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Garzón M, Balasch-Bernat M, Cook C, Ezzatvar Y, Álvarez-Lliso Ó, Dueñas L, Lluch E. How long does tendinopathy last if left untreated? Natural history of the main tendinopathies affecting the upper and lower limb: A systematic review and meta-analysis of randomized controlled trials. Musculoskelet Sci Pract 2024; 72:103103. [PMID: 38879981 DOI: 10.1016/j.msksp.2024.103103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Natural history of disease refers to the progression of a disease process in an individual over time, in the absence of treatment. Understanding natural history of tendinopathies is key for clinicians to make accurate prognostic predictions and design effective intervention studies. OBJECTIVE To quantify the natural history of the main tendinopathies regarding pain and function and to compare outcomes between untreated individuals and those receiving treatment. METHODS A systematic literature search was conducted until February 2023, across PubMed, Cochrane, Embase and Scopus databases. Selection criteria included randomized controlled trials (RCTs) with a "wait-and-see" group and cohort studies with ≥3 months of follow-up reporting on pain and function-related outcomes. Standardized mean differences (SMDs) of "wait-and-see" groups were pooled using a random-effects inverse-variance model. Risk of bias was assessed using Cochrane Risk-of-Bias (RoB2), and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS Six RCTs were included, encompassing 518 subjects with tendinopathy. Pooled results demonstrated significant pain (SMD = 0.30, 95%CI: 0.19-0.41) and physical function improvement (SMD = 0.38, 95%CI: 0.28-0.48). These estimates remained consistent regardless of age or follow-up duration. In rotator cuff tendinopathy, untreated individuals improved but did not fully recover at one year, with similar outcomes to other interventions (e.g., surgery). Subjects with lateral elbow, patellar and achilles tendinopathies when untreated, did not fully resolve symptoms within 12-16 weeks. CONCLUSIONS This review provides limited conclusions about natural history of tendinopathies. Future studies should incorporate true no-intervention groups to accurately reflect tendinopathy's natural progression.
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Affiliation(s)
- M Garzón
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain.
| | - M Balasch-Bernat
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain.
| | - C Cook
- Division of Physical Therapy, Department of Orthopaedics, Department of Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
| | - Y Ezzatvar
- Nursing Department, Faculty of Nursing and Podiatry, University of Valencia, 46010, Valencia, Spain.
| | - Ó Álvarez-Lliso
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain.
| | - L Dueñas
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain.
| | - E Lluch
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain; Departments of Human Physiology and Rehabilitation Sciences, "Pain in Motion" International Research Group, Brussels, Belgium.
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Silveira A, Lima C, Beaupre L, Chepeha J, Jones A. Shoulder specific exercise therapy is effective in reducing chronic shoulder pain: A network meta-analysis. PLoS One 2024; 19:e0294014. [PMID: 38683828 PMCID: PMC11057978 DOI: 10.1371/journal.pone.0294014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/24/2023] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Exercise therapy (ET) is frequently an early treatment of choice when managing shoulder pain, yet evidence on its efficacy to expedite recovery is inconsistent. Moreover, the value of adding adjunct therapies (i.e. injections, manual therapy, electrotherapy) to ET is currently unclear. This study combined both direct and indirect evidence across studies on the effectiveness of ET with/without adjunct therapies compared to usual medical care for adults with chronic shoulder pain. METHODS AND FINDINGS Using a network meta-analysis, randomized control trials comparing ET along with adjunct therapies were identified in MEDLINE, Embase, CINAHL, Sportdiscus, CENTRAL, Conference Proceedings Citation Index-Science, clinicaltrials.gov, and association websites. Outcomes included pain, range of motion (ROM), and health-related quality of life (HRQL) measures in adult patients with chronic shoulder pain. Data analysis used a Frequentist hierarchical model. CINeMA tool assessed the confidence in the results and Cochrane Risk of Bias tool assessed quality of studies. 54 studies primarily from Europe (40.38%) included 3,893 participants who were followed up to 52 weeks. Shoulder-specific ET (Mean difference (MD) = -2.1; 95% confidence interval (CI) = -3.5 to -0.7) or in combination with electro-physical agents (MD = -2.5; 95% CI = -4.2 to -0.7), injections (MD = -2.4; 95% CI = -3.9 to-1.04) or manual therapy (MD = -2.3; 95% CI = -3.7 to -0.8) decreased pain compared to usual medical care. Trends with ROM and HRQL scores were seen; however, only Manual Therapy (MD = -12.7 and 95% CI = -24.4 to -1.0) achieved meaningfully important changes. Sensitivity analysis excluding studies with high risk of bias showed similar results, with exception of injections that did not reach significance (MD = -1.3; 95% CI = -4.3 to 1.7). CONCLUSION(S) Shoulder-specific ET provided pain relief up to 52 weeks. Adjunct therapies to shoulder-specific ET added little value in reducing pain. The quality of evidence varied between moderate and very low.
