreased after treatment, with gains being maintained at 1 and 13 months following treatment. Levels of suffering, stress, and quality of life revealed statistically significant improvement as well. MTR resulted in clinically significant improvements in the primary measures of pain, objective mechanical tissue properties, and secondary measures in patients with chronic shoulder pain. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Elite swimmers with and without unilateral shoulder pain: mechanical hyperalgesia and active/latent muscle trigger points in neck-shoulder muscles.

    Science.gov (United States)

    Hidalgo-Lozano, A; Fernández-de-las-Peñas, C; Calderón-Soto, C; Domingo-Camara, A; Madeleine, P; Arroyo-Morales, M

    2013-02-01

    Our aim was to investigate the presence of mechanical hypersensitivity and active trigger points (TrPs) in the neck-shoulder muscles in elite swimmers with/without unilateral shoulder pain. Seventeen elite swimmers with shoulder pain; 18 swimmers without shoulder pain; and 15 elite athletes matched controls were recruited. Pressure pain thresholds (PPT) were assessed over the levator scapulae, sternocleidomastoid, upper trapezius, infraspinatus, scalene, subscapularis and tibialis anterior muscles. TrPs in the levator scapulae, upper trapezius, infraspinatus, scalene, sternocleidomastoid and subscapularis muscles were also explored. Swimmers with shoulder pain showed significant lower PPT in all muscles compared with controls (Pactive; 2.6 ± 1.4 latent) and 4.7 ± 1.3 (1.3 ± 1.3 active; 3.4 ± 1.5 latent), whereas healthy athletes only showed latent TrPs (2.4 ± 1.2). Elite swimmers with shoulder pain showed higher number of active TrPs than swimmers without pain, whereas it was the opposite for the number of latent muscle TrP (Pactive TrPs play a role in the development of shoulder pain in elite swimmers. © 2011 John Wiley & Sons A/S.

  12. Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain.

    Science.gov (United States)

    Andersen, Lars L; Hansen, Klaus; Mortensen, Ole S; Zebis, Mette K

    2011-07-22

    Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain. Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years) with nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'. In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%). In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%). In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations. A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius. ISRCTN60264809.

  13. Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain

    Science.gov (United States)

    2011-01-01

    Background Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain. Methods Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years) with nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'. Results In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%). In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%). In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations. Conclusions A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius. Trial Registration ISRCTN60264809 PMID:21777478

  14. Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain

    Directory of Open Access Journals (Sweden)

    Mortensen Ole S

    2011-07-01

    Full Text Available Abstract Background Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain. Methods Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years with nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'. Results In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%. In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%. In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations. Conclusions A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius. Trial Registration ISRCTN60264809

  15. Decubital shoulder ulcers in sows - a review of classification, pain and welfare consequences

    DEFF Research Database (Denmark)

    Herskin, Mette S; Bonde, Marianne; Jørgensen, Erik

    2011-01-01

    in the skin and the underlying tissue. This paper reviews existing knowledge about decubital shoulder ulcers in sows, focusing on the pathogenesis, classification and consequences in terms of pain and animal welfare. On the basis of available human as well as animal literature, we describe the primary causal...... of the welfare consequences of decubital shoulder ulcers is limited. On the basis of the tissue structures that are involved, we assume that the development and presence of decubital shoulder ulcers in sows are a painful and prolonged condition. It is concluded that the extent of the welfare problem related...... to decubital shoulder ulcers cannot be fully determined until a valid ante-mortem classification system is available, and knowledge about the duration of the condition (including the various stages), as well as the possible consequences in terms of pain or discomfort have been established...

  16. Chronic shoulder pain referred from thymic carcinoma: a case report and review of literature

    Directory of Open Access Journals (Sweden)

    Dee SW

    2012-09-01

    Full Text Available Shu-Wei Dee,1 Mu-Jung Kao,2,3 Chang-Zern Hong,4 Li-Wei Chou,1,5 Henry L Lew6,71Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, 2Department of Physical Medicine and Rehabilitation, Yangming Branch, Taipei City Hospital, Taipei, 3Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, 4Department of Physical Therapy, Hungkuang University, Taichung, 5School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 6Defense and Veterans Brain Injury Center, Virginia Commonwealth University, Richmond, Virginia, 7University of Hawaii at Manoa, John A Burns School of Medicine, Honolulu, Hawaii, USAAbstract: We report a case of thymic carcinoma presenting as unilateral shoulder pain for 13 months. Before an accurate diagnosis was made, the patient received conservative treatment, cervical discectomies, and myofascial trigger point injection, none of which relieved his pain. When thymic carcinoma was eventually diagnosed, he received total resection of the tumor and the shoulder pain subsided completely. Thymic carcinoma is a rare carcinoma, and our review of the literature did not show shoulder pain as its initial presentation except for one case report. The purpose of this report is to document our clinical experience so that other physiatrists can include thymic carcinoma in their differential diagnosis of shoulder pain.Keywords: referred pain, shoulder pain, thymic carcinoma

  17. Features of Golf-Related Shoulder Pain in Korean Amateur Golfers.

    Science.gov (United States)

    Lee, Chang Hwa; Hong, Jin Young; Jeon, Po Song; Hwang, Ki Hun; Moon, Won Sik; Han, Yong Hyun; Jeong, Ho Joong

    2017-06-01

    To investigate the causes and characteristics of golf-related shoulder injuries in Korean amateur golfers. Golf-related surveys were administered to, and ultrasonography were conducted on, 77 Korean amateur golfers with golf-related shoulder pain. The correlation between the golf-related surveys and ultrasonographic findings were investigated. The non-dominant shoulder is more likely to have golf-related pain and abnormal findings on ultrasonography than is the dominant shoulder. Supraspinatus muscle tear was the most frequent type of injury on ultrasonography, followed by subscapularis muscle tear. Investigation of the participants' golf-related habits revealed that only the amount of time spent practicing golf was correlated with supraspinatus muscle tear. No correlation was observed between the most painful swing phases and abnormal ultrasonographic findings. Participants who had not previously visited clinics were more likely to present with abnormal ultrasonographic findings, and many of the participants complained of additional upper limb pain. Golf-related shoulder injuries and pain are most likely to be observed in the non-dominant shoulder. The supraspinatus muscle was the most susceptible muscle to damage. A correlation was observed between time spent practicing golf and supraspinatus muscle tear.

