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Chang TT, Yang QH, Chen PJ, Wang XQ. Epidemiology of Musculoskeletal Injuries in the Navy: A Systematic Review. Int J Public Health 2022; 67:1605435. [PMID: 36531604 PMCID: PMC9751041 DOI: 10.3389/ijph.2022.1605435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives: This study aimed to critically review the results of recent studies that investigated the epidemiology of noncombat-related musculoskeletal injuries (MSIs) in the Navy. Methods: A systematic search was conducted of three major databases (Pubmed, Embase, and Cochrane) to identify epidemiological studies on MSIs in the Navy. Study selection and risk of bias assessment were conducted. Results: The overall prevalence of MSIs ranged from 12.69% to 48.81%. And the prevalence of head and face injuries, upper extremity injuries, spine injuries, chest injuries, and lower extremity injuries were 0.11%-0.66%, 0.53%-11.47%, 0.75%-12.09%, 0.43%-0.95%, and 0.4%-21.17%, respectively. For the specific MSIs, the incidence ranged from 0.03/1000 person-years to 32.3/1000 person-years in the Navy and Marines. The ankle-foot, lumbopelvic, knee and lower leg, and shoulder were identified as the most frequent location for MSIs. Conclusion: This systematic review summarized that the Navy population had a high prevalence of MSIs. And different risk factors for MSIs varied from different anatomic locations. This systematic review also provided valuable information on MSIs for sports medicine specialists.
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Affiliation(s)
- Tian-Tian Chang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Qi-Hao Yang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Pei-Jie Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China,*Correspondence: Pei-Jie Chen, ; Xue-Qiang Wang,
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China,Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China,Shanghai Key Lab of Human Performance, Shanghai University of Sport, Shanghai, China,*Correspondence: Pei-Jie Chen, ; Xue-Qiang Wang,
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Powell JK, Schram B, Lewis J, Hing W. "You have (rotator cuff related) shoulder pain, and to treat it, I recommend exercise." A scoping review of the possible mechanisms underpinning exercise therapy. Musculoskelet Sci Pract 2022; 62:102646. [PMID: 35964499 DOI: 10.1016/j.msksp.2022.102646] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Exercise is considered to be both essential and at the forefront of the management of rotator cuff-related shoulder pain (RCRSP). Despite this, many fail to substantially improve with exercise-based treatment. Hence, expanding the current knowledge about the possible mechanisms of exercise for RCRSP is critical. OBJECTIVE To synthesise the range of mechanisms proposed for exercise in people with RCRSP. DESIGN Scoping review METHODS: A systematic search of the Physiotherapy Evidence Database (PEDro) was conducted from inception to July 3, 2022. Two reviewers conducted the search and screening process and one reviewer extracted the data from each study. Randomised clinical trials using exercise for the management of RCRSP of any duration were included. The PEDro search terms used were "fitness training", "strength training", "stretching, mobilisation, manipulation, massage", "upper arm, shoulder, or shoulder girdle", "pain", and "musculoskeletal". Data were analysed using quantitative and qualitative approaches. RESULTS 626 studies were identified and 110 were included in the review. Thirty-two unique mechanisms of exercise were suggested by clinical trialists, from which 4 themes emerged: 1) neuromuscular 2) tissue factors 3) neuro-endocrine-immune 4) psychological. Neuromuscular mechanisms were proposed most often (n = 156, 77%). Overall, biomedical mechanisms of exercise were proposed in 95% of cases. CONCLUSIONS The causal explanation for the beneficial effect of exercise for RCRSP in clinical research is dominated by biomedical mechanisms, despite a lack of supporting evidence. Future research should consider testing the mechanisms identified in this review using mediation analysis to progress knowledge on how exercise might work for RCRSP.
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Affiliation(s)
- Jared K Powell
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia.
| | - Ben Schram
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
| | - Jeremy Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom; Clinical Therapies, University of Limerick, Ireland
| | - Wayne Hing
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia
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Scanaliato JP, Sandler AB, Baird MD, Dunn JC, Uhlinger J, Parnes N. Glenoid microfracture in active-duty military patients: minimum 5-year follow-up demonstrates 75% survival. JSES Int 2022; 7:86-92. [PMID: 36820416 PMCID: PMC9937841 DOI: 10.1016/j.jseint.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background To present midterm patient-reported outcomes and survivorship data of active-duty military patients undergoing microfracture for full-thickness cartilage defects of the glenoid. Methods All consecutive patients from January 2013 through December 2016 who underwent glenoid microfracture for full-thickness cartilage injuries with complete outcome scores were identified. Twenty patients met the final inclusion criteria for the study, and all were active-duty military at the time of surgery. A separate subgroup analysis was performed to determine if dominant-shoulder involvement portends worse outcomes. Results The mean follow-up was 81.45 ± 19.43 months (range, 60-108). Of the 20 patients, 5 required a secondary surgical procedure within 5 years of their index procedure, with an average time to failure of 45.6 ± 13.15 months. For the 15 patients who did not fail, there was a statistically significant increase in the mean American Shoulder and Elbow Surgeons score (57.20 vs. 88.27, P < .0001) and Single Assessment Numeric Evaluation (45.00 vs. 86.33, P < .0001). Mean pain decreased significantly as measured by the pain visual analog scale (5.40 vs. 1.37, P < .0001). Range of motion in forward elevation, external rotation, and internal rotation did not change significantly postoperatively (P = .4528, .4810, and .1919, respectively). Concomitant procedures did not predict changes in pain, American Shoulder and Elbow Surgeons, or Single Assessment Numeric Evaluation scores. A majority of patients (13/20, 65%) were able to remain on unrestricted military active-duty service, but 7 (35%) underwent medical discharge, including the 5 patients who had experienced treatment failure, plus 2 additional patients. Conclusion Glenoid microfracture can result in pain relief and symptomatic improvement for a select group of active-duty military patients, with 75% survivorship at 5 years. Approximately one in three (35%) patients, however, were unable to remain on active-duty military service.
