Long-term prognosis for neck-shoulder pain and disorders: a 14-year follow-up study

Ultrasound findings and prognosis of shoulder pain: A role for Doppler signal?

PURPOSE

To find ultrasound prognostic factors for shoulder pain.

METHODS

This was an observational, prospective study, comparing the evolution of ultrasound findings with clinical outcomes, in patients with shoulder pain. Data were collected in two appointments, from February 2018 to March 2021. Two-tailed non-parametric statistics were used, and p values <0.05 were considered significant.

RESULTS

A total of 79 participants were included in this study (median age 59 years, range 24-70, 61 women). A positive Doppler signal on tendons (p = 0.002) and absent tendon heterogeneity (p = 0.01) were associated with the patient's self-reported improvement. Tendon calcifications with poorly defined contours (p = 0.03) and sparse distribution (p = 0.001) were associated with VAS improvement. A reduction in the number of calcifications (p = 0.004), in the supraspinatus tendon thickness (p = 0.01), in subacromial effusions (p = 0.03), and in color Doppler grade (p = 0.02), between initial and follow-up exams, was found in patients with an improved DASH outcome.

CONCLUSION

A positive Doppler signal on shoulder tendons can be a marker for a better prognosis in shoulder pain. Poorly defined and sparsely distributed calcifications can also indicate a better course of the disease.

Can a metric combining arm elevation and trapezius muscle activity predict neck/shoulder pain? A prospective cohort study in construction and healthcare

OBJECTIVE

To determine whether a composite metric of arm elevation and trapezius activity (i.e. neck/shoulder load) is more strongly associated with the 2-year course of neck and shoulder pain intensity (NSPi) among construction and healthcare workers than each exposure separately.

METHODS

Dominant arm elevation and upper trapezius muscle activity were estimated in construction and healthcare employees (n = 118) at baseline, using accelerometry and normalized surface electromyography (%MVE), respectively. At baseline and every 6 months for 2 years, workers reported NSPi (score 0-3). Compositions of working time were determined for arm elevation (< 30°; 30-60°;  > 60°), trapezius activity (< 0.5%; 0.5-7.0%; > 7.0%MVE), and a composite metric "neck/shoulder load" (restitution, low, medium, and high load). Associations between each of these three compositions and the 2-year course of NSPi were determined using linear mixed models.

RESULTS

Associations between exposure compositions and the course of NSPi were all weak and in general uncertain. Time spent in 0.5-7.0%MVE showed the largest and most certain association with changes in NSPi during follow-up (β = - 0.13; p = 0.037; corresponding to a -0.01 change in NPSi every 6 months). Among pain-free workers at baseline, medium (β = - 0.23; p = 0.039) and high (β = 0.15; p = 0.031) neck/shoulder load contributed the most to explaining changes in NSPi.

CONCLUSION

The composite metric of neck/shoulder load did not show a stronger association with the course of NSPi than arm elevation or trapezius activity alone in the entire population, while some indications of a stronger association were found among those who were pain-free at baseline.

Relationship Between Intensity of Neck Pain and Disability and Shoulder Pain and Disability in Individuals With Subacromial Impingement Symptoms: A Cross-Sectional Study

OBJECTIVE

This study aimed to verify a possible relationship between shoulder disability and shoulder pain intensity and the variables related to cervical-spine dysfunction, and determine which of these can differentiate moderate to severe shoulder pain (>4 on a numerical rating scale [NRS]) from mild shoulder pain (≤4 on the NRS) in individuals with subacromial impingement symptoms.

METHODS

One hundred and forty volunteers with shoulder pain were evaluated. Demographic information and variables related to the shoulder and neck were collected. Self-reported pain and disability of the shoulder and cervical spine were measured using the Shoulder Pain and Disability Index (SPADI) and Neck Disability Index (NDI) questionnaires, respectively. An NRS was used to measure pain in the shoulder and cervical spine. A purposeful modeling strategy was used to determine the best model to predict shoulder disability and shoulder pain (dependent variables). Multiple logistic regression analysis followed by receiver operating curve analysis was used to determine which variables better differentiated moderate to severe shoulder pain from mild shoulder pain.

RESULTS

Variables such as Neck Disability Index (NDI) score (β = 1.09, P = .00) and age (β = -0.19, P = .03) were associated with the total SPADI score. Neck pain was significantly associated with shoulder pain (β = 0.40, P = .00). The combination of variables predicting moderate to severe shoulder pain was total SPADI score (odds ratio [OR] = 1.15, P = .003), neck pain (OR = 3.20, P = .04), and age (OR = 1.01, P = .05).

CONCLUSION

Our results demonstrate the important connection between shoulder- and neck-related symptoms in individuals with subacromial impingement symptoms.

Comparison Between a Job-Exposure Matrix (JEM) Score and Self-Reported Exposures for Carrying Heavy Loads Over the Working Lifetime in the CONSTANCES Cohort

OBJECTIVES

Job-exposure matrices (JEMs) were developed to allow assessment of past work exposure for large population-based studies where better exposures data are unavailable. Few studies have directly compared biomechanical JEMs to self-administered questionnaires. We compared assessments of cumulative exposure to carrying heavy loads based on 'JEM Constances' to individually self-reported (SR) exposures.