  18. Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial

    Directory of Open Access Journals (Sweden)

    Stegenga Boudewijn

    2011-01-01

    Full Text Available Abstract Background Shoulder pain is a common musculoskeletal problem that is often chronic or recurrent. Myofascial trigger points (MTrPs cause shoulder pain and are prevalent in patients with shoulder pain. However, few studies have focused on MTrP therapy. The aim of this study was to assess the effectiveness of multimodal treatment of MTrPs in patients with chronic shoulder pain. Methods A single-assessor, blinded, randomized, controlled trial was conducted. The intervention group received comprehensive treatment once weekly consisting of manual compression of the MTrPs, manual stretching of the muscles and intermittent cold application with stretching. Patients were instructed to perform muscle-stretching and relaxation exercises at home and received ergonomic recommendations and advice to assume and maintain good posture. The control group remained on the waiting list for 3 months. The Disabilities of Arm, Shoulder and Hand (DASH questionnaire score (primary outcome, Visual Analogue Scale for Pain (VAS-P, Global Perceived Effect (GPE scale and the number of muscles with MTrPs were assessed at 6 and 12 weeks in the intervention group and compared with those of a control group. Results Compared with the control group, the intervention group showed significant improvement (P Conclusions The results of this study show that 12-week comprehensive treatment of MTrPs in shoulder muscles reduces the number of muscles with active MTrPs and is effective in reducing symptoms and improving shoulder function in patients with chronic shoulder pain. Trial registration number ISRCTN: ISRCTN75722066

  19. The molecular pathophysiology of subacromial bursitis in rotator cuff disease.

    Science.gov (United States)

    Blaine, Theodore A; Kim, Yang-Soo; Voloshin, Ilya; Chen, Darwin; Murakami, Koko; Chang, Seong-Sil; Winchester, Robert; Lee, Francis Y; O'keefe, Regis J; Bigliani, Louis U

    2005-01-01

    Little information exists on the molecular and biochemical pathophysiology of subacromial bursitis and rotator cuff disease. We investigated the pattern of expression of cytokines (interleukin [IL]-1beta, IL-1, IL-6, tumor necrosis factor [TNF] alpha, small inducible cytokines), metalloproteases, and cyclooxygenases in the subacromial bursa in patients with rotator cuff disease. Subacromial bursa specimens were prepared for molecular and biochemical analysis in patients undergoing shoulder surgery following an institutional review board-approved protocol. Specimens were analyzed for the presence of cytokines, metalloproteases, and cyclooxygenases by use of microarray for gene expression and immunohistocytochemistry. Microarray analysis for gene expression and immunohistochemistry demonstrated that the expression of several cytokine genes (TNF, IL-1alpha, IL-1beta, and IL-6) was increased in patients with subacromial bursitis compared with control specimens. Furthermore, the expression of metalloproteases (MMP-1 and MMP-9) and cyclooxygenases (COX-1 and COX-2) in the bursitis group was found to be increased as compared with controls. Although further investigation is required, these studies suggest that inflammation of the subacromial bursa does occur in patients with rotator cuff disease. These findings support the role of anti-inflammatory agents in the treatment of subacromial impingement and emphasize the importance of subacromial bursectomy to reduce inflammation in rotator cuff disease.

  20. Radiological evaluation of acromial characteristic using supraspinatus outlet view in shoulder impingement syndrome

    Directory of Open Access Journals (Sweden)

    Marcel Prasetyo

    2007-09-01

    Full Text Available Purpose of this study was to find the association between shoulder impingement syndrome (SIS and morphological characteristics of acromion (acromial tilt angle, type of acromion, subacromial osteophyte. Supraspinatus outlet view was performed using fluoroscopy. There were 40 SIS patients and 40 individuals with no shoulder pain examined and measured for their acromial tilt angle, type of acromion (according to Bigliani’s classification and Park’s criteria and for the presence of subacromial osteophyte. Average acromial tilt angle was 34.1° (SD 7.6 for SIS group and 32.1° (SD 7.7 for control group. Type II acromion was found more frequent in both groups (85% and 95%. The association between SIS and acromial tilt angle or between SIS and type of acromion were statistically insignificant (p=0.241 and p=0.221. Subacromial osteophyte was found in 52.5% of SIS group compare to 12.5% among the control group, and the association with SIS was statistically significant (p=0.0003. Subacromial osteophyte was found to have significant association with SIS. Such association was not found in acromial tilt angle and type of acromion. (Med J Indones 2007; 16:176-80 Keywords: shoulder impingement syndrome, acromion, supraspinatus

  1. Neck/shoulder and back pain in new graduate nurses: A growth mixture modeling analysis.

    Science.gov (United States)

    Lövgren, Malin; Gustavsson, Petter; Melin, Bo; Rudman, Ann

    2014-04-01

    Although it is well known that musculoskeletal disorders are common among registered nurses, little longitudinal research has been conducted to examine this problem from nursing education to working life. The aim was to investigate the prevalence and incidence of neck/shoulder and back pain in nursing students in their final semester, and one and two years after graduation. Furthermore, to identify common trajectories of neck/shoulder and back pain, and explore sociodemographic and lifestyle-related factors, contextual factors and health outcome that might be characteristic of individuals in the various trajectories. Longitudinal study following nursing students from their final year of studies, with follow-ups one and two years after graduation. Nursing students who graduated from the 26 universities providing undergraduate nursing education in Sweden 2002 were invited to participate (N=1700). Of those asked, 1153 gave their informed consent. The participants answered postal surveys at yearly intervals. Descriptive statistics were used to analyze prevalence and incidence of pain, and growth mixture modeling was applied to identify different homogeneous clusters of individuals following similar trajectories in pain development across time. The prevalence of neck/shoulder and back pain remained constant over time (around 50% for neck/shoulder pain and just over 40% for back pain). Six different development trajectories for each symptom were found, reflecting patterns of stable pain levels or variation in levels over time: one symptom-free group, two decreasing pain groups, two increasing pain groups, and one chronic pain group. With few exceptions, the same factors (sex, children, chronic disease, working overtime, work absence, sickness presence, physical load, depression, self-rated health, sleep quality and muscular tension) were associated with neck/shoulder and back pain trajectories. Different types of physical load characterized new nurses with neck/shoulder

  2. In vivo temperature measurement in the subacromial bursa during arthroscopic subacromial decompression.

    Science.gov (United States)

    Barker, Scott L; Johnstone, Alan J; Kumar, Kapil

    2012-06-01

    The purpose of the study was to evaluate whether use of a bi-polar radiofrequency (RF) ablation wand would cause excess heating, which may lead to collateral damage to the surrounding tissues during arthroscopic subacromial decompression. Cadaveric studies have shown that high temperatures can potentially be reached when using RF ablation wands in arthroscopic shoulder surgery. Only 1 other published study assesses these temperature rises in the clinical setting. Fifteen patients were recruited to participate in the study. A standard arthroscopic subacromial decompression was performed using continuous flow irrigation, with intermittent use of the RF ablation wand for soft tissue debridement. The temperature of the irrigation fluid within the subacromial bursa and the outflow fluid from the suction port of the wand were measured during the procedure using fiber-optic thermometers. The mean peak temperature recorded in the subacromial bursa was 32.0°C (29.3-43.1°C), with a mean rise from baseline of 9.8°C. The mean peak temperature recorded from the outflow fluid from the wand was 71.6°C (65.6-77.6°C), with a mean rise from baseline of 49.4°C. High temperatures were noted in the outflow fluid from the wand; however, this was not evident in the subacromial bursa itself. Use of room temperature inflow fluid, maintenance of flow through the bursa, and avoidance of prolonged uninterrupted use of the wand all appear to ensure that safe temperatures are maintained in the subacromial bursa not only in the laboratory but also in a clinical setting. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  3. [The effectiveness of a comprehensive program of physiotherapy in shoulder pain syndromes].

