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Pellegrino R, Brindisino F, Barassi G, Sparvieri E, DI Iorio A, de Sire A, Ruosi C. Combined ultrasound guided peritendinous hyaluronic acid (500-730 Kda) injection with extracorporeal shock waves therapy vs. extracorporeal shock waves therapy-only in the treatment of shoulder pain due to rotator cuff tendinopathy. A randomized clinical trial. J Sports Med Phys Fitness 2022; 62:1211-1218. [PMID: 35686864 DOI: 10.23736/s0022-4707.22.13924-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Rotator cuff tendinopathy (RCTe) is the most common cause of pain and shoulder dysfunction. Numerous clinical studies have demonstrated the therapeutic capacity of exogenous peritendinous hyaluronic acid (HA), and the effectiveness of extracorporeal shockwaves therapy (ESWT) in reducing pain. The aim of this study was to evaluate the added effects of HA treatment plus ESWT (E-g) or ESWT alone (SC-g), focusing on reduction of self-reported pain and disability of patients with RCTe. METHODS Monocentric, randomized open-label clinical trial. Patients' selection, enrollment and interventions were conducted at the Chiparo Physical Medicine and Rehabilitation outpatient facility (Lecce, Italy). Patients with a diagnosis of RCTe, were randomly allocated to the E-g or to the SC-g. Participants were assessed for self-perceived pain, and for disability, at baseline, after 30 and 60 days. RESULTS Forty adults (mean age 50.8±6.3; 23 woman, 17 men) were enrolled in the study, twenty for each group. During the study, both groups improved their perceived level of disability of the arm (-25.01±2.79; P<0.001), and for pain (-3.13±0.50; P<0.001). A multiplicative effect was demonstrated in the time × treatment interaction for disability (beta±SE beta: 7.40±1.77; P<0.001), and pain (beta±SE beta: 0.95±0.32; P<0.001). Moreover, more patients in the E-g reached the MCID in the outcomes-score compared to SC-g. Lastly, number needed to treat were calculated, for disability: NNT=2 (95% CI: 1-3), and for pain-score: NNT=1 (95% CI: 1-2). CONCLUSIONS This study provides preliminary evidence that, compared to ESWT alone, the combining ESWT and peritendinous HA-injections, revert disability and reduces shoulder pain faster in patients with RCTe.
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Affiliation(s)
- Raffaello Pellegrino
- Unit of Antalgic Mini-Invasive and Rehab-Outpatients, Department of Medicine and Science of Aging, G. D'Annunzio University, Chieti, Italy.,Department of Scientific Research, Campus Ludes, Semmelweis University, Lugano, Switzerland
| | - Fabrizio Brindisino
- Vincenzo Tiberio Department of Medicine and Health Science, Cardarelli Hospital, University of Molise, Campobasso, Italy
| | - Giovanni Barassi
- Unit of Antalgic Mini-Invasive and Rehab-Outpatients, Department of Medicine and Science of Aging, G. D'Annunzio University, Chieti, Italy
| | | | - Angelo DI Iorio
- Unit of Antalgic Mini-Invasive and Rehab-Outpatients, Department of Medicine and Science of Aging, G. D'Annunzio University, Chieti, Italy -
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Carlo Ruosi
- School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Maselli F, Storari L, Lorusso M, Mourad F, Pennella D, Barbari V, Salomon M, Brindisino F. Osteoid Osteoma in an Adult Wheelchair Basketball Player Mimicking Musculoskeletal Shoulder Pain: Red Flag or a Red Herring? Tomography 2022; 8:389-401. [PMID: 35202197 PMCID: PMC8877604 DOI: 10.3390/tomography8010032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/13/2022] [Accepted: 01/29/2022] [Indexed: 12/01/2022] Open
Abstract
Osteoid osteoma (OO) is a relatively common, benign bone-forming tumour, which mainly occurs on the long tubular bones of the limbs in adolescents. Usually, the OO is classified based on its localisation. Night-time pain is the major symptom of OO, which is commonly relieved using non-steroidal anti-inflammatory drugs, while surgery is required only for those patients with severe pain or in case of failure of previous conservative treatments. Our case report describes a 56-year-old male basketball player who self-referred to our outpatient physical therapy with a shoulder pain complaint. Considering the anamnesis and the physical examination, the physical therapist referred the patient to an orthopaedic surgeon, who suggested a detailed imaging investigation. The peculiarity of this clinical case is the overlapping of two clinical presentations: the symptomatology of the OO and the concurrent mechanical disorder due to a rotator cuff tendinopathy.
