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Daghiani M, Negahban H, Ebrahimzadeh MH, Moradi A, Kachooei AR, Raeesi J, Divandari A. The effectiveness of comprehensive physiotherapy compared with corticosteroid injection on pain, disability, treatment effectiveness, and quality of life in patients with subacromial pain syndrome: a parallel, single-blind, randomized controlled trial. Physiother Theory Pract 2022:1-15. [DOI: 10.1080/09593985.2022.2044421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Maryam Daghiani
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, East Door of Ferdowsi University, Mashhad, Iran
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, East Door of Ferdowsi University, Mashhad, Iran
- Orthopaedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Ali Moradi
- Orthopaedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Reza Kachooei
- Orthopaedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Raeesi
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, East Door of Ferdowsi University, Mashhad, Iran
| | - Akram Divandari
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, East Door of Ferdowsi University, Mashhad, Iran
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Riley SP, Harris J, O'Halloran BJ, Showalter CR, Learman KE. Symptom response to mobilization and outcomes in patients with subacromial pain syndrome: A cohort study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1914. [PMID: 34028940 DOI: 10.1002/pri.1914] [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: 11/20/2020] [Revised: 03/20/2021] [Accepted: 05/13/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The objectives of this study were the following: (1) to determine if there was a difference in outcomes between immediate responders to glenohumeral mobilizations at the initial evaluation, 2-week, 4-week, and 6-month follow-up as compared to those that do not respond in participants with subacromial pain syndrome; (2) to see if there were statistically significant differences in outcomes within these groups between these time frames of interest, and (3) to see if symptom response at the initial evaluation was predictive of a favorable recovery. METHODS This was a prospective, single-group observational design. Clinicians pragmatically identified positive responders as improving at least two points on the Numeric Pain Rating Scale and/or a 20° improvement in shoulder active range of motion (AROM) following shoulder mobilization at the initial evaluation. Data were collected for the subjective and objective variables of interest at the initial evaluation, 2-week, 4-week, and 6-month follow-up. RESULTS The prevalence of responders at the initial evaluation was 99 (81.8%). There were no statistically significant between-group differences for the variables of interest except for the Global Rating of Change (GRoC; f = 2.79, p = 0.006). The shoulder abduction AROM between-group difference exceeded the minimal detectable change at 4 weeks. The pair-wise comparison showed statistically significant differences for the outcomes of interest at each time point except for the GRoC between 4 weeks and 6 months. There was a statistically significant correlation between responders at the initial evaluation and shoulder abduction AROM at the 4-week follow-up (rpb (112) = 0.27, p = 0.004). CONCLUSION Individuals with SAPS may benefit from shoulder mobilization independent of their within-session response to shoulder mobilization at the initial evaluation. Future research should seek to differentiate if these improvements are related to the within-session positive treatment response at the initial evaluation in individuals who are randomized to receive shoulder mobilization or not.
