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Menek B, Tarakci D, Algun ZC. The effect of Mulligan mobilization on pain and life quality of patients with Rotator cuff syndrome: A randomized controlled trial. J Back Musculoskelet Rehabil 2019; 32:171-178. [PMID: 30248039 DOI: 10.3233/bmr-181230] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mulligan mobilization techniques cause pain and affect the function in patients with Rotator cuff syndrome. OBJECTIVE The aim of the study was to investigate the effect of Mulligan mobilization on pain and quality of life in individuals with Rotator cuff syndrome. METHODS This study was conducted on 30 patients with Rotator cuff syndrome. The patients were randomized into Mulligan and control group. All the patients participating in this study were treated with conventional physiotherapy. Additionally, the Mobilization with movement (MWM) technique was used in the Mulligan group. Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH), goniometer for the normal range of motion (ROM) and Short Form-36 (SF-36) questionnaires were used for assessment. RESULTS Statistically significant improvement was found in the post-treatment VAS, DASH, SF-36, and ROM values significantly improved in both groups (p< 0.05). However, the Mulligan group showed much better results when compared to the control group in ROM, VAS, DASH (p< 0.05). In the SF-36 questionnaire, significant results were obtained for both groups, except the social function parameter. For the SF-36 parameters, both groups performed equally. CONCLUSIONS Mulligan mobilization was more effective than general treatment methods for pain as well as normal joint motion, DASH scoring and some parameters of SF-36 compared with general treatment methods.
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Affiliation(s)
- Burak Menek
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Devrim Tarakci
- Department of Occupational Therapy, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Z Candan Algun
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
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Holt K, Boettcher C, Halaki M, Ginn KA. Humeral torsion and shoulder rotation range of motion parameters in elite swimmers. J Sci Med Sport 2017; 20:469-474. [DOI: 10.1016/j.jsams.2016.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/23/2016] [Accepted: 10/09/2016] [Indexed: 11/28/2022]
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Rodeghero JR, Cleland JA, Mintken PE, Cook CE. Risk stratification of patients with shoulder pain seen in physical therapy practice. J Eval Clin Pract 2017; 23:257-263. [PMID: 27357623 DOI: 10.1111/jep.12591] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Musculoskeletal shoulder pain is commonly treated in physical therapy. There is inconsistency in the literature regarding patient characteristics related to prognosis. Having prognostic information could be useful for improving clinical efficiency and decreasing the cost of associated care. The objective of this study was to identify predictive characteristics related to patients with shoulder pain who have a high-risk of a bad prognosis (lowest functional recovery compared with visit utilization) as well as those who are at low-risk of a bad prognosis (highest functional recovery compared with visit utilization). METHODS We completed a secondary analysis of a retrospective cohort using data obtained from an existing commercial outcomes database. Data from 5214 patients with shoulder pain were analysed to determine predictive characteristics that identify patients who either have a low-risk or a high-risk of a bad prognosis to physical therapy care. Multinomial regression was used to identify significant patient characteristics predictive of treatment response. RESULTS Statistically significant predictors of high-risk categorization included older age, no surgical history, insurance designated as worker's compensation, litigation or automotive and three or more co-morbidities. Predictors of low risk categorization were younger age, shorter duration of symptoms, no surgical history and payer type. CONCLUSION Selected variables were associated with both poor and good recovery. Further research on prognosis, efficacy of physical therapy care and cost appear warranted for patients with shoulder pain.
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Affiliation(s)
| | - Joshua A Cleland
- Physical Therapy Program, Franklin Pierce University, Rindge, NH, USA
| | - Paul E Mintken
- Department of Physical Therapy, University of Colorado School of Medicine, Aurora, CO, USA
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Development of a Prognostic Model for Patients With Shoulder Complaints in Physical Therapist Practice. Phys Ther 2017; 97:72-80. [PMID: 27538898 DOI: 10.2522/ptj.20150649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 08/01/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Health care providers need prognostic factors to distinguish between patients who are likely to recover and those who are not likely to recover. OBJECTIVE The aim of this study was to: (1) describe the clinical course of recovery and (2) identify prognostic factors of recovery in patients with shoulder pain at the 26-week follow-up. DESIGN A prospective cohort study was carried out in the Netherlands and included 389 patients who consulted a physical therapist for a new episode of shoulder pain. METHOD Participants were followed for 26 weeks. Potential predictors of recovery were selected from the literature and, with the addition of 2 new variables (ie, use of diagnostic ultrasound and working alliance), evaluated in the multivariable regression analysis. Multiple imputation was used to handle missing data, and bootstrap methods were used for internal validation. RESULTS The recovery rate was 60% for the total population and 65% for the working population after 26 weeks. Short duration of complaints, lower disability scores, having a paid job, better working alliance, and no feelings of anxiety or depression were associated with recovery. In the working population, only duration of complaints and disability remained in the final model. The area under the receiver operating characteristic curve (AUC) for the final model was 0.67 for the total population and 0.63 for the working population. After internal validation, the AUC was corrected to 0.66 and 0.63, respectively. LIMITATIONS External validation of the prognostic model should be done prior to its use in clinical practice. CONCLUSION The results of this study indicate that several factors can predict recovery.