METHODS

In the French CONSTANCES cohort at inception, past SR exposure to carrying heavy loads (ever/never and durations) and a detailed job history were available for 26 929 subjects. JEM Constances, an existing biomechanical JEM based on SR current exposures from 26 821 asymptomatic workers, was combined with job history to build a cumulative biomechanical exposure score. Using individual SR exposure as the reference, Area Under the Curve (AUC) of Receiver Operating Characteristic (ROC) curves, sensitivity, and specificity were calculated. For both methods, associations with low back pain and knee pain were computed using multinomial logistic models. Additional analyses compared older (>10 years) to more recent (≤10 years) exposures.

RESULTS

AUCs ranged from 0.795 (0.789-0.800) when all periods were considered, to 0.826 (0.820-0.833) for more recent biomechanical exposure (≤10 years). Associations between carrying heavy loads and low back pain or knee pain were less strong using JEM assessment than individually SR exposure: for low back pain ORSR = 3.02 (2.79-3.26) versus ORJEM = 1.70 (1.59-1.82) and for knee pain ORSR = 2.27 (2.10-2.46) versus ORJEM = 1.64 (1.53-1.77).

CONCLUSIONS

JEM Constances' assessment of cumulative exposure of carrying heavy loads seems to be a useful method compared to a self-administrated questionnaire for large population-based studies where other methods are not available.

Neck and upper extremity pain in sonographers - a longitudinal study

Background

Sonographers have reported a high occurrence of musculoskeletal pain for more than 25 years. Assessments of occupational risk factors have previously been based on cross-sectional surveys. The aim of this longitudinal study was to determine which factors at baseline that were associated with neck/shoulder and elbow/hand pain at follow-up.

Methods

A questionnaire was answered by 248 female sonographers at baseline and follow-up (85% of the original cohort). 208 were included in the analyses. Physical, visual, and psychosocial work-related conditions were assessed at baseline. Pain in two body regions (neck/shoulders and elbows/hands) was assessed at both baseline and follow up.

Results

Pain at baseline showed the strongest association with pain at follow-up in both body regions [prevalence ratio (PR) 2.04; 95% confidence interval (CI) 1.50–2.76], for neck/shoulders and (PR 3.45; CI 2.29–5.22) for elbows/hands. Neck/shoulder pain at follow-up was associated with inability of ergonomic adjustments at the ultrasound device (PR 1.25; CI 1.05–1.49), a high mechanical exposure index (PR 1.66; CI 1.09–2.52), and adverse visual conditions (PR 1.24; CI 1.00–1.54) at baseline. Moreover, among participants with no neck/shoulder pain at baseline, high job demands (PR 1.78; CI 1.01–3.12), and a high mechanical exposure index (PR 2.0; CI 0.98–4.14) predicted pain at follow-up. Pain in the elbows/hands at follow-up was associated with high sensory demands at baseline (PR 1.63; CI 1.08–2.45), and among participants without pain at baseline high sensory demands predicted elbow/hand pain at follow-up (PR 3.34; CI 1.53–7.31).

Conclusion

Pain at baseline was the strongest predictor for pain at follow-up in both body regions. We also found several occupational factors at baseline that were associated with pain at follow-up: inability to adjust equipment, adverse visual conditions, a high MEI, high job demands and high sensory demands. These results point at a possibility to influence pain with better ergonomics.

Neck pain in South Africa: An overview of the prevalence, assessment and management for the contemporary clinician

BACKGROUND

Neck pain is a prevalent condition and is associated with high levels of disability and pain. The long-term prognosis can be poor, and therefore effective management in the acute stage is important.

OBJECTIVES

To provide an overview of the prevalence of neck pain and physiotherapy management and to provide evidence-informed recommendations for clinical practice within a South African context.

METHOD

The literature was reviewed considering prevalence, risk factors and examination. Management recommendations were derived from the highest levels of evidence of clinical practice guidelines, systematic reviews and randomised clinical trials.

RESULTS

Neck pain is classified into four grades, and three trajectories of recovery have been identified. Although the incidence of neck pain globally is high, in the South African context the majority of the population have limited access to physiotherapy management. Sound clinical reasoning is important in the assessment and decision-making process for management. Exercise, and mobilisation or manipulation are effective treatment options in the management of most types of neck pain. Other physical modalities such as needling, transcutaneous electrical nerve stimulation, laser and intermittent traction may be used as an adjunct to management.

CONCLUSION

The burden of neck pain globally is high; however, there is a lack of information on current practice, prevalence and burden of neck pain in the South African context. Sound evidence-informed clinical reasoning to inform a working diagnosis and to enable patient-centred management is important.

CLINICAL IMPLICATIONS

A thorough assessment is essential to gather information to formulate hypotheses regarding diagnosis and prognosis for neck pain. Exercise, and mobilisation or manipulation are effective management options.