    Science.gov (United States)

    Kuciel-Lewandowska, Jadwiga; Wierzchowska, Malwina; Paprocka-Borowicz, Małgorzata; Kierzek, Andrzej; Pozowski, Andrzej; Heider, Roman; Guła, Michał; Laber, Wojciech Tomasz

    2010-01-01

    Periarthritis humeroscapularis (PHS) is a disease notable for serious therapeutic problems arising from lesions in various tissue structures. The shoulder is the most important biokinematic element in the upper extremity. For this reason, physiotherapy continues to search for an ideal form of rehabilitation. Treatment of PHS is long and difficult. The correct diagnosis combined with physiotherapy can reduce the suffering of the patient and shorten the duration of the disease. Thus, the restoration of physical activity can be expedited. We decided to assess the effectiveness of a comprehensive program of physiotherapy in shoulder pain syndromes. The study was done at the Rehabilitation Unit of the Stabłowice Clinic of the Wroclaw Health Center. We enrolled 30 patients aged 30 to 85 years (mean age: 60 +/- 14 years) with pain and limited mobility of the shoulder diagnosed as PHS. A questionnaire with 12 questions addressing the intensity and extent of shoulder pain was prepared. Shoulder joint mobility was determined with a goniometric method. In addition, an 11-grade Numerical Rating Scale (NRS), where 0 meant no pain and 10 the most severe pain, was adopted. All patients underwent a series of 10 physiotherapeutic procedures directed at the shoulder joint. Assessment was made before and after therapy. A considerable reduction of pain was noted after physiotherapy and massage, while exercises significantly improved mobility, muscle status, and function of the upper extremity. The present study has shown that the comprehensive program of physiotherapy carried out at the Rehabilitation Unit of the Stabłowice Clinic of the Wrocław Health Center is effective in treating patients with the shoulder pain syndrome.

  4. Shoulder pain and dysfunction in young surf lifesavers.

    Science.gov (United States)

    Carter, Josh; Marshall, Nick; Abbott, Allan

    2015-05-01

    To determine the incidence and prevalence of significantly interrupting shoulder pain (SIP) in young surf lifesavers and to determine association with training dosage and the 'combined elevation test'. 54 surf lifesavers aged 10-18 from the Gold Coast, Australia. Retrospective survey of SIP and training dosage. Cross-sectional measures of the combined elevation test. Retrospective. 56.5% of female surf lifesavers reported a history of SIP compared to males with 48.5%. Females had a higher combined elevation score compared to males, 28.32 ± SD 8.52 cm and 26.09 ± SD 6.64 cm, respectively. Young surf lifesavers had an incidence rate of 2.1 SIP episodes per thousand hours of training, an incidence proportion of 51.9% and prevalence of 18.5%. Combined elevation had low level positive trends with training dosages and statistically significant negative correlation with board paddling sessions per week (r = -0.287, p ≤ 0.05). Those with a history of SIP had a statistically significant higher number of sessions (p = 0.008), duration (p = 0.015) and distance (p = 0.005) swimming per week. Young surf lifesavers with a history of SIP have greater swimming dosage not associated with a decreased combined elevation score. More board paddling sessions per week decreased the combined elevation score of young surf lifesavers. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Effect of depressive symptoms on perceived disability in patients with chronic shoulder pain.

    Science.gov (United States)

    Roh, Young Hak; Lee, Beom Koo; Noh, Jung Ho; Oh, Joo Han; Gong, Hyun Sik; Baek, Goo Hyun

    2012-09-01

    Psychological distress may be an important determinant of perceived disability in patients with chronic musculoskeletal disorders. We evaluated the relationship between depressive symptoms and perceived disability in patients with chronic shoulder pain and quantified the contribution made by depression to perceived disability. In this prospective study, 109 patients with chronic shoulder pain caused by degenerative or inflammatory disorders were evaluated using the Disability of Arm, Shoulder and Hand (DASH) questionnaire and the Center for Epidemiologic Studies-Depression (CES-D) Scale to determine relationships between depressive symptoms and perceived disability in patients with chronic shoulder pain. In addition, pain scores were evaluated using a visual analog scale (VAS) during activity, and range of motion (ROM) and abduction strength (strength) measurements were measured. Multivariate analyses of variance and regression modeling were used to assess the relative contributions made by depressive symptoms (CES-D) and other clinical parameters to patient-perceived disability (DASH). DASH scores were found to be moderately correlated (0.3 pain VAS and CES-D; DASH scores were more strongly correlated with CES-D scores than with pain VAS scores or range of motion (r = 0.58; p pain VAS and CES-D scores independently predicted DASH score and accounted for 43 % of the variance. CES-D score was found to be the strongest predictor of DASH score and accounted for 23 % of the variance. Degrees of depressive symptoms were found to be significantly associated with higher symptom scores and greater disability in patients with chronic shoulder pain. Although a large proportion of perceived disability remains unexplained, perceived disability in patients with chronic shoulder pain was found to be strongly influenced by depressive symptoms. Level 2, prospective cohort study, prognostic study.

  6. Implementation of neck/shoulder exercises for pain relief among industrial workers: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Hannerz Harald

    2011-09-01

    Full Text Available Abstract Background Although leisure-time physical activity is important for health, adherence to regular exercise is challenging for many adults. The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise. This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers. Methods Cluster-randomized controlled trial involving 537 adults from occupations with high prevalence of neck and shoulder pain (industrial production units. Participants were randomized to 20 weeks of high-intensity strength training for the neck and shoulders three times a week (n = 282 or a control group receiving advice to stay physically active (n = 255. The strength training program followed principles of progressive overload and periodization. The primary outcome was changes in self-reported neck and shoulder pain intensity (scale 0-9. Results 85% of the participants followed the strength training program on a weekly basis. In the training group compared with the control group, neck pain intensity decreased significantly (-0.6, 95% CI -1.0 to -0.1 and shoulder pain intensity tended to decrease (-0.2, 95% CI -0.5 to 0.1, P = 0.07. For pain-cases at baseline (pain intensity > = 3 the odds ratio - in the training group compared with the control group - for being a non-case at follow-up (pain intensity Conclusion High-intensity strength training relying on principles of progressive overload can be successfully implemented at industrial workplaces, and results in significant reductions of neck and shoulder pain. Trial registration NCT01071980.

  7. Transcutaneous Electrical Nerve Stimulation Reduces Post-Thoractomy Ipsilateral Shoulder Pain. A Prospective Randomized Study.

    Science.gov (United States)

    Esteban González, Pedro; Novoa, Nuria M; Varela, Gonzalo

    2015-12-01

    The patient's position during an axillary thoracotomy can cause postoperative pain and decrease mobility of the ipsilateral shoulder. In this study, we assessed whether the implementation of a standardized analgesia program using transcutaneous electrical nerve stimulation (TENS) decreases local pain and improves ipsilateral shoulder mobility. Randomized, single-blind, single-center clinical trial of 50 patients who had undergone anatomical lung resection via axillary muscle-sparing thoracotomy. Patients were treated with TENS devices for 30 minutes every 8 hours, beginning on postoperative day 1. Pain and mobility of the affected limb were recorded at the same time on postoperative days 1 through 3. A visual analogue scale was used for pain assessment and shoulder mobility was assessed with a goniometer. Results were compared using a non-parametric test. Twenty-five patients were randomized to each group. Mean age of the control group was 62.7±9.3 years and 63.4±10.2 years in the experimental group. Shoulder mobility parameters were similar in both groups on all postoperative days. However, pain during flexion significantly decreased on day 2 (P=.03) and day 3 (P=.04) in the experimental group. The use of TENS decreases pain from shoulder flexion in patients undergoing axillary thoracotomy for pulmonary resection. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  8. The Effects of Dry Cupping Therapy on the Shoulder Pain and Fatigue of Nurses

    Directory of Open Access Journals (Sweden)

    Dorina Sohn

    2011-06-01

    Full Text Available Objective: This research was done to identify the effects of dry cupping therapy on the shoulder pain and fatigue of nurses. Methods: The research design was time series design. The participants were 27 nurses with shoulder pain at P University Hospital in Busan metropolitan city from July 6, 2009 to August 3, 2009. The dry cupping therapy was done 4 times, twice a week for 2 weeks. Before intervention, the severity and frequency of pain and fatigue were measured three times at one week intervals, and then those were measured after one week and two weeks of experimental treatment. The results were analyzed using descriptive statistics, paired t-test and repeated measure ANOVA with the SPSS program. Results: There were statistically significant difference in severity and frequency of shoulder pain,and fatigue after dry cupping therapy. Dry cupping therapy was effective for the management of shoulder pain and fatigue among nurses in this study. Conclusion: Therefore dry cupping therapy can be considered an effective nursing intervention that relieves shoulder pain and fatigue of nurses.