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Affiliation(s)
- John P. Scanaliato
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, TX, USA
- Corresponding author: John P Scanaliato, MD, William Beaumont Army Medical Center, Department of Orthopaedic Surgery, 18511 Highlander Medics Street, Fort Bliss, TX 79918, USA.
| | - Alexis B. Sandler
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, TX, USA
| | - Michael D. Baird
- Walter Reed National Military Medical Center, Department of Orthopaedic Surgery, Bethesda, MD, USA
| | - John C. Dunn
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, TX, USA
| | - Jason Uhlinger
- Carthage Area Hospital, Department of Orthopaedic Surgery, Carthage, NY, USA
| | - Nata Parnes
- Carthage Area Hospital, Department of Orthopaedic Surgery, Carthage, NY, USA
- Claxton-Hepburn Medical Center, Department of Orthopaedic Surgery, Ogdensburg, NY, USA
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Scanaliato JP, Eckhoff MD, Dunn JC, Czajkowski H, Fink WA, Parnes N. Long-term Results of Arthroscopic Repair of Full-Thickness Traumatic Rotator Cuff Tears in Active Duty Military Patients Under the Age of 40 Years. Am J Sports Med 2022; 50:2753-2760. [PMID: 35862618 DOI: 10.1177/03635465221107371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic rotator cuff repair is an effective procedure through which to decrease pain and increase strength, with favorable long-term outcomes demonstrated in older patient populations with full-thickness rotator cuff tears. The long-term outcomes after this procedure in younger, higher-demand patients, however, is not as clearly defined. PURPOSE To report on the long-term outcomes after arthroscopic rotator cuff repair of traumatic full-thickness rotator cuff tears in active duty military patients under the age of 40 years at the time of surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS Preoperative, midterm, and final evaluations were collected, including scores on the visual analog scale for pain, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons shoulder form. A total of 42 patients were screened for inclusion: 3 underwent additional surgical procedures on the operative shoulder and 2 were lost to follow-up, leaving 37 patients with mean follow-up of 104.51 months available for analysis. A subgroup analysis was performed comparing outcomes between patients with Southern California Orthopaedic Institute grade 1 or 2 tears and those with grade 3 or 4 tears. RESULTS At final follow-up, pain per the visual analog scale decreased to 1.16 from 8.03 (P < .0001); the Single Assessment Numeric Evaluation score increased to 87.32 from 48.24 (P < .0001); and the American Shoulder and Elbow Surgeons score increased to 88.68 from 41.00 (P < .0001). There was no statistically significant difference in outcome scores or range of motion between midterm and final follow-up. Improvement in outcome scores and range of motion at final follow-up did not vary between patients with small and large tears. Of 42 patients, 37 (88.1%) were able to return to full unrestricted active duty and sporting activity, while 5 (11.9%) were medically separated from the military. CONCLUSION Active duty military patients under the age of 40 years with traumatic full-thickness rotator cuff tears had statistically and clinically significant increases in outcome scores and decreases in pain after arthroscopic rotator cuff repair at long-term follow-up.
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Affiliation(s)
| | | | - John C Dunn
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | | | - Walter A Fink
- Carson Tahoe Health Administration, Carson City, Nevada, USA
| | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA.,Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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Hsu TH, Lin CL, Wu CW, Chen YW, Vitoonpong T, Lin LC, Huang SW. Accuracy of Critical Shoulder Angle and Acromial Index for Predicting Supraspinatus Tendinopathy. Diagnostics (Basel) 2022; 12:diagnostics12020283. [PMID: 35204373 PMCID: PMC8871498 DOI: 10.3390/diagnostics12020283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Critical shoulder angle (CSA) is the angle between the superior and inferior bony margins of the glenoid and the most lateral border of the acromion. The acromial index (AI) is the distance from the glenoid plane to the acromial lateral border and is divided by the distance from the glenoid plane to the lateral aspect of the humeral head. Although both are used for predicting shoulder diseases, research on their accuracy in predicting supraspinatus tendinopathy in patients with shoulder pain is limited. Data were retrospectively collected from 308 patients with supraspinatus tendinopathy between January 2018 and December 2019. Simultaneously, we gathered the data of 300 patients with shoulder pain without supraspinatus tendinopathy, confirmed through ultrasound examination. Baseline demographic data, CSA, and AI were compared using the independent Student’s t test and Mann–Whitney U test. Categorical variables were analyzed using the chi-square test. A receiver operating characteristic curve (ROC) analysis was performed to investigate the accuracy of CSA and AI for predicting supraspinatus tendinopathy, and the optimal cut-off point was determined using the Youden index. No statistical differences were observed for age, sex, body mass index, evaluated side (dominant), diabetes mellitus, and hyperlipidemia between the groups. The supraspinatus tendinopathy group showed higher CSAs (p < 0.001) than did the non-supraspinatus tendinopathy group. For predicting supraspinatus tendinopathy, the area under the curve (AUC) of ROC curve of the CSA was 76.8%, revealing acceptable discrimination. The AUC of AI was 46.9%, revealing no discrimination. Moreover, when patients with shoulder pain had a CSA > 38.11°, the specificity and sensitivity of CSA in predicting supraspinatus tendinopathy were 71.0% and 71.8%, respectively. CSA could be considered an objective assessment tool to predict supraspinatus tendinopathy in patients with shoulder pain. AI revealed no discrimination in predicting supraspinatus tendinopathy in patients with shoulder pain.
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Affiliation(s)
- Tzu-Herng Hsu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (T.-H.H.); (C.-W.W.); (Y.-W.C.); (L.-C.L.)
| | - Che-Li Lin
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan;
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chin-Wen Wu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (T.-H.H.); (C.-W.W.); (Y.-W.C.); (L.-C.L.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Yi-Wen Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (T.-H.H.); (C.-W.W.); (Y.-W.C.); (L.-C.L.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Timporn Vitoonpong
- Rehabilitation Department, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand;
| | - Lien-Chieh Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (T.-H.H.); (C.-W.W.); (Y.-W.C.); (L.-C.L.)