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Affiliation(s)
- Sean P Riley
- Doctor of Physical Therapy Program, Sacred Heart University, Fairfield, Connecticut, USA
| | - Jonathan Harris
- Doctor of Physical Therapy Program, Sacred Heart University, Fairfield, Connecticut, USA
| | | | | | - Kenneth E Learman
- Department of Graduate Studies in Health and Rehabilitation Sciences, Youngstown State University, Youngstown, Ohio, USA
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Spinal Manipulation and Electrical Dry Needling in Patients With Subacromial Pain Syndrome: A Multicenter Randomized Clinical Trial. J Orthop Sports Phys Ther 2021; 51:72-81. [PMID: 32857944 DOI: 10.2519/jospt.2021.9785] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare the effects of spinal thrust manipulation and electrical dry needling (TMEDN group) to those of nonthrust peripheral joint/soft tissue mobilization, exercise, and interferential current (NTMEX group) on pain and disability in patients with subacromial pain syndrome (SAPS). DESIGN Randomized, single-blinded, multicenter parallel-group trial. METHODS Patients with SAPS were randomized into the TMEDN group (n = 73) or the NTMEX group (n = 72). Primary outcomes included the Shoulder Pain and Disability Index and the numeric pain-rating scale. Secondary outcomes included the global rating of change scale (GROC) and medication intake. The treatment period was 6 weeks, with follow-ups at 2 weeks, 4 weeks, and 3 months. RESULTS At 3 months, the TMEDN group experienced greater reductions in shoulder pain and disability (P<.001) compared to the NTMEX group. Effect sizes were large in favor of the TMEDN group. At 3 months, a greater proportion of patients within the TMEDN group achieved a successful outcome (GROC score of 5 or greater) and stopped taking medication (P<.001). CONCLUSION Cervicothoracic and upper-rib thrust manipulation combined with electrical dry needling resulted in greater reductions in pain, disability, and medication intake than nonthrust peripheral joint/soft tissue mobilization, exercise, and interferential current in patients with SAPS. The effects were maintained at 3 months. J Orthop Sports Phys Ther 2021;51(2):72-81. Epub 28 Aug 2020. doi:10.2519/jospt.2021.9785.
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Jo CH, Lee SY, Yoon KS, Oh S, Shin S. Allogeneic Platelet-Rich Plasma Versus Corticosteroid Injection for the Treatment of Rotator Cuff Disease: A Randomized Controlled Trial. J Bone Joint Surg Am 2020; 102:2129-2137. [PMID: 33044249 DOI: 10.2106/jbjs.19.01411] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of platelet-rich plasma (PRP) for the treatment of rotator cuff disease is still controversial. The purpose of the present study was to investigate the safety and efficacy of a fully characterized allogeneic pure PRP injection into the subacromial space of patients with rotator cuff disease in comparison with corticosteroid injection. METHODS A 2-group, parallel, assessor-blinded, randomized controlled trial was conducted. A total of 60 patients with clinically and structurally diagnosed rotator cuff disease were randomly assigned to receive a subacromial injection of either 4 mL of allogeneic pure PRP or a 4-mL mixture of 1 mL of 40-mg/mL triamcinolone acetonide and 3 mL of 2% lidocaine under ultrasonographic guidance. The primary outcomes were safety and the Constant score at 1 month. The secondary outcomes were pain, range of motion, muscle strength, functional scores, and overall satisfaction and function. RESULTS There were no treatment-related adverse events. The Constant score at 1 month did not significantly differ between the PRP and corticosteroid groups. At 6 months, the DASH (Disabilities of the Arm, Shoulder and Hand) score, overall function, and external rotation were significantly better in the PRP group than in the corticosteroid group, and the other clinical outcomes did not show significant differences. All pain measurements, the strength of the supraspinatus and infraspinatus, and 5 functional scores also improved slowly and steadily after injection, becoming significantly better at 6 months compared with those before the injection, whereas those in the corticosteroid group responded promptly but did not further improve. CONCLUSIONS Allogeneic PRP injections for the treatment of rotator cuff disease are safe but are not definitely superior to corticosteroid injections with respect to pain relief and functional improvement during 6 months. The DASH score, overall function, and external rotation were significantly better in the PRP group than in the steroid group at 6 months. Generally, PRP slowly but steadily reduced pain and improved function of the shoulder until 6 months, whereas corticosteroid did not. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Chris Hyunchul Jo
