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A. Hamid MS, Sazlina SG. Platelet-rich plasma for rotator cuff tendinopathy: A systematic review and meta-analysis. PLoS One 2021; 16:e0251111. [PMID: 33970936 PMCID: PMC8109792 DOI: 10.1371/journal.pone.0251111] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/20/2021] [Indexed: 01/01/2023] Open
Abstract
Shoulder rotator cuff tendinopathy is a common debilitating condition that affects a person daily function and the quality of life. Despite its frequent occurrence, the best treatment is still inconclusive. This review assessed the clinical effect of platelet-rich plasma injection for rotator cuff tendinopathy. A systematic literature search was conducted using CINAHL, Medline, SCOPUS, SPORTSDiscus and Web of Science databases to retrieve articles published in peer-reviewed journals until December 2020. Randomised controlled trials (RCTs), which compared clinical effects of PRP injection to the usual care among adults diagnosed with rotator cuff conditions were reviewed. The main outcomes of interest were changes in shoulder pain symptoms and shoulder functions. All variables were analysed using random effects meta-analyses. Eight RCTs were reviewed in this study. The risk of bias for randomization was low for 6 RCTs, one study had unclear risk and the other was a high risk. Studies vary on the PRP techniques including preparation and injections. Moreover, the control intervention also differs. Four studies compared PRP with normal saline injection while in the remaining 4 RCTs the control intervention were rehabilitation program and dry needling. Meta-analysis of selected studies showed that PRP injection was safe and effective intervention for long-term pain control and shoulder function in patients with RC disorders.
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Affiliation(s)
| | - Shariff Ghazali Sazlina
- Faculty of Medicine and Health Sciences, Department of Family Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- * E-mail:
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Jayaseelan DJ, T Faller B, H Avery M. The utilization and effects of filiform dry needling in the management of tendinopathy: a systematic review. Physiother Theory Pract 2021; 38:1876-1888. [PMID: 33904812 DOI: 10.1080/09593985.2021.1920076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Tendinopathy is frequently associated with pain, soft tissue impairments and muscle performance limitations. Dry needling (DN) incorporates a fine filiform needle to penetrate the skin and underlying soft tissue in an effort to decrease pain and improve function. While injectable interventions and gauged-needle tendon fenestration for tendinopathy has been reviewed, DN for tendinopathy has yet to be synthesized.Objective: To systematically review the utilization and effects of DN for tendinopathy.Methods: Six electronic databases (PubMed, CINAHL, Scopus, SportDiscus, PEDro and the Cochrane Library) were searched from inception through August 15, 2020, using appropriate keywords and relevant synonyms.Results: After screening 462 articles, 10 studies met inclusion criteria. Study designs included case reports, case series, and randomized clinical trials. DN was used in isolation in 3/10 studies and as part of a multimodal approach in 7/10 studies. DN was associated with improved pain, function, muscle performance and perceived improvement in each study evaluating the relevant outcome. Conflicting results were found in comparative studies evaluating DN.Conclusions: DN may be a useful adjunctive treatment in the conservative management of tendinopathy, although its discrete effect is unclear. Very Low-quality evidence and methodological limitations suggest further investigation is warranted.
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Affiliation(s)
- Dhinu J Jayaseelan
- Department of Health, Human Function and Rehabilitation Sciences, Program in Physical Therapy, George Washington University, . Washington DC, USA
| | - Brian T Faller
- Department of Health, Human Function and Rehabilitation Sciences, Program in Physical Therapy, George Washington University, . Washington DC, USA
| | - Melinda H Avery
- International Spine Pain and Performance Center, Washington DC, USA
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Dupuis F, Sole G, Wassinger C, Bielmann M, Bouyer LJ, Roy JS. Fatigue, induced via repetitive upper-limb motor tasks, influences trunk and shoulder kinematics during an upper limb reaching task in a virtual reality environment. PLoS One 2021; 16:e0249403. [PMID: 33831037 PMCID: PMC8031876 DOI: 10.1371/journal.pone.0249403] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 03/17/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Efficient shoulder movement depends on the ability of central nervous system to integrate sensory information and to create an appropriate motor command. Various daily encountered factors can potentially compromise the execution of the command, such as fatigue. This study explored how fatigue influences shoulder movements during upper limb reaching. METHODS Forty healthy participants were randomly assigned to one of two groups: Control or Fatigue Group. All participants completed an upper limb reaching task at baseline and post-experimental, during which they reached four targets located at 90° of shoulder abduction, 90° external rotation at 90° abduction, 120° scaption, and 120° flexion in a virtual reality environment. Following the baseline phase, the Fatigue Group completed a shoulder fatigue protocol, while Controls took a 10-minute break. Thereafter, the reaching task was repeated. Upper limb kinematic (joint angles and excursions) and spatiotemporal (speed and accuracy) data were collected during the reaching task. Electromyographic activity of the anterior and middle deltoids were also collected to characterize fatigue. Two-way repeated-measures ANOVA were performed to determine the effects of Time, Group and of the interaction between these factors. RESULTS The Fatigue group showed decreased mean median power frequency and increased electromyographic amplitudes of the anterior deltoid (p < 0.05) following the fatigue protocol. Less glenohumeral elevation, increased trunk flexion and rotation and sternoclavicular elevation were also observed in the Fatigue group (Group x Time interaction, p < 0.05). The Control group improved their movement speed and accuracy in post-experimental phase, while the Fatigue group showed a decrease of movement speed and no accuracy improvement (Group x Time interaction, p < 0.05). CONCLUSION In a fatigued state, changes in movement strategy were observed during the reaching task, including increased trunk and sternoclavicular movements and less glenohumeral movement. Performance was altered as shown by the lack of accuracy improvement over time and a decrease in movement speed in the Fatigue group.
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Affiliation(s)
- Frédérique Dupuis
- Faculty of Medicine, Université Laval, Quebec City, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada
| | - Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Craig Wassinger
- Department of Physical Therapy, East Tennessee State University, Johnson City, TN, United States of America
| | - Mathieu Bielmann
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada
| | - Laurent J. Bouyer
- Faculty of Medicine, Université Laval, Quebec City, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada
| | - Jean-Sébastien Roy
- Faculty of Medicine, Université Laval, Quebec City, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Canada
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Vallance P, Crowley L, Vicenzino B, Malliaras P. Contralateral mechanical hyperalgesia and altered pain modulation in men who have unilateral insertional Achilles tendinopathy: A cross-sectional study. Musculoskelet Sci Pract 2021; 52:102353. [PMID: 33636582 DOI: 10.1016/j.msksp.2021.102353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 02/07/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The primary aim was to assess whether men who have insertional Achilles tendinopathy (IAT) have altered endogenous modulation of painful stimuli, and secondarily if they exhibit unaffected-side pressure hyperalgesia. METHODS Using a cross-sectional design, we recruited men with unilateral IAT and asymptomatic men as controls matched for age, body mass index (BMI) and activity history (participation in running, lower limb loading sport or sedentary). We collected pressure pain threshold (PPT) at the asymptomatic side Achilles tendon insertion for cases, and dominant side Achilles tendon insertion for controls. We compared PPT between groups before and after immersion of the hand in painful cold water. RESULTS Twenty men with unilateral IAT (45.4 years [SD 10.02], BMI 29.09 [SD 4.61], 60% sedentary) and 34 men without symptoms (43.2 years [SD 8.78], BMI 27.59 [SD 3.18], 50% sedentary) participated. An interaction effect was found for group x time (F (1,50) = 7.67, p = 0.008), with PPT increase after cold water immersion being 1.20 (95%CI 0.25 to 2.15) Kg greater in the control group (1.44 Kg [SD 1.79]) compared to IAT unaffected side (0.24 Kg [SD 1.47]). Before cold water immersion, PPT was 4.77 (CI 3.22 to 6.31; p < 0.001) Kg greater in the control group. DISCUSSION This study provides evidence men with IAT have altered endogenous modulation of a painful stimulus, and display pressure hyperalgesia at their unaffected side compared to men without symptoms. These findings infer alterations to pain processing in men with IAT, suggesting nociplastic mechanism(s) may contribute to pain.
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Affiliation(s)
- Patrick Vallance
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Victoria, Australia; Peninsula Sports Medicine Group, Langwarrin, Victoria, Australia.
| | - Liam Crowley
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Victoria, Australia; Physio and Fitness Clinic, Seaford, Victoria, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences: Physiotherapy, University of Queensland, Queensland, Australia
| | - Peter Malliaras
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Victoria, Australia; Complete Sports Care, Hawthorn, Victoria, Australia
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Hathcock JA, Boyer CW, Morris JB. Shoulder Pain of Spinal Source in the Military: A Case Series. Mil Med 2021; 187:e1240-e1246. [PMID: 33591318 DOI: 10.1093/milmed/usab059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/22/2020] [Accepted: 02/03/2021] [Indexed: 11/13/2022] Open
Abstract
Musculoskeletal injury (MSI) presents the greatest threat to military mission readiness. Atraumatic shoulder pain is a common military MSI that often results in persistent functional limitations. Shoulder orthopedic evaluation presents many diagnostic challenges, due in part to the possibility of a spinal source of symptoms. This case series outlines the use of mechanical diagnosis and therapy to screen the cervical and thoracic spine in active duty (AD) service members (SMs) with a chief complaint of unchanging or worsening shoulder pain. All three SMs previously received shoulder-specific diagnoses from experienced clinicians, yet repeated movements revealed a possible spinal nociceptive driver that guided targeted intervention. Treatment directed only at the cervical spine resulted in a clinically important improvement within an average of 10 days from the initial evaluation, return to duty (RTD) within an average of 32 days, and continued resolution at 3 months. SMs can independently complete the screening process with guidance from healthcare providers, ultimately shaping the treatment strategy and possibly facilitating self-management of future recurrence. This case series demonstrates that identification of shoulder pain of spinal source in the military population may be an important step in facilitating timely RTD. These cases also highlight the use of a standardized, systematic method to screen the cervical and thoracic spine that concurrently reveals the indicated treatment. Further research to determine the prevalence of shoulder pain of spinal source in the AD population and its impact on RTD rates has the potential to reduce the substantial burden of MSI in the military.
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Affiliation(s)
- Joseph A Hathcock
- Department of Rehabilitation Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Chris W Boyer
- 97th Military Police Battalion, Fort Riley, KS 66442, USA
| | - Jamie B Morris
- Army-Baylor Doctoral Program in Physical Therapy, Fort Sam Houston, TX 78234, USA
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56
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Şahinoğlu E, Ünver B, Yamak K. The relationship of range of motion and muscle strength to patients' perspectives in pain, disability, and health-related quality of life in patients with rotator cuff disease. Ir J Med Sci 2021; 190:177-183. [PMID: 32666502 DOI: 10.1007/s11845-020-02305-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/02/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The literature emphasizes that a consideration of patients' perspectives is an important part of the assessment process; however, it is ignored by many clinicians because they believe physical impairment measures can reflect patients' perspectives about their symptoms. But the relevance of changes in physical impairments to changes in patient-reported outcome scores in rotator cuff disease is ambiguous. AIMS The purpose of this study is to determine the relationship between changes in glenohumeral range of motion (ROM) and shoulder muscle strength and changes in pain, disability, and health-related quality of life scores before and after physical therapy in patients with rotator cuff disease. METHODS This was a retrospective study of thirty-nine patients with unilateral rotator cuff disease. All patients received a 6-week physical therapy program. The outcome measures were glenohumeral ROM, shoulder muscle strength, pain and disability using the Shoulder Pain and Disability Index (SPADI), and health-related quality of life as measured by the Western Ontario Rotator Cuff Index. All outcomes were measured before and after the treatment period. RESULTS There were weak correlations between the changes in abduction ROM and the SPADI-total score (r = - 0.32, p < 0.05), and the changes in external rotation strength and the SPADI-disability score (r = - 0.32, p < 0.05). There was no correlation between the changes in the other parameters. CONCLUSIONS This study implies that the changes in glenohumeral ROM and shoulder muscle strength do not represent the changes in patients' perspectives in pain, disability, and health-related quality of life after the physical therapy program in patients with rotator cuff disease.