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (T.-H.H.); (C.-W.W.); (Y.-W.C.); (L.-C.L.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Correspondence: ; Tel.: +886-222-490-088 (ext. 1602)
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Korkmaz N, Yardımcı G, Yılmaz B. Temporo-spatial parameters, shoulder kinematics and acute tendon changes in four different stroke patterns in men wheelchair users with spinal cord injury. PM R 2021; 14:939-948. [PMID: 34741794 DOI: 10.1002/pmrj.12733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Manual wheelchair propulsion causes the shoulder tendon pathologies in wheelchair users with spinal cord injury due to its repetitive nature. Four different wheelchair stroke patterns can cause varying amounts of acute changes in the shoulder tendons. OBJECTIVE To evaluate and compare acute changes in the supraspinatus and biceps tendons and acromio-humeral distance (AHD) after propulsion between different stroke patterns in individuals with spinal cord injury. Additionally, to associate tendon changes with demographic and biomechanical characteristics. DESIGN Prospective and comparative study between four groups. SETTING Tertiary rehabilitation hospital. PATIENTS Men wheelchair users with spinal cord injury. INTERVENTIONS Participants were divided into 4 groups according to stroke pattern (arcing, semicirculer (SC), single-loop (SL) and double-loop (DL)), in which they used their wheelchair on a motorized treadmill at a speed of 1 m/s. A sample of 40 people was created, 10 in each group. All participants performed a propulsion test. MAIN OUTCOME MEASURES Temporo-spatial variables and shoulder kinematics were analyzed. Supraspinatus tendon thickness (SSTT), long head of biceps tendon thickness (LHBTT) and AHD were measured before and after the propulsion test. RESULTS SC pattern had lower cadance and larger contact angle. A reduction in SSTT and LHBTT in arcing pattern, LHBTT and AHD in SC pattern and, LHBTT in DL pattern was observed (all P < 0.05). However, SL pattern did not differ significantly in all ultrasonographic measurements (all P > 0.05). Body mass index was associated with a decrease in SSTT. Age and number of daily push-up were associated with a decrease in AHD. CONCLUSIONS Less tendon changes after the propulsion in the SL pattern suggested that the supraspinatus and biceps tendons were preserved in this pattern. The SL pattern may be a better choice for men wheelchair users with supraspinatus and biceps tendon pathologies. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Nurdan Korkmaz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Gokhan Yardımcı
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Bilge Yılmaz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
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Barbeau P, Michaud A, Hamel C, Rice D, Skidmore B, Hutton B, Garritty C, da Silva DF, Semeniuk K, Adamo KB. Musculoskeletal Injuries Among Females in the Military: A Scoping Review. Mil Med 2021; 186:e903-e931. [PMID: 33367692 DOI: 10.1093/milmed/usaa555] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/04/2020] [Accepted: 12/10/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Musculoskeletal injuries (MSKi) are a common challenge for those in military careers. Compared to their male peers, reports indicate that female military members and recruits are at greater risk of suffering MSKi during training and deployment. The objectives of this study were to identify the types and causes of MSKi among female military personnel and to explore the various risk factors associated with MSKi. MATERIALS AND METHODS A scoping review was conducted over a 4-month time frame of English language, peer-reviewed studies published from 1946 to 2019. Search strategies for major biomedical databases (e.g., MEDLINE; Embase Classic + Embase; and the following EBM Reviews-Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and the NHS Economic Evaluation Database) were developed by a senior medical information specialist and included 2,891 titles/abstracts. Study selection and data collection were designed according to the Population, Concept, and Context framework. Studies were included if the study population provided stratified data for females in a military context. RESULTS From a total of 2,287 citations captured from the literature searches, 168 peer-reviewed publications (144 unique studies) were eligible for inclusion. Studies were identified from across 10 countries and published between 1977 and 2019. Study designs were primarily prospective and retrospective cohorts. Most studies assessed both prevalence/incidence and risk factors for MSKi (62.50%), with few studies assessing cause (13.69%). For MSKi of female recruits compared to active female members, the prevalence was higher (19.7%-58.3% vs. 5.5%-56.6%), but the incidence (0.02%-57.7% vs. 13.5%-71.9%) was lower. The incidence of stress fractures was found to be much higher in female recruits than in active members (1.6%-23.9% vs. 2.7%). For anthropometric risk factors, increased body fat was a predictor of MSKi, but not stress fractures. For physiological risk factors for both female military groups, being less physically fit, later menarche, and having no/irregular menses were predictors of MSKi and stress fractures. For biomechanical risk factors, among female recruits, longer tibial length and femoral neck diameter increased the risk of stress fractures, and low foot arch increased risk of an ankle sprain. For female active military members, differences in shoulder rotation and bone strength were associated with risk of MSKi. For biological sex, being female compared to male was associated with an increased risk of MSKi, stress fractures, and general injuries. The consequences of experiencing MSKi for active military included limited duties, time off, and discharge. For recruits, these included missed training days, limited duty days, and release. CONCLUSIONS This scoping review provides insight into the current state of the evidence regarding the types and causes of MSKi, as well as the factors that influence MSKi among females in the military. Future research endeavors should focus on randomized controlled trials examining training paradigms to see if women are more susceptible. The data presented in the scoping review could potentially be used to develop training strategies to mitigate some of the identified barriers that negatively impact women from pursuing careers in the military.