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Affiliation(s)
- Filippo Maselli
- Sovrintendenza Sanitaria Regionale Puglia INAIL, 70126 Bari, Italy;
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), Campus of Savona, University of Genova, 17100 Savona, Italy;
| | - Lorenzo Storari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), Campus of Savona, University of Genova, 17100 Savona, Italy;
- Correspondence:
| | - Mariangela Lorusso
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (M.L.); (D.P.); (M.S.); (F.B.)
| | - Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Differdange, Luxembourg;
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg
| | - Denis Pennella
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (M.L.); (D.P.); (M.S.); (F.B.)
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise C/da Tappino c/o Cardarelli Hospital, 86100 Campobasso, Italy
| | - Valerio Barbari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), Campus of Savona, University of Genova, 17100 Savona, Italy;
| | - Mattia Salomon
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (M.L.); (D.P.); (M.S.); (F.B.)
| | - Fabrizio Brindisino
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (M.L.); (D.P.); (M.S.); (F.B.)
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise C/da Tappino c/o Cardarelli Hospital, 86100 Campobasso, Italy
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Brindisino F, Indaco T, Giovannico G, Ristori D, Maistrello L, Turolla A. Shoulder Pain and Disability Index: Italian cross-cultural validation in patients with non-specific shoulder pain. Shoulder Elbow 2021; 13:433-444. [PMID: 34394741 PMCID: PMC8355649 DOI: 10.1177/1758573220913246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/21/2019] [Accepted: 02/10/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Health-related patient reported outcome measures are considered essential to determine the impact of disease on the life of individuals. Aim of this study is to culturally adapt the Italian version of the Shoulder Pain and Disability Index (SPADI). The secondary aim is to evaluate psychometric proprieties in patients with non-specific shoulder pain. METHODS The current study is an analysis of a sample of 59 adult patients with non-specific shoulder pain. The SPADI was translated and cross-culturally adapted, and then psychometric properties were tested. Participants completed the Shoulder Pain and Disability Index-Italian (SPADI-I), 36-item short form health survey, the Oxford Shoulder Score, the Disability of Arm, Shoulder, and Hand scale and a pain intensity visual analogue scale. RESULTS SPADI-I included two domains. Internal consistency analysis showed good values for total (α = 0.84) and subscales (α = 0.94 and α = 0.76). For construct validity, there was good correlation between the visual analogue scale, the Oxford Shoulder Score, the DASH and the SPADI-I total score and subscales. Standard error of measurement and minimally detectable change were calculated. CONCLUSIONS The SPADI-I was culturally adapted into Italian. SPADI-I is centred on pain and disability of the shoulder only and can be considered as a useful tool in daily clinical practice for assessing musculoskeletal non-specific shoulder pain because of its good internal consistency and validity. Further studies should focus on other psychometric proprieties such as test re-test reliability, responsiveness and clinical interpretability to improve the available clinimetrics of the tool.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health
Science “Vincenzo Tiberio”, University of Molise C/da Tappino c/o Cardarelli
Hospital, Campobasso, Italy
- Physiotherapy and Manual Therapy-FTM-,
Physiotherapy Clinic, Lecce, Italy
| | - Tiziana Indaco
- Physiotherapy Department, Medical Clinic
Aventino, Roma, Italy
| | - Giuseppe Giovannico
- Department of Medicine and Health
Science “Vincenzo Tiberio”, University of Molise C/da Tappino c/o Cardarelli
Hospital, Campobasso, Italy
- Physiotherapy and Manual Therapy-FTM-,
Physiotherapy Clinic, Lecce, Italy
| | - Diego Ristori
- Department of Neuroscience,
Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of
Genova, Genova, Italy
| | - Lorenza Maistrello
- Laboratory of Neurorehabilitation
Technologies, IRCCS San Camillo Hospital Foundation, Venezia, Italy
| | - Andrea Turolla
- Laboratory of Neurorehabilitation
Technologies, IRCCS San Camillo Hospital Foundation, Venezia, Italy