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Abstract
A fully functioning, painless shoulder joint is essential to maintain a healthy, normal quality of life. Disease of the rotator cuff tendons (RCTs) is a common issue that affects the population, increasing with age, and can lead to significant disability and social and health costs. RCT injuries can affect younger, healthy patients and the elderly alike, and may be the result of trauma or occur as a result of chronic degeneration. They can be acutely painful, limited to certain activities or completely asymptomatic and incidental findings. A wide variety of treatment options exists ranging from conservative local and systemic pain modalities, to surgical fixation. Regardless of management ultimately chosen, physiotherapy of the RCT, rotator cuff muscles and surrounding shoulder girdle plays an essential role in proper treatment. Length of treatment, types of therapy and timing may vary if therapy is definitive care or part of a postoperative protocol. Allowing time for adequate RCT healing must always be considered when implementing ROM and strengthening after surgery. With current rehabilitation methods, patients with all spectrums of RCT pathology can improve their function, pain and quality of life. This manuscript reviews current theories and practice involving rehabilitation for RCT injuries.
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Affiliation(s)
- Jeffrey D Osborne
- a Department of Orthopaedic Surgery , Beaumont Hospital , Royal Oak , MI , USA
| | - Ashok L Gowda
- a Department of Orthopaedic Surgery , Beaumont Hospital , Royal Oak , MI , USA
| | - Brett Wiater
- a Department of Orthopaedic Surgery , Beaumont Hospital , Royal Oak , MI , USA
| | - J Michael Wiater
- a Department of Orthopaedic Surgery , Beaumont Hospital , Royal Oak , MI , USA
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Burner T, Abbott D, Huber K, Stout M, Fleming R, Wessel B, Massey E, Rosenthal A, Burns E. Shoulder symptoms and function in geriatric patients. J Geriatr Phys Ther 2015; 37:154-8. [PMID: 24534849 DOI: 10.1519/jpt.0b013e3182abe7d6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Musculoskeletal problems, including shoulder pain, are common in the general population and are often cited as reasons for physician visits. Although many risk factors for shoulder pain are postulated, the effects of shoulder pain on functional level and perceived quality of life are poorly characterized in older adults. In this study, we set out to determine the prevalence and impact of shoulder symptoms and dysfunction in an older adult veteran population. METHODS A chart review, cross-sectional survey, and examination were performed. A sample of 93 individuals, aged 60 years or older, was recruited from a primary clinic outpatient waiting room at the Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin. Patients were asked about shoulder symptoms and self-assessed health and completed the Stanford Modified Health Assessment Questionnaire. A series of 3 shoulder maneuvers was used to assess shoulder mobility and pain. The presence of diabetes and statin use was documented. A more thorough chart review was performed on individuals who reported shoulder pain and disability. RESULTS Severe shoulder pain was common in the study group, reported by 31% of all participants. Functional limitation measured by the Modified Health Assessment Questionnaire and answering "yes" to greater difficulty performing daily tasks was associated with reduced internal rotation, which was present in almost 36% of all participants. Symptoms were often bilateral. No statistically significant risk factors emerged in this small sample, but suggestive trends were apparent. Interestingly, few patients reported discussing these problems with their providers, and shoulder-related problems were documented in only 10% of corresponding problem lists of symptomatic patients. CONCLUSIONS With an aging population, the high prevalence of shoulder pain may have considerable impact on public health. It will become increasingly important to define risk factors, delineate etiologies, and devise new management strategies for patients with symptomatic shoulder disease.
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Affiliation(s)
- Todd Burner
- 1Medical College of Wisconsin, Milwaukee. 2University of Wisconsin-Milwaukee
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Notarnicola A, Maccagnano G, Tafuri S, Fiore A, Margiotta C, Pesce V, Moretti B. Prognostic factors of extracorporeal shock wave therapy for tendinopathies. Musculoskelet Surg 2015; 100:53-61. [PMID: 25982090 DOI: 10.1007/s12306-015-0375-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/06/2015] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Extracorporeal shock wave therapy is very widely used for the management of tendinopathies and plantar fasciitis. AIM The aim of the study is to determine whether there are prognostic factors that may influence the outcome of extracorporeal shock wave therapy for these diseases. METHODS Three hundred fifty-five patients were analyzed 2 months after shock wave treatment for rotator cuff tendinitis, epicondylitis, Achilles tendinopathy, trocanteritis, jumper's knee or plantar fasciitis. We recorded the epidemiological, clinical and treatment protocol, and these data were correlated with treatment outcome. RESULTS Clinical improvement was achieved in 45.9 % of these patients. We discovered that laterality different to the dominant limb (p < 0.0001) and repeated shock wave treatments (p = 0.004) are prognostic factors in an unsuccessful therapy, while being male (p = 0.015) and a high body mass index (p = 0.004) are factors for success. We found no differences in relation to age, diet, blood type, work or sport activity, presence of co-morbidities, drugs, type of tendinopathy, density of energy delivered and other physiotherapy treatment. Knowledge of these prognostic factors may lead to improved insight for physicians and physiotherapists to predict the extent of the recovery and adjust rehabilitation and patient expectations accordingly.