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Affiliation(s)
- Pauline Barbeau
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Alan Michaud
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Candyce Hamel
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Danielle Rice
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Becky Skidmore
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Chantelle Garritty
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
| | - Danilo F da Silva
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kevin Semeniuk
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Gun BK, Frank RM, Gratton RW, Bader JO, Kusnezov N, Orr JD, Waterman BR. Non-modifiable Risk Factors Associated with Avascular Necrosis in the US Military. Mil Med 2021; 185:e178-e182. [PMID: 31184698 DOI: 10.1093/milmed/usz128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/04/2019] [Accepted: 05/15/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Often referred to as aseptic or osteonecrosis, avascular necrosis (AVN) typically affects people between 30 and 50 years of age. Given the substantial morbidity associated with AVN as well as overlapping age groups of both the military and average age at diagnosis for AVN, the military represents an ideal cohort for a large database study to elicit the incidence and epidemiology of AVN. The purpose of this study was to identify demographic risk factors in the United States military. MATERIALS AND METHODS First-time occurrences for ICD-9-CM codes for all types of AVN (head of humerus, head and neck of femur, medial femoral condyle, talus, and other bone) between 2004 and 2014 were queried in the Defense Medical Epidemiology Database. Multivariate data analysis was performed to obtain adjusted rate (adjusted for age, sex, race, rank, and branch of service). RESULTS Between 2005 and 2014, 2,671 cases of AVN occurred among an at-risk population of 13,820,906 servicemembers for an unadjusted IR of 0.19 per 1,000 person-years. The most common location was located at the proximal femur, responsible for 41.7% of all cases. With an adjusted rate ratio of 18.7, the over 40 age-group accounted for 53.3% of cases. Servicemembers of black race, Senior rank, and the Army branch of service were more at risk for AVN. CONCLUSIONS The overall incidence of AVN was 0.19 per 1,000 person-years. Whilte increasing age had the greatest influence on the development of symptomatic AVN, other statistically significant risk factors were found to be increasing age, black race, senior enlisted rank, and Army branch of service.
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Affiliation(s)
- Baris K Gun
- III Corps HHBn, US Army, 1001 West 761st Tank Battalion Avenue, Fort Hood, TX 76544
| | - Rachel M Frank
- University of Colorado Sports Medicine, 2000 S. Colorado Blvd, Denver, CO 80222
| | - Ryan W Gratton
- University of Texas Health Sciences at Houston, 1133 John Freeman Blvd, Houston, TX 77030
| | - Julia O Bader
- William Beaumont Army Medical Center, 5005 N Piedras St, El Paso, TX 79920
| | - Nicholas Kusnezov
- William Beaumont Army Medical Center, 5005 N Piedras St, El Paso, TX 79920
| | - Justin D Orr
- William Beaumont Army Medical Center, 5005 N Piedras St, El Paso, TX 79920
| | - Brian R Waterman
- Wake Forest Baptist Medical Center, 1 Medical Center Vlvd, Winston-Salem, NC 27157
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Bokshan SL, Kotchman HM, Li LT, DeFroda SF, Cameron KL, Owens BD. Incidence of Posterior Shoulder Instability in the United States Military: Demographic Considerations From a High-Risk Population. Am J Sports Med 2021; 49:340-345. [PMID: 33264052 DOI: 10.1177/0363546520976143] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Relatively little is known about the true incidence of posterior shoulder instability in the United States. PURPOSE/HYPOTHESIS The purpose of this study was to characterize the incidence of posterior shoulder instability in the US military population and to examine which characteristics place these patients at highest risk. We hypothesized that the rate of posterior instability in this cohort of patients would be higher than previously reported. STUDY DESIGN Descriptive epidemiology study. METHODS All initial cases of posterior shoulder dislocation and subluxation in the Defense Medical Epidemiology Database were screened between 2016 and 2018 using the relevant International Classification of Diseases-Tenth Revision-Clinical Modification codes. Incidences were calculated, and multivariate Poisson regression was used to calculate adjusted rate ratios for the effects of sex, race, age, military service branch, rank, and year. RESULTS The overall unadjusted incidence was 0.032 per 1000 person-years for posterior dislocations, 0.064 per 1000 person-years for posterior subluxations, and 0.096 per 1000 person-years for all cases of posterior shoulder instability. The total incidence of all shoulder instability was 1.84 per 1000 person-years, with posterior shoulder instability accounting for 5.2% of total cases. For posterior subluxation, significant differences between groups were found in the unadjusted and adjusted rate ratio (ARR) for sex (ARR, 3.31; 95% CI, 1.85-5.93 for men), race (ARR, 0.458; 95% CI, 0.294-0.714 for Black servicemembers and ARR, 0.632; 95% CI, 0.421-0.948 for servicemembers of other race), age (ARR, 3.69; 95% CI, 1.56-8.70 for patients aged 30-34 years), and military service branch (ARR, 0.663; 95% CI, 0.460-0.955 for Air Force servicemembers). For posterior shoulder dislocations, a significant difference was found only between men and women (ARR, 4.55; 95% CI, 1.85-11.2 for men). CONCLUSION The incidence of posterior shoulder instability among US military personnel is higher than previously reported in the general US population, with a majority of cases due to subluxation. This increased incidence is likely reflective of a young and highly active population along with improvements in awareness and diagnosis of posterior instability in recent years.
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Affiliation(s)
- Steven L Bokshan
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Halle M Kotchman
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lambert T Li
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Steven F DeFroda
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, New York, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
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Vidt ME, Potochny J, Dodge D, Green M, Sturgeon K, Kass R, Schmitz KH. The influence of mastectomy and reconstruction on residual upper limb function in breast cancer survivors. Breast Cancer Res Treat 2020; 182:531-541. [PMID: 32506338 DOI: 10.1007/s10549-020-05717-z] [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: 12/17/2019] [Accepted: 06/01/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Breast cancer survivorship is common (90% of women survive 5 or more years), but many women are not able to return to full function and well-being after treatment due to functional limitations, persistent pain, and inability to perform daily activities. Since each surgical reconstructive option (e.g., autologous tissue flaps versus implants) can impact shoulder and arm function differently, it is important to understand how shoulder and upper limb strength, mobility, and function are influenced by the type of surgical intervention. Efforts can then focus on prehabiliation strategies to prevent the onset of limitations and on developing rehabilitation protocols that directly target shortcomings. METHODS The current paper presents a review summarizing how shoulder and upper limb function may be affected by surgical mastectomy and breast reconstruction. RESULTS Mastectomy and breast reconstruction with implants or autologous tissues present different functional outcomes for patients. Each surgical procedure is associated with unique sequelae derived from the tissues and procedures associated with each surgery. Characterizing the specific functional outcomes associated with each surgical approach will promote the development of targeted rehabilitation strategies that can be implemented into a multidisciplinary treatment planning pathway for breast cancer patients. CONCLUSIONS Surgical treatments for breast cancer, including mastectomy and breast reconstruction, can have negative effects. Focused efforts are needed to better understand treatment-specific effects so that targeted rehabilitation can be developed to improve patient function, QoL, and ability to return to work and life activities post-breast cancer.