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Dominguez-Romero JG, Jiménez-Rejano JJ, Ridao-Fernández C, Chamorro-Moriana G. Exercise-Based Muscle Development Programmes and Their Effectiveness in the Functional Recovery of Rotator Cuff Tendinopathy: A Systematic Review. Diagnostics (Basel) 2021; 11:529. [PMID: 33809604 PMCID: PMC8002167 DOI: 10.3390/diagnostics11030529] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/10/2021] [Accepted: 03/13/2021] [Indexed: 12/28/2022] Open
Abstract
(1) Background: Rotator cuff (RC) tendinopathy causes pain and functional limitation of the shoulder. Physical exercises are effective therapies but there is no consensus on which exercise programme is the most appropriate. Objective: To analyze and compare the effectiveness of different intervention modalities-based exclusively on physical exercise muscle-development programs to improve shoulder pain and function in RC tendinopathy. (2) Methods: Systematic review (PRISMA) through a search in PubMed, WOS, PEDro, Cinahl, Scopus and Dialnet. The PEDro Scale and the Cochrane Risk of Bias analyzed the methodological quality. A pre-established table collected data on: patients, interventions, outcome measures and results. A narrative synthesis of the results was conducted. (3) Results: eight articles were selected (Cochrane: low risk of bias; PEDro: good quality). All assessed programs were effective. Only one study found statistically and clinically significant differences in favour of eccentric training. The exercises used were: eccentric/concentric/conventional, open/closed kinetic chain, with/without co-activation of glenohumeral muscle, with/without pain, and in clinic/at home. (4) Conclusions: All exercise programs were effective in RC tendinopathy, improving pain and shoulder function. No solid results were obtained when the interventions were compared due to their heterogeneity. Patients perception assessment tools were the most widely used. Amount of load applied should be considered.
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Affiliation(s)
| | | | | | - Gema Chamorro-Moriana
- Research Group “Area of Physiotherapy” CTS-305, University of Seville, 41009 Seville, Spain; (J.G.D.-R.); (J.J.J.-R.); (C.R.-F.)
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Brindisino F, Pellicciari L, Lorusso M, Pennella D, Padua R, Di Bari M. Cross-cultural adaptation, reliability, and validity of the Italian version of the Shoulder Disability Questionnaire. Musculoskelet Sci Pract 2020; 46:102123. [PMID: 32217269 DOI: 10.1016/j.msksp.2020.102123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/20/2020] [Accepted: 01/25/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Shoulder Disability Questionnaire (SDQ) demonstrated promising psychometric properties, but currently there is no evidence of an Italian version. OBJECTIVE To cross-culturally adapt the Italian version of the SDQ (SDQ-I) and to explore its psychometric properties in patients with non-specific shoulder pain (SP). METHODS The SDQ-I was translated according to international guidelines and administered to 105 patients with SP. The SDQ-I scores were compared with Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), Numerical Pain Rating Scale (NPRS), and 36-item Short Form Health Survey (SF-36). Structural validity (Exploratory Factor Analysis [EFA]), internal consistency (Cronbach's alpha), test-retest reliability (Intraclass Correlation Coefficient [ICC]), measurement error (Standard Error of the Measurement [SEM], Minimal Detectable Change [MDC]), and construct validity (hypothesis testing with correlation of the DASH, NPRS, and SF-36) were explored. RESULTS The EFA identified two subscales (activity and participation-psychosocial factors). The internal consistency was supported for activity (α = 0.78), but not for participation-psychosocial subscales (α = 0.45). Both subscales demonstrated high test-retest reliability (ICC = 0.97 [95%CI = 0.96-0.98] and ICC = 0.95 [95%CI = 0.93-0.97]), a SEM of 5.8% and 7.0%, and a MDC of 15% and 19% for the first and second subscale, respectively. Construct validity was satisfactory, as >75% of the expected correlations were met for each subscale. CONCLUSIONS The SDQ-I was successfully cross-cultural adapted into Italian and proved to be valid for patients with non-specific SP, but its reliability should be further assessed, as internal consistency of the participation-psychosocial subscale showed some psychometric flaws. Further research is needed to refine the instrument.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy; Physiotherapy and Manual Therapy -FTM, Physiotherapy Clinic, Lecce, Italy.
| | - Leonardo Pellicciari
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Pisana, Rome, Italy.
| | - Mariangela Lorusso
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy; "Equilibrio" Physiotherapy Clinic, Andria, BT, Italy.