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Affiliation(s)
- A Notarnicola
- Course of Motor and Sports Sciences, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, Lungomare Starita 1, 70123, Bari, Italy. .,Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - G Maccagnano
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - S Tafuri
- Department of Biomedical Sciences and Human Oncology, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - A Fiore
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - C Margiotta
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - V Pesce
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - B Moretti
- Course of Motor and Sports Sciences, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, Lungomare Starita 1, 70123, Bari, Italy.,Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Requejo PS, Furumasu J, Mulroy SJ. Evidence-Based Strategies for Preserving Mobility for Elderly and Aging Manual Wheelchair Users. TOPICS IN GERIATRIC REHABILITATION 2015; 31:26-41. [PMID: 26366040 PMCID: PMC4562294 DOI: 10.1097/tgr.0000000000000042] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Elderly and aging manual wheelchair (MWC) users have increased risk for accelerated loss of function and mobility that greatly limits independence and affects quality of life. This review paper addresses important issues for preserving function and mobility for elderly and aging individuals who use a MWC by presenting the current available evidence and recommendations. These include recommendations for maximizing function, by decreasing pain, improving the ability to self-propel, and prolonging mobility and endurance through ergonomics, individualized wheelchair selection and configuration, and adaptations for increasing the capacity to handle the daily mobility demands through training, strengthening, and exercise. Each recommendation is supported by current research in each relevant area.
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Affiliation(s)
- Philip S. Requejo
- Physical Therapy Department, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
- Rehabilitation Engineering Program, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
| | - Jan Furumasu
- Physical Therapy Department, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
| | - Sara J. Mulroy
- Physical Therapy Department, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, 7601 E. Imperial Highway, Downey, CA 90242, USA
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Gialanella B, Bertolinelli M. Corticosteroids injection in rotator cuff tears in elderly patient: pain outcome prediction. Geriatr Gerontol Int 2013; 13:993-1001. [PMID: 24131759 DOI: 10.1111/ggi.12046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2013] [Indexed: 11/27/2022]
Abstract
AIM The aim of this prospective study was to evaluate the effect of corticosteroids intra-articular injections on pain in patients with rotator cuff tear (RCT), and to identify predictors for pain outcomes. METHODS A total of 60 patients with RCT were enrolled. All patients underwent rehabilitation; 20 patients received a single intra-articular injection of 40 mg triamcinolone acetonide and 20 patients had a repeat injection at a 21-day interval. Backward stepwise regression analysis was used to predict effectiveness and improvement of pain. The independent variables were age, sex, symptom duration, tear size, passive range of motion (ROM), active ROM, non-steroidal anti-inflammatory drugs request, pain at rest, number of triamcinolone injections and severity of osteoarthritis at admission. RESULTS At 3 and 6 months, patients who received triamcinolone had higher effectiveness and improvement in pain during activities and pain at night than those of control group. At the 3-month interval post-therapy, active ROM was the only predictor for effectiveness in pain during activity, effectiveness in pain at night and improvement in pain at night. Six months after therapy, active ROM was a predictor for improvement in pain at night. Age was a predictor for effectiveness in pain at night, whereas tear size of RCT was a predictor for effectiveness and improvement in pain during activity. CONCLUSIONS Corticosteroids can relieve pain in RCT. Active ROM is the most important predictor of pain outcomes. This finding can be useful to physicians when deciding on the type of patients who might best benefit from intra-articular injections of corticosteroids.
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Affiliation(s)
- Bernardo Gialanella
- Operative Unit for Recovery and Functional Rehabilitation, Fondazione Salvatore Maugeri IRCCS, Lumezzane (BS), Italy
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Krischak G, Gebhard F, Reichel H, Friemert B, Schneider F, Fisser C, Kaluscha R, Kraus M. A prospective randomized controlled trial comparing occupational therapy with home-based exercises in conservative treatment of rotator cuff tears. J Shoulder Elbow Surg 2013; 22:1173-9. [PMID: 23523073 DOI: 10.1016/j.jse.2013.01.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 12/23/2012] [Accepted: 01/07/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND This pilot study evaluates the outcome after occupational therapy, compared to home-based exercises in the conservative treatment of patients with full thickness rotator cuff tears. METHODS Forty-three adult subjects (range, 18-75 years), who had a full thickness rupture of the rotator cuff which was verified by magnetic imaging tomography, with clinical signs of a chronic rotator cuff impingement, and who were available for follow-up, were randomized to occupational therapy or to independent home-based exercises using a booklet. After drop-out, 38 patients were available for full examination at follow-up. Before therapy and after 2 months of conservative treatment, pain intensity, the Constant-Murley score, isokinetic strength testing in abduction and external rotation, functional limitation, clinical shoulder tests and health-related quality of life (EQ-5D) were evaluated. RESULTS Two-thirds of the patients improved in clinical shoulder tests, regardless of the therapy group. There were no significant differences between the groups with reference to pain, range of motion, maximum peak force (abduction, external rotation), the Constant-Murley score, and the EQ-5D index. The only significant difference observed was the improvement in the self-assessed health- related quality of life (EQ-5D VAS) favoring home-based exercises. CONCLUSION Home-based exercise, on the basis of an illustrated booklet with exercises twice a day, supplies comparable results to formal occupational therapy in the conservative treatment of rotator cuff tears. The results of this pilot study suggest some potential advantages related to psychological benefits using home-based treatment.