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Affiliation(s)
- Ertan Şahinoğlu
- Graduate School of Health Sciences, Dokuz Eylül University, Mithatpaşa Cad. No. 1606 İnciraltı, Balçova, İzmir, Turkey.
| | - Bayram Ünver
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
| | - Kamil Yamak
- İzmir Bozyaka Education and Research Hospital, University of Health Sciences, İzmir, Turkey
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Millar NL, Silbernagel KG, Thorborg K, Kirwan PD, Galatz LM, Abrams GD, Murrell GAC, McInnes IB, Rodeo SA. Tendinopathy. Nat Rev Dis Primers 2021; 7:1. [PMID: 33414454 DOI: 10.1038/s41572-020-00234-1] [Citation(s) in RCA: 283] [Impact Index Per Article: 94.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/14/2022]
Abstract
Tendinopathy describes a complex multifaceted pathology of the tendon, characterized by pain, decline in function and reduced exercise tolerance. The most common overuse tendinopathies involve the rotator cuff tendon, medial and lateral elbow epicondyles, patellar tendon, gluteal tendons and the Achilles tendon. The prominent histological and molecular features of tendinopathy include disorganization of collagen fibres, an increase in the microvasculature and sensory nerve innervation, dysregulated extracellular matrix homeostasis, increased immune cells and inflammatory mediators, and enhanced cellular apoptosis. Although diagnosis is mostly achieved based on clinical symptoms, in some cases, additional pain-provoking tests and imaging might be necessary. Management consists of different exercise and loading programmes, therapeutic modalities and surgical interventions; however, their effectiveness remains ambiguous. Future research should focus on elucidating the key functional pathways implicated in clinical disease and on improved rehabilitation protocols.
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Affiliation(s)
- Neal L Millar
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
| | | | - Kristian Thorborg
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Paul D Kirwan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leesa M Galatz
- Department of Orthopaedic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Martínez-Merinero P, Aneiros Tarancón F, Montañez-Aguilera J, Nuñez-Nagy S, Pecos-Martín D, Fernández-Matías R, Achalandabaso-Ochoa A, Fernández-Carnero S, Gallego-Izquierdo T. Interaction between Pain, Disability, Mechanosensitivity and Cranio-Cervical Angle in Subjects with Cervicogenic Headache: A Cross-Sectional Study. J Clin Med 2021; 10:jcm10010159. [PMID: 33466533 PMCID: PMC7796513 DOI: 10.3390/jcm10010159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/21/2020] [Accepted: 01/02/2021] [Indexed: 12/25/2022] Open
Abstract
The relationship between the forward head posture and mechanosensitivity in subjects with a cervicogenic headache (CGH) remains uncertain. The aim of the study was to evaluate if there was a relationship between the tissue mechanosensitivity and cranio-cervical angle (CCA) that was moderated by pain intensity and/or disability in subjects with CGH. A convenience sample of 102 subjects was recruited. The CCA was measured with photographs, using a postural assessment software. The pain intensity was measured with a visual analogue scale (VAS), and the disability was measured with the Northwick Park Questionnaire. The pressure pain threshold (PPT) was measured at the spinous process of C2, the upper trapezius and splenius capitis muscles, and the median nerve. Simple moderation multiple regression analyses were constructed. There was a positive relationship between PPT at C2 and CCA, but a nonsignificant relationship for the PPT measured at the muscles and median nerve. The effect of PPT at C2 over CCA was moderated by pain intensity (R2 = 0.17; R2 change = 0.06; p < 0.05) but not disability. The Johnson–Neyman analysis revealed a cut-off point for the statistical significance of 4.66 cm in VAS. There seems to be a positive relationship between PPT at C2 and CCA, which is positively moderated by pain intensity in subjects with CGH.
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Affiliation(s)
- Patricia Martínez-Merinero
- Physiotherapy Department, Faculty of Health, Exercise and Sport, European University, Villaviciosa de Odón, 28660 Madrid, Spain;
| | | | - Javier Montañez-Aguilera
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, 46115 Alfara del Patriarca, Spain;
| | - Susana Nuñez-Nagy
- Department of Physiotherapy and Nursing, Alcalá University, 28871 Alcalá de Henares, Spain; (S.N.-N.); (D.P.-M.); (S.F.-C.); (T.G.-I.)
| | - Daniel Pecos-Martín
- Department of Physiotherapy and Nursing, Alcalá University, 28871 Alcalá de Henares, Spain; (S.N.-N.); (D.P.-M.); (S.F.-C.); (T.G.-I.)
- Research Institute of Physical Therapy and Pain, Alcalá University, 28871 Alcalá de Henares, Spain;
| | - Rubén Fernández-Matías
- Research Institute of Physical Therapy and Pain, Alcalá University, 28871 Alcalá de Henares, Spain;
| | - Alexander Achalandabaso-Ochoa
- Research Institute of Physical Therapy and Pain, Alcalá University, 28871 Alcalá de Henares, Spain;
- Department of Health Sciences, Universidad de Jaén, 23071 Jaén, Spain
- Correspondence:
| | - Samuel Fernández-Carnero
- Department of Physiotherapy and Nursing, Alcalá University, 28871 Alcalá de Henares, Spain; (S.N.-N.); (D.P.-M.); (S.F.-C.); (T.G.-I.)
- Research Institute of Physical Therapy and Pain, Alcalá University, 28871 Alcalá de Henares, Spain;
| | - Tomás Gallego-Izquierdo
- Department of Physiotherapy and Nursing, Alcalá University, 28871 Alcalá de Henares, Spain; (S.N.-N.); (D.P.-M.); (S.F.-C.); (T.G.-I.)
- Research Institute of Physical Therapy and Pain, Alcalá University, 28871 Alcalá de Henares, Spain;
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Baeske R, Hall T, Silva MF. The inclusion of mobilisation with movement to a standard exercise programme for patients with rotator cuff related pain: a randomised, placebo-controlled protocol trial. BMC Musculoskelet Disord 2020; 21:744. [PMID: 33183274 PMCID: PMC7663889 DOI: 10.1186/s12891-020-03765-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/03/2020] [Indexed: 11/15/2022] Open
Abstract
Background Rotator cuff related pain (RCRP) is one of the most common sources of musculoskeletal shoulder pain affecting the general population. Conservative treatment, in the form of exercise, is considered the first line approach, nonetheless, improvements seem to be modest. One therapeutic modality that might be an adjunct to the treatment of this condition is mobilisation with movement (MWM). MWM is a pain-free manual procedure that targets restricted and painful movements, commonly seen in patients with RCRP. The purpose of clinical trial is to determine whether MWM with exercise has benefits over sham MWM with exercise in RCRP. Methods A randomised, sham-controlled trial of 70 adults complaining of RCRP will compare the effects of MWM combined with exercise over sham MWM with exercise. Participants will be allocated to one of two groups: exercise and MWM (EG) or exercise and sham MWM (CG). Two weekly individual treatment sessions will be conducted over five weeks. All assessments will be performed by a blinded assessor. Primary outcome measures will be the shoulder pain and disability index (SPADI) and the numeric pain rating scale (NPRS), assessed at baseline, discharge and one-month follow-up. Secondary outcome measures will be active range of motion, self-efficacy and the global rating of change scale. The analyses will be conducted considering a statistically significant p-value ≤0.05. Normality will be assessed with the Kolmogorov-Smirnov test and homogeneity with the Levene’s test. For the primary outcome measures (SPADI and NPRS) and self-efficacy, a 2 × 3 ANOVA with treatment group (EG versus CG) and time (baseline, end of the treatment and follow-up) factors will be performed. Separate 2 × 2 ANOVA will be used for range of motion (baseline and end of the treatment). Global rating scale of change analysis will be conducted using descriptive statistics. Intention-to-treat analysis will be adopted. Discussion As there is a paucity of longitudinal studies investigating the use of MWM in patients with RCRP, this study will help to better understand its role together with a structured exercise programme. Trial registration Clinical Trials Registry number NCT04175184. November, 2019.
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Affiliation(s)
- Rafael Baeske
- Science of Rehabilitation programme at Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245, Porto Alegre, Rio Grande do Sul, CEP 90050-170, Brazil. .,, São Leopoldo, Brazil.
| | - Toby Hall
- School of Physiotherapy & Exercise Science, Curtin University, Kent Street, Bentley, Western Australia, 6102
| | - Marcelo Faria Silva
- Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245, Porto Alegre, Rio Grande do Sul, CEP 90050-170, Brazil
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Marks D, Comans T, Bisset L, Thomas M, Scuffham PA. Shoulder pain cost-of-illness in patients referred for public orthopaedic care in Australia. AUST HEALTH REV 2020; 43:540-548. [PMID: 30318033 DOI: 10.1071/ah17242] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 06/25/2018] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to calculate the societal economic burden of shoulder pain in patients on the orthopaedic waiting list at an Australian public hospital and calculate the cost (from the government's perspective) of care delivered by the hospital for those patients. Methods A cost-of-illness analysis was undertaken in a cohort of 277 orthopaedic patients on the Gold Coast in Australia. Outcomes included a health care costs and impacts questionnaire, work absenteeism, presenteeism questionnaires (Work Limitations Questionnaire (WLQ) and Work Productivity and Activity Impairment Questionnaire (WPAI)) and hospital care provision over a 2-year period. Results The mean societal cost of healthcare and domestic support was AU$20.72 per day (AU$7563 annually) per patient on the orthopaedic waiting list. When absenteeism and presenteeism were included, the cost per patient who was employed was AU$38.04 per day (AU$13885 annually) calculated with the WLQ and AU$61.31 per day (AU$22378 annually) calculated with the WPAI. The mean per-patient cost to government of public hospital care was AU$2622 in Year 1 and AU$3835.78 (s.d. 4961.28) over 2 years. The surgical conversion rate was 22%, and 51% of hospital care cost was attributable to outpatient services. Conclusions Public orthopaedic shoulder waiting lists create a large economic burden for society; few referrals require surgery and just over half the hospital care costs are for out-patient services. New models of care that better manage shoulder pain and identify surgical candidates before orthopaedic referral could reduce this burden. What is known about the topic? Little is known about the cost of shoulder pain in Australia, or the cost of patients referred for public orthopaedic care. What does this paper add? This article quantifies the costs of shoulder pain and the value of lost production from shoulder pain. The time spent waiting for public hospital orthopaedic appointments and the costs associated with waiting demonstrate that the time spent on a waiting list is a key driver of the economic burden. What are the implications for practitioners? Greater resourcing to reduce public orthopaedic shoulder waiting lists may be helpful, but system change is also required. Earlier and more accurate identification of surgical cases could reduce inefficient referrals and improve hospital productivity. Collaboration between clinicians and policy makers is needed to design more economically efficient shoulder care.