| | - Denis Pennella
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy; "Manual Therapy Lab" Clinic, Bari, Italy.
| | - Roberto Padua
- Orthopedics Working Group on Evidence Based Medicine, GLOBE, Rome, Italy; Unicamillus International University, Rome, Italy.
| | - Mauro Di Bari
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Geriatrics, Department of Medicine and Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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6
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Smith BE, Hendrick P, Bateman M, Moffatt F, Rathleff MS, Selfe J, Smith TO, Logan P. A loaded self-managed exercise programme for patellofemoral pain: a mixed methods feasibility study. BMC Musculoskelet Disord 2019; 20:129. [PMID: 30917806 PMCID: PMC6438027 DOI: 10.1186/s12891-019-2516-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/17/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A novel loaded self-managed exercise programme that includes pain education and self-management strategies may result in better outcomes for people with patellofemoral pain (PFP). However, establishing program feasibility is an essential first step before testing efficacy. The purpose of this study was to evaluate the feasibility and acceptability of conducting a definitive RCT which will evaluate the clinical and cost-effectiveness of a loaded self-managed exercise programme for people with PFP compared with usual physiotherapy. METHODS In a mixed methods, pragmatic, randomised controlled feasibility study, 60 participants with PFP (57% female; mean age 29 years) were recruited from a physiotherapy clinic within a large UK teaching hospital. They were randomly allocated to receive either a loaded self-managed exercise programme (n = 30) or usual physiotherapy (n = 30). Feasibility indicators of process, resources, and management were collected through follow-up of standardised questionnaires six months after recruitment and semi-structured interviews with 20 participants and physiotherapists. RESULTS Recruitment rate was 5 participants per month; consent rate was 99%; adherence to intervention appointments was 87%; completeness of questionnaire data was 100%; and adherence to intervention delivery was 95%. Three exercise diaries were returned at six months (5%). At six months, 25 questionnaire booklets were returned (9 in the loaded self-managed group, 16 in the usual physiotherapy group), with a total retention rate of 42%. At six months, 56% (5/9) of respondents in the loaded self-managed group and 56% (9/16) in the usual physiotherapy group were classified as 'recovered'. Both groups demonstrated improvements in average pain (VAS), kinesiophobia, pain catastrophizing, general self-efficacy and EQ-5D-5 L from baseline to six months. CONCLUSION The results of this feasibility study confirm that it is feasible and acceptable to deliver a loaded self-managed exercise programme to adults with PFP in an NHS physiotherapy outpatient setting. However, between group differences in lost to follow up and poor exercise diary completion mean we are uncertain on some feasibility aspects. These methodological issues need addressing prior to conducting a definitive RCT. TRIAL REGISTRATION ISRCTN 35272486 . Registered 19th December 2016.
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Affiliation(s)
- Benjamin E. Smith
- Physiotherapy Department (Level 3) London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, DE1 2QY UK
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Marcus Bateman
- Physiotherapy Department (Level 3) London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, DE1 2QY UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Toby O. Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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Spargoli G. TREATMENT OF ROTATOR CUFF TENDINOPATHY AS A CONTRACTILE DYSFUNCTION. A CLINICAL COMMENTARY. Int J Sports Phys Ther 2019; 14:148-158. [PMID: 30746301 PMCID: PMC6350671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND AND PURPOSE Rotator cuff (RC) tendinopathy is a common disorder affecting many individuals, both in athletic and sedentary settings. Etiology of RC pathology or the most effective conservative treatment are not totally understood. The Mechanical Diagnosis and Treatment (MDT®) method is a widely known rehabilitative technique that allows therapists to diagnose and treat spinal, and peripheral mechanical disorders. Therefore, the purpose of this clinical commentary is to briefly describe RC tendinopathy, and its management using the MDT® method. DESCRIPTION OF TOPIC RC tendinopathies are often named with several different terms, showing the difficulty related unambiguous terminology and the diagnostic process. Pathologies at the glenohumeral joint are mostly labeled according to anatomy or the impaired tissues rather than in a functional way. MDT® examination allows mechanical disorders of the shoulder to be classified into categories that show good outcomes when treated accordingly. RELATION TO CLINICAL PRACTICE The MDT® method may offer a practical, inexpensive, and effective solution to management of RC tendinopathies that present with a mechanical component. LEVEL OF EVIDENCE 5.