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Affiliation(s)
- Anelise Silveira
- University of Alberta, School of Public Health, Edmonton, Alberta, Canada
| | - Camila Lima
- University of Alberta, School of Public Health, Edmonton, Alberta, Canada
| | - Lauren Beaupre
- University of Alberta, Faculty of Rehabilitation Sciences, Edmonton, Alberta, Canada
- University of Alberta, Collaborative Orthopaedic Research, Edmonton, Alberta, Canada
| | - Judy Chepeha
- University of Alberta, Collaborative Orthopaedic Research, Edmonton, Alberta, Canada
| | - Allyson Jones
- University of Alberta, Faculty of Rehabilitation Sciences, Edmonton, Alberta, Canada
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Leatherwood W, Torres A, Hidalgo Perea S, Paulus M. Demographic and Diagnostic Factors in Physical Therapy Attendance. Cureus 2024; 16:e55908. [PMID: 38601391 PMCID: PMC11004832 DOI: 10.7759/cureus.55908] [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] [Accepted: 03/10/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction Physical therapy (PT) is an effective nonoperative treatment for various orthopedic diagnoses. However, patients may have many reasons to dismiss PT, including favoring another intervention for their injury, time constraints, transportation, and cost. This dismissal of PT may contribute to inadequate patient compliance. This study aimed to elucidate patient compliance with a basic PT prescription and whether PT led to subjective injury improvement. Methods This is a retrospective study of patients observed in Stony Brook Orthopedic clinics from 08/01/2022 to 12/23/2022. Patients prescribed PT received a phone call six weeks after the PT prescription. The primary outcome was patient attendance at PT. Secondary outcomes were subjective; symptomatic improvement was listed as better, worse, or the same. Chi-square testing was used to compare outcomes. Results A total of 100 patients were enrolled in the study. Patients prescribed PT following surgery were more likely to attend compared to patients prescribed PT as a primary treatment (P value=0.027). The association between attendance at PT and a change in subjective symptoms (better, worse, same) was not significant. Patients' age, sex, and chronicity of injury were not significant factors in PT attendance. Of the 40 patients who did not attend PT, 14 cited time constraints, 11 utilized self-directed treatment, three cited insurance, two cited transportation, and 10 cited other reasons. Conclusions Overall, postoperative patients were more likely to attend PT compared to patients prescribed PT as a primary treatment. Factors such as age, sex, and chronicity of injury did not affect whether a patient attended PT. Of the patients enrolled, 71% stated subjective improvement in symptoms, but there was no association between symptoms and PT attendance. This study highlights the characteristics of those patient factors that may influence PT compliance and underscores the importance of further research into the population most likely to attend and benefit from PT.