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Affiliation(s)
- Gert Krischak
- Institute of Research in Rehabilitation Medicine at Ulm University, Wuhrstrasse 2/1, Bad Buchau, Germany.
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Morphology of large rotator cuff tears and of the rotator cable and long-term shoulder disability in conservatively treated elderly patients. J Comput Assist Tomogr 2013; 37:631-8. [PMID: 23863543 DOI: 10.1097/rct.0b013e318290fd82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to describe the morphology of the rotator cuff tendon tears and long-term shoulder disability in conservatively treated elderly patients and determine if an association exists between these factors. METHODS Assessment of the rotator cuff tendon tear dimensions and depth, rotator interval involvement, rotator cable morphology and location, and rotator cuff muscle status was carried out on magnetic resonance studies of 24 elderly patients treated nonoperatively for rotator cuff tendon tears. Long-term shoulder function was measured using the Western Ontario Rotator Cuff (WORC) index; Disabilities of the Shoulder, Arm, and Hand questionnaire; and the American Shoulder Elbow Self-assessment form, and a correlation between the outcome scores and morphologic magnetic resonance findings was carried out. RESULTS The majority of large rotator cuff tendon tears are limited to the rotator cuff crescent. Medial rotator interval involvement (isolated or in association with lateral rotator interval involvement) was significantly associated with WORC physical symptoms total (P = 0.01), WORC lifestyle total (P = 0.04), percentage of all WORC domains (P = 0.03), and American Shoulder Elbow Self-assessment total (P = 0.01), with medial rotator interval involvement associated with an inferior outcome. CONCLUSIONS Medial rotator interval tears are associated with long-term inferior outcome scores in conservatively treated elderly patients with large rotator cuff tendon tears.
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Chan S, Hill R, Kerr J. Passive joint mobilisation: does it enhance outcome of adhesive capsulitis of the shoulder following corticosteroid injection? ACTA ACUST UNITED AC 2013. [DOI: 10.1179/175361410x12652805807594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Karel YHJM, Scholten-Peeters WGM, Thoomes-de Graaf M, Duijn E, Ottenheijm RPG, van den Borne MPJ, Koes BW, Verhagen AP, Dinant GJ, Tetteroo E, Beumer A, van Broekhoven JB, Heijmans M. Current management and prognostic factors in physiotherapy practice for patients with shoulder pain: design of a prospective cohort study. BMC Musculoskelet Disord 2013; 14:62. [PMID: 23399098 PMCID: PMC3606323 DOI: 10.1186/1471-2474-14-62] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 11/19/2012] [Indexed: 11/26/2022] Open
Abstract
Background Shoulder pain is disabling and has a considerable socio-economic impact. Over 50% of patients presenting in primary care still have symptoms after 6 months; moreover, prognostic factors such as pain intensity, age, disability level and duration of complaints are associated with poor outcome. Most shoulder complaints in this group are categorized as non-specific. Musculoskeletal ultrasound might be a useful imaging method to detect subgroups of patients with subacromial disorders. This article describes the design of a prospective cohort study evaluating the influence of known prognostic and possible prognostic factors, such as findings from musculoskeletal ultrasound outcome and working alliance, on the recovery of shoulder pain. Also, to assess the usual physiotherapy care for shoulder pain and examine the inter-rater reliability of musculoskeletal ultrasound between radiologists and physiotherapists for patients with shoulder pain. Methods A prospective cohort study including an inter-rater reliability study. Patients presenting in primary care physiotherapy practice with shoulder pain are enrolled. At baseline validated questionnaires are used to measure patient characteristics, disease-specific characteristics and social factors. Physical examination is performed according to the expertise of the physiotherapists. Follow-up measurements will be performed 6, 12 and 26 weeks after inclusion. Primary outcome measure is perceived recovery, measured on a 7-point Likert scale. Logistic regression analysis will be used to evaluate the association between prognostic factors and recovery. Discussion The ShoCoDiP (Shoulder Complaints and using Diagnostic ultrasound in Physiotherapy practice) cohort study will provide information on current management of patients with shoulder pain in primary care, provide data to develop a prediction model for shoulder pain in primary care and to evaluate whether musculoskeletal ultrasound can improve prognosis.
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Affiliation(s)
- Yasmaine H J M Karel
- Faculty of Health, Research group Diagnostics, Avans University of Applied Sciences, PO Box 90,1164800, RA, Breda, The Netherlands.
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Contreras F, Brown HC, Marx RG. Predictors of success of corticosteroid injection for the management of rotator cuff disease. HSS J 2013; 9:2-5. [PMID: 24426836 PMCID: PMC3640713 DOI: 10.1007/s11420-012-9316-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 11/02/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of subacromial corticosteroid injection (CSI) to treat rotator cuff tendinopathy is controversial. We hypothesized that characteristics such as activity level, American Shoulder and Elbow Surgeons (ASES) score, duration of symptoms, and status of the rotator cuff may be prognostic factors for resolution of symptoms postinjection. METHODS During a 12-month period, consecutive patients with rotator cuff disease were analyzed. Patients received subacromial CSI, oral NSAIDs, and physical therapy. Baseline ASES score, simple shoulder test, an activity scale, and demographic data were recorded. Patients who remained symptomatic and were indicated for surgery were considered failures. Patients that did not undergo surgery were reassessed after a minimum of 1 year. RESULTS Forty-nine patients met our criteria. Follow-up was obtained for 81.6%. Sixteen cases (40%) failed conservative treatment at final follow-up (22.4 ± 11 months). CSI were successful in 76.2% of males and 45% of females (p = 0.04). Full-thickness tears were present in 8% of the patients with symptom resolution and 25% of those that failed conservative treatment (p = 0.29). No significant difference was found in age, hand dominance, duration of symptoms, or any of the scoring systems. CONCLUSION It is difficult to predict outcomes after CSI. Our treatment strategy showed a 40% failure rate.