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Affiliation(s)
- Darryn Marks
- Gold Cost Hospital and Health Service, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld 4215, Australia.
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Level 2,Building 33, Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia. Email
| | - Leanne Bisset
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Qld 4222, Australia. Email
| | - Michael Thomas
- Gold Cost Hospital and Health Service, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld 4215, Australia.
| | - Paul A Scuffham
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, Qld 4111, Australia.
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Brindisino F, Ristori D, Lorusso M, Miele S, Pellicciari L, Rossettini G, Bonetti F, Heick JD, Testa M. Subacromial impingement syndrome: a survey of Italian physiotherapists and orthopaedics on diagnostic strategies and management modalities. Arch Physiother 2020; 10:16. [PMID: 32905154 PMCID: PMC7465722 DOI: 10.1186/s40945-020-00087-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIM The subacromial impingement syndrome (SIS) represents a common cause of disability in approximately 74% of patients with Shoulder Pain (SP). Even if contemporary research suggests that this mechanism is not (always) the dominant driver in SP, SIS is still a source of debate among scholars and clinicians. From a clinical point of view, evidence has suggested that clinicians can use both medical and physiotherapy approaches as effective methods to treat SIS.This survey aims to investigate models of management of patients with SIS in a sample of Italian physiotherapist specialists (Orthopaedic Manipulative Physical Therapists, -OMPTs-) and orthopaedic surgeons. MATERIALS AND METHODS An online survey with 29-item questionnaire was administered to assess the knowledge of OMPTs and orthopaedic surgeons about: a) strategies of clinical examination; b) the role of imaging in the diagnostic process; c) the physiotherapy management; and d) the pharmacological and surgical management in patients with SIS. RESULTS Six-hundred and twenty-nine respondents completed the survey (511 OMPTs (79.97%) and 128 orthopaedic surgeons (20.03%)). Ninety-two percent (n = 470) of the OMPTs and 80.5% (n = 103) of orthopaedic surgeons stated that in patients with SIS, a combination of diagnostic tests produced better accuracy (p = < 0.001). Twenty point seven % of OMPTs (n = 106) and 4.7% of orthopaedic surgeon (n = 6) stated that the Lift off was the most specific test (p = < 0.001). Four-hundred-and-twenty-four OMPTs (83%) and 40 orthopaedic surgeons (31.3%) answered that the gold standard for diagnosis of a patient with SIS are history and clinical examination (p < 0.001). CONCLUSION OMPTs and orthopaedic surgeons approach patients with SIS differently during both the assessment and the treatment. OMPTs appear to be appropriate in planning and managing clinical examination and therapeutic strategies to use with patients with SIS.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise C/da Tappino c/o Cardarelli Hospital, 86100 Campobasso, Italy
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Diego Ristori
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| | - Mariangela Lorusso
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Simone Miele
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| | | | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| | - Francesca Bonetti
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - John Duane Heick
- Department of Physical Therapy and Athletic Training, Northern Arizona University Flagstaff, Flagstaff, AZ USA
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
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September 2020 Letter to the Editor-in-Chief. J Orthop Sports Phys Ther 2020; 50:533-534. [PMID: 32867577 DOI: 10.2519/jospt.2020.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Letter to the Editor-in-Chief of JOSPT as follows: "Is It Time to Put Special Tests for Rotator Cuff-Related Shoulder Pain Out to Pasture?" with Authors' Response J Orthop Sports Phys Ther 2020;50(9):533-534. doi:10.2519/jospt.2020.0203.
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Tolerance and effectiveness of eccentric vs. concentric muscle strengthening in rotator cuff partial tears and moderate to severe shoulder pain. A randomized pilot study. J Clin Orthop Trauma 2020; 14:106-112. [PMID: 33680816 PMCID: PMC7919957 DOI: 10.1016/j.jcot.2020.07.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/10/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Rotator cuff tears are the main cause of shoulder pain and disability. First line of treatment is conservative; there is evidence regarding the advantage of using eccentric over concentric exercises in tendinopathies, but there are no evidence-based recommendations on starting strengthening exercise during painful phases nor on the effectiveness and advantages of eccentric vs. concentric exercise in rotator cuff tears. OBJECTIVE To evaluate the tolerance of a resistance strengthening program and to compare eccentric vs. concentric programs. DESIGN A pilot, experimental, randomized controlled study. SETTING Outpatient Rehabilitation Center. PATIENTS Twenty-six patients with a diagnosis of partial rotator cuff tear were randomly assigned to: the experimental group (eccentric, n = 12) and the control (concentric, n = 14). INTERVENTION The experimental group performed muscle strengthening with eccentric technique directed to shoulder and scapular girdle muscles, while the control group performed the concentric technique. MAIN OUTCOME MEASURES Visual Analogue Scale (VAS), Constant Scale, Strength, Structure (Ultrasound report). RESULTS The tolerance rate was 96% in both groups. Median age (experimental vs. control) was 54.5 vs. 54 years (p = 0.69). Results at baseline, and at months 1, 3, and 12 (median) were as follows: for VAS (mm), experimental: 55, 30, 30, and 10, p < 0.001 (intra-group); control: 50, 30, 30, and 5, p = 0.01; Constant scale (points): experimental 58.5, 88, 93, and 85, p < 0.001; control 50.62, 80, and 91.5, p = 0.038; normalized strength (Kg); experimental: 0.23, 0.29, 0.73, and 0.72, p = 0.001, and control: 0.24, 0.21, 0.54, and 0.66, p = 0.01. We found inter-group differences in the Constant scale at 1 and 3 months (p < 0.05), and in strength at months 1 and 3 (p < 0.05). We observed structural differences in tendon (healing) between groups at 3 and 12 months. CONCLUSIONS Eccentric and concentric strengthening were well tolerated; both show early improvement in pain, functionality and tendon structure. Eccentric training appears to be more effective than concentric in the early improvement of functionality, strength and tendon healing.
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Isokinetic Fatigue Ratio of Shoulder Rotators in Elite Softball Players With and Without Rotator Cuff Tendinopathy, and its Association With the Subacromial Space. J Sport Rehabil 2020; 29:766-771. [PMID: 31629332 DOI: 10.1123/jsr.2019-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Fatigue of the shoulder rotators may cause reduction of the subacromial space (SAS) and contribute to rotator cuff tendinopathy. OBJECTIVES To compare the isokinetic peak torques and fatigue ratios of shoulder external rotators (ER) and internal rotators (IR) between elite softball athletes with and without rotator cuff tendinopathy and to investigate their associations with the SAS. DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS Twenty-five elite softball players and 31 asymptomatic sedentary controls participated in this study. MAIN OUTCOME MEASURES Isokinetic concentric IR and ER peak torque and fatigue ratio were measured at 60°/s and at 180°/s, respectively; and ultrasound measurement of the SAS was measured during 0° and 60° of shoulder abduction. RESULTS Athletes with rotator cuff tendinopathy demonstrated lower peak torque in shoulder concentric ER when compared with their healthy counterparts (37.8 [5.8%] vs 43.6 [8.5%]). No significant difference was found in the fatigue ratios of ER, IR, and ER/IR when compared between elite softball athletes with and without rotator cuff tendinopathy (all P > .24). In asymptomatic athletes, greater IR peak torque (r = .583, P = .03), lower ER/IR strength ratio (r = -.605, P = .02), and greater ER/IR fatigue ratio (r = .575, P = .03) were moderately associated with more reduction of the SAS during 0° and 60° of shoulder abduction. CONCLUSIONS Decreased strength ratio and fatigue ratio of ER/IR were related to reduction of the SAS.
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Ilaltdinov AW, Gong Y, Leong DJ, Gruson KI, Zheng D, Fung DT, Sun L, Sun HB. Advances in the development of gene therapy, noncoding RNA, and exosome-based treatments for tendinopathy. Ann N Y Acad Sci 2020; 1490:3-12. [PMID: 32501571 DOI: 10.1111/nyas.14382] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/16/2022]
Abstract
Tendinopathy is a common musculoskeletal disorder characterized by chronic low-grade inflammation and tissue degeneration. Tendons have poor innate healing ability and there is currently no cure for tendinopathy. Studies elucidating mechanisms underlying the pathogenesis of tendinopathy and mechanisms mediating the genesis of tendons during development have provided novel targets and strategies to enhance tendon healing and repair. This review summarizes the current understanding and treatments for tendinopathy. The review also highlights recent advances in gene therapy, the potential of noncoding RNAs, such as microRNAs, and exosomes, which are nanometer-sized extracellular vesicles secreted from cells, for the treatment of tendinopathy.
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Affiliation(s)
- Angela Wang Ilaltdinov
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, New York.,Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York.,Department of Biomedical Engineering, City College of New York, New York, New York.,New York R&D Center for Translational Medicine and Therapeutics, Inc., New Rochelle, New York
| | - Yubao Gong
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, New York.,Department of Orthopaedic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Daniel J Leong
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, New York.,Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York.,New York R&D Center for Translational Medicine and Therapeutics, Inc., New Rochelle, New York
| | - Konrad I Gruson
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, New York
| | - Deyou Zheng
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York.,Department of Neurology, Albert Einstein College of Medicine, Bronx, New York.,Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York
| | - David T Fung
- New York R&D Center for Translational Medicine and Therapeutics, Inc., New Rochelle, New York
| | - Li Sun
- New York R&D Center for Translational Medicine and Therapeutics, Inc., New Rochelle, New York
| | - Hui B Sun
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, New York.,Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York.,New York R&D Center for Translational Medicine and Therapeutics, Inc., New Rochelle, New York
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Smythe A, White J, Littlewood C, Bury J, Haines T, Malliaras P. Physiotherapists deliver management broadly consistent with recommended practice in rotator cuff tendinopathy: An observational study. Musculoskelet Sci Pract 2020; 47:102132. [PMID: 32148327 DOI: 10.1016/j.msksp.2020.102132] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/02/2019] [Accepted: 02/13/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Rotator cuff tendinopathy is a common and disabling cause of shoulder pain. While conservative treatment is recommended as initial management, recent findings suggest that general practitioners and rheumatologists do not consistently align with recommended care. This study aimed to survey Australian physiotherapists to explore the extent to which recommended management is being applied. METHODS A cross-sectional online survey. RESULTS Five hundred and two Australian physiotherapists completed the survey. Results demonstrated the majority of physiotherapists provide conservative management consistent with guideline recommendations, through delivery of exercise and education, comparable to management by physiotherapists in the United Kingdom, Belgium and the Netherlands. Parameters and construction of exercise treatment programs were highly variable within the cohort, qualitative analysis highlighting varied reasoning underpinning these management decisions. CONCLUSIONS Australian physiotherapists are broadly consistent with providing recommended management, however heterogeneity exists in the methods and parameters of treatment delivery.