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Langer L, Osborne R, Rowe RH, Beneciuk JM. Laser testing for upper extremity proprioceptive deficits following rotator cuff injury: two case reports. Physiother Theory Pract 2019; 36:1493-1501. [PMID: 30676184 DOI: 10.1080/09593985.2019.1571141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Rotator cuff (RTC) dysfunction incidence ranges from 7% to 25% in the general population with a high recurrence rate. RTC musculature plays a significant role in dynamic stability of the glenohumeral joint with damage to these structures associated with proprioceptive impairments. Impaired proprioception has been linked to increased injury risk in other body regions; however, similar relationships with the upper extremity have not been extensively evaluated. The purpose of this case report is to present a preliminary, yet clinically feasible approach for using a laser for proprioceptive assessment and treatment in patients with RTC dysfunction. Case description: Patient 1 was a 21-year-old female with right shoulder pain from injury at work as a waitress where she lifted a heavy tray of plates. Patient 2 was a 48-year-old male with gradual and insidious onset of right shoulder pain during recreational baseball. Examination findings indicated contractile tissue involvement in both patients. Reaching and throwing tasks requiring accurate proprioceptive function were essential for return of each patient to their functional tasks. Laser proprioception testing was performed every 2 weeks with proprioceptive training provided as a supplement to other interventions. Outcomes: Over 4 weeks, improvements in objective laser proprioceptive test results were observed for both patients (Patient 1 = 6.0 cm; Patient 2 = 5.5 cm) in conjunction with active range-of-motion and self-report measures for pain intensity and function. Discussion: This case report describes a clinically feasible approach to testing and treating upper extremity proprioceptive deficits after RTC injury. Future research is required to establish reliability and validity of these methods.
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Affiliation(s)
| | - Raine Osborne
- Brooks Rehabilitation , Jacksonville, FL, USA.,Department of Physical Therapy, University of North Florida, Brooks College of Health , Jacksonville, FL, USA
| | | | - Jason M Beneciuk
- Brooks Rehabilitation , Jacksonville, FL, USA.,Department of Physical Therapy, University of Florida, College of Public Health & Health Professions , Gainesville, FL, USA
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9
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Spargoli G. SUPRASPINATUS TENDON PATHOMECHANICS: A CURRENT CONCEPTS REVIEW. Int J Sports Phys Ther 2018; 13:1083-1094. [PMID: 30534473 PMCID: PMC6253746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND AND PURPOSE Tendinopathy of the supraspinatus muscle is a frequent cause of shoulder pain. Although it is a common condition, the pathophysiology is not fully understood. The purpose of this clinical commentary is to provide an overview of the pathophysiology of supraspinatus tendinopathy and discuss the conservative treatment solutions. DESCRIPTION Supraspinatus tendinopathy is thought to be caused by both intrinsic, and extrinsic factors. Structural and biological changes happen when tendinopathy develops. Cellular and extracellular modifications characterize tendon healing stages that continue over time. Assessment is paramount in order to differentiate the structure involved, and to offer a proper treatment solution. RELATION TO CLINICAL PRACTICE Knowledge of the general concepts regarding the development of supraspinatus tendinopathy, and of the healing process should guide physiotherapists when proposing treatment options. Physical modalities commonly utilized for supraspinatus tendinopathy such as: laser, ultrasound, and shock-wave therapy have little and contradictory evidence. Exercise in form of eccentric training may be considered as it seems to have beneficial effects, however, more research is needed.