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Affiliation(s)
- Fernando Contreras
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA , />Apartado 99-1000 San José, San José, Costa Rica
| | - Haydée C. Brown
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Robert G. Marx
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Steele L, Lade H, McKenzie S, Russell TG. Assessment and Diagnosis of Musculoskeletal Shoulder Disorders over the Internet. Int J Telemed Appl 2012; 2012:945745. [PMID: 23193395 PMCID: PMC3501948 DOI: 10.1155/2012/945745] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 09/22/2012] [Accepted: 09/25/2012] [Indexed: 11/29/2022] Open
Abstract
Shoulder disorders are common, debilitating, and represent a considerable burden on society. As primary contact practitioners, physiotherapists play a large role in the management and rehabilitation of people with these conditions. For those living outside of urban areas, however, access to physiotherapy can be limited. The aim of this study was to evaluate the validity and reliability of using a telerehabilitation system to collect physical examination findings and correctly identify disorders of the shoulder. Twenty-two participants with 28 shoulder disorders were recruited and underwent a face-to-face physical examination and a remote telerehabilitation examination. Examination findings and diagnoses from the two modes of assessment were used to determine validity and reliability of the new method. Diagnostic agreement and agreement on individual findings between the two methods were found to be consistent with the reliability of conventional assessment methods. This study provides important preliminary findings on the validity and reliability of musculoskeletal examinations conducted via telerehabilitation.
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Affiliation(s)
- Leah Steele
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia
| | - Hannah Lade
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia
| | - Stephanie McKenzie
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia
| | - Trevor G. Russell
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia
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Brody LT. Effective therapeutic exercise prescription: the right exercise at the right dose. J Hand Ther 2012; 25:220-31; quiz 232. [PMID: 22212491 DOI: 10.1016/j.jht.2011.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 09/20/2011] [Accepted: 09/27/2011] [Indexed: 02/03/2023]
Abstract
The prescription of an effective therapeutic exercise program requires the right dosage of the right exercise, at the right time for that patient. The therapist must understand and apply training principles effectively in the presence of pathology, injury, or otherwise unhealthy tissue. The intervention goal is to close the gap between current performance and the desired goal or capacity. Although there may be a preferred linear path from current performance to optimal outcome, complexities of the human body, internal factors, and external variables may create barriers to this direct path. Successful programs include key program design considerations such as ensuring a stable baseline before progression, treating the right impairments and activity limitations, understanding contextual factors, considering the principles of specificity and optimal loading, and applying dosing principles. Program progression can be achieved through increases in total exercise volume and/or through manipulation of exercise challenges at the same exercise volume. Effective application of these principles will guide patients toward their goals as quickly and efficiently as possible.
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Affiliation(s)
- Lori Thein Brody
- Senior Clinical Specialist, Spine and Sports Physical Therapy, UW Clinics Research Park, Madison, Wisconsin 53711, USA.
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Hegedus EJ, Zavala J, Kissenberth M, Cook C, Cassas K, Hawkins R, Tobola A. Positive outcomes with intra-articular glenohumeral injections are independent of accuracy. J Shoulder Elbow Surg 2010; 19:795-801. [PMID: 20655766 DOI: 10.1016/j.jse.2010.03.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 03/22/2010] [Accepted: 03/28/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder pain is a common, costly, and recalcitrant affliction. One treatment for shoulder pain is intra-articular injection of corticosteroid. Clinical opinion is that injection guided by palpation is accurate and effective, and there is some evidence to support a positive effect of injection on pain. However, great controversy exists as to the accuracy of injection by palpation, whether or not accuracy is important, and what the effect is of accuracy on pain. METHODS We used a blinded, longitudinal observational design of effectiveness in an effort to determine the accuracy of intra-articular injections and the effect of that accuracy on pain and functional outcomes in patients with various shoulder pathologies. RESULTS Injection accuracy data were captured on 103 patients. Of the 103 blinded injections, 54 received injections that were identified by fluoroscopy as "in" the capsule, whereas 49 were identified as "outside" the capsule; an accuracy rate of 52.4%. In the 4-week follow up, regardless of group assignment or accuracy of the injection, patients improved significantly (P < .01) from pre- to post-injection. Improvement was typically over by 2.5 points in the Numeric Pain Rating Scale (NPRS) categories, over 8 points on the Short-Form McGill Pain Questionnaire (SFMPQ), and over by 13 points on the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH). DISCUSSION Our accuracy rate was within the range reported in the literature. Improvements in all subjects with regard to pain and self-reported function occurred even in light of a wide variance in subject duration of symptoms, multiple injectors with varied training, a blinded approach to injection, and multiple injection approaches. CONCLUSIONS The accuracy of the injection does not appear to depend on the experience of the physician and may be irrelevant in treating shoulder pain of multiple origins.