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Affiliation(s)
- Meghan E Vidt
- Department of Biomedical Engineering, Pennsylvania State University, 331 Chemical and Biomedical Engineering Building, University Park, PA, 16802, USA. .,Department of Physical Medicine and Rehabilitation, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.
| | - John Potochny
- Department of Plastic Surgery, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Daleela Dodge
- Department of Surgery, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Humanities, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Michael Green
- Department of Humanities, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Medicine, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Kathleen Sturgeon
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Rena Kass
- Department of Surgery, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Medicine, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
| | - Kathryn H Schmitz
- Department of Physical Medicine and Rehabilitation, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA.,Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA, 17033, USA
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11
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Andres J, Painter PJ, McIlvain G, Timmons MK. The Effect of Repeated Shoulder Motion on Scapular Dyskinesis in Army ROTC Cadets. Mil Med 2020; 185:e811-e817. [PMID: 31783408 DOI: 10.1093/milmed/usz408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Altered or abnormal scapular motion has been associated with increased shoulder pain and dysfunction. Fatigue of the scapular stabilizing muscles resulting from repeated arm motion has been reported to alter scapular kinematics, which could result in the clinical assessment of scapular dyskinesis. The purpose of this study was to characterize the effect of repeated arm motion on the development of scapular dyskinesis. The hypothesis was that repeated arm motion will induce a subtle or obvious scapular dyskinesis. MATERIALS AND METHODS About 30 army Reserve Officer Training Corps (ROTC) cadets participated in the research study. The cadets level of shoulder function was determined using the Quick Disabilities of the Arm Shoulder and Hand and Pennsylvania Shoulder Score shoulder scores. Cadets performed an exercise protocol of 30 repetitions of weighted shoulder motion in the frontal plane. Shoulder and scapular musculature strength measurements were recorded prior to and immediately following the exercise protocol using hand-held dynamometry. The scapular dyskinesis test was performed prior to the exercise protocol and during the last five repetitions of the exercise protocol. RESULTS Prior to the exercise, protocol 3/30 were categorized with scapular dyskinesis on the left side and 3/30 were categorized with scapular dyskinesis on their right side. Following the exercise, protocol 8/30 were categorized with left-side scapular dyskinesis (χ2 = 9.167, P = 0.002) and 6/30 with right-side dyskinesis (χ2 = 4.537, P = 0.033). Shoulder strength decreased following the exercise protocol for all participants. The participants that developed scapular dyskinesis were weaker than those with normal scapular motion. However, the difference did not reach statistical significance. Participants graded with obvious scapular dyskinesis following the exercise protocol reported higher Quick Disabilities of the Arm Shoulder and Hand scores (P = 0.04) and lower scores on the Pennsylvania Shoulder Score (P = 0.005). CONCLUSIONS Repeated shoulder motion increased the frequency of scapular dyskinesis in army ROTC cadets. The cadets that developed scapular dyskinesis also reported greater disability and lower function of the upper extremity. The results provide a link between scapular dyskinesis, upper extremity function, and the strength of the scapular stabilizing muscles. Improving the strength of the scapular stabilizing musculature might reduce the effects of repeated arm motions.
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Affiliation(s)
- Jade Andres
- College of Health Professions, Marshall University, Marshall University, 1 John Marshall Drive, Huntington, WV 25755
| | - Paul J Painter
- Marshall University, 1 John Marshall Drive, Huntington, WV 25755
| | - Gary McIlvain
- College of Health Professions, Marshall University, Marshall University, 1 John Marshall Drive, Huntington, WV 25755
| | - Mark K Timmons
- School of Kinesiology, College of Health Professions, Marshall University, Gullickson Hall 109, 1 John Marshall Drive, Huntington, WV 25755
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12
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Eliasberg CD, Wada S, Carballo CB, Nakagawa Y, Nemirov DA, Bhandari R, Otero M, Deng XH, Rodeo SA. Identification of Inflammatory Mediators in Tendinopathy Using a Murine Subacromial Impingement Model. J Orthop Res 2019; 37:2575-2582. [PMID: 31378986 DOI: 10.1002/jor.24434] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/17/2019] [Indexed: 02/04/2023]
Abstract
Subacromial impingement is associated with a spectrum of disorders-including rotator cuff disease-but their relationship is complex. We have established a novel murine model of subacromial impingement to study supraspinatus tendinopathy. The purpose of this study was to evaluate changes in gene expression in this murine shoulder impingement model to further elucidate the mechanisms underlying the development of tendinopathy. Twenty-eight C57BL/6 mice were used in this study. All mice underwent bilateral surgery with insertion of a small metal clip in the subacromial space or a sham procedure. The supraspinatus tendons underwent histological analyses, biomechanical testing, and RNA extraction for multiplex gene expression analysis (NanoString, Seattle, WA). Histology demonstrated increased cellularity and disorganized collagen fibers of the supraspinatus tendon in the clip impingement group. Mean load to failure (5.20 vs. 1.50 N, p < 0.001) and mean stiffness (4.95 vs. 1.47 N/mm, p < 0.001) were lower in the impingement group than the sham group. NanoString analyses revealed 111 differentially expressed genes (DEGs) between the impingement and sham groups. DEGs of interest included Mmp3 (expression ratio [ER]: 2.68, p = 0.002), Tgfb1 (ER: 1.76, p = 0.01), Col3a1 (ER: 1.66, p = 0.03), and Tgfbr2 (ER: 1.53, p = 0.01). Statement of clinical significance: We identified 111 DEGs that may contribute to the development of tendinopathy in this model. Further studies of these specific genes will allow identification of their roles in the initiation and regulation of tendon damage, and their potential to serve as novel therapeutic targets in the treatment of rotator cuff disease. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2575-2582, 2019.