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Affiliation(s)
| | - Adrian Torres
- Department of Orthopaedic Surgery, Stony Brook University, New York, USA
| | | | - Megan Paulus
- Department of Orthopaedic Surgery, Stony Brook University, New York, USA
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Tanık F, Keskin M, Özer Kaya D. Pressure pain sensitivity, thermographic changes, function, life and sleep quality in patients with unilateral rotator cuff injury: A case-control study. Musculoskelet Sci Pract 2023; 67:102860. [PMID: 37741010 DOI: 10.1016/j.msksp.2023.102860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/03/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION-AIM This study aimed to assess pressure pain sensitivity, thermographic changes, functional status, quality of life, and sleep in individuals with unilateral shoulder pain due to rotator cuff tear and compare these parameters with the unaffected side and asymptomatic individuals. MATERIAL-METHOD Thirty-two patients with unilateral rotator cuff injury and 32 volunteers without shoulder problems were included. Pain was evaluated using a visual analogue scale, pressure pain sensitivity with a digital algometer, thermographic changes with a thermal camera, upper extremity function through the Disabilities of the Arm, Shoulder, and Hand Disability Questionnaire, sleep quality using the Pittsburgh Sleep Quality Index, and quality of life using SF-36. RESULTS Pressure pain sensitivity of the deltoideus, supraspinatus, and subscapularis muscles in the affected limb was lower than in the unaffected limb (p = 0.027, p = 0.005, p < 0.001). Conversely, pressure sensitivity of the deltoideus, biceps brachii, and subscapularis muscles was higher in the patient group (p = 0.008, p = 0.042, p < 0.001). Furthermore, a decrease in temperature was observed in all patients, except for the trapezius muscles of the affected side (p < 0.05). CONCLUSION This study sheds light on altered pressure pain sensitivity and thermographic changes in individuals with unilateral shoulder pain due to rotator cuff tear. Additionally, the study highlights impairments in functional status, quality of life, and sleep in these individuals, emphasizing the broader impact of such injuries. Targeted interventions based on these findings have the potential to enhance overall well-being and functional outcomes for affected individuals. LEVEL OF EVIDENCE Level III, Case-control study, prognosis study.
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Affiliation(s)
- Faruk Tanık
- Department of Physiotherapy and Rehabilitation, Health Sciences Institute, Izmir Katip Celebi University, Izmir, Turkey.
| | - Merve Keskin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Derya Özer Kaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
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Kamonseki DH, Haik MN, Ribeiro LP, Almeida RF, Camargo PR. Scapular movement training is not superior to standardized exercises in the treatment of individuals with chronic shoulder pain and scapular dyskinesis: randomized controlled trial. Disabil Rehabil 2023; 45:2925-2935. [PMID: 36000960 DOI: 10.1080/09638288.2022.2114552] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 08/06/2022] [Accepted: 08/13/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate whether scapular movement training (SMT) is superior to standardized exercises in improving scapular biomechanics, behavioral, and clinical aspects of individuals with shoulder pain. METHODS AND METHODS A total of 64 individuals with chronic shoulder pain were randomly assigned to receive 16 sessions of SMT or SE over 8 weeks. Outcome measures included three-dimensional scapular kinematics, muscle activity of scapulothoracic muscles, pain, disability, fear-avoidance, kinesiophobia, and self-perceived changes. Kinematics and muscle activity were assessed at baseline and after treatment, and self-reported measurements at baseline, 4, 8, and 12 weeks. RESULTS SMT significantly (p < 0.05) decreased scapular internal rotation during arm elevation and lowering at sagittal and scapular planes (mean difference [MD]: ranged from 2.8 to 4.1°), and at lower angles of arm elevation and lowering at the frontal plane (MD: 3.4° and 2.4°, respectively), increased upper trapezius (UT) activity (MD: 10.3%) and decreased middle trapezius (MT) (MD: 60.4%) and serratus anterior (MD: 9.9%) activity during arm lowering compared to SE. Both groups significantly improved pain, disability, fear-avoidance, kinesiophobia, and self-perceived changes over 4 weeks, which was sustained over the remaining 8 weeks. CONCLUSIONS SMT is not superior to standardized exercises in improving scapular biomechanics, behavioral, and clinical aspects of individuals with shoulder pain. CLINICAL TRIAL REGISTRATION NUMBER NCT03528499Implications for rehabilitationScapular movement training (SMT) showed small and likely not clinically relevant changes in scapular kinematics and muscle activity compared to standardized exercises.SMT and standardized exercises presented similar improvements in pain, disability, fear-avoidance beliefs, kinesiophobia, and self-perceived change in health condition immediately following 4-weeks of treatment, which was sustained over the following 8 weeks.The changes in patient-reported outcome measures are unlikely to be associated with changes in scapular kinematics and electromyographic activity.Clinicians should consider other factors than scapular movement during the treatment of patients with shoulder pain.