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Affiliation(s)
- Eric J Hegedus
- Physical Therapy Division, Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC 27708, USA.
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Yeldan I, Cetin E, Ozdincler AR. The effectiveness of low-level laser therapy on shoulder function in subacromial impingement syndrome. Disabil Rehabil 2009; 31:935-40. [PMID: 19031167 DOI: 10.1080/09638280802377985] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the effectiveness of low-level laser therapy (LLLT) in addition to exercise programme on shoulder function in subacromial impingement syndrome (SAIS). METHOD Sixty-seven patients with SAIS were randomly assigned to either a group that received laser (n = 34) or a group that received placebo Laser (n = 26). Pain, functional assessment, disability and muscle strength of shoulder were assessed before and after a 3-week rehabilitation programme. Besides Laser or placebo Laser, superficial cold and progressive exercise programme were administered to both groups, 5 days a week, for 3 weeks. A progressive exercise programme that was done daily twice under supervision in clinic and at home was given to the patients. RESULTS After the treatment, all outcome measurements had shown significant improvement except muscle strength in both the groups. When the parameters of the improvement were compared, there were no significant differences between the two groups after treatment. CONCLUSION We concluded that there is no fundamental difference between LLLT and placebo LLLT when they are supplementing an exercise programme for rehabilitation of patients with shoulder impingement syndrome.
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Affiliation(s)
- Ipek Yeldan
- School of Physical Therapy and Rehabilitation, Istanbul University, 34390 Istanbul, Turkey.
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Adhesive capsulitis: establishing consensus on clinical identifiers for stage 1 using the DELPHI technique. Phys Ther 2009; 89:906-17. [PMID: 19589853 DOI: 10.2522/ptj.20080341] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Adhesive capsulitis often is difficult to diagnose in its early stage and to differentiate from other commonly seen shoulder disorders with the potential to cause pain and limited range of movement. OBJECTIVES The purpose of this study was to establish consensus among a group of experts regarding the clinical identifiers for the first or early stage of primary (idiopathic) adhesive capsulitis. DESIGN A correspondence-based Delphi technique was used in this study. METHODS Three sequential questionnaires, each building on the results of the previous round, were used to establish consensus. RESULTS A total of 70 experts from Australia and New Zealand involved in the diagnosis and treatment of adhesive capsulitis completed the 3 rounds of questionnaires. Following round 3, descriptive statistics were used to screen the data into a meaningful subset. Cronbach alpha and factor analysis then were used to determine agreement among the experts. Consensus was achieved on 8 clinical identifiers. These identifiers clustered into 2 discrete domains of pain and movement. For pain, the clinical identifiers were a strong component of night pain, pain with rapid or unguarded movement, discomfort lying on the affected shoulder, and pain easily aggravated by movement. For movement, the clinical identifiers included a global loss of active and passive range of movement, with pain at the end-range in all directions. Onset of the disorder was at greater than 35 years of age. CONCLUSIONS This is the first study to use the Delphi technique to establish clinical identifiers indicative of the early stage of primary (idiopathic) adhesive capsulitis. Although limited in differential diagnostic ability, these identifiers may assist the clinician in recognizing early-stage adhesive capsulitis and may inform management, as well as facilitate future research.
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The relationship of pain intensity, physical impairment, and pain-related fear to function in patients with shoulder pathology. J Orthop Sports Phys Ther 2009; 39:270-7. [PMID: 19346624 DOI: 10.2519/jospt.2009.2879] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES This study examined the baseline relationship of pain intensity, physical impairment, and pain-related fear to shoulder function. BACKGROUND There is no consensus regarding the influence psychological variable have on function and recovery in individuals with shoulder pathologies. While pain-related fear has been shown to predict disability for patients with low-back and cervical pain, this relationship has not been consistently reported for patients with shoulder pain. METHODS AND MEASURES One hundred forty-two subjects (78 male, 64 female; mean age, 41.4 years) with nonoperative unilateral shoulder disorders were identified from a clinical database of impairment and outcome measures.Demographic information, duration of symptoms, mechanism of injury, pain intensity, pain-related fear, and range-of-motion (ROM) measures were collected. Self-report of function was measured with the Shoulder Pain and Disability Index (SPADI). Hierarchical regression analysis determined the proportions of explained variance in function. RESULTS Demographic variables (duration of symptoms, sex, age, and mechanism of injury) collectively contributed approximately 9% (P=.003) of the variance in function scores. Average pain intensity and flexion ROM contributed an additional 22% (P<.001) of the variance, and Tampa Scale of Kinesiophobia (TSK-11) scores contributed an additional 3% (P<.001). In the final parsimonious model, presence of symptoms longer than 3 months (beta=.23, P=.003), pain intensity (beta=.25, P=.002), shoulder flexion ROM index (beta=-.35, P=.001), and kinesiophobia (beta=.17, P=.026) explained 33% of the variance in SPADI function score (P<.001). CONCLUSIONS Presence of symptoms longer than 3 months, average pain intensity, flexion ROM index (strongest contributor in multivariate model), and fear-of-pain scores all contributed to baseline shoulder function. The immediate clinical relevance of these findings is unclear but they do provide direction for prospective studies.