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Affiliation(s)
- Claire D Eliasberg
- Department of Orthopaedic Surgery, Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York, 10021
| | - Susumu Wada
- Department of Orthopaedic Surgery, Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York, 10021
| | - Camila B Carballo
- Department of Orthopaedic Surgery, Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York, 10021
| | - Yusuke Nakagawa
- Department of Orthopaedic Surgery, Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York, 10021
| | - Daniel A Nemirov
- Department of Orthopaedic Surgery, Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York, 10021
| | - Reyna Bhandari
- Department of Orthopaedic Surgery, Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York, 10021
| | - Miguel Otero
- Department of Orthopaedic Surgery, Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York, 10021
| | - Xiang-Hua Deng
- Department of Orthopaedic Surgery, Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York, 10021
| | - Scott A Rodeo
- Department of Orthopaedic Surgery, Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York, 10021
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13
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Djade CD, Porgo TV, Zomahoun HTV, Perrault-Sullivan G, Dionne CE. Incidence of shoulder pain in 40 years old and over and associated factors: A systematic review. Eur J Pain 2019; 24:39-50. [PMID: 31514243 DOI: 10.1002/ejp.1482] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/06/2019] [Accepted: 09/03/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Shoulder pain is one of the most frequent musculoskeletal complaints, and its prevalence and consequences increase with age. However, little is known about the incidence of shoulder pain among aging adults. We conducted this review to estimate the incidence of shoulder pain in ageing adults and its associated factors. DATABASES AND DATA TREATMENT We conducted a systematic review of cohort studies in which the incidence of shoulder pain and associated factors were explored in adults aged 40 years and over. PubMed, Embase, and Web of Science databases were consulted. RESULTS We retrieved 3332 studies and included six, of which five were prospective cohort studies and one was retrospective. For adults aged 45-64 years, the annual cumulative incidence was 2.4%. The incidence density was estimated at 17.3 per 1,000 person-years for adults in the 45-64 years age group, at 12.8 per 1000 person-years for those in the 65-74 years group and at 6.7 per 1000 person-years among those aged 75 years and over. Occupational factors, notably physical demands of work, were associated with the incidence of shoulder pain. Non-occupational factors were also linked to the occurrence of shoulder pain. CONCLUSION Few studies have estimated the incidence of shoulder pain and associated factors among ageing adults. From this systematic review, we conclude that studies on the incidence of shoulder pain are scarce, and that both occupational and non-occupational factors could be associated with the onset of shoulder pain among adults 40 years and over. This very limited evidence calls for more studies on this topic. SIGNIFICANCE Shoulder pain is one of the most frequent musculoskeletal complaints, and its prevalence and consequences increase with age. However, since the prevalence of a recurring condition is determined by its incidence and the number and duration of episodes, it is important to have valid incidence estimates and to conduct aetiological studies on incidence measures to untangle risk factors of the occurrence of shoulder pain from those affecting the duration and number of episodes . In this systematic review, we sought to estimate the incidence of shoulder pain in ageing adults along with its associated factors. This work could lead to better interventions to prevent shoulder pain in older individuals.
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Affiliation(s)
- Codjo D Djade
- Department of Social and Preventive Medicine, Université Laval Québec, Québec, QC, Canada.,Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, Québec, QC, Canada.,Centre d'excellence sur le vieillissement de Québec (CEVQ), Hôpital du Saint-Sacrement, Québec, QC, Canada
| | - Teegwendé V Porgo
- Department of Social and Preventive Medicine, Université Laval Québec, Québec, QC, Canada.,Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, Québec, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- Department of Social and Preventive Medicine, Université Laval Québec, Québec, QC, Canada.,Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, Québec, QC, Canada.,Population Health and Practice-Changing Research Group, Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation component of the Québec SPOR-SUPPORT Unit, Université Laval, Québec, QC, Canada
| | - Gentiane Perrault-Sullivan
- Department of Social and Preventive Medicine, Université Laval Québec, Québec, QC, Canada.,Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, Québec, QC, Canada
| | - Clermont E Dionne
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, Québec, QC, Canada.,Centre d'excellence sur le vieillissement de Québec (CEVQ), Hôpital du Saint-Sacrement, Québec, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
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14
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Gomes BSQ, Coelho VK, Terra BS, Bunn PS, Saragiotto BT, Ferreira AS, Nogueira LAC. Patients with Subacromial Pain Syndrome Present no Reduction of Shoulder Proprioception: A Matched Case-Control Study. PM R 2019; 11:972-978. [PMID: 30609221 DOI: 10.1002/pmrj.12055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/22/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Shoulder pain is common among patients with musculoskeletal pain and the prevalence of patients with subacromial pain syndrome (SAPS) is high. Despite the high prevalence, there is a lack of an extensive evaluation of the proprioception acuity in patients with SAPS. Knowledge of the proprioceptive deficit would assist clinicians in the proper treatment and may offer an alternative explanation for the mechanisms underlying SAPS, which are poorly understood. OBJECTIVE To compare the proprioceptive function of the shoulder in patients with SAPS and matched controls. STUDY DESIGN Matched case-control study. SETTING Physical Functional Rehabilitation Service of an outpatient clinic. PARTICIPANTS A total of 32 consecutive patients with SAPS who sought physical therapy for shoulder pain and 32 healthy participants (control group) matched for age, sex, and handedness. INTERVENTIONS All participants completed a questionnaire containing sociodemographic information, pain intensity and characteristics, the Numerical Pain Rating Scale, and the Shoulder Pain and Disability Index. MAIN OUTCOME MEASUREMENTS The proprioceptive assessment was performed through kinesthesia, passive joint position sense (PJPS), and the active joint position sense (AJPS). RESULTS The groups showed no statistically significant differences in kinesthesia, PJPS, and AJPS for internal or external rotation. The proprioceptive acuity was not associated with pain intensity or functional disability in patients with SAPS. CONCLUSIONS Participants with SAPS did not present proprioceptive deficits in a pain-free motion of medial and lateral rotation when compared to their matched controls. The proprioceptive deficit may not be involved with the mechanisms underlying SAPS and seems not to interfere with the clinical outcomes of patients with SAPS. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Bruno S Q Gomes