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Affiliation(s)
- A Smythe
- A Game Physiotherapy, Somerville, Melbourne, 3912, Australia.
| | - J White
- School of Primary and Allied Health Care, Monash University, Frankston, 3199, Australia
| | - C Littlewood
- Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, ST54 5BG, UK
| | - J Bury
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster Royal Infirmary, Doncaster, DN2 5LT, UK
| | - T Haines
- School of Primary and Allied Health Care, Monash University, Frankston, 3199, Australia
| | - P Malliaras
- School of Primary and Allied Health Care, Monash University, Frankston, 3199, Australia
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Wong WK, Li MY, Yung PSH, Leong HT. The effect of psychological factors on pain, function and quality of life in patients with rotator cuff tendinopathy: A systematic review. Musculoskelet Sci Pract 2020; 47:102173. [PMID: 32452391 DOI: 10.1016/j.msksp.2020.102173] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Psychological factors may affect the pain level, shoulder function and quality of life in patients with rotator cuff tendinopathy. OBJECTIVE To systematically review the prevalence of psychological factors reported in patients with rotator cuff tendinopathy; and to determine the association between psychological factors and pain, function and quality of life in patients with rotator cuff tendinopathy. STUDY DESIGN Systematic review METHODS: Pubmed, Embase, CINAHL and Web of Science were systematically searched from inception to June 2019. Studies that investigated patients with signs and symptoms suggestive of rotator cuff tendinopathy, and reported psychological variables and patient-reported outcome measures including pain, shoulder function or disability and quality of life. RESULTS A total of 14 studies were included. Our results showed that 22.8%-26.2% of patients with rotator cuff tendinopathy reported depression; 23% reported anxiety; and 70.2%-89% of patients reported sleep disturbance or insomnia. Overall, nine psychological factors were identified to be associated with pain, function and quality of life in patients with rotator cuff tendinopathy. Low-to-moderate quality of evidence suggests that various psychological factors are associated with pain, function and quality of life in patients with rotator cuff tendinopathy CONCLUSION: This review identified various psychological factors may affect the pain level, shoulder function and quality of life in patients with rotator cuff tendinopathy, and the causal relationship warrants future high-quality prospective studies.
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Affiliation(s)
- Wai Keung Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Ming Yan Li
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Hio Teng Leong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong.
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68
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Ge Z, Zhou B, Zheng X, Yang M, Lü J, Deng H, Tang K, Chen W. [Circular RNA expression pattern and competing endogenous RNA network involved in rotator cuff tendinopathy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:608-614. [PMID: 32410429 DOI: 10.7507/1002-1892.201911094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective To detect the differentially expressed circular RNA (circRNA) in rotator cuff tendinopathy and analyze the potential molecular mechanism of these parental genes. Methods Ten supraspinatus tendons donated from patients who underwent tendon repair surgery between June 2018 and June 2019 were used for RNA-sequence. All rotator cuff tendinopathy and normal tendon samples were confirmed by MRI, histological staining, and observation by arthroscopy. All pathological tendons were matched with tendon samples for patients' age, gender, body mass index, and Bonar score. The bioinformatic analysis was performed based on the differentially expressed circRNA and their parental genes, including gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and competing endogenous RNA (ceRNA) network construction. Results There were 94 differentially expressed circRNAs, including 31 up-regulated and 63 down-regulated, detected between the rotator cuff tendinopathy and normal tendon samples with |log2 fold change (FC)| >2, P<0.05. GO analysis showed that the genes were mostly enriched in response to cyclic adenosine monophosphate (cAMP). KEGG pathway analysis showed that the most genes were enriched in extracellular matrix-receptor interaction, protein digestion and absorption, cell cycle, and nuclear factor κB signaling pathway. ceRNA networks showed the interactions among circRNAs, mRNAs, and miRNAs. And circRNA.8951-has-miR-6089-DNMT3B was the most sum max energy. Conclusion This bioinformatic study reveals several potential therapeutic targets for rotator cuff tendinopathy, which paves the way to better treatment and prevention of this disorder.
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Affiliation(s)
- Zilu Ge
- Department of Orthopeadics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University, Chongqing, 400038, P.R.China
| | - Binghua Zhou
- Department of Orthopeadics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University, Chongqing, 400038, P.R.China
| | - Xiaolong Zheng
- Department of Orthopeadics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University, Chongqing, 400038, P.R.China
| | - Mingyu Yang
- Department of Orthopeadics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University, Chongqing, 400038, P.R.China
| | - Jingtong Lü
- Department of Orthopeadics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University, Chongqing, 400038, P.R.China
| | - Honghao Deng
- Department of Orthopeadics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University, Chongqing, 400038, P.R.China
| | - Kanglai Tang
- Department of Orthopeadics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University, Chongqing, 400038, P.R.China
| | - Wan Chen
- Department of Orthopeadics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University, Chongqing, 400038, P.R.China
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Porter KN, Blanch PD, Walker HM, Shield AJ. The effect of previous shoulder pain on supraspinatus tendon thickness changes following swimming practice. Scand J Med Sci Sports 2020; 30:1442-1448. [DOI: 10.1111/sms.13678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/27/2020] [Accepted: 03/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kirsten N. Porter
- School of Exercise and Nutrition Science Queensland University of Technology Brisbane Australia
- Sport and Performance Innovation Excellence Queensland Academy of Sport Brisbane QLD Australia
- School of Physiotherapy Australian Catholic University Ballarat VIC Australia
| | - Peter D. Blanch
- School of Allied Health Sciences Brisbane Lions Football Club Woolloongabba QLD Australia
- School of Allied Health Sciences Griffith University Gold Coast QLD Australia
| | - Helen M. Walker
- School of Physiotherapy Physio4athletes Melbourne VIC Australia
| | - Anthony J. Shield
- School of Exercise and Nutrition Science Queensland University of Technology Brisbane Australia
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Dhein W, Wagner Neto ES, Miranda IF, Pinto AB, Moraes LR, Loss JF. Effects of Kinesio Taping on scapular kinematics and electromyographic activity in subjects with shoulder impingement syndrome. J Bodyw Mov Ther 2020; 24:109-117. [DOI: 10.1016/j.jbmt.2019.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/24/2019] [Accepted: 10/02/2019] [Indexed: 12/15/2022]
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Matthews W, Ellis R, Furness JW, Rathbone E, Hing W. Staging achilles tendinopathy using ultrasound imaging: the development and investigation of a new ultrasound imaging criteria based on the continuum model of tendon pathology. BMJ Open Sport Exerc Med 2020; 6:e000699. [PMID: 32341798 PMCID: PMC7173997 DOI: 10.1136/bmjsem-2019-000699] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2020] [Indexed: 12/04/2022] Open
Abstract
Aim To develop a standardised ultrasound imaging (USI)-based criteria for the diagnosis of tendinopathy that aligns with the continuum model of tendon pathology. Secondary aims were to assess both the intra-rater and inter-rater reliability of the criteria. Methods A criteria was developed following a face validity assessment and a total of 31 Achilles tendon ultrasound images were analysed. Intra-rater and inter-rater reliability were assessed for overall tendinopathy stage (normal, reactive/early dysrepair or late dysrepair/degenerative) as well as for individual parameters (thickness, echogenicity and vascularity). Quadratic weighted kappa (kw) was used to report on reliability. Results Intra-rater reliability was ‘substantial’ for overall tendinopathy staging (kw rater A; 0.77, 95% CI 0.59 to 0.94, rater B; 0.70, 95% CI 0.52 to 0.89) and ranged from ‘substantial’ to ‘almost perfect’ for thickness (kw rater A; 0.75, 95% CI 0.59 to 0.90, rater B; 0.84, 95% CI 0.71 to 0.98), echogenicity (kw rater A; 0.78, 95% CI 0.62 to 0.95, rater B; 0.73, 95% CI 0.58 to 0.89) and vascularity (kw rater A; 0.86, 95% CI 0.74 to 0.98, rater B; 0.89, 95% CI 0.79 to 0.99). Inter-rater reliability ranged from ‘substantial’ to ‘almost perfect’ for overall tendinopathy staging (kw round 1; 0.75, 95% CI 0.58 to 0.91, round 2; 0.81, 95% CI 0.63 to 0.99), thickness (kw round 1; 0.65, 95% CI 0.48 to 0.83, round 2; 0.77, 95% CI 0.60 to 0.93), echogenicity (kw round 1; 0.70, 95% CI 0.54 to 0.85, round 2; 0.76, 95% CI 0.58 to 0.94) and vascularity (kw round 1; 0.89, 95% CI 0.79 to 0.99, round 2; 0.86, 95% CI 0.74 to 0.98). Inter-rater reliability increased from ‘substantial’ in round 1 (kw 0.75, 95% CI 0.58 to 0.91) to ‘almost perfect’ in round 2 (0.81, 95% CI 0.63 to 0.99). Conclusion Intra-rater and inter-rater reliability were ‘substantial’ to ‘almost perfect’ when utilising an USI-based criteria to diagnose Achilles tendinopathy. This is the first study to use the continuum model of tendon pathology to develop an USI-based criteria to diagnose tendinopathy.
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Affiliation(s)
- Wesley Matthews
- Bond Institute of Health and Sport, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
| | - Richard Ellis
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - James W Furness
- Bond Institute of Health and Sport, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
| | - Evelyne Rathbone
- Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
| | - Wayne Hing
- Bond Institute of Health and Sport, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
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Ager AL, Roy JS, Gamache F, Hébert LJ. The Effectiveness of an Upper Extremity Neuromuscular Training Program on the Shoulder Function of Military Members With a Rotator Cuff Tendinopathy: A Pilot Randomized Controlled Trial. Mil Med 2020; 184:e385-e393. [PMID: 30423137 DOI: 10.1093/milmed/usy294] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/26/2018] [Accepted: 10/15/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Shoulder pain, a leading reason to consult a physician or physiotherapist, continues to be a challenge to rehabilitate, particularly with a military population. A rotator cuff (RC) tendinopathy, the most important source of shoulder pain, is one of the leading reasons for sick leave or a discharge from active military service. Research encourages the use of exercise prescription for the management of a RC tendinopathy, however the ideal method of delivery (group setting versus one-on-one) remains uncertain. The purpose of this single-blind (evaluator) pilot randomized clinical trial was to compare two 6-week rehabilitation programs, a newly developed group-supervised neuromuscular training program and usual one-on-one physiotherapy care, on the pain and symptoms of Canadian soldiers affected by a RC tendinopathy. MATERIALS AND METHODS Thirty-one soldiers with the Canadian Armed Forces were randomly assigned to (1) a group-supervised neuromuscular training program (UPEx-NTP) or; (2) one-on-one usual physiotherapy care (UPC). The primary outcome was the Disability of Arm, Hand and Shoulder (DASH) questionnaire. Secondary outcomes included the Western Ontario Rotator Cuff (WORC) Index, pain levels at rest, and maximum isometric voluntary contractions (MIVC) of the abductors and external (lateral) rotators of the affected shoulder. Both were assessed at baseline (T0), 6 (T6) and 12 (T12) weeks. Analysis included two-way repeated measures of variance for intention-to-treat (ITT) and per-protocol analyses. RESULTS Eighty military members with a RC tendinopathy were contacted, resulting in 31 participants who were randomized for their active intervention, in the UPEx-NTP or UPC, respectively. No significant group (p ≥ 0.16) or group × time interactions (p ≥ 0.11) were found for either ITT or per-protocol analyses. A statistically significant time effect (p < 0.001) was established for the DASH and WORC, showing that both groups improved over time. CONCLUSIONS Our preliminary data demonstrates that both rehabilitation approaches, grounded in active exercises, were not statistically different from each other, and derived similar benefits over time for a military population. This suggests that a group intervention for a RC tendinopathy has potential to be just as effective as a one-on-one approach for a military population, an interesting avenue for an active working population. Larger sample sizes and further investigation are warranted regarding the cost and clinical resource benefits of a supervised group approach.