  9. The Use of Peritoneal Suction Drainage to Reduce Shoulder Pain Caused by Gynecological Laparoscopy.

    Science.gov (United States)

    Haghgoo, Ameneh; Chaichian, Shahla; Ghahremani, Mehran; Nooriardebili, Shahla; Akbaian, Abdolrasool; Moazzami, Bahram

    2016-03-01

    To compare the outcomes of patients undergoing uncomplicated laparoscopic gynecologic procedures with and without drainage, and investigate the effects of drainage on postoperative shoulder pain, hospital stay and analgesic medications. In this randomized clinical trial, 92 patients undergoing uncomplicated laparoscopic gynecologic procedures at Pars Hospital, Tehran, Iran, between April 2012 and July 2014 entered the study. Patients were randomly divided into two groups: one group received a drain at the end of operation, whereas the second group didn't receive a drain. For patients closed with drainage, Hemovac plastic passive drains were inserted without negative pressure. Severity of the patients' postoperative shoulder pain was evaluated at rest using the 10-point visual analogue scale (VAS) at 12 h, 24 h, and 48 h after surgery. There was no difference between the two groups regarding age, weight, height, BMI, the cause of surgery and the blood loss during the surgery. At 12 h and 24 h after surgery, the shoulder pain was statistically lower in the group with drainage (P shoulder pain among patients undergoing gynecological laparoscopic surgeries and decrease the need for pain medication. Further studies are recommended to assess the feasibility and cost effectiveness of using this method for reducing the postoperative shoulder pain.

  10. Ultrasound-guided interventional procedures around the shoulder.

    Science.gov (United States)

    Messina, Carmelo; Banfi, Giuseppe; Orlandi, Davide; Lacelli, Francesca; Serafini, Giovanni; Mauri, Giovanni; Secchi, Francesco; Silvestri, Enzo; Sconfienza, Luca Maria

    2016-01-01

    Ultrasound is an established modality for shoulder evaluation, being accurate, low cost and radiation free. Different pathological conditions can be diagnosed using ultrasound and can be treated using ultrasound guidance, such as degenerative, traumatic or inflammatory diseases. Subacromial-subdeltoid bursitis is the most common finding on ultrasound evaluation for painful shoulder. Therapeutic injections of corticosteroids are helpful to reduce inflammation and pain. Calcific tendinopathy of rotator cuff affects up to 20% of painful shoulders. Ultrasound-guided treatment may be performed with both single- and double-needle approach. Calcific enthesopathy, a peculiar form of degenerative tendinopathy, is a common and mostly asymptomatic ultrasound finding; dry needling has been proposed in symptomatic patients. An alternative is represented by autologous platelet-rich plasma injections. Intra-articular injections of the shoulder can be performed in the treatment of a variety of inflammatory and degenerative diseases with corticosteroids or hyaluronic acid respectively. Steroid injections around the long head of the biceps brachii tendon are indicated in patients with biceps tendinopathy, reducing pain and humeral tenderness. The most common indication for acromion-clavicular joint injection is degenerative osteoarthritis, with ultrasound representing a useful tool in localizing the joint space and properly injecting various types of drugs (steroids, lidocaine or hyaluronic acid). Suprascapular nerve block is an approved treatment for chronic shoulder pain non-responsive to conventional treatments as well as candidate patients for shoulder arthroscopy. This review provides an overview of these different ultrasonography-guided procedures that can be performed around the shoulder.

  11. Subacromial impingement syndrome--effectiveness of physiotherapy and manual therapy.

    Science.gov (United States)

    Gebremariam, Lukas; Hay, Elaine M; van der Sande, Renske; Rinkel, Willem D; Koes, Bart W; Huisstede, Bionka M A

    2014-08-01

    The subacromial impingement syndrome (SIS) includes the rotator cuff syndrome, tendonitis and bursitis of the shoulder. Treatment includes surgical and non-surgical modalities. Non-surgical treatment is used to reduce pain, to decrease the subacromial inflammation, to heal the compromised rotator cuff and to restore satisfactory function of the shoulder. To select the most appropriate non-surgical intervention and to identify gaps in scientific knowledge, we explored the effectiveness of the interventions used, concentrating on the effectiveness of physiotherapy and manual therapy. The Cochrane Library, PubMed, EMBASE, PEDro and CINAHL were searched for relevant systematic reviews and randomised clinical trials (RCTs). Two reviewers independently extracted data and assessed the methodological quality. A best-evidence synthesis was used to summarise the results. Two reviews and 10 RCTs were included. One RCT studied manual therapy as an add-on therapy to self-training. All other studies studied the effect of physiotherapy: effectiveness of exercise therapy, mobilisation as an add-on therapy to exercises, ultrasound, laser and pulsed electromagnetic field. Moderate evidence was found for the effectiveness of hyperthermia compared to exercise therapy or ultrasound in the short term. Hyperthermia and exercise therapy were more effective in comparison to controls or placebo in the short term (moderate evidence). For the effectiveness of hyperthermia, no midterm or long-term results were studied. In the midterm, exercise therapy gave the best results (moderate evidence) compared to placebo or controls. For other interventions, conflicting, limited or no evidence was found. Some physiotherapeutic treatments seem to be promising (moderate evidence) to treat SIS, but more research is needed before firm conclusions can be drawn. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. Musculoskeletal morbidity: the growing burden of shoulder pain and disability and poor quality of life in diabetic outpatients.

    Science.gov (United States)

    Laslett, L L; Burnet, S P; Jones, J A; Redmond, C L; McNeil, J D

    2007-01-01

    To investigate shoulder pain and disability and quality of life (QoL) over 12 months in patients with diabetes and in a non-diabetic control group. Cross-sectional study with 12-month follow-up in diabetic (n=189) and medical (n=99) outpatients employing the Shoulder Pain and Disability Index (SPADI) and SF-36 version 2. The results were analysed using restricted maximum likelihood (REML). The prevalence of current shoulder symptoms was 35% in diabetics and 17% in controls. Shoulder pain and disability as calculated by the SPADI were independently associated with diabetes (vs controls) and current shoulder symptoms, and worsened over 12 months. Disability scores worsened with age in diabetics, and pain scores were higher in diabetics than controls among patients reporting current shoulder symptoms. Poor physical QoL worsened over time in patients with diabetes and was worse in patients with current shoulder symptoms, whether they had diabetes or not. Mental QoL was worse only in patients with current shoulder symptoms. Shoulder symptoms are common, affecting 1 in every 3 diabetic patients and 1 in every 6 control patients. In this study shoulder pain, disability and physical QoL were poorer among diabetics and patients reporting current shoulder symptoms, and worsened over time. Mental QoL was worse in patients reporting current shoulder symptoms and was independent of diabetes. Therefore, shoulder symptoms are common, are associated with poor physical and mental QoL in addition to shoulder pain and disability, and are worse in patients with diabetes, even in a population with relatively moderate shoulder pain and disability.