- Departments of Orthopedic Surgery (C.H.J., S.Y.L., and K.S.Y.), Biostatistics (S.O.), and Laboratory Medicine (S.S.), SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
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Do the Number of Visits and the Cost of Musculoskeletal Care Improve Outcomes? More May Not Be Better. J Orthop Sports Phys Ther 2020; 50:642-648. [PMID: 33131393 DOI: 10.2519/jospt.2020.9440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine the relationship between health care use and the magnitude of change in patient-reported outcomes in individuals who received treatment for subacromial pain syndrome. The secondary objective was to determine the value of care, as measured by change in pain and disability per dollar spent. DESIGN Secondary analysis of a randomized clinical trial that investigated the effects of nonsurgical care for subacromial pain syndrome. METHODS Two groups of treatment responders were created, based on 1-year change in Shoulder Pain and Disability Index (SPADI) score (high, 46.83 points; low, 8.21 points). Regression analysis was performed to determine the association between health care use and 1-year change in SPADI score. Baseline SPADI score was used as a covariate in the regression analysis. Value was measured by comparing health care visits and costs expended per SPADI 1-point change between responder groups. RESULTS Ninety-eight patients were included; 38 were classified as high responders (mean 1-year SPADI change score, 46.83 points) and 60 were classified as low responders (1-year SPADI change score, 8.21 points). Neither unadjusted medical visits (5.89; 95% confidence interval [CI]: 4.35, 7.44 versus 6.30; 95% CI: 5.14, 7.46) nor medical costs ($1404.86; 95% CI: $1109.34, $1779.09 versus $1679.26; 95% CI: $1391.54, $2026.48) were significantly different between high and low responders, respectively. CONCLUSION Neither the number of visits nor the financial cost of nonsurgical shoulder- related care was associated with improvement in shoulder pain and disability at 1 year. J Orthop Sports Phys Ther 2020;50(11):642-648. doi:10.2519/jospt.2020.9440.
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Major DH, Røe Y, Grotle M, Jessup RL, Farmer C, Småstuen MC, Buchbinder R. Content reporting of exercise interventions in rotator cuff disease trials: results from application of the Consensus on Exercise Reporting Template (CERT). BMJ Open Sport Exerc Med 2019; 5:e000656. [PMID: 31908837 PMCID: PMC6936978 DOI: 10.1136/bmjsem-2019-000656] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2019] [Indexed: 12/18/2022] Open
Abstract
Background Exercise interventions are frequently recommended for patients with rotator cuff disease, but poor content reporting in clinical trials of exercise limits interpretation and replication of trials and clinicians’ ability to deliver effective exercise protocols. The Consensus on Exercise Reporting Template (CERT) was developed to address this problem. Objective To assess completeness of content reporting of exercise interventions in randomised controlled trials for patients with rotator cuff disease and the inter-rater reliability of the CERT. Design Critical appraisal. Methods Independent pairs of reviewers applied the CERT to all 34 exercise trials from the most recent Cochrane Review evaluating the effect of manual therapy and exercise for patients with rotator cuff disease. We used the CERT Explanation and Elaboration Statement to guide assessment of whether each of the 19-item criteria were clearly described (score 0–19; higher scores indicate better reporting). Percentage agreement and the prevalence and bias adjusted kappa (PABAK) coefficient were used to measure inter-rater reliability. Results The median CERT score was 5 (range 0–16). Percentage agreement was high for 15 items and acceptable for 4 items. The PABAK coefficient indicated excellent (5 items), substantial (11 items) and moderate (3 items) inter-rater agreement. Conclusion The description of exercise interventions for patients with rotator cuff disease in published trials is poorly reported. Overall, the inter-rater reliability of the CERT is high/acceptable. We strongly encourage journals to mandate use of the CERT for papers reporting trial protocols and results investigating exercise interventions.