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Affiliation(s)
- Danilo Harudy Kamonseki
- Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Melina Nevoeiro Haik
- Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Larissa Pechincha Ribeiro
- Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Rafaela Firmino Almeida
- Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Paula Rezende Camargo
- Department of Physical Therapy, Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos, São Carlos, Brazil
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Jafarian Tangrood Z, Spontelli Gisselman A, Sole G, Cury Ribeiro D. Clinical course of pain and function in subacromial shoulder pain: a systematic review with meta-analysis. PHYSICAL THERAPY REVIEWS 2023. [DOI: 10.1080/10833196.2023.2192620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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Azin Z, Kamali F, Salehi Dehno N, Abolahrari-Shirazi S. Comparison of Manual Therapy Technique to Therapeutic Exercise in the Treatment of Patients With Subacromial Impingement Syndrome: A Randomized Clinical Trial. J Manipulative Physiol Ther 2023; 46:98-108. [PMID: 37777940 DOI: 10.1016/j.jmpt.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/22/2023] [Accepted: 06/26/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the effects of manual therapy to therapeutic exercise on shoulder pain, disability, and range of motion (ROM) in patients with subacromial impingement syndrome (SAIS). METHODS Sixty patients with SAIS were randomly assigned into the manual therapy (MT) and therapeutic exercise (TE) groups. Patients in the MT group were treated with joint mobilization, which was applied to the glenohumeral, acromioclavicular, sternoclavicular and scapulothoracic joints, and trigger point (TrP) inactivation using ischemic compression. Patients in the TE group performed therapeutic exercises. Shoulder pain, disability and active ROM (elevation, external rotation, and internal rotation) were assessed by the visual analog scale, the Shoulder Pain and Disability Index, and a goniometer, respectively. The outcomes were measured at baseline, after the intervention, and 1 month after the intervention. RESULTS After the treatment, both groups had significant improvements in shoulder pain, disability, and ROM (P < .05). The MT group experienced a greater reduction in shoulder pain than the TE group (P < .001). However, in disability and ROM, both groups exhibited similar improvements in post-treatment and follow-up periods. CONCLUSION Both MT and TE were effective in improving shoulder pain, disability, and ROM in patients with SAIS. Greater improvement in shoulder pain was observed in the MT group.
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Affiliation(s)
- Zeynab Azin
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Kamali
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Salehi Dehno
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Abolahrari-Shirazi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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El-Gendy MH, Ibrahim MM, Helmy ES, Neamat Allah NH, Alkhamis BA, Koura GM, Hamada HA. Effect of manual physical therapy on sleep quality and jaw mobility in patients with bruxism: A biopsychosocial randomized controlled trial. Front Neurol 2022; 13:1041928. [PMID: 36570455 PMCID: PMC9774945 DOI: 10.3389/fneur.2022.1041928] [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: 09/13/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
This study aimed to investigate the effects of deep-stripping and trigger-point pressure release massage on the Pittsburgh Sleep Quality Index (PSQI), jaw mobility, and pressure pain threshold (PPT) of masticatory muscles in patients with sleep bruxism. A randomized controlled trial was conducted among 45 patients diagnosed with sleep bruxism. The patients were randomly assigned to three groups. Group I was the control group and included five men and 10 women; Group II was the deep-stripping massage group, which included two men and 13 women; and Group III was the pressure release group, which involved four men and 11 women. Patients were tested two times, before and after 6 weeks. Group I received transcutaneous electrical nerve stimulation and passive stretching; Group II received a deep-stripping massage; and Group III received a trigger-point pressure release massage. Findings revealed significant improvements in PSQI (p = 0.0001), jaw opening (p = 0.0001), jaw protrusion (p = 0.0001), jaw left lateral movement (p = 0.004), jaw retraction (p = 0.0001), right temporalis PPT (p = 0.0001), left temporalis PPT (p = 0.0001), right master PPT (p = 0.001), left master PPT (p = 0.001), right lateral pterygoid PPT (p = 0.001), left lateral pterygoid PPT (p = 0.001), right digastric muscle PPT (p = 0.001), and left digastric muscle PPT (p = 0.001) in the post-test condition in Group II compared with Group I and Group III. Deep-stripping massage improved PSQI, jaw mobility, or PPT of the masticatory muscles compared with trigger-point pressure release massage and traditional treatment techniques in patients with sleep bruxism.