  13. Is fibromyalgia a cause of failure in the treatment of a painful shoulder?

    Science.gov (United States)

    Blonna, D; Bellato, E; Marini, E; Barbasetti, N; Mattei, L; Fissore, F; Arrigoni, C; Castoldi, F

    2013-06-01

    This study aims to review the incidence of fibromyalgia in a cohort of patients who were treated for shoulder pain and address whether a concomitant fibromyalgia could have had detrimental effect on outcomes. The treatment of 286 consecutive patients for shoulder pain was reviewed. Eighteen patients (6.3 %) were diagnosed as having fibromyalgia, but in 13 of them (72 %), the diagnosis was initially missed. Five patients received a total of 11 surgeries for treatment of the shoulder. At an average follow-up of 15 months (range 12-27), the average new Oxford shoulder score (OS score) was 49 % (range 6-87 %). The average physical component of the Short-Form-12 Healthy Survey (SF-12) was 36 (range 21-55), and the mental component 30 (range 15-46). The Summary Outcome Determination score (SOD score) was 1.3 (range-3 to 6). Fibromyalgia occurs relatively frequently in patients who complain of shoulder pain and it can be a cause of failure in the treatment of concomitant painful shoulder conditions.

  14. The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial.

    Science.gov (United States)

    Thelen, Mark D; Dauber, James A; Stoneman, Paul D

    2008-07-01

    Prospective, randomized, double-blinded, clinical trial using a repeated-measures design. To determine the short-term clinical efficacy of Kinesio Tape (KT) when applied to college students with shoulder pain, as compared to a sham tape application. Tape is commonly used as an adjunct for treatment and prevention of musculoskeletal injuries. A majority of tape applications that are reported in the literature involve nonstretch tape. The KT method has gained significant popularity in recent years, but there is a paucity of evidence on its use. Forty-two subjects clinically diagnosed with rotator cuff tendonitis/impingement were randomly assigned to 1 of 2 groups: therapeutic KT group or sham KT group. Subjects wore the tape for 2 consecutive 3-day intervals. Self-reported pain and disability and pain-free active ranges of motion (ROM) were measured at multiple intervals to assess for differences between groups. The therapeutic KT group showed immediate improvement in pain-free shoulder abduction (mean +/- SD increase, 16.9 degrees +/- 23.2 degrees ; P = .005) after tape application. No other differences between groups regarding ROM, pain, or disability scores at any time interval were found. KT may be of some assistance to clinicians in improving pain-free active ROM immediately after tape application for patients with shoulder pain. Utilization of KT for decreasing pain intensity or disability for young patients with suspected shoulder tendonitis/impingement is not supported. Therapy, level 1b-.

  15. The Effects of Dry Cupping Therapy on the Shoulder Pain and Fatigue of Nurses

    OpenAIRE

    Dorina Sohn; Hyunmin Yoon; Hyangmi Jung

    2011-01-01

    Objective: This research was done to identify the effects of dry cupping therapy on the shoulder pain and fatigue of nurses. Methods: The research design was time series design. The participants were 27 nurses with shoulder pain at P University Hospital in Busan metropolitan city from July 6, 2009 to August 3, 2009. The dry cupping therapy was done 4 times, twice a week for 2 weeks. Before intervention, the severity and frequency of pain and fatigue were measured three times at one week in...

  16. Correlates of shoulder pain in wheelchair basketball players from the Japanese national team: A cross-sectional study.

    Science.gov (United States)

    Tsunoda, Kenji; Mutsuzaki, Hirotaka; Hotta, Kazushi; Tachibana, Kaori; Shimizu, Yukiyo; Fukaya, Takashi; Ikeda, Eiji; Wadano, Yasuyoshi

    2016-11-21

    To reveal correlates of shoulder pain in wheelchair basketball players from the Japanese national team. Study participants were 19 males (29.7 ± 5.2 years) and 21 females (29.0 ± 8.2 years) players. We assessed shoulder pain using the wheelchair user's shoulder pain index (WUSPI). As potential correlates of shoulder pain, age, ability class, practice time and years of experience in wheelchair basketball were collected. The total WUSPI score for men (16.18 ± 17.39 points) was significantly higher than that for women (8.62 ± 15.70 points). In men, higher age was significantly correlated with greater shoulder pain for total WUSPI score and on two WUSPI items. Lower ability in wheelchair basketball was correlated with men's greater shoulder pain on three WUSPI items. In men, there were also significant correlations between longer years of experience and greater shoulder pain for total WUSPI score and on three WUSPI items. For women, there were significant correlations between longer practice time and less pain for total WUSPI score and on four WUSPI items. Because top male wheelchair basketball players have a higher risk of shoulder pain than female players, daily care of shoulder and periodic medical checkups are needed, especially for older male players with lower ability and more experience.

  17. Arthroscopic treatment of a case with concomitant subacromial and subdeltoid synovial chondromatosis and labrum tear.

    Science.gov (United States)

    Aydogan, Nevres Hurriyet; Kocadal, Onur; Ozmeric, Ahmet; Aktekin, Cem Nuri

    2013-01-01

    Synovial chondromatosis is a disease that seldomly seen in shoulder joint and is related to benign synovial proliferation and synchronous chondral tissue formation within the joint cavity. Patients suffer from progressive restriction of range of motion and shoulder pain. Extra-articular involvement is an extremely rare condition. Degenerative osteoarthritis, joint subluxation, and bursitis are common complications in untreated patients. Open or arthroscopic surgery is suitable while there is no consensus related to superiority of different approaches. We presented an arthroscopic treatment of a male patient, 48 years old with labrum tear and synovial chondromatosis localized in subacromial and subdeltoid region. Advantages of arthroscopic surgery in the presence of intra- and extra-articular combined pathologies are also discussed.

  18. Arthroscopic Treatment of a Case with Concomitant Subacromial and Subdeltoid Synovial Chondromatosis and Labrum Tear

    Directory of Open Access Journals (Sweden)

    Nevres Hurriyet Aydogan

    2013-01-01

    Full Text Available Synovial chondromatosis is a disease that seldomly seen in shoulder joint and is related to benign synovial proliferation and synchronous chondral tissue formation within the joint cavity. Patients suffer from progressive restriction of range of motion and shoulder pain. Extra-articular involvement is an extremely rare condition. Degenerative osteoarthritis, joint subluxation, and bursitis are common complications in untreated patients. Open or arthroscopic surgery is suitable while there is no consensus related to superiority of different approaches. We presented an arthroscopic treatment of a male patient, 48 years old with labrum tear and synovial chondromatosis localized in subacromial and subdeltoid region. Advantages of arthroscopic surgery in the presence of intra- and extra-articular combined pathologies are also discussed.