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Affiliation(s)
- Daniel H Major
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Yngve Røe
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Margreth Grotle
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway
| | - Rebecca L Jessup
- Cabrini Institute, Monash Department of Clinical Epidemiology, Melbourne, Victoria, Australia.,Monash University Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia
| | - Caitlin Farmer
- Cabrini Institute, Monash Department of Clinical Epidemiology, Melbourne, Victoria, Australia.,Monash University Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia
| | - Milada Cvancarova Småstuen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway
| | - Rachelle Buchbinder
- Cabrini Institute, Monash Department of Clinical Epidemiology, Melbourne, Victoria, Australia.,Monash University Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia
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Morgan BC, Deyle GD, Petersen EJ, Allen CS, Koppenhaver SL. DRY NEEDLING IN THE MANAGEMENT OF PATIENTS MEETING CLINICAL DIAGNOSTIC CRITERIA FOR SUBACROMIAL PAIN SYNDROME: A CASE SERIES. Int J Sports Phys Ther 2019; 14:637-654. [PMID: 31440414 PMCID: PMC6670052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Physical therapy interventions of exercise and manual therapy provide benefit in treatment of subacromial pain syndrome (SAPS). Dry needling is an emerging technique for treating musculoskeletal conditions; however, conflicting investigative evidence exists regarding the use of dry needling for SAPS. PURPOSE The purpose of this case series was to describe the use of dry needling, in conjunction with exercise, as a management strategy for patients meeting clinical diagnostic criteria of SAPS and to observe the short- and intermediate-term effects of dry needling with therapeutic exercise in this population. A secondary purpose was to describe a framework of clinical reasoning to guide the pragmatic application of dry needling and exercise in clinical practice. STUDY DESIGN Case series. METHODS Twenty-five patients met criteria for SAPS and provided informed consent. Patients received examination-based dry needling for the first two visits with exercises added beginning at the third treatment session to help distinguish treatment effects. The primary outcome measure used in this study was the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) survey assessed at their third clinical visit, at four-weeks after starting intervention and again at a three-month follow up visit. RESULTS On the Q-DASH survey 21 of 24 patients reported improvement at the third visit (range 4.5 to 38.6 points) and 19 of 22 reported improvement at the 3-month follow-up (range 0.1-54.5 points) relative to baseline. Sixteen of 24 patients at the third visit and 19 of 22 patients at the 3-month follow-up reported Global Rating of Changes scores of +3 or greater. CONCLUSION This case series provides insight to the observed short- and intermediate-term effects of dry needling combined with exercise for SAPS. Additionally, it discusses the framework of clinical reasoning when applying this intervention. The results are encouraging for dry needling as an adjunct to exercise for treating patients with SAPS. LEVEL OF EVIDENCE Therapy, level 4.
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Affiliation(s)
- Brandon C. Morgan
- Fellow, Army-Baylor University Doctoral Fellowship in Orthopedic Manual Physical Therapy, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Gail D. Deyle
- Senior Faculty and Professor, Army-Baylor University Doctoral Fellowship in Orthopedic Manual Physical Therapy, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Evan J. Petersen
- Associate Professor, University of the Incarnate Word, School of Physical Therapy, San Antonio, TX, USA
| | - Christopher S. Allen
- Program Director and Associate Professor, Army-Baylor University Doctoral Fellowship in Orthopedic Manual Physical Therapy, Brooke Army Medical Center, Fort Sam Houston, TX, USA
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Loudon K, Zwarenstein M, Sullivan FM, Donnan PT, Gágyor I, Hobbelen HJSM, Althabe F, Krishnan JA, Treweek S. The PRECIS-2 tool has good interrater reliability and modest discriminant validity. J Clin Epidemiol 2017; 88:113-121. [PMID: 28603007 DOI: 10.1016/j.jclinepi.2017.06.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 05/12/2017] [Accepted: 06/02/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES PRagmatic Explanatory Continuum Indicator Summary (PRECIS)-2 is a tool that could improve design insight for trialists. Our aim was to validate the PRECIS-2 tool, unlike its predecessor, testing the discriminant validity and interrater reliability. STUDY DESIGN AND SETTING Over 80 international trialists, methodologists, clinicians, and policymakers created PRECIS-2 helping to ensure face validity and content validity. The interrater reliability of PRECIS-2 was measured using 19 experienced trialists who used PRECIS-2 to score a diverse sample of 15 randomized controlled trial protocols. Discriminant validity was tested with two raters to independently determine if the trial protocols were more pragmatic or more explanatory, with scores from the 19 raters for the 15 trials as predictors of pragmatism. RESULTS Interrater reliability was generally good, with seven of nine domains having an intraclass correlation coefficient over 0.65. Flexibility (adherence) and recruitment had wide confidence intervals, but raters found these difficult to rate and wanted more information. Each of the nine PRECIS-2 domains could be used to differentiate between trials taking more pragmatic or more explanatory approaches with better than chance discrimination for all domains. CONCLUSION We have assessed the validity and reliability of PRECIS-2. An elaboration study and web site provide guidance to help future users of the tool which is continuing to be tested by trial teams, systematic reviewers, and funders.