- B.S.Q.G., V.K.C. Rehabilitation Science Department, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil and Physical Therapy Department, Admiral Adalberto Nunes Physical Education Center (Brazilian Navy), Rio de Janeiro, Brazil
| | - Vanessa K Coelho
- B.S.Q.G., V.K.C. Rehabilitation Science Department, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil and Physical Therapy Department, Admiral Adalberto Nunes Physical Education Center (Brazilian Navy), Rio de Janeiro, Brazil
| | - Bruno S Terra
- B.S.T. Physical Therapy Department, Admiral Adalberto Nunes Physical Education Center (Brazilian Navy), Rio de Janeiro, Brazil
| | - Priscila S Bunn
- P.S.B. Physical Therapy Department, Admiral Adalberto Nunes Physical Education Center (Brazilian Navy), Rio de Janeiro, Brazil and Exercise and Sport Sciences Department, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Bruno T Saragiotto
- B.T.S. Musculoskeletal Division, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Arthur S Ferreira
- A.S.F. Rehabilitation Science Department, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
| | - Leandro A C Nogueira
- L.A.C.N. Rehabilitation Science Department, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil and Physical Therapy Department, Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
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15
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Eagle SR, Connaboy C, Nindl BC, Allison KF. Significantly Increased Odds of Reporting Previous Shoulder Injuries in Female Marines Based on Larger Magnitude Shoulder Rotator Bilateral Strength Differences. Orthop J Sports Med 2018; 6:2325967118756283. [PMID: 29497623 PMCID: PMC5824909 DOI: 10.1177/2325967118756283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Musculoskeletal injuries to the extremities are a primary concern for the United States (US) military. One possible injury risk factor in this population is side-to-side strength imbalance. Purpose: To examine the odds of reporting a previous shoulder injury in US Marine Corps Ground Combat Element Integrated Task Force volunteers based on side-to-side strength differences in isokinetic shoulder strength. Study Design: Cohort study; Level of evidence, 3. Methods: Male (n = 219) and female (n = 91) Marines were included in this analysis. Peak torque values from 5 shoulder internal/external rotation repetitions were averaged and normalized to body weight. The difference in side-to-side strength measurements was calculated as the absolute value of the limb difference divided by the mean peak torque of the dominant limb. Participants were placed into groups based on the magnitude of these differences: <10%, 10% to 20%, and >20%. Odds ratios (ORs) and 95% CIs were calculated. Results: When separated by sex, 13.2% of men reported an injury, while 5.5% of women reported an injury. Female Marines with >20% internal rotation side-to-side strength differences demonstrated increased odds of reporting a previous shoulder injury compared with female Marines with <10% strength differences (OR, 15.4; 95% CI, 1.4-167.2; P = .03 ) and female Marines with 10% to 20% strength differences (OR, 13.9; 95% CI, 1.3-151.2; P = .04). No significant ORs were demonstrated in male Marines. Conclusion: Marines with larger magnitude internal rotation strength differences demonstrated increased odds of reporting a previous shoulder injury compared with those with lesser magnitude differences. Additionally, female sex appears to drastically affect the increased odds of reporting shoulder injuries (OR, 13.9-15.4) with larger magnitude differences (ie, >20%) compared with those with lesser magnitude differences (ie, <10% and 10%-20%). The retrospective cohort design of this study cannot delineate cause and effect but establishes a relationship between female Marines and greater odds of larger magnitude strength differences after returning from an injury.
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Affiliation(s)
- Shawn R Eagle
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chris Connaboy
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bradley C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Katelyn F Allison
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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16
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Monrad N, Ganestam A, Kallemose T, Barfod KW. Alarming increase in the registration of degenerative rotator cuff-related lesions a nationwide epidemiological study investigating 244,519 patients. Knee Surg Sports Traumatol Arthrosc 2018. [PMID: 28647843 DOI: 10.1007/s00167-017-4626-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE AND HYPOTHESIS Shoulder lesions are common and a challenge to diagnose. They often result in significant disability for the patient and are an economic burden to society. From recent studies, an increasing incidence has been reported. The purpose of this study was to investigate and map the incidence of shoulder lesions in Denmark from 1996 to 2013 with focus on sex, age and geographical area. METHODS The Danish National Patient Registry was searched retrospectively to find the number of shoulder lesions in Denmark during the period 1996-2013. Regional population data were retrieved from the services of Statistics Denmark. Incidence rates were analysed using Poisson regression models, and all analyses were done in R 3.2.2, and p values less than 0.05 were considered statistically significant. RESULTS During the 18-year period, 244,519 patients with a DM 75 diagnosis were registered. Male-to-female ratio was 51:49, and median age was 51. Most frequent were rotator cuff syndrome with a mean incidence rate of 313.3 (confidence interval 241.8-384.8) per 105 person-years at risk (PYRS). A statistically significant increase in overall incidence rate from 149.4 per 105 PYRS in 1996 to 715.3 per 105 PYRS in 2013 was found (p < 0.01). Incidence was highest for men aged 51-70 (1085.1 per 105 PYRS in 2013). There was no significant difference in incidence between sexes. Rural areas had a 1.4-fold higher mean incidence rate than urban areas. CONCLUSION The incidence of shoulder lesions rapidly increased mainly due to an increase among people of working age (31-70 years). There were no significant differences in incidence between sexes. Rural areas had a 1.4-fold higher incidence rate than urban areas. As shoulder lesions impose a huge socioeconomic burden on society, not to mention a great distress to the patient, the present findings is highly relevant for political decision-making regarding preventive and health promoting initiatives.