  19. Clinically relevant magnetic resonance imaging (MRI findings in elite swimmers’ shoulders

    Directory of Open Access Journals (Sweden)

    Arno Celliers

    2017-01-01

    Full Text Available Background: Shoulder pain is the most common and well-documented site of musculoskeletal pain in elite swimmers. Structural abnormalities on magnetic resonance imaging (MRI of elite swimmers’ symptomatic shoulders are common. Little has been documented about the association between MRI findings in the asymptomatic shoulder versus the symptomatic shoulder.Objective: To assess clinically relevant MRI findings in the shoulders of symptomatic and asymptomatic elite swimmers.Method: Twenty (aged 16–23 years elite swimmers completed questionnaires on their swimming training, pain and shoulder function. MRI of both shoulders (n = 40 were performed and all swimmers were given a standardised clinical shoulder examination. Results: Both shoulders of 11 male and 9 female elite swimmers (n = 40 were examined. Eleven of the 40 shoulders were clinically symptomatic and 29 were asymptomatic. The most common clinical finding in both the symptomatic and asymptomatic shoulders was impingement during internal rotation, with impingement in 54.5% of the symptomatic shoulders and in 31.0% of the asymptomatic shoulders. The most common MRI findings in the symptomatic and asymptomatic shoulders were supraspinatus tendinosis (45.5% vs. 20.7%, subacromial subdeltoid fluid (45.5% vs. 34.5%, increased signal in the AC Joint (45.5% vs. 37.9% and AC joint arthrosis (36.4% vs. 34.5%. Thirty-nine (97.5% of the shoulders showed abnormal MRI features.Conclusion: MRI findings in the symptomatic and asymptomatic shoulders of young elite swimmers are similar and care should be taken when reporting shoulder MRIs in these athletes. Asymptomatic shoulders demonstrate manifold MRI abnormalities that may be radiologically significant but appear not to be clinically significant.

  20. Shoulder pain and jerk during recovery phase of manual wheelchair propulsion.

    Science.gov (United States)

    Jayaraman, Chandrasekaran; Beck, Carolyn L; Sosnoff, Jacob J

    2015-11-05

    Repetitive loading of the upper limb due to wheelchair propulsion plays a leading role in the development of shoulder pain in manual wheelchair users (mWCUs). There has been minimal inquiry on understanding wheelchair propulsion kinematics from a human movement ergonomics perspective. This investigation employs an ergonomic metric, jerk, to characterize the recovery phase kinematics of two recommended manual wheelchair propulsion patterns: semi-circular and the double loop. Further it examines if jerk is related to shoulder pain in mWCUs. Data from 22 experienced adult mWCUs was analyzed for this study (semi-circular: n=12 (pain/without-pain:6/6); double-loop: n=10 (pain/without-pain:4/6)). Participants propelled their own wheelchair fitted with SMARTWheels on a roller dynamometer at 1.1 m/s for 3 min. Kinematic and kinetic data of the upper limbs were recorded. Three dimensional absolute jerk experienced at the shoulder, elbow and wrist joint during the recovery phase of wheelchair propulsion were computed. Two-way ANOVAs were conducted with the recovery pattern type and shoulder pain as between group factors. (1) Individuals using a semi-circular pattern experienced lower jerk at their arm joints than those using a double loop pattern (Pwrist;(P=0.05, η(2)=0.19)elbow;(Pwrist;(P≤0.05, η(2)=0.30)elbow;(P≤0.05, η(2)=0.31)shoulder. Jerk during wheelchair propulsion was able to distinguish between pattern types (semi-circular and double loop) and the presence of shoulder pain. Jerk provides novel insights into wheelchair propulsion kinematics and in the future it may be beneficial to incorporate jerk based metric into rehabilitation practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Reliability and validity of the Thai version of the Shoulder Pain and Disability Index (Thai SPADI).

    Science.gov (United States)

    Phongamwong, Chanwit; Choosakde, Apijaree

    2015-09-04

    The Shoulder Pain and Disability Index (SPADI) is a good clinical tool to evaluate patients with shoulder pain, but has not been adapted to Thai version. The objectives of this study were to translate the English version and culturally adapt the SPADI to Thai version and to evaluate the internal consistency and construct validity of the Thai SPADI among Thai participants having shoulder pain. Following the cross-cultural adaptation guidelines stated by the American Association of Orthopedic Surgeons (AAOS) Outcome Committee, the SPADI was translated to Thai version (Thai SPASI). Thai participants with shoulder pain completed the three questionnaires, i.e., the Thai SPADI, bodily pain subscale of the Thai Short Form 36 second version (Thai SF-36 V2) and the Thai version of disabilities of the arm, shoulder, and hand (Thai DASH). Internal consistency of the Thai SPADI was measured using Cronbach's alpha coefficient. Convergent and divergent validity was used to measure construct validity of the Thai SPADI by assessing the correlation of the Thai SPADI with the Thai DASH and bodily pain subscale of the Thai SF-36 V2. Of 44 participants, the majority of participants were female (68.2%) and had Bachelor's degree or higher education level (59.1%) with a mean age of 50.4 years (SD 14.3). Cronbach's alpha coefficient of the Thai SPADI in pain subscale, disability subscale and total scale was 0.92, 0.94 and 0.95, respectively. The correlation of the Thai SPADI with the Thai DASH and bodily pain subscale of the Thai SF-36 V was 0.79 (p shoulder disability among Thais.

  2. Older Age as a Prognostic Factor of Attenuated Pain Recovery after Shoulder Arthroscopy

    Science.gov (United States)

    Simon, Corey B.; Riley, Joseph L.; Coronado, Rogelio A.; Valencia, Carolina; Wright, Thomas W.; Moser, Michael W.; Farmer, Kevin W.; George, Steven Z.

    2015-01-01

    Background Shoulder pain and surgery are common among older adults. However, the extent to which older age affects recovery after shoulder surgery is not well understood. Objective To assess influence of older age on post-operative recovery factors three and six months after shoulder arthroscopy. Design Prospective Cohort Study Setting Institutional Patients Convenience sample of 139 individuals between 20 and 79 years of age who experienced shoulder pain, musculoskeletal dysfunction based on imaging and physician assessment, and were scheduled for an arthroscopic shoulder procedure. Main Outcome Measures Post-operative outcomes were compared among younger, middle-aged and older adults at pre-surgery, 3 months and 6 months after surgery using ANOVA modeling. Movement-evoked pain and an experimental laboratory correlate of pain processing were assessed at each time point. Older age influence on three and six month pain outcomes were determined via multivariate regression analyses after accounting for pre-operative, intra-operative, and post-operative prognostic factors. Results Older adults had higher movement-evoked pain intensity (F2,108 = 5.18, p=.007) and experimental pain response (F2,111 = 7.24, p=.001) at three months compared to young and middle-aged adults. After controlling for key prognostic factors, older age remained a positive predictor of three-month movement-evoked pain (R2=.05; St. Beta=.263, p=.031) and experimental pain response (R2=.07; St. Beta=.295, p=.014). Further, older age remained a positive predictor of movement-evoked pain at six months (R2=.04; St. Beta=.231, p=.004), despite no age group differences in outcome. Older age was found to be the strongest predictor of three and six month movement-evoked pain. Conclusion Older adults may experience more pain related to movement as well as endogenous pain excitation in the first few months after shoulder arthroscopy. Future age-related research should consider use of movement-evoked pain