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Affiliation(s)
- Kirsty Loudon
- Nursing Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, University of Stirling Innovation Park, Stirling FK9 4NF, UK.
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, Western Centre for Public Health and Family Medicine, 1151 Richmond St, London, Ontario N6A 4K7, Canada
| | - Frank M Sullivan
- School of Medicine, Medical & Biological Sciences, North Haugh, St Andrews KY16 9ST, UK; North York General Hospital, 4001 Leslie Street, Toronto, Ontario M2K 1E1, Canada
| | - Peter T Donnan
- Division of Population Health Sciences, School of Medicine, University of Dundee, The Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, UK
| | - Ildikó Gágyor
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, D-37073 Göttingen, Germany
| | - Hans J S M Hobbelen
- Ageing and Healthcare Research Group, Healthy Ageing, Allied Health Care and Nursing, Centre of Expertise Healthy Ageing, Hanze University of Applied Sciences Groningen, Eyssoniusplein 18, Kamer A0.17, Postbus 3109 9701 DC Groningen, The Netherlands
| | - Fernando Althabe
- Departamento de Investigación en Salud de la Madre y el Niño, Instituto de Efectividad Clínica y Sanitaria (IECS), Dr Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - Jerry A Krishnan
- Population Health Sciences, Office of the Vice Chancellor for Health Affairs, Medicine and Public Health, University of Illinois at Chicago, 1200 West Harrison St., Chicago, IL 60607, USA
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK
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Puentedura EJ, O'Grady WH. To letter to the editor: 'Safety of thrust joint manipulation in the thoracic spine: a systematic review'. J Man Manip Ther 2016; 23:174-5. [PMID: 26917934 DOI: 10.1179/2042618615y.0000000018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Emilio J Puentedura
- University of Nevada Las Vegas, School of Allied Health Sciences, Department of Physical Therapy, NV, USA
| | - William H O'Grady
- University of Nevada Las Vegas, School of Allied Health Sciences, Department of Physical Therapy, NV, USA
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Puentedura EJ, O'Grady WH. Safety of thrust joint manipulation in the thoracic spine: a systematic review. J Man Manip Ther 2015; 23:154-61. [PMID: 26309386 DOI: 10.1179/2042618615y.0000000012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There appears to be very little in the research literature on the safety of thrust joint manipulation (TJM) when applied to the thoracic spine. PURPOSE To retrospectively analyze all available documented case reports in the literature describing patients who had experienced severe adverse events (AE) after receiving TJM to their thoracic spine. DATA SOURCES Case reports published in peer reviewed journals were searched in Medline (using Ovid Technologies, Inc.), Science Direct, Web of Science, PEDro (Physiotherapy Evidence Database), Index of Chiropractic literature, AMED (Allied and Alternative Medicine Database), PubMed and the Cumulative Index to Nursing and Allied Health (CINHAL) from January 1950 to February 2015. STUDY SELECTION Case reports were included if they: (1) were peer-reviewed; (2) were published between 1950 and 2015; (3) provided case reports or case series; and (4) had TJM as an intervention. Articles were excluded if: (1) the AE occurred without TJM (e.g. spontaneous); (2) the article was a systematic or literature review; or (3) it was written in a language other than English or Spanish. DATA EXTRACTION Data extracted from each case report included: gender; age; who performed the TJM and why; presence of contraindications; the number of manipulation interventions performed; initial symptoms experienced after the TJM; as well as type of severe AE that resulted. RESULTS Ten cases, reported in 7 case reports, were reviewed. Cases involved females (8) more than males (2), with mean age being 43.5 years (SD=18.73, Range = 17 -71). The most frequent AE reported was injury (mechanical or vascular) to the spinal cord (7/10), with pneumothorax and hematothorax (2/10) and CSF leak secondary to dural sleeve injury (1/10). LIMITATIONS There were only a small number of case reports published in the literature and there may have been discrepancies between what was reported and what actually occurred, since physicians dealing with the effects of the AE, rather than the clinician performing the TJM, published the cases. CONCLUSIONS Serious AE do occur in the thoracic spine, most commonly, trauma to the spinal cord, followed by pneumothorax. This suggests that excessive peak forces may have been applied to thoracic spine, and it should serve as a cautionary note for clinicians to decrease these peak forces.