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Affiliation(s)
- Amanda L Ager
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - France Gamache
- Physiotherapy Department, Valcartier Garrison, Canadian Armed Forces, Quebec, Canada
| | - Luc J Hébert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada.,Department of Radiology/Nuclear Medicine, Faculty of Medicine, Laval University, Quebec, Canada.,1 Canadian Field Hospital, Detachment Ottawa, Ottawa, Ontario, Canada
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Lee E, Diver C. Corticosteroid injections in the management of subacromial pain: Experiences and decision making of physiotherapists. Musculoskelet Sci Pract 2020; 45:102092. [PMID: 31747637 DOI: 10.1016/j.msksp.2019.102092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/18/2019] [Accepted: 11/13/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite ongoing debate in the literature regarding their efficacy, corticosteroid injections remain a common treatment intervention for physiotherapists to consider for patients with subacromial pain. Very little is known about what factors and how clinician's experiences inform decision making in this area. OBJECTIVES To investigate the experiences and decision making of physiotherapists in relation to the use of corticosteroid injections for subacromial pain. DESIGN A qualitative study using semi-structured interviews, which were then analysed using thematic analysis. SETTING A social enterprise organisation delivering NHS primary care musculo-skeletal physiotherapy services. PARTICIPANTS Nine physiotherapists. RESULTS Three broad codes were identified: (1) initial management; (2) patient factors; (3) therapist beliefs. Within these three codes, seven sub-themes were identified. Confidence in diagnosis and satisfaction that conservative management had been attempted was important. Features of a patient's presentation were key to decision making, i.e. pain severity, function and effect on sleep. Patient engagement with rehabilitation was also considered important, as was consideration of the effect of psychosocial factors. Therapist beliefs and experiences around the efficacy of corticosteroid injections was also considered influential on decision making. Some dissuasive factors were also discussed. CONCLUSION Some of the key factors in the decision making of physiotherapists in relation to the use of corticosteroid injections for subacromial pain have been identified, such as patient presentation and engagement, clinician experience and consideration of current literature. Further research is indicated to explore this subject further to enable better understanding around clinical decision making and the use of corticosteroid injections.
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Affiliation(s)
- Edward Lee
- MOSAIC Service, Nottingham CityCare Partnership, Mary Potter Centre, Nottingham, NG7 5HY, UK; Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - Claire Diver
- Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK.
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Meredith TJ, Falk NP, Rennicke J, Hornsby H. Athletic Injuries. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_59-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dube MO, Roy JS. Effect of fatigue and the absence of visual feedback on shoulder motor control in an healthy population during a reaching task. Gait Posture 2019; 74:135-141. [PMID: 31522106 DOI: 10.1016/j.gaitpost.2019.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 08/02/2019] [Accepted: 09/04/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The main role of the upper limb is to position the hand in order to carry out varied activities requiring coordinated multi-joint movement, which requires mobility and stability at the glenohumeral joint. This is made possible by the interaction between active and passive structures as well as the integration of information coming from multiple systems. This interaction can be compromised by factors such as muscle fatigue and lack of visual feedback, leading to decreased performance. Several studies have investigated their isolated effect without looking at their combined effect. OBJECTIVE To measure the specific and the combined effects of shoulder muscles fatigue and of lack of visual feedback on shoulder motor control during a reaching task with the arm in an elevated position. METHODS 60 healthy participants were randomly assigned to one of four experimental groups: 1) control with visual feedback; 2) control without visual feedback; 3) fatigue with visual feedback; 4) fatigue without visual feedback. Subjects had to perform 10 trials of a reaching task in the KINARM robotic arm. Kinematic variables of interest were time taken to complete the task, final error, initial angle of deviation and area under curve. Non-parametric ANOVAs were used. RESULTS Analyses showed that there were statistically significant differences (p < 0,01) for the time taken to complete the task (1.15 s compared to 0.70 s), the area under the curve (0.015m2 compared to 0.009m2) and the final error (0.025 m compared to 0,011 m) between those who had visual feedback and those who did not. No statistically significant fatigue or feedback X fatigue interaction effects were found for all kinematic variables. CONCLUSION Findings show that lack of visual feedback had an impact on the reaching task performance while fatigue did not. In addition, fatigue did not increase the effect of the lack of visual feedback.
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Affiliation(s)
- Marc-Olivier Dube
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, G1M 2S8, Canada.
| | - Jean-Sebastien Roy
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, G1M 2S8, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, G1R 1P5, Canada.
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Broilo C, Schuster RC, Dhein W. Análise eletromiográfica de músculos do complexo do ombro durante exercícios de rotação externa com faixa elástica. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/19004126032019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
RESUMO Na artrocinemática do ombro, o manguito rotador atua estabilizando a cabeça umeral em contato com a cavidade glenoidal, enquanto realiza a translação inferior para contrabalancear a força rotacional promovida principalmente pelo deltoide. Exercícios de rotação externa (RE) vêm sendo utilizados na reabilitação de pacientes com disfunções no complexo do ombro buscando restaurar a artrocinemática. Porém, poucos estudos abordam a utilização da faixa elástica e a avaliação dos músculos da cintura escapular, determinantes para uma cinemática adequada. O objetivo deste estudo é comparar a atividade eletromiográfica (EMG) de músculos do complexo do ombro durante exercícios de rotação externa com faixa elástica. Participaram 11 sujeitos do sexo masculino que foram avaliados durante os movimentos de (1) RE em ortostase; (2) RE com abdução de ombro; (3) RE em decúbito lateral (DL). Os músculos avaliados pela EMG foram: (1) trapézio superior (TS); (2) deltoide médio (DM); (3) deltoide posterior (DP); e (4) infraespinal (IN). A resistência foi determinada por uma faixa elástica cinza calibrada com carga de 5% do peso corporal. A análise dos dados foi realizada no software Biomec-SAS e as estatísticas foram calculadas por meio da Anova de medidas repetidas no software SPSS v20.0. Pôde-se constatar que os músculos TS e DM obtiveram maior atividade EMG durante o exercício de RE com abdução de ombro, o músculo DP durante a RE com abdução de ombro e RE em decúbito lateral, enquanto o IN a obteve durante a RE em ortostase e RE em decúbito lateral.
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Ribeiro DC, Jafarian Tangrood Z, Sole G, Abbott JH. Effectiveness of a tailored rehabilitation versus standard strengthening programme for patients with shoulder pain: a protocol for a feasibility randomised controlled trial (the Otago MASTER trial). BMJ Open 2019; 9:e028261. [PMID: 31366649 PMCID: PMC6677989 DOI: 10.1136/bmjopen-2018-028261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Exercise therapy is the treatment of choice for the management of patients with shoulder subacromial pain. However, we do not know whether a tailored rehabilitation programme is more effective than a standardised strengthening programme. The aim of this feasibility trial is to assess: (1) participant recruitment rate, (2) the proportion of participants enrolled from the total number screened, (3) adherence to the rehabilitation programme, (4) drop-out rates, (5) obtain estimates of adverse reactions to treatment, (6) obtain estimates of intervention effects in order to inform the sample size of the fully-powered randomised controlled trial, (7) conduct a preliminary cost-effectiveness analysis of the standardised strengthening and the tailored rehabilitation interventions. METHODS The MAnagement of Subacromial disorders of The shouldER (MASTER) trial, is a two-arm, patient-blinded and assessor-blinded, randomised controlled feasibility trial. Participants will be randomly allocated into one of the interventions group: tailored or standardised rehabilitation. To obtain estimates of intervention effects, we will compare changes in pain and shoulder-related disability scores between the two intervention groups using a repeated mixed-model analysis of variance, with alpha set at 0.05, and power at 80%. Since this is a feasibility study, we will not adjust alpha for multiple comparisons. To determine whether it is feasible to conduct the full trial, we will consider 75% CI as the probability threshold at 3-month follow-up. ETHICS AND DISSEMINATION This study was approved by the University of Otago Ethics Committee (Ref: H17/080). Findings from this study will be presented at national and international conferences, and will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ANZCTR: 12617001405303.
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Affiliation(s)
- Daniel C Ribeiro
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | | | - Gisela Sole
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - J Haxby Abbott
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Vanderstukken F, Maenhout A, Spanhove V, Jansen N, Mertens T, Cools AM. Quantifying acromiohumeral distance in elite male field hockey players compared to a non-athletic population. Braz J Phys Ther 2019; 24:273-279. [PMID: 31076255 DOI: 10.1016/j.bjpt.2019.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 04/08/2019] [Accepted: 04/16/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Shoulders of elite field hockey players are loaded continuously during play. Frequent high shoulder loading is known to influence certain shoulder variables, such as acromiohumeral distance. However, the influence of elite field hockey play on acromiohumeral distance is not examined yet. OBJECTIVE To examine the acromiohumeral distance in elite male field hockey players compared to a non-athletic control group. DESIGN Cross-sectional study. METHODS Fifty male participants were included; 25 elite field hockey players (age: 24.0±2.72 years; weight: 77.2±5.29kg; height; 180.5±5.37cm) and 25 age- and gender matched non-athletes (23.0±2.29 years; weight: 75.7±9.53kg; height: 181.8±5.52cm). A Telemed-Colormaster-128 EXT-IZ device was used to bilaterally obtain ultrasound acromiohumeral distance images at 3 different angles of shoulder abduction in the frontal plane. RESULTS Field hockey players showed a bilateral larger acromiohumeral distance at 45° (mean difference: 1.46mm [95% CI 0.46; 2.46]; p=0.005) and 60° (mean difference: 1.07mm [95% CI 0.21; 1.93]; p=0.016) compared to controls. In both groups, a significant but clinically less relevant, side difference was established for the acromiohumeral distance at 60° (mean difference: 0.79mm [95% CI 0.21; 1.34]; p=0.009). CONCLUSION With active shoulder abduction, elite field hockey players show a larger acromiohumeral distance in comparison to non-athletic participants. This may be a protective sport-specific adaptation, to better guard the shoulder from injury. Thus, acromiohumeral distance measurement may help physical therapists/coaches decide which athletes could benefit from specific, additional exercises aimed at enlarging the subacromial space.
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Affiliation(s)
- Fran Vanderstukken
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
| | - Annelies Maenhout
- Occupational Therapy Department, Artevelde University College, Ghent, Belgium
| | - Valentien Spanhove
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | | | | | - Ann Marcelle Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Abstract
The most common source of shoulder pain is thought to involve the tendons of the rotator cuff and associated structures around the subacromial space. A generic diagnostic term has been suggested, rotator cuff-related shoulder pain (RCRSP), which is an overarching clinical term that includes a number of conditions, such as subacromial impingement syndrome, subacromial pain syndrome, and rotator cuff tendinopathy. The management of RCRSP may include exercise, surgery, or injection therapy. Those who perform or recommend injection therapy for RCRSP have a duty of care to provide advice on the expected benefits and outcomes, as well as the potential risks and associated harms. Clinicians also need to consider what medication to inject, where to inject it, and how to inject it. The aim of this Viewpoint is to discuss these issues. J Orthop Sports Phys Ther 2019;49(5):289-293. doi:10.2519/jospt.2019.0607.