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Abstract
UNLABELLED There is a growing body of literature associating abnormal scapular positions and motions, and, to a lesser degree, clavicular kinematics with a variety of shoulder pathologies. The purpose of this manuscript is to (1) review the normal kinematics of the scapula and clavicle during arm elevation, (2) review the evidence for abnormal scapular and clavicular kinematics in glenohumeral joint pathologies, (3) review potential biomechanical implications and mechanisms of these kinematic alterations, and (4) relate these biomechanical factors to considerations in the patient management process for these disorders. There is evidence of scapular kinematic alterations associated with shoulder impingement, rotator cuff tendinopathy, rotator cuff tears, glenohumeral instability, adhesive capsulitis, and stiff shoulders. There is also evidence for altered muscle activation in these patient populations, particularly, reduced serratus anterior and increased upper trapezius activation. Scapular kinematic alterations similar to those found in patient populations have been identified in subjects with a short rest length of the pectoralis minor, tight soft-tissue structures in the posterior shoulder region, excessive thoracic kyphosis, or with flexed thoracic postures. This suggests that attention to these factors is warranted in the clinical evaluation and treatment of these patients. The available evidence in clinical trials supports the use of therapeutic exercise in rehabilitating these patients, while further gains in effectiveness should continue to be pursued. LEVEL OF EVIDENCE Level 5.
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Beneciuk JM, Bishop MD, George SZ. Clinical prediction rules for physical therapy interventions: a systematic review. Phys Ther 2009; 89:114-24. [PMID: 19095806 PMCID: PMC2636674 DOI: 10.2522/ptj.20080239] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Accepted: 10/30/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Clinical prediction rules (CPRs) involving physical therapy interventions have been published recently. The quality of the studies used to develop the CPRs was not previously considered, a fact that has potential implications for clinical applications and future research. The purpose of this systematic review was to determine the quality of published CPRs developed for physical therapy interventions. METHODS Relevant databases were searched up to June 2008. Studies were included in this review if the explicit purpose was to develop a CPR for conditions commonly treated by physical therapists. Validated CPRs were excluded from this review. Study quality was independently determined by 3 reviewers using standard 18-item criteria for assessing the methodological quality of prognostic studies. Percentage of agreement was calculated for each criterion, and the intraclass correlation coefficient (ICC) was determined for overall quality scores. RESULTS Ten studies met the inclusion criteria and were included in this review. Percentage of agreement for individual criteria ranged from 90% to 100%, and the ICC for the overall quality score was .73 (95% confidence interval=.27-.92). Criteria commonly not met were adequate description of inclusion or exclusion criteria, inclusion of an inception cohort, adequate follow-up, masked assessments, sufficient sample sizes, and assessments of potential psychosocial factors. Quality scores for individual studies ranged from 48.2% to 74.0%. DISCUSSION AND CONCLUSION Validation studies are rarely reported in the literature; therefore, CPRs derived from high-quality studies may have the best potential for use in clinical settings. Investigators planning future studies of physical therapy CPRs should consider including inception cohorts, using longer follow-up times, performing masked assessments, recruiting larger sample sizes, and incorporating psychological and psychosocial assessments.
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Affiliation(s)
- Jason M Beneciuk
- Department of Physical Therapy, University of Florida, Gainesville, FL 32610-0154, USA.
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Stuelcken MC, Ginn KA, Sinclair PJ. Shoulder strength and range of motion in elite female cricket fast bowlers with and without a history of shoulder pain. J Sci Med Sport 2008; 11:575-80. [PMID: 17889611 DOI: 10.1016/j.jsams.2007.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 05/30/2007] [Accepted: 06/07/2007] [Indexed: 10/22/2022]
Abstract
This study aimed to determine the prevalence of shoulder pain in female cricket fast bowlers and compare the shoulder rotation range of motion and strength of those bowlers with and without a history of shoulder pain. The active range of motion and isokinetic strength of the shoulder internal and external rotators was assessed in the bowling and non-bowling shoulders of 26 elite Australian female fast bowlers. Twelve bowlers had a history of shoulder pain. There were significant bilateral differences in external rotation range of motion for those bowlers without a history of shoulder pain (p<0.05), and in internal rotation range of motion for both the total cohort and those bowlers with a history of shoulder pain (p<0.05). There were no bilateral differences in average torques or average torque ratios, nor were there any differences in rotation range of motion, torques or torque ratios in the bowling shoulder between bowlers with and without a history of shoulder pain. There was an association between concentric internal rotation torque for the bowling shoulder and years of fast bowling (r(s)=0.45). Given the relatively small number of elite female cricketers, future research in this field will need to recruit fast bowlers from other cricket playing nations to increase the power of studies and provide more confidence in the statistical outcomes.
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Affiliation(s)
- Max C Stuelcken
- Discipline of Exercise and Sports Science, University of Sydney, NSW, Australia.