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Affiliation(s)
- Emilio J Puentedura
- University of Nevada Las Vegas, School of Allied Health Sciences, Department of Physical Therapy, Las Vegas, NV, USA
| | - William H O'Grady
- University of Nevada Las Vegas, School of Allied Health Sciences, Department of Physical Therapy, Las Vegas, NV, USA
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Orthopaedic manual physical therapy for shoulder pain and impaired movement in a patient with glenohumeral joint osteoarthritis: a case report. J Orthop Sports Phys Ther 2015; 45:453-61, A1-3. [PMID: 25927500 DOI: 10.2519/jospt.2015.5887] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report. BACKGROUND Comprehensive treatment strategies are needed for individuals with glenohumeral joint osteoarthritis (OA), especially when they are young and active. Prior dislocation, with or without subsequent shoulder stabilization surgery, complicates the clinical presentation and increases the risk of OA progression. The purpose of this case report was to describe an orthopaedic manual physical therapy approach used in a patient with glenohumeral joint OA who presented with shoulder pain and impaired movement. CASE DESCRIPTION A 38-year-old male military officer presented with left-shoulder pain of 2 months in duration that was unrelieved with a subacromial injection. He reported a history of anterior-inferior dislocation with subsequent stabilization surgery 15 years prior and arthroscopic subacromial decompression 2 years prior. Physical examination demonstrated painful limitations in shoulder elevation and internal/external rotation movements, stiffness with testing using accessory glides, and rotator cuff and scapular musculature weakness associated with pain. OUTCOMES Treatment consisted of 5 sessions provided over 4 weeks. The plan of care included manual physical therapy, exercises, and progressive functional activities specifically tailored to the patient's clinical presentation. Shoulder Pain and Disability Index scores decreased from 43% to 17%, and the Patient-Specific Functional Scale average score improved from 3.0 to 7.3 out of 10. After 4 additional weeks of a home exercise program, the Shoulder Pain and Disability Index score was 4% and Patient-Specific Functional Scale average score was 9.0. Improvements in self-reported function were maintained at 6 months. Four "booster" treatment sessions were administered at 9 months, contributing to sustained outcomes through 1 year. DISCUSSION In a young, active patient with glenohumeral joint OA, clinically meaningful short-term improvements in self-reported function and pain, maintained at 1 year, were observed with manual physical therapy and exercise. LEVEL OF EVIDENCE Therapy, level 4.