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Edwards A, Chepeha J, Jones A, Sheps DM, Beaupré L. Can clinical assessment differentiate partial thickness rotator cuff tears from full thickness rotator cuff tears? A secondary analysis. Disabil Rehabil 2019; 42:2351-2358. [PMID: 30735064 DOI: 10.1080/09638288.2018.1563637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: Shoulder pain causes significant disability, with rotator cuff disease as a common diagnosis. Differentially diagnosing partial tears of the rotator cuff tendons is difficult despite use of imaging and clinical examination. Our objective was to determine if a clinical assessment framework could discriminate between patients with partial and full thickness tears.Materials and Methods: Pre-operative baseline data from two randomized controlled trials of 452 adult patients awaiting rotator cuff repair were analyzed in this secondary analysis. Nineteen items from a pre-defined clinical assessment framework were investigated for association with the outcome of surgically confirmed partial or full thickness tear. Logistic regression tested independent associations and multivariable models were developed to create the most parsimonious model.Results: Thirty-two participants (7%) had partial thickness tears. Constant Power Score was the sole item associated with partial thickness tears (OR 1.07, 95% CI 1.02-1.12). Traumatic mechanism of injury trended toward significance (OR 2.17, 95% CI 1.06-4.48).Conclusions: Greater abduction strength (i.e., Constant Power Score) was associated with partial thickness tears. Other clinical assessment items did not differentiate between partial and full tears. Our results add to the growing body of research showing most clinical findings are not associated with a diagnosis in rotator cuff disease.Implications for RehabilitationGreater shoulder abduction strength (as measured with the Constant Power Score) was associated with partial thickness rotator cuff tears.Most findings within our clinical assessment framework did not distinguish between partial thickness and full thickness rotator cuff tears and thus, did not contribute to a differential pathoanatomical diagnosis.Since structural integrity of the rotator cuff and patient presentation show poor association, and rehabilitation intervention is often impairment-based, pathoanatomical diagnosis may not adequately direct non-surgical treatment. Including movement-based diagnoses or treatment classification systems in evaluation of rotator cuff disease may improve selection of appropriate conservative treatment.
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Affiliation(s)
- Anne Edwards
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Judy Chepeha
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Allyson Jones
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - David M Sheps
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Lauren Beaupré
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
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81
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Weisman A, Masharawi Y. Does Altering Sitting Posture Have a Direct Effect on Clinical Shoulder Tests in Individuals With Shoulder Pain and Rotator Cuff Degenerative Tears? Phys Ther 2019; 99:194-202. [PMID: 30351428 DOI: 10.1093/ptj/pzy111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 08/07/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Posture variations have been repeatedly linked to shoulder kinematics, strength, range of motion, and rotator cuff diseases. However, to our knowledge, no study has yet examined their possible link with shoulder pain provocation and pain levels during clinical shoulder tests. OBJECTIVE The objective was to examine whether changing posture while sitting modifies pain provocation and pain level during performance of 3 clinical shoulder tests in participants with shoulder pain and rotator cuff degenerative tears (RCDTs). METHODS Seventy individuals were allocated into 2 groups by an experienced physical therapist: 35 participants with symptomatic shoulders and RCDT diagnosed by ultrasound (tear size = 1.0 +/- 0.5 cm) and 35 control participants with no symptoms in the upper limb. All participants were tested by a second physical therapist for pain provocation (yes/no) and pain level (visual analog scale) using 3 common clinical shoulder tests: the Neer, the Hawkins-Kennedy, and the empty can while sitting in a neutral, slouched, and upright posture. Shoulder muscle forces were examined by a hand-held dynamometer for possible correlations only in the neutral posture. All participants were asked to fill out the quick DASH (disabilities of the arm shoulder and hand) questionnaire. RESULTS In the symptomatic group, all 3 clinical tests demonstrated similar pain provocation (100% repeatability) and pain level in all 3 sitting postures (visual analog scale scores 3.7-4.4). Muscle force mean ranges of the study groups were 4.4 to 7 kg and, in the control group, 6 to 10.5 kg. No correlations were found between age, body mass index, shoulder pain, hand dominance, onset of symptoms, severity, and tear size with any of the dependent variables. CONCLUSIONS Changing posture while sitting did not directly affect pain provocation and pain levels during performance of 3 clinical shoulder tests in participants with shoulder pain and RCDTs.
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Affiliation(s)
- Asaf Weisman
- Clalit Health Services, Holon, Israel; and Spinal Research Laboratory, Department of Physical Therapy, Tel Aviv University, Tel Aviv, Israel
| | - Youssef Masharawi
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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82
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Sole G, Mącznik AK, Ribeiro DC, Jayakaran P, Wassinger CA. Perspectives of participants with rotator cuff-related pain to a neuroscience-informed pain education session: an exploratory mixed method study. Disabil Rehabil 2019; 42:1870-1879. [PMID: 30634871 DOI: 10.1080/09638288.2018.1542037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To explore perceptions and initial outcomes of patients with rotator cuff-related pain to a pain education session.Materials and Methods: Ten individuals with persistent rotator cuff-related pain (≥3 months duration) attended an individual pain education session. They completed patient-reported outcomes measures on a weekly basis, three weeks prior and three weeks following the session. Individual semi-structured interviews were conducted three weeks following the pain education. Interviews were recorded, transcribed verbatim, and analyzed using the General Inductive Approach.Results: There were two over-arching key themes: firstly, 'Participants' Perspectives' of the session generated four themes: Improved understanding of 'the whole'; Mindful self-awareness; Taking charge; "The pain is still there". Their understanding of pain was reconceptualised, evident by their ability to describe the role of neurophysiological mechanisms, stress and general well-being towards their pain. The second over-arching key theme, 'Participants' Recommendations', had two themes: Integrating neuroscience with pathoanatomical knowledge and Educating other health professionals. Pain levels decreased post-pain education compared to pre-pain education.Conclusions: Following the pain education session, participants had greater understanding of factors influencing their shoulder pain. Pain education, in addition to pathoanatomical information may be useful as part of treatment for persistent rotator cuff-related pain.
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Affiliation(s)
- Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Aleksandra K Mącznik
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Daniel Cury Ribeiro
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prasath Jayakaran
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Craig A Wassinger
- Department of Physical Therapy, East Tennessee State University, Johnson City, USA
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The Effects of Rigid Scapular Taping on the Subacromial Space in Athletes With and Without Rotator Cuff Tendinopathy: A Randomized Controlled Study. J Sport Rehabil 2018; 28:250-255. [PMID: 29466076 DOI: 10.1123/jsr.2017-0287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT Reduction of the subacromial space (SAS) during arm elevation may contribute to rotator cuff (RC) tendinopathy. The effects of scapular taping on the SAS in athletes with and without RC tendinopathy are unknown. OBJECTIVE To investigate the immediate effects of scapular taping on the SAS in athletes with and without RC tendinopathy. DESIGN Randomized controlled study with repeated measures. SETTING University laboratory. PARTICIPANTS A total of 43 male volleyball players (17 asymptomatic and 26 with RC tendinopathy, mean age = 22.9 [3.5] y) participated in the study. INTERVENTION Three scapular taping protocols-no taping (control), taping with tension (therapeutic taping), and taping without tension (sham taping). MAIN OUTCOME MEASURES Ultrasound measurements of the SAS with the arm at 0° and 60° of shoulder abduction, and the change in the SAS between 0° and 60° of shoulder abduction (SAS0°-60°) were calculated. RESULTS Athletes with RC tendinopathy demonstrated larger SAS with therapeutic taping at 60° of shoulder abduction (6.9 [1.9] mm vs 5.8 [1.7] mm, mean difference = 1.1 mm, 95% confidence interval, -1.80 to -0.39, P = .002) when compared with the no taping condition. The tendinopathy group also showed less reduction in the SAS with therapeutic taping during SAS0°-60° (2.0 [1.4] mm vs 2.8 [1.4] mm, P = .02) when compared with the no taping condition. When tape was applied to the scapula in asymptomatic athletes, our results showed a relatively small increase in the SAS with therapeutic taping during arm resting at 0° of abduction when compared with the no taping condition (8.7 [0.9] mm vs 8.3 [0.8] mm, mean difference = 0.4 mm, 95% confidence interval, -0.71 to -0.11, P = .01). CONCLUSIONS Athletes with RC tendinopathy demonstrated less reduction of the SAS with rigid scapular taping during early arm abduction. Such observation was not evidenced in asymptomatic athletes.
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84
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Sandford FM, Sanders TA, Wilson H, Lewis JS. A randomised controlled trial of long-chain omega-3 polyunsaturated fatty acids in the management of rotator cuff related shoulder pain. BMJ Open Sport Exerc Med 2018; 4:e000414. [PMID: 30364577 PMCID: PMC6196970 DOI: 10.1136/bmjsem-2018-000414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 11/24/2022] Open
Abstract
Study design Multicentre, double-blind, placebo-controlled randomised clinical trial. Objectives To compare the effectiveness of long chain omega-3 polyunsaturated fatty acids (PUFAs) as part of the management for people diagnosed with rotator cuff related shoulder pain (RCRSP). Summary of background Although there is no robust evidence to support their use, omega-3 PUFAs have been recommended for those with tendinopathy due to their potential to moderate inflammation. Methods Participants with RCRSP (n=73) were randomised to take either nine MaxEPA capsules providing 1.53 g eicosapentaenoic acid, 1.04 g docosahexaenoic acid or nine matching placebo capsules containing oleic acid per day for 8 weeks. In addition, participants attended an exercise/education programme for 8 weeks. Participants were assessed at prerandomisation, 8 weeks (primary outcome point), 3 months, 6 months and 12 months (secondary outcome point). Primary outcome was the Oxford Shoulder Score (OSS). Secondary outcomes included the Shoulder Pain and Disability Index (SPADI), Patient Specific Functional Score, Euro Qol 5D-3L, Short Form 36, global rating of change and impairment measurements. Analysis was by intention to treat. Results Difference in the change in the OSS between the two groups at 2 months was –0.1 (95% CI −2.6 to 2.5, p=0.95). The change in SPADI scores was −8.3 (95% CI −15.6 to −0.94, p=0.03, analysed by analysis of covariance adjusted for baseline) at 3 months. Conclusion Omega-3 PUFA supplementation may have a modest effect on disability and pain outcomes in RCRSP.
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Affiliation(s)
- Fiona M Sandford
- Guys and St Thomas' NHS Foundation Trust, Hand Therapy Department, London, UK
| | - Thomas A Sanders
- King's College London, Department of Nutritional Sciences, London, UK
| | - Hannah Wilson
- Royal Free London NHS Foundation Trust, Physiotherapy Department, London, UK
| | - Jeremy S Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK.,Central London Community Healthcare, NHS Trust, London, UK
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Matthews W, Ellis R, Furness J, Hing W. Classification of Tendon Matrix Change Using Ultrasound Imaging: A Systematic Review and Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2059-2080. [PMID: 30007477 DOI: 10.1016/j.ultrasmedbio.2018.05.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/17/2018] [Accepted: 05/29/2018] [Indexed: 06/08/2023]
Abstract
Ultrasound imaging (US) is an accurate and reliable method used to diagnose tendinopathy. This systematic review was aimed at identifying common criteria and parameters used to diagnose tendinopathy, the methodological quality of studies and the predictive value of US. Nineteen studies met the inclusion criteria, with the Achilles, quadriceps and patella tendons being investigated. Overall, there was significant heterogeneity between the criteria used to diagnose tendinopathy utilising US. The methodological quality of included studies was "good." Additionally, meta-analysis revealed that US-identified abnormalities were predictive of future symptoms, and classification of tendinopathy using three US defined parameters indicated a higher relative risk of developing clinical tendinopathy compared with the use of two US-defined parameters. Further research into the development of a standardised US criterion that incorporates both clinical and US findings is required to allow for greater consistency in the diagnosis of tendinopathy.