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Requejo P, Mulroy S, Haubert LL, Newsam C, Gronley J, Perry J. Evidence-Based Strategies to Preserve Shoulder Function in Manual Wheelchair Users with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2008. [DOI: 10.1310/sci1304-86] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Nawoczenski DA, Ritter-Soronen JM, Wilson CM, Howe BA, Ludewig PM. Clinical trial of exercise for shoulder pain in chronic spinal injury. Phys Ther 2006; 86:1604-18. [PMID: 17138842 DOI: 10.2522/ptj.20060001] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE The high prevalence of shoulder pain in wheelchair users may be related to the repetitive use of the upper limbs during self-care and wheelchair-related activities. The purpose of this study was to determine the effects of a controlled 8-week, scapula-focused exercise intervention on pain and functional disability in people with spinal cord injury (SCI) and shoulder impingement symptoms. SUBJECTS Forty-one manual wheelchair users (with SCI and spina bifida), both with (n=21) and without (n=20) shoulder impingement symptoms, participated. METHODS The study design was a clinical trial with an asymptomatic control group. Subjects completed the Wheelchair User's Shoulder Pain Index (WUSPI) and the Shoulder Rating Questionnaire (SRQ) and provided patient satisfaction scores at initial and 8-week visits. Subjects in the intervention group were instructed in a home exercise program consisting of stretching and strengthening exercises. Subjects in the asymptomatic control group received no intervention. An analysis of variance model was used to test for group and time effects for the WUSPI, SRQ, and satisfaction scores. RESULTS Subjects in the intervention group showed significant improvements in all measures as a result of the intervention, whereas asymptomatic control group subjects remained stable. DISCUSSION AND CONCLUSION A selective 8-week home exercise program is effective in reducing pain and improving function and satisfaction in this population of wheelchair users.
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Affiliation(s)
- Deborah A Nawoczenski
- Department of Physical Therapy, Ithaca College-Rochester Campus, 1100 S Goodman St, Rochester, NY 14620, USA.
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Millar AL, Lasheway PA, Eaton W, Christensen F. A retrospective, descriptive study of shoulder outcomes in outpatient physical therapy. J Orthop Sports Phys Ther 2006; 36:403-14. [PMID: 16776489 DOI: 10.2519/jospt.2006.2101] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A retrospective, descriptive study of clients with shoulder dysfunction referred to physical therapy. OBJECTIVES To (1) describe the clinical and functional outcomes of clients with shoulder dysfunction following outpatient physical therapy, and (2) to compare the outcomes by type of shoulder dysfunction. BACKGROUND Although individuals with shoulder dysfunction are commonly referred to physical therapy few large descriptive studies regarding outcomes following physical therapy are available. METHODS AND MEASURES Data for 878 clients (468 female, 410 male) were retrieved and analyzed. This database was developed between 1997 and 2000 and included 4 outpatient facilities from 1 healthcare system in the southwest corner of Michigan. Clients were classified by type of shoulder dysfunction, and standardized tests were performed upon admittance and discharge to physical therapy. Descriptive and inferential statistics were calculated for all data. RESULTS Of all clients, 55.1% had shoulder impingement, while 18.3% had postoperative repair, 8.9% had a frozen shoulder, 7.6% had a rotator cuff tear, 3.0% had shoulder instability, 2.1% were post fracture, and the remaining 4.9% had miscellaneous diagnoses. The average (+/-SD) age of the patients was 53.6 +/- 16.4 years, with an average (+/-SD) number of treatment sessions of 13.7 +/- 11.0. All groups showed significant changes following physical therapy intervention. CONCLUSIONS Clients with diverse types of shoulder dysfunction demonstrated improvement in both clinical and functional measures at the conclusion of physical therapy, although it is not possible to determine whether these changes were due to the interventions or due to time. The type of shoulder dysfunction appears to affect the prognosis, thus expected outcomes should be based upon initial diagnosis and specific measures.
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Affiliation(s)
- A Lynn Millar
- Department of Physical Therapy, Andrews University, Berrien Springs, Ml 49104, USA.
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Ginn KA, Cohen ML, Herbert RD. Does hand-behind-back range of motion accurately reflect shoulder internal rotation? J Shoulder Elbow Surg 2006; 15:311-4. [PMID: 16679230 DOI: 10.1016/j.jse.2005.08.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 08/16/2005] [Indexed: 02/01/2023]
Abstract
Shoulder internal rotation (IR) is commonly assessed by an indirect method where the hand is placed behind the back and the distance reached by the tip of the extended thumb is recorded. The aim of this study was to assess the validity of measuring active IR range of motion (ROM) by use of the indirect hand-behind-back (HBB) ROM method in subjects with shoulder pain of mechanical origin. We recruited 137 subjects with unilateral shoulder pain. HBB ROM was determined by measuring the distance between the T1 spinous process and the radial styloid process. Active shoulder IR was measured in the supine position in 45 degrees or 90 degrees abduction. Correlation coefficients adjusted for measurement error were calculated. HBB ROM demonstrated only a low to moderate correlation with active shoulder IR. Active HBB ROM is not an accurate method of measuring active shoulder IR in patients with shoulder pain.
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Affiliation(s)
- Karen A Ginn
- Faculty of Health Sciences, University of Sydney, Sydney, Australia.
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Turk DC, Burwinkle TM. Assessment of chronic pain in rehabilitation: Outcomes measures in clinical trials and clinical practice. Rehabil Psychol 2005. [DOI: 10.1037/0090-5550.50.1.56] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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