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Affiliation(s)
- Mohamed H. El-Gendy
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Mostafa M. Ibrahim
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Emad S. Helmy
- Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Giza, Egypt
| | - Neama H. Neamat Allah
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Batool Abdulelah Alkhamis
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Ghada M. Koura
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia,Department of Physical Therapy for Musculoskeletal Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Hamada A. Hamada
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt,*Correspondence: Hamada A. Hamada
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Effects of Upper Trapezius Myofascial Trigger Points on Scapular Kinematics and Muscle Activation in Overhead Athletes. J Hum Kinet 2022; 84:32-42. [DOI: 10.2478/hukin-2022-000079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract
Prolonged overactivity of the upper trapezius muscle with myofascial trigger points might cause muscle fatigue and subsequently change scapular kinematics and associated muscular activities. Scapular kinematics and associated muscular activities were investigated in 17 overhead athletes with upper trapezius myofascial trigger points and 17 controls before and after a fatigue task. Participants performed a fatigue task requiring sustained isometric scapular elevation. The outcomes included scapular kinematics (upward/downward rotation, external/internal rotation, posterior/anterior tilt) that were tracked by the Polhemus FASTRAK (Polhemus Inc., Colchester, VT, USA) system with Motion Monitor software and muscular activities (upper trapezius, lower trapezius and serratus anterior) that were collected at 1000 Hz per channel using a 16-bit analog-to-digital converter (Model MP 150, Biopac systems Inc., CA, USA) with pairs of silver chloride circular surface electrodes (The Ludlow Company LP, Chocopee, MA) during arm elevation. Mixed ANOVAs were conducted to characterize the outcomes with and without a fatigue task in participants with myofascial trigger points. Decreased scapular posterior tipping during 90 degrees of arm raising/lowering (effect sizes of 0.51 and 0.59) was likely to be elicited by the scapular elevation fatigue task in the presence of myofascial trigger points. Activity of the lower trapezius was higher in the myofascial trigger point group (6.2%, p = 0.036) than in the control group. Following the fatigue task, both groups showed increased activity in the upper trapezius (9.0%, p = 0.009) during arm lowering and in the lower trapezius (2.7%, p < 0.01) during arm raising and lowering. Decreased scapular posterior tipping during 90 degrees of arm raising/lowering after a fatigue task may lead to impingement. We found that the presence of upper trapezius myofascial trigger points in amateur overhead athletes was related to impaired scapular kinematics and associated muscular activities during arm elevation after a fatigue task, especially the decreased scapular tipping during 90 degrees of raising/lowering.