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Affiliation(s)
- Wesley Matthews
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia.
| | - Richard Ellis
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - James Furness
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia
| | - Wayne Hing
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia
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86
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Sandford FM, Sanders TAB, Lewis JS. Exploring experiences, barriers, and enablers to home- and class-based exercise in rotator cuff tendinopathy: A qualitative study. J Hand Ther 2018. [PMID: 28641737 DOI: 10.1016/j.jht.2017.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Qualitative study. INTRODUCTION Adherence is paramount to the successful outcome of exercise-based treatment. PURPOSE OF STUDY The barriers and enablers to adherence to a home- and class-based exercise program were explored in this qualitative study. METHODS Semi-structured interviews were carried out to establish common themes relating to the participants' experiences during a year-long randomized controlled trial. RESULTS/DISCUSSION Twelve participants were interviewed. The main enablers to exercise were highlighted as equipment, perceived benefit from the exercises, and longer and more intensive monitoring. Barriers included the lack of motivation, lack of equipment, and pain. CONCLUSIONS Implications for practice are incorporating enablers and addressing barriers including self-discharge from classes; the importance of longer term follow-up and the benefits of adopting exercise into a well-established routine may provide potential benefits. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Fiona M Sandford
- Hand Therapy Department, Guys's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Thomas A B Sanders
- Nutrition and Dietetics, Division of Diabetes and Nutritional Sciences, King's College London, United Kingdom
| | - Jeremy S Lewis
- Department of Allied Health Professions and Midwifery, University of Hertfordshire, Hatfield Hertfordshire, United Kingdom
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Bleichert S, Renaud G, MacDermid J, Watson L, Faber K, Lenssen R, Saulnier M, Phillips P, Evans T, Sadi J. Rehabilitation of symptomatic atraumatic degenerative rotator cuff tears: A clinical commentary on assessment and management. J Hand Ther 2018. [PMID: 28641732 DOI: 10.1016/j.jht.2017.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Clinical Commentary. INTRODUCTION Atraumatic rotator cuff (RC) disease, is one of the most common cause of shoulder pain, which encompasses a continuum from tendinopathy to full thickness cuff tears. Extrinsic, intrinsic and environmental factors have been implicated in the pathophysiology of this disorder, affecting the clinical presentation of symptoms including pain and irritability. Successful rehabilitation of symptomatic atraumatic degenerative rotator cuff (SADRC) tears must address the underlying mechanisms causing dysfunction and correct modifiable factors. PURPOSE OF THE STUDY The purpose of this paper is to review the shoulder complex anatomy, introduce atraumatic degenerative RC pathology, differentiate between symptomatic and asymptomatic degenerative RC tears, propose an assessment and introduce the Rotator Cuff Protocol 1 (RCP1) designed by the clinical reasoning of one of the lead authors (LW) as a rehabilitation management approach for those clients who present with SADRC tears. METHODS/RESULTS/DISCUSSION N/A for clinical commentary. CONCLUSIONS The ability to identify SADRC tears should consider shoulder anatomy, extrinsic, intrinsic and environmental factors, and the consideration for the natural history of atraumatic partial and full thickness tears in the general population. A thorough clinical history and examination, which includes shoulder symptom modification tests, allows the examiner to determine at what phase the patient may start their exercise program. The RCP1 is a program that has been used clinically by many therapists and clients over the years and research is underway to test this protocol in atraumatic rotator cuff disease including SADRC tears. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Sarah Bleichert
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Genevieve Renaud
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Joy MacDermid
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Lyn Watson
- LifeCare Prahran Sports Medicine Centre and Melbourne Orthopaedic Group, Melbourne, Australia
| | - Ken Faber
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ross Lenssen
- LifeCare Prahran Sports Medicine Centre and Melbourne Orthopaedic Group, Melbourne, Australia
| | - Marie Saulnier
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Paul Phillips
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Tyler Evans
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jackie Sadi
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada.
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88
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Abstract
In 1972, American orthopaedic surgeon Charles Neer published his seminal paper, "Anterior Acromioplasty for the Chronic Impingement Syndrome in the Shoulder: A Preliminary Report." It wasn't a robust scientific paper; however, it changed the direction of orthopaedic practice for the next half century. Neer argued that a primary cause of shoulder pain was attrition of the supraspinatus tendon and related structures from the overlying acromion, especially when the arm was elevated. Neer recommended surgical removal to stop the impingement, and over the last half century, it could be argued that millions of people around the globe would have undergone acromioplasty surgery to stop this portion of the bone impinging onto the soft tissues located in the subacromial space. More recently, against the tide of subacromial decompression surgery there has been dissent, and the relationship between the acromion and symptoms has been challenged. J Orthop Sports Phys Ther 2018;48(3):127-129. doi:10.2519/jospt.2018.0102.
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89
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Cook T, Minns Lowe C, Maybury M, Lewis JS. Are corticosteroid injections more beneficial than anaesthetic injections alone in the management of rotator cuff-related shoulder pain? A systematic review. Br J Sports Med 2018; 52:497-504. [DOI: 10.1136/bjsports-2016-097444] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 11/04/2022]
Abstract
ObjectiveTo compare the effectiveness of corticosteroid injections to local anaesthetic injections in the management of rotator cuff-related shoulder pain (RCRSP).DesignSystematic review with best evidence synthesis.Data sourcesThe Cochrane, PubMed, CINAHL Plus, PEDro and EMBASE electronic databases were searched (inception until 8 June 2017). Reference lists of included articles were also hand searched.Eligibility criteriaTwo reviewers independently evaluated eligibility. Randomised controlled trials (RCTs) were included if they compared subacromial injections of corticosteroid with anaesthetic injections. Two reviewers independently extracted data regarding short-term, midterm and long-term outcomes for pain, self-reported function, range of motion and patient-perceived improvement.ResultsThirteen RCTs (n=1013) were included. Four trials (n=475) were judged as being at low risk of bias. Three studies of low risk of bias favoured the use of corticosteroid over anaesthetic-only injections in the short term (up to 8 weeks). There was strong evidence of no significant difference between injection types in midterm outcomes (12–26 weeks). There was limited evidence of no significant difference between injection types in long-term outcomes.ConclusionCorticosteroid injections may have a short-term benefit (up to 8 weeks) over local anaesthetic injections alone in the management of RCRSP. Beyond 8 weeks, there was no evidence to suggest a benefit of corticosteroid over local anaesthetic injections.Trial registration numberPROSPERO CRD42016033161.
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90
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McCreesh KM, Purtill H, Donnelly AE, Lewis JS. Increased supraspinatus tendon thickness following fatigue loading in rotator cuff tendinopathy: potential implications for exercise therapy. BMJ Open Sport Exerc Med 2017; 3:e000279. [PMID: 29333279 PMCID: PMC5759726 DOI: 10.1136/bmjsem-2017-000279] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 12/29/2022] Open
Abstract
Background/aim Exercise imparts a load on tendon tissue that leads to changes in tendon properties. Studies suggest that loading immediately reduces tendon thickness, with a loss of this response in symptomatic tendinopathy. No studies investigating the response of tendon dimensions to load for the rotator cuff tendons exist. This study aimed to examine the short-term effect of loading on the thickness of the supraspinatus tendon and acromiohumeral distance those with and without rotator cuff tendinopathy. Methods Participants were 20 painfree controls, and 23 people with painful rotator cuff tendinopathy. Supraspinatus tendon thickness and acromiohumeral distance were measured using ultrasound scans before, and at three time points after loading (1, 6 and 24 hours). Loading involved isokinetic eccentric and concentric external rotation and abduction. Results There was a significant increase in supraspinatus tendon thickness in the pain group at 1 (7%, ∆=0.38, 95% CI 0.19 to 0.57) and 6 hours (11%, ∆=0.53, 95% CI 0.34 to 0.71), although only the 6 hours difference exceeded minimal detectable difference. In contrast, there was a small non-significant reduction in thickness in controls. The acromiohumeral distance reduced significantly in both groups at 1 hour (controls: ∆=0.64, 95% CI 0.38 to 0.90; pain: ∆=1.1, 95% CI 0.85 to 1.33), with a larger change from baseline in the pain group. Conclusion Those diagnosed with painful supraspinatus tendinopathy demonstrated increased thickening with delayed return to baseline following loading. Rehabilitation professionals may need to take into account the impact of loading to fatigue when planning rehabilitation programmes.
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Affiliation(s)
- Karen M McCreesh
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Helen Purtill
- Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Alan E Donnelly
- Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Physical Education and Sports Sciences, University of Limerick, Limerick, Ireland
| | - Jeremy S Lewis
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.,Department of Musculoskeletal Services, Central London Community Healthcare NHS Trust, London, UK.,Department of Allied Health Professions, School of Health and Social Work, University of Hertfordshire, Hatfield, UK
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91
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Ingwersen KG, Jensen SL, Sørensen L, Jørgensen HR, Christensen R, Søgaard K, Juul-Kristensen B. Three Months of Progressive High-Load Versus Traditional Low-Load Strength Training Among Patients With Rotator Cuff Tendinopathy: Primary Results From the Double-Blind Randomized Controlled RoCTEx Trial. Orthop J Sports Med 2017; 5:2325967117723292. [PMID: 28875153 PMCID: PMC5576542 DOI: 10.1177/2325967117723292] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Progressive high-load exercise (PHLE) has led to positive clinical results in patients with patellar and Achilles tendinopathy. However, its effects on rotator cuff tendinopathy still need to be investigated. Purpose: To assess the clinical effects of PHLE versus low-load exercise (LLE) among patients with rotator cuff tendinopathy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients with rotator cuff tendinopathy were recruited and randomized to 12 weeks of PHLE or LLE, stratified for concomitant administration of corticosteroid injection. The primary outcome measure was change from baseline to 12 weeks in the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, assessed in the intention-to-treat population. Results: A total of 100 patients were randomized to PHLE (n = 49) or LLE (n = 51). Mean changes in the DASH questionnaire were 7.11 points (95% CI, 3.07-11.16) and 8.39 points (95% CI, 4.35-12.44) in the PHLE and LLE groups, respectively; this corresponded to a statistically nonsignificant adjusted mean group difference of −1.37 points (95% CI, −6.72 to 3.99; P = .61). Similar nonsignificant results were seen for pain, range of motion, and strength. However, a significant interaction effect was found between the 2 groups and concomitant corticosteroid use (P = .028), with the largest positive change in DASH in favor of PHLE for the group receiving concomitant corticosteroid. Conclusion: The study results showed no superior benefit from PHLE over traditional LLE among patients with rotator cuff tendinopathy. Further investigation of the possible interaction between exercise type and corticosteroid injection is needed to establish optimal and potentially synergistic combinations of these 2 factors. Registration: NCT01984203 (ClinicalTrials.gov identifier): Rotator Cuff Tendinopathy Exercise Trial (RoCTEx).