  3. Hemiplegic shoulder pain syndrome: frequency and characteristics during inpatient stroke rehabilitation.

    Science.gov (United States)

    Dromerick, Alexander W; Edwards, Dorothy F; Kumar, Ashok

    2008-08-01

    To clarify the pathophysiology of hemiplegic shoulder pain by determining the frequency of abnormal shoulder physical diagnosis signs and the accuracy of self-report. Prospective inception cohort. Academic inpatient stroke rehabilitation service. Consecutive admissions (N=46) to stroke rehabilitation service. Not applicable. The Neer test, Speed test, acromioclavicular shear test, Rowe test, and palpation for point tenderness. Participants were enrolled at a mean time to evaluation of 18.9+/-14.1 days after stroke. Weakness of shoulder flexion, extension, or abduction was present in 94% of subjects, and neglect was found in 29%. Pain was present by self-report in 37%. The most common finding, which was found in nearly all persons with abnormalities in the study physical examination maneuvers, was bicipital tendon tenderness (54%), followed by supraspinatus tenderness (48%). The Neer sign was positive in 30%; 28% had the triad of bicipital tenderness, supraspinatus tenderness, and the Neer sign. Self-reported pain was a poor predictor of abnormalities elicited on the examination maneuvers, even in those without neglect. Our data implicate 2 vertical stabilizers of the humerus in early onset hemiplegic shoulder pain, the long head of the biceps and the supraspinatus. Our results also suggest that simple questioning of stroke rehabilitation inpatients about shoulder pain may not be adequate for clinical care or research purposes, even in the absence of neglect.

  4. Inflammation and shoulder pain--a perspective on rotator cuff disease, adhesive capsulitis, and osteoarthritis: conservative treatment.

    Science.gov (United States)

    Saccomanni, Bernardino

    2009-05-01

    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.

  5. Correlation of Patient-Reported Outcome Measurement Information System Physical Function Upper Extremity Computer Adaptive Testing, With the American Shoulder and Elbow Surgeons Shoulder Assessment Form and Simple Shoulder Test in Patients With Shoulder Pain.

    Science.gov (United States)

    Minoughan, Chelsea E; Schumaier, Adam P; Fritch, John L; Grawe, Brian M

    2018-02-13

    To evaluate the Patient-Reported Outcome Measurement Information System Physical Function Upper Extremity Computer Adaptive Testing (PROMIS PFUE CAT) measurement tool against the already validated American Shoulder and Elbow Surgeons Shoulder Assessment Form (ASES) and the Simple Shoulder Test (SST) in patients presenting with shoulder pain and determine the responder burden for each of the 3 surveys. Ninety patients presenting with shoulder pain were asked to fill out the ASES, SST, and PROMIS PFUE CAT. The time for completion of each survey was measured to determine responder burden, and the Pearson correlation between the 3 instruments was defined as excellent (r > 0.7), excellent-good (0.61 ≤ r ≤ 0.7), good (0.31 ≤ r ≤ 0.6), and poor (0.2 ≤ r ≤ 0.3). The PROMIS PFUE CAT showed an excellent correlation with the SST (r = 0.82, P shoulder pain. The time saving of the PROMIS PFUE CAT was found to be smaller than that of the ASES and SST but shows that moving forward, using the PROMIS PFUE CAT would not place any additional burden on the patient filling out the survey. The lack of ceiling or floor effects with the PROMIS PFUE CAT indicates its ability to differentiate both high and low functioning patients. All of these findings indicate that the PROMIS PFUE CAT is an adequate tool for the evaluation of patients with shoulder pain and should be used in these patients going forward. Level II, diagnostic study. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  6. Taping patients with clinical signs of subacromial impingement syndrome: the design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Knol Dirk L

    2011-08-01

    Full Text Available Abstract Background Shoulder problems are a common complaint of the musculoskeletal system. Physical therapists treat these patients with different modalities such as exercise, massage, and shoulder taping. Although different techniques have been described, the effectiveness of taping has not yet been established. The aim of this study is to assess the effectiveness and cost-effectiveness of usual physical therapy care in combination with a particular tape technique for subacromial impingement syndrome of the shoulder compared to usual physical therapy care without this tape technique in a primary healthcare setting. Methods and design An economic evaluation alongside a randomized controlled trial will be conducted. A sample of 140 patients between 18 and 65 years of age with a diagnosis of subacromial impingement syndrome (SAIS as assessed by physical therapists will be recruited. Eligible patients will be randomized to either the intervention group (usual care in combination with the particular tape technique or the control group (usual care without this tape technique. In both groups, usual care will consist of individualized physical therapy care. The primary outcomes will be shoulder-specific function (the Simple Shoulder Test and pain severity (11-point numerical rating scale. The economic evaluation will be performed using a societal perspective. All relevant costs will be registered using cost diaries. Utilities (Quality Adjusted Life Years will be measured using the EuroQol. The data will be collected at baseline, and 4, 12, and 26 weeks follow-up. Discussion This pragmatic study will provide information about the effectiveness and cost-effectiveness of taping in patients presenting with clinical signs of SAIS. Trial registration Trial registration number: NTR2575

  7. PET/CT shows subjective pain in shoulder joints to be associated with uptake of (18)F-FDG.

    Science.gov (United States)

    Kamasaki, Toshihiko; Hayashida, Naomi; Miyamoto, Izumi; Usui, Toshiya; Chiba, Kenya; Kudo, Takashi; Takamura, Noboru

    2014-01-01

    The aim of the study was to evaluate the capability of fluorine-18-fluorodeoxyglucose (F-FDG)-positron emission tomography (PET)/computed tomography (CT) in the screening of musculoskeletal inflammation and injury of the shoulder region. The study included 122 participants (69 men and 53 women) who complained of shoulder pain at rest and 122 age-matched and sex-matched controls who did not experience pain at rest. Standardized uptake values (SUVs) were calculated for both the left and right shoulders and compared using a four-point visual analog scale of subjective shoulder pain. Correlations between SUVs and uric acid and C-reactive proteins were also evaluated. SUVs for shoulder joints with rest and/or motion pain were significantly higher than those for pain-free shoulder joints. SUVs associated with mild and severe pain at rest were significantly higher than those associated with absence of pain at rest, and SUVs associated with moderate and severe pain on motion were significantly higher than those associated with absence of motion pain. Furthermore, SUVs were significantly correlated with uric acid in men (β=0.21, P=0.02) and in all participants (β=0.22, Pshoulder region. As shoulder pain is common, especially among elderly individuals, we should carefully consider the necessity of further examination when identifying the uptake of F-FDG in shoulder joints.

  8. Ultrasonographic and clinical study of post-stroke painful hemiplegic shoulder

    OpenAIRE

    Mohamed, Rania E.; Amin, Mohamed A.; Aboelsafa, Ashraf A.

    2014-01-01

    Aim of the work: To describe the structural abnormalities of the painful hemiplegic shoulder (PHS) by ultrasound (U/S) and their relationship with some clinical variables. Materials and methods: Eighty consecutive patients with post-stroke PHS were subjected to both clinical assessment and ultrasonographic examination of both shoulders. Ultrasonographic imaging data were classified into five grades. Results: The biceps tendon sheath effusion (51.25%) and the SA–SD bursitis (43.75%) were...