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Lv S, Wang Q, Ni Q, Qi C, Ma Y, Li S, Xu Y. Progress of Muscle Chain Theory in Shoulder Pain Rehabilitation: Potential Ideas for Pulmonary Rehabilitation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:2537957. [PMID: 36110187 PMCID: PMC9470317 DOI: 10.1155/2022/2537957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022]
Abstract
Pulmonary dysfunction is very common in stroke patients. A study has shown that acute stroke patients often cause a series of pulmonary dysfunction due to primary damage to the respiratory center, which is an important reason for hindering disease treatment and recovery. American Thoracic Society (ATS) and the European Respiratory Society (ERS) pointed out that pulmonary rehabilitation (PR) can be applied to the rehabilitation of stroke patients to improve their lung function. PR can improve the respiratory muscle strength of stroke patients, which is beneficial to improving the respiratory function of patients. At the same time, it can also significantly increase the maximum oxygen intake of patients, effectively improve the cardiopulmonary function of stroke patients, and reduce respiratory complications such as aspiration pneumonia. However, the common dysfunction of joints and muscles such as shoulder pain after stroke will affect the process of pulmonary rehabilitation. This is mainly because the changes in the position of the shoulder girdle, the decrease in the range of motion of the cervical and thoracic spine, and the changes in the cervical spondylolisthesis position caused by the elevation of the upper limbs will directly affect the breathing movement during the pulmonary rehabilitation process. The instability of the spine will weaken the deep abdominal muscles and reduce the function of the diaphragm; moreover, changes in the alignment and stability of the cervical and thoracic spine will also lead to wrong breathing methods. Therefore, it is of practical clinical significance to evaluate the functional rehabilitation of shoulder joint muscles and evaluate the efficacy of stroke patients to improve their respiratory function. This article through an extensive review of domestic and foreign literature in recent years, combined with clinical practice experience, summarizes the practical application of chain structure theory in the fields of rehabilitation training, postural adjustment, pain relief, etc., and further studies the functional exercise method based on muscle chain theory. The research on the muscle chain of shoulder pain rehabilitation as a model illustrates the positive effect of reconstructing neuroarticular muscle function on the respiratory system, hoping to provide new ideas for the treatment of respiratory diseases in stroke patients.
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Affiliation(s)
- Shi Lv
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - Qian Wang
- Postdoctoral Workstation, Department of Central Laboratory, The Affiliated Taian City Central Hospital of Qingdao University, Taian 271000, China
| | - Qingbin Ni
- Postdoctoral Workstation, Department of Central Laboratory, The Affiliated Taian City Central Hospital of Qingdao University, Taian 271000, China
| | - Chunhua Qi
- Postdoctoral Workstation, Department of Central Laboratory, The Affiliated Taian City Central Hospital of Qingdao University, Taian 271000, China
| | - Yihong Ma
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-0811, Japan
| | - Simin Li
- Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
| | - Yuzhen Xu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
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Sathe T, Prabhu A, Vishal K. Within-Subject Changes in Shoulder Girdle Muscle Activation After Soft Tissue Mobilization of the Upper Trapezius. J Chiropr Med 2022; 21:149-156. [PMID: 36118108 PMCID: PMC9479171 DOI: 10.1016/j.jcm.2022.04.003] [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: 05/13/2020] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 10/16/2022] Open
Abstract
Objective The purpose of this study was to investigate the effect of the integrated neuromuscular inhibition technique (INIT) of the upper trapezius (UT) on shoulder muscle activity in chronic shoulder pain. Methods Twenty-two patients (mean age 42.5 ± 16.07) with chronic unilateral shoulder pain with UT myofascial trigger points (MTrPs) (n = 27) and scapular dyskinesis received a single session of INIT (∼15 minutes for each MTrP). The pain on the visual analog scale, along with surface electromyographic activity, maximum voluntary contraction in % (in arm raising and lowering in scapular plane), and pressure pain threshold (PPT) of 5 girdle muscles UT, lower trapezius, serratus anterior, middle deltoid, and infraspinatus were measured before and immediately after treatment. Wilcoxon signed-rank test was used for analysis (at α ≤ 0.05). Results Muscle activity of all the muscles, especially the lower trapezius, was reduced during arm raising in the scapular plane (76.69%-71.14% [p = 0.003]). UT activity decreased during arm lowering also (56.70%-45.99% [p ˂ 0.001]). The intensity of shoulder pain reduced (50.50 mm to 22 mm, [p ˂ 0.001]), and PPT values of all 5 muscles improved post-treatment. Conclusion The findings