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Leib C. Management of the unilateral shoulder impingement syndrome. Ann Intern Med 2015; 162:237. [PMID: 25643309 DOI: 10.7326/l15-5043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Singh HP, Mehta SS, Pandey R. A preoperative scoring system to select patients for arthroscopic subacromial decompression. J Shoulder Elbow Surg 2014; 23:1251-6. [PMID: 25127909 DOI: 10.1016/j.jse.2014.05.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/21/2014] [Accepted: 05/23/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study investigated the clinical and radiographic factors that influence outcome after arthroscopic subacromial decompression (ASAD) for shoulder impingement syndrome. The goal was to develop a new preoperative scoring system to identify patients who would have a prompt and sustained benefit from ASAD. METHODS We prospectively reviewed 112 consecutive patients with impingement syndrome who subsequently underwent ASAD. The Oxford Shoulder Score (OSS) was recorded preoperatively and 3 and 12 months postoperatively. A statistically significant improvement in OSS at 3 months after surgery was considered a good outcome. RESULTS The variables associated with good outcome were shoulder pain with overhead activities, persistent symptoms for more than 6 months, symptoms persistent despite a 3-month course of supervised physiotherapy, consistently positive Hawkins test result, radiologic changes of impingement on both acromion and humerus in the subacromial region, and improvement for more than 1 week after a steroid injection. These 6 criteria were combined into a single score for this study, termed the preoperative score (PrOS). Sixty-two patients who had been symptomatic for 1 year with a preoperative score of 5 to 6 showed significant improvement in OSS at 3 months after surgery (P < .001). Thirty-eight patients with a score 3 to 4 had no statistically significant improvement in OSS at 3 months but had a further slight improvement at 1 year. Twelve patients with a score of ≤2 had no significant improvement in OSS at 3 months or 1 year. CONCLUSION This scoring system can identify patients who would have a prompt benefit from ASAD. The impact of surgery in patients with a PrOS of ≤4 points is questionable.
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Affiliation(s)
- Harvinder Pal Singh
- Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK.
| | - Saurabh Sagar Mehta
- Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Radhakant Pandey
- Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
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van der Sande R, Rinkel WD, Gebremariam L, Hay EM, Koes BW, Huisstede BM. Subacromial impingement syndrome: effectiveness of pharmaceutical interventions-nonsteroidal anti-inflammatory drugs, corticosteroid, or other injections: a systematic review. Arch Phys Med Rehabil 2012; 94:961-76. [PMID: 23246416 DOI: 10.1016/j.apmr.2012.11.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 10/12/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To present an evidence-based overview of the effectiveness of pharmaceutical interventions, including nonsteroidal anti-inflammatory drugs, corticosteroid injections, and other injections, used to treat the subacromial impingement syndrome (SIS). An overview can help physicians select the most appropriate pharmaceutical intervention, and it can identify gaps in scientific knowledge. DATA SOURCES The Cochrane Library, PubMed, Embase, PEDro, and CINAHL databases. STUDY SELECTION Two reviewers independently selected relevant reviews and randomized clinical trials. DATA EXTRACTION Two reviewers independently extracted the data and assessed the methodologic quality. DATA SYNTHESIS A best evidence synthesis was used to summarize the results. Three reviews and 5 randomized clinical trials were included. Although we found limited evidence for effectiveness in favor of 2 sessions with corticosteroid injections versus 1 session, for the effectiveness of corticosteroid injections versus placebo, nonsteroidal anti-inflammatory drugs, or acupuncture, only conflicting and no evidence for effectiveness was found. Moderate evidence was found in favor of immediate release oral ibuprofen compared with sustained-released ibuprofen in the short-term. Also, moderate evidence for effectiveness was found in favor of glyceryltrinitrate patches versus placebo patches in the short-term and mid term. Furthermore, injections with disodium ethylene diamine tetraacetic acid plus ultrasound with ethylene diamine tetraacetic acid gel were more effective (moderate evidence) than was placebo treatment in the short- and long-term. CONCLUSIONS This article presents an overview of the effectiveness of pharmaceutical interventions for SIS. Some treatments seem to be promising (moderate evidence) to treat SIS, but more research is needed before firm conclusions can be drawn.
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Affiliation(s)
- Renske van der Sande
- Department of General Practice, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
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