  9. Effects of Acupuncture on the Recovery Outcomes of Stroke Survivors with Shoulder Pain: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Janita Pak Chun Chau

    2018-01-01

    Full Text Available BackgroundPoststroke shoulder pain limits stroke survivors’ physical functioning, impairs their ability to perform daily activities, and compromises their quality of life. The use of acupuncture to manage shoulder pain after a stroke is believed to free the blockage of energy flow and produce analgesic effects, but the evidence is unclear. We therefore conducted a systematic review to summarize the current evidence on the effects of acupuncture on the recovery outcomes of stroke survivors with shoulder pain.MethodsFourteen English and Chinese databases were searched for data from January 2009 to August 2017. The review included adult participants with a clinical diagnosis of ischemic or hemorrhagic stroke who had developed shoulder pain and had undergone conventional acupuncture, electroacupuncture, fire needle acupuncture, or warm needle acupuncture. The participants in the comparison group received the usual stroke care only.ResultsTwenty-nine randomized controlled trials were included. Most studies were assessed as having a substantial risk of bias. Moreover, due to the high heterogeneity of the acupuncture therapies examined, pooling the results in a meta-analysis was not appropriate. A narrative summary of the results is thus presented. The review showed that conventional acupuncture can be associated with benefits in reducing pain and edema and improving upper extremity function and physical function. The effects of conventional acupuncture on improving shoulder range of motion (ROM are in doubt because this outcome was only examined in two trials. Electroacupuncture might be effective in reducing shoulder pain and improving upper extremity function, and conclusions on the effects of electroacupuncture on edema, shoulder ROM, and physical function cannot be drawn due to the limited number of eligible trials. The evidence to support the use of fire needle or warm needle acupuncture in stroke survivors with shoulder pain is also

  10. Subacromial impingement syndrome.

    Science.gov (United States)

    Umer, Masood; Qadir, Irfan; Azam, Mohsin

    2012-05-09

    Subacromial impingement syndrome (SAIS) represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate. However, the etiology is multi-factorial, and it has been attributed to both extrinsic and intrinsic mechanisms. Management includes physical therapy, injections, and, for some patients, surgery. No high-quality randomized controlled trials are available so far to provide possible evidence for differences in outcome of different treatment strategies. There remains a need for high-quality clinical research on the diagnosis and treatment of SAIS.

  11. Subacromial impingement syndrome

    Directory of Open Access Journals (Sweden)

    Masood Umer

    2012-05-01

    Full Text Available Subacromial impingement syndrome (SAIS represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate. However the etiology is multi-factorial, and has been attributed to both extrinsic and intrinsic mechanisms. Management includes physical therapy, injections, and, for some patients, surgery. No high-quality RCTs are available so far to provide possible evidence for differences in outcome of different treatment strategies. There remains a need for high-quality clinical research on the diagnosis and treatment of SAIS.

  12. Continuous interscalene brachial plexus block versus parenteral analgesia for postoperative pain relief after major shoulder surgery.

    Science.gov (United States)

    Ullah, Hameed; Samad, Khalid; Khan, Fauzia A

    2014-02-04

    Postoperative pain may lead to adverse effects on the body, which might result in an increase in morbidity. Its management therefore poses a unique challenge for the clinician. Major shoulder surgery is associated with severe postoperative pain, and different modalities are available to manage such pain, including opioid and non-opioid analgesics, local anaesthetics infiltrated into and around the shoulder joint and regional anaesthesia. All of these techniques, alone or in combination, have been used to treat the postoperative pain of major shoulder surgery but with varying success. The objective of this review was to compare the analgesic efficacy of continuous interscalene brachial plexus block (ISBPB) with parenteral opioid analgesia for pain relief after major shoulder surgery. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 12), MEDLINE (1950 to December 2012), EMBASE (1980 to December 2012), Web of Science (1954 to December 2012), CINAHL (1982 to December 2012) and bibliographies of published studies. We included randomized controlled trials assessing the effectiveness of continuous ISBPB compared with different forms of parenteral opioid analgesia in relieving pain in adult participants undergoing elective major shoulder surgery. Two review authors independently assessed trial quality and extracted outcome data. We included two randomized controlled trials (147 participants). A total of 17 participants were excluded from one trial because of complications related to continuous ISBPB (16) or parenteral opioid analgesia (one). Thus we have information on 130 participants (66 in the continuous ISBPB group and 64 in the parenteral opioid group). The studies were clinically heterogeneous. No meta-analysis was undertaken. However, results of the two included studies showed better pain relief with continuous ISBPB following major shoulder surgery and a lower incidence of complications when interscalene block is performed under

  13. Subacromial bursitis related to HIV infection: case report.

    Science.gov (United States)

    Ejnisman, Benno; Figueiredo, Eduardo Antônio de; Terra, Bernardo Barcellos; Lima, Ana Lucia L Munhoz; Uip, David E

    2010-01-01

    Describe a subacromial bursitis at the right shoulder of a 45-year-old male subject. The patient has been living with HIV/AIDS for 22 years. The ultrasonography and the MRI revealed the presence of a pronounced subacromial effusion, with an inflammatory reaction of adjacent tissues. The tumoration was handled firstly with a needle-puncture aspiration, with a thick liquid outflow, followed by an open drainage. Histopathological evaluation showed no evidence of any AIDS defining disease. There was complete remission of the infection after five months thereafter the symptoms had started. After reviewing the scarce literature in the area, no reports of subacromial bursitis in HIV/AIDS patients were found. The authors point out that, although rare, this disease should be considered as differential diagnosis of shoulder diseases in HIV-infected subjects.

  14. Effects of Interscalene Nerve Block for Postoperative Pain Management in Patients after Shoulder Surgery.

    Science.gov (United States)

    Chen, Hsiu-Pin; Shen, Shih-Jyun; Tsai, Hsin-I; Kao, Sheng-Chin; Yu, Huang-Ping

    2015-01-01

    Shoulder surgery can produce severe postoperative pain and movement limitations. Evidence has shown that regional nerve block is an effective management for postoperative shoulder pain. The purpose of this study was to investigate the postoperative analgesic effect of intravenous patient-controlled analgesia (PCA) combined with interscalene nerve block in comparison to PCA alone after shoulder surgery. In this study, 103 patients receiving PCA combined with interscalene nerve block (PCAIB) and 48 patients receiving PCA alone after shoulder surgery were included. Patients' characteristics, preoperative shoulder score and range of motion, surgical and anesthetic condition in addition to visual analog scale (VAS) pain score, postoperative PCA consumption, and adverse outcomes were evaluated. The results showed that PCA combined with interscalene nerve block (PCAIB) group required less volume of analgesics than PCA alone group in 24 hours (57.76 ± 23.29 mL versus 87.29 ± 33.73 mL, p block is effective postoperatively in reducing the demand for PCA analgesics and decreasing opioids-induced adverse events following shoulder surgery.

  15. Correlation of findings in clinical and high resolution ultrasonography examinations of the painful shoulder.

    Science.gov (United States)

    Micheroli, Raphael; Kyburz, Diego; Ciurea, Adrian; Dubs, Beat; Toniolo, Martin; Bisig, Samuel Pascal; Tamborrini, Giorgio

    2015-03-01

    High resolution ultrasonography is a non-painful and non-invasive imaging technique which is useful for the assessment of shoulder pain causes, as clinical examination often does not allow an exact diagnosis. The aim of this study was to compare the findings of clinical examination and high resolution ultrasonography in patients presenting with