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Smith BE, Hendrick P, Bateman M, Moffatt F, Rathleff MS, Selfe J, Smith TO, Logan P. Study protocol: a mixed methods feasibility study for a loaded self-managed exercise programme for patellofemoral pain. Pilot Feasibility Stud 2017; 4:24. [PMID: 28748107 PMCID: PMC5520346 DOI: 10.1186/s40814-017-0167-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022] Open
Abstract
Background Patellofemoral pain (PFP) is one of the most common forms of knee pain in adults under the age of 40, with a prevalence of 23% in the general population. The long-term prognosis is poor, with only one third of people pain-free 1 year after diagnosis. The biomedical model of pain in relation to persistent PFP has recently been called into question. It has been suggested that interventions for chronic musculoskeletal conditions should consider alternative mechanisms of action, beyond muscles and joints. Modern treatment therapies should consider desensitising strategies, with exercises that target movements and activities patients find fearful and painful. High-quality research on exercise prescription in relation to pain mechanisms, not directed at specific tissue pathology, and dose response clearly warrants further investigation. Our primary aim is to establish the feasibility and acceptability of conducting a definitive RCT which will evaluate the clinical and cost-effectiveness of a loaded self-managed exercise programme for people with patellofemoral pain. Method This is a single-centred, multiphase, sequential, mixed-methods trial that will evaluate the feasibility of running a definitive large-scale randomised controlled trial of a loaded self-managed exercise programme versus usual physiotherapy. Initially, 8–10 participants with a minimum 3-month history of PFP will be recruited from an NHS physiotherapy waiting list and interviewed. Participants will be invited to discuss perceived barriers and facilitators to exercise engagement, and the meaning and impact of PFP. Then, 60 participants will be recruited in the same manner for the main phase of the feasibility trial. A web-based service will randomise patients to a loaded self-managed exercise programme or usual physiotherapy. The loaded self-managed exercise programme is aimed at addressing lower limb knee and hip weakness and is positioned within a framework of reducing fear/avoidance with an emphasis on self-management. Baseline assessment will include demographic data, average pain within the last week (VAS), fear avoidance behaviours, catastrophising, self-efficacy, sport and leisure activity participation, and general quality of life. Follow-up will be 3 and 6 months. The analysis will focus on descriptive statistics and confidence intervals. The qualitative components will follow a thematic analysis approach. Discussion This study will evaluate the feasibility of running a definitive large-scale trial on patients with patellofemoral pain, within the NHS in the UK. We will identify strengths and weaknesses of the proposed protocol and the utility and characteristics of the outcome measures. The results from this study will inform the design of a multicentre trial. Trial registration ISRCTN35272486.
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Affiliation(s)
- Benjamin E Smith
- Derby Teaching Hospitals NHS Foundation Trust, Physiotherapy Department (Level 3), London Road Community Hospital, Derby, DE1 2QY UK.,Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Marcus Bateman
- Derby Teaching Hospitals NHS Foundation Trust, Physiotherapy Department (Level 3), London Road Community Hospital, Derby, DE1 2QY UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine at Aalborg University, Aalborg, Denmark.,Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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Abady AH, Rosedale R, Overend TJ, Chesworth BM, Rotondi MA. Inter-examiner reliability of diplomats in the mechanical diagnosis and therapy system in assessing patients with shoulder pain. J Man Manip Ther 2014; 22:199-205. [PMID: 25395828 DOI: 10.1179/2042618614y.0000000068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To investigate the inter-examiner reliability of Mechanical Diagnosis and Therapy (MDT)-trained diplomats in classifying patients with shoulder disorders. The MDT system has demonstrated acceptable reliability when used in patients with spinal disorders; however, little is known about its utility when used for appendicular conditions. METHODS Fifty-four clinical scenarios were created by a group of 11 MDT diploma holders based on their clinical experience with patients with shoulder pain. The vignettes were made anonymous, and their clinical diagnoses sections were left blank. The vignettes were sent to a second group of six international McKenzie Institute diploma holders who were asked to classify each vignette according to the MDT categories for upper extremity. Inter-examiner agreement was evaluated with kappa statistics. RESULTS There was 'very good' agreement among the six MDT diplomats for classifying the McKenzie syndromes in patients with shoulder pain (kappa = 0.90, SE = 0.018). The raw overall level of multi-rater agreement among the six clinicians in classifying the vignettes was 96%. After accounting for the actual MDT category for each vignette, kappa and the raw overall level of agreement decreased negligibly (0.89 and 95%, respectively). DISCUSSION Using clinical vignettes, the McKenzie system of MDT has very good reliability in classifying patients with shoulder pain. As an alternative, future reliability studies could use real patients instead of written vignettes.
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Affiliation(s)
| | | | - Tom J Overend
- School of Physical Therapy, Western University, London, Canada
| | - Bert M Chesworth
- School of Physical Therapy, Western University, London, Canada ; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Michael A Rotondi
- School of Kinesiology and Health Sciences, York University, Toronto, Canada
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Littlewood C, Malliaras P, Mawson S, May S, Walters S. Development of a self-managed loaded exercise programme for rotator cuff tendinopathy. Physiotherapy 2013; 99:358-62. [DOI: 10.1016/j.physio.2012.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 12/11/2012] [Indexed: 11/27/2022]
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