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Affiliation(s)
- Kim Gordon Ingwersen
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Department of Physiotherapy, Hospital Lillebaelt, Vejle Hospital, Vejle, Denmark
| | - Steen Lund Jensen
- Department of Orthopaedic Surgery, Shoulder Clinic, Aalborg University Hospital, Farsø Hospital, Farsø, Denmark
| | - Lilli Sørensen
- Department of Orthopaedic Surgery, Shoulder Clinic, Hospital Lillebaelt, Vejle Hospital, Vejle, Denmark
| | - Hans Ri Jørgensen
- Department of Orthopaedic Surgery, Shoulder Clinic, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Birgit Juul-Kristensen
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Department of Health Sciences, Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
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92
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Koca TT, Arslan A, Özdemir F, Acet G. Clinical features of patients diagnosed with degenerative rotator cuff tendon disease: a 6-month prospective-definitive clinical study from turkey. J Phys Ther Sci 2017; 29:1433-1437. [PMID: 28878478 PMCID: PMC5574353 DOI: 10.1589/jpts.29.1433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 05/26/2017] [Indexed: 01/28/2023] Open
Abstract
[Purpose] In rotator cuff tendon disease (RCTD), anamnesis is as important as clinical
findings and anatomic/radio diagnostic examination. This study aimed to investigate the
clinical features of patients diagnosed with RCTD using clinical and radiological methods
between March 2015 and August 2015 at Malatya Research and Training Hospital Physical
Medicine and Rehabilitation department. [Subjects and Methods] The study included 178
patients who were diagnosed with RCTD (128 females and 50 males). A questionnaire
comprising 33 questions was given to each patient. [Results] Eighty-eight of the patients
(49.9%) had an involvement on their right side, eighty-four (47.1%) had an involvement on
their left side, and 6 had bilateral involvement. Mean visual analog scale (VAS) score was
found to be statistically significant in favor of female patients. A statistically
significant correlation was found between educational status and VAS. The body mass index
(BMI) of the female patients was found to be higher than that of the male patients.
Statistically significant correlation between doing risky work and gender showed that
males were at a higher risk. [Conclusion] RCDT is more seen in people who have high BMI
and are at their 50s. Pain complaint and BMI were found higher in female patients. DM,
thyroid and cardiac diseases were seen more in the patients who are diagnosed with RCTD
relative to the healthy population.
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Affiliation(s)
- Tuba Tülay Koca
- Physical Medicine and Rehabilitation Clinic, Research and Training Hospital, Turkey
| | - Aydın Arslan
- Orthopedics and Traumatology Clinic, Research and Training Hospital, Turkey
| | - Filiz Özdemir
- Department of Physical Medicine and Rehabilitation, Inonu University, Turkey
| | - Günseli Acet
- Physical Medicine and Rehabilitation Clinic, Research and Training Hospital, Turkey
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93
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Gillespie MA, M Cznik A, Wassinger CA, Sole G. Rotator cuff-related pain: Patients' understanding and experiences. Musculoskelet Sci Pract 2017; 30:64-71. [PMID: 28582682 DOI: 10.1016/j.msksp.2017.05.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persistent musculoskeletal pain is a multi-factorial entity, influenced by biological, genetic and psychosocial factors. Psychosocial factors, such as individuals' beliefs and experiences, need to be considered in the management of such pain. While extensive research has explored beliefs of individuals with spinal pain, less is known about individuals' beliefs regarding shoulder pain. OBJECTIVES To explore beliefs about the cause of pain in individuals with persistent rotator cuff-related pain, as well as the experiences of the effect of pain on their daily lives. DESIGN A mixed methods design, using semi-structured interviews and validated outcome questionnaires. METHOD Five men and five women, aged 47-68 years, with shoulder pain for at least three months were recruited. Individual semi-structured interviews were audio-recorded, transcribed verbatim and analysed using the general inductive approach. RESULTS/FINDINGS Four key themes emerged. The cause of pain, 'Understanding the pain', was described in terms of anatomical factors within the context of the participants' lives. The pain impacted all areas of life, creating another theme, 'It affects everything'. Participants responded to their pain by adopting certain, 'Pain-associated behaviours' and sought information for diagnosis, general management and exercise prescription, 'Emotional responses and the future'. CONCLUSIONS The participants with rotator cuff-related pain believed the cause of their pain to be local to the shoulder region. However, they also described various stressors in their work-, sports- and family-related lives. Rehabilitation may need to include educating the individual, expanding their understanding regarding pain mechanisms and appropriate interventions, based on individual goal-setting.
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Affiliation(s)
- Melissa A Gillespie
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand; Advance Wellness Centre, Hamilton, New Zealand
| | - Aleksandra M Cznik
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Craig A Wassinger
- Department of Physical Therapy, East Tennessee State University, Johnson City, TN, USA
| | - Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand.
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94
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Leong HT, Ng GYF, Chan SC, Fu SN. Rotator cuff tendinopathy alters the muscle activity onset and kinematics of scapula. J Electromyogr Kinesiol 2017; 35:40-46. [DOI: 10.1016/j.jelekin.2017.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/29/2017] [Accepted: 05/29/2017] [Indexed: 01/26/2023] Open
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95
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Hickey D, Solvig V, Cavalheri V, Harrold M, Mckenna L. Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis. Br J Sports Med 2017; 52:102-110. [DOI: 10.1136/bjsports-2017-097559] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2017] [Indexed: 11/04/2022]
Abstract
BackgroundIt is unclear whether the presence of scapular dyskinesis increases the risk of developing shoulder pain in asymptomatic athletes.ObjectivesTo determine whether the presence of scapular dyskinesis in asymptomatic athletes increases the risk of developing shoulder pain by systematic review and meta-analysis.MethodsA systematic search was conducted in the Cochrane Library, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database and SPORTDiscus. Prospective studies that assessed athletes for scapular dyskinesis and recorded incidents of shoulder pain were included. Study quality was assessed using the Downs and Black checklist. Meta-analysis was conducted to derive a pooled risk ratio (RR) for the development of shoulder pain in athletes with scapular dyskinesis compared with those without scapular dyskinesis.ResultsFive studies were included with a total of 419 athletes. Of the athletes with scapular dyskinesis, 35% (56/160) experienced shoulder pain during the follow-up, whereas 25% (65/259) of athletes without scapular dyskinesis experienced symptoms. The presence of scapular dyskinesis at baseline indicated a 43% increased risk of a shoulder pain event over a 9 to 24 months follow-up (RR=1.43, 95% CI 1.05 to 1.93).ConclusionsAthletes with scapular dyskinesis have 43% greater risk of developing shoulder pain than those without scapular dyskinesis.
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96
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Ginn KA, Reed D, Jones C, Downes A, Cathers I, Halaki M. Is subscapularis recruited in a similar manner during shoulder internal rotation exercises and belly press and lift off tests? J Sci Med Sport 2017; 20:566-571. [DOI: 10.1016/j.jsams.2016.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 10/16/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
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97
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Thorpe A, Hurworth M, O'Sullivan P, Mitchell T, Smith A. Rotator cuff disease: opinion regarding surgical criteria and likely outcome. ANZ J Surg 2017; 87:291-295. [DOI: 10.1111/ans.13862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 08/09/2016] [Accepted: 10/12/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Alison Thorpe
- School of Physiotherapy and Exercise Science; Curtin University; Perth Western Australia Australia
| | - Mark Hurworth
- Department of Orthopaedic Surgery; Royal Perth Hospital; Perth Western Australia Australia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science; Curtin University; Perth Western Australia Australia
| | - Tim Mitchell
- School of Physiotherapy and Exercise Science; Curtin University; Perth Western Australia Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science; Curtin University; Perth Western Australia Australia
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98
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Lewis J, Sim J, Barlas P. Acupuncture and electro-acupuncture for people diagnosed with subacromial pain syndrome: A multicentre randomized trial. Eur J Pain 2017; 21:1007-1019. [DOI: 10.1002/ejp.1001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 11/10/2022]
Affiliation(s)
- J. Lewis
- Department of Clinical Therapies; University of Limerick; Ireland
- School of Health and Social Work; University of Hertfordshire; Hatfield United Kingdom
- Central London Community Healthcare NHS Trust; London United Kingdom
| | - J. Sim
- Institute for Primary Care and Health Sciences; Keele University; Staffordshire United Kingdom
| | - P. Barlas
- School of Health and Rehabilitation; Keele University; Staffordshire United Kingdom
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99
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Lewis JS, McCreesh K, Barratt E, Hegedus EJ, Sim J. Inter-rater reliability of the Shoulder Symptom Modification Procedure in people with shoulder pain. BMJ Open Sport Exerc Med 2016; 2:e000181. [PMID: 27900200 PMCID: PMC5125418 DOI: 10.1136/bmjsem-2016-000181] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 12/04/2022] Open
Abstract
Background Musculoskeletal conditions involving the shoulder are common and, because of the importance of the upper limb and hand in daily function, symptoms in this region are commonly associated with functional impairment in athletic and non-athletic populations. Deriving a definitive diagnosis as to the cause of shoulder symptoms is fraught with difficulty. Limitations have been recognised for imaging and for orthopaedic special tests. 1 solution is to partially base management on the response to tests aimed at reducing the severity of the patient's perception of symptoms. 1 (of many) such tests is the Shoulder Symptom Modification Procedure (SSMP). The reliability of this procedure is unknown. Methods 37 clinician participants independently watched the videos of 11 patient participants undergoing the SSMP and recorded each patient's response as improved (partially or completely), no change or worse. Inter-rater reliability was assessed by Krippendorff's α, which ranges from 0 to 1. Results Krippendorff's α was found to range from 0.762 to 1.000, indicating moderate to substantial reliability. In addition, short (3-hour) and longer (1-day) durations of training were associated with similar levels of reliability across the techniques. Conclusions Deriving a definitive structural diagnosis for a person presenting with a musculoskeletal condition involving the shoulder is difficult. The findings of the present study suggest that the SSMP demonstrates a high level of reliability. More research is needed to better understand the relevance of such procedures. Trial registration number ISRCTN95412360.
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Affiliation(s)
- Jeremy S Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK; Department of Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Karen McCreesh
- Department of Clinical Therapies , University of Limerick , Limerick , Ireland
| | - Eva Barratt
- Department of Clinical Therapies , University of Limerick , Limerick , Ireland
| | - Eric J Hegedus
- Department of Physical Therapy , Congdon School of Health Sciences, High Point University , High Point, North Carolina , USA
| | - Julius Sim
- Institute for Primary Care and Health Sciences, Keele University , Stoke-on-Trent , UK
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100
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Effects of scapular taping on the activity onset of scapular muscles and the scapular kinematics in volleyball players with rotator cuff tendinopathy. J Sci Med Sport 2016; 20:555-560. [PMID: 27839664 DOI: 10.1016/j.jsams.2016.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/23/2016] [Accepted: 10/21/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To examine the effect of scapular taping on the activity onset of scapular muscles and the scapular kinematics during arm elevation in volleyball players with rotator cuff (RC) tendinopathy. DESIGN Randomized placebo-controlled repeated measures METHODS: Twenty-six male volleyball players with RC tendinopathy (mean age=23.6±3.3years) participated in the study. Electromyography (EMG) activity onset of upper trapezius (UT), middle trapezius (MT), lower trapezius (LT) and serratus anterior (SA) and the three-dimensional scapular kinematics quantified by using an acromial marker cluster method were compared with three scapular taping protocols, namely, no taping, therapeutic taping, and placebo taping. RESULTS The MT, LT and SA activated significantly earlier in both therapeutic taping (all p<0.005) and placebo taping conditions than no taping conditions (all p<0.002). There was a small increase in the scapular upward rotation when therapeutic taping and no taping conditions were compared (p=0.007). CONCLUSIONS Scapular taping may enhance the neuromotor control of the scapular muscles. Whether it provides adequate support for normal scapular kinematics during arm movement in athletes with RC tendinopathy await for further studies.
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