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Affiliation(s)
- Nina Monrad
- Department of Orthopedics, Clinical Orthopedic Research Hvidovre, Clinical Research Center, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - Ann Ganestam
- Department of Orthopedics, Clinical Orthopedic Research Hvidovre, Clinical Research Center, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Thomas Kallemose
- Department of Orthopedics, Clinical Orthopedic Research Hvidovre, Clinical Research Center, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Kristoffer Weisskirchner Barfod
- Department of Orthopedics, Clinical Orthopedic Research Hvidovre, Clinical Research Center, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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17
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van der Molen HF, Foresti C, Daams JG, Frings-Dresen MHW, Kuijer PPFM. Work-related risk factors for specific shoulder disorders: a systematic review and meta-analysis. Occup Environ Med 2017; 74:745-755. [PMID: 28756414 DOI: 10.1136/oemed-2017-104339] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/24/2017] [Accepted: 06/17/2017] [Indexed: 02/06/2023]
Abstract
The objective of this systematic review and meta-analysis is to examine which work-related risk factors are associated with specific soft tissue shoulder disorders. We searched the electronic databases of Medline and Embase for articles published between 2009 and 24 March 2016 and included the references of a systematic review performed for the period before 2009. Primary cross-sectional and longitudinal studies were included when outcome data were described in terms of clinically assessed soft tissue shoulder disorders and at least two levels of work-related exposure were mentioned (exposed vs less or non-exposed). Two authors independently selected studies, extracted data and assessed study quality. For longitudinal studies, we performed meta-analyses and used GRADE (Grades of Recommendations, Assessment, Development and Evaluation) to assess the evidence for the associations between risk factors and the onset of shoulder disorders. Twenty-seven studies met the inclusion criteria. In total, 16 300 patients with specific soft tissue shoulder disorders from a population of 2 413 722 workers from Denmark, Finland, France, Germany and Poland were included in the meta-analysis of one case-control and six prospective cohort studies. This meta-analysis revealed moderate evidence for associations between shoulder disorders and arm-hand elevation (OR=1.9, 95% CI 1.47 to 2.47) and shoulder load (OR=2.0, 95% CI 1.90 to 2.10) and low to very low evidence for hand force exertion (OR=1.5, 95% CI 1.25 to 1.87), hand-arm vibration (OR=1.3, 95% CI 1.01 to 1.77), psychosocial job demands (OR=1.1, 95% CI 1.01 to 1.25) and working together with temporary workers (OR=2.2, 95% CI 1.2 to 4.2). Low-quality evidence for no associations was found for arm repetition, social support, decision latitude, job control and job security. Moderate evidence was found that arm-hand elevation and shoulder load double the risk of specific shoulder disorders. Low to very-low-quality evidence was found for an association between hand force exertion, hand-arm vibration, psychosocial job demands and working together with temporary workers and the incidence of specific shoulder disorders.
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Affiliation(s)
- Henk F van der Molen
- Coronel Institute of Occupational Health, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.,Netherlands Center for Occupational Diseases, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Chiara Foresti
- School of Occupational Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Joost G Daams
- Coronel Institute of Occupational Health, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.,Netherlands Center for Occupational Diseases, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Monique H W Frings-Dresen
- Coronel Institute of Occupational Health, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.,Netherlands Center for Occupational Diseases, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.,Netherlands Center for Occupational Diseases, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
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18
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Rizzo JR, Thai P, Li EJ, Tung T, Hudson TE, Herrera J, Raghavan P. Structured Wii protocol for rehabilitation of shoulder impingement syndrome: A pilot study. Ann Phys Rehabil Med 2017; 60:363-370. [PMID: 28330586 DOI: 10.1016/j.rehab.2016.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the feasibility and efficacy of using a structured Nintendo Wii protocol to improve range of motion, strength, and quality of life in patients with shoulder impingement syndrome. METHODS A total of 14 patients with shoulder pain were randomized to perform a structured Wii protocol (n=8) or conventional therapy (n=6). Pain-free shoulder range of motion, strength, shoulder pain and disability, and quality of life were assessed pre- and post-treatment. RESULTS All 8 patients completed the Wii protocol, and 3 completed conventional therapy. The Wii protocol conferred significant improvements in shoulder range of motion, pain and disability, and quality of life but not strength, whereas conventional therapy conferred a significant improvement in strength. CONCLUSIONS As compared to conventional treatment, the structured Wii protocol implemented in this pilot study was a viable adjunct to therapy for shoulder impingement syndrome. Gaming may have a supplemental benefit by increasing motivation, pleasure, and/or adherence. Further investigation in larger cohorts is warranted.
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Affiliation(s)
- John-Ross Rizzo
- Rusk Rehabilitation, New York University School of Medicine, New York University, New York, USA; Department of Neurology, New York University School of Medicine, New York University, New York, USA; Department of Psychology and Center for Neural Science, New York University, New York, USA
| | - Peter Thai
- Rusk Rehabilitation, New York University School of Medicine, New York University, New York, USA; College of Medicine, SUNY Upstate Medical University, New York, USA
| | - Edward J Li
- Mount Sinai School of Medicine, New York, USA
| | - Terence Tung
- Rusk Rehabilitation, New York University School of Medicine, New York University, New York, USA
| | - Todd E Hudson
- Rusk Rehabilitation, New York University School of Medicine, New York University, New York, USA; Department of Neurology, New York University School of Medicine, New York University, New York, USA
| | | | - Preeti Raghavan
- Rusk Rehabilitation, New York University School of Medicine, New York University, New York, USA; Department of Physical Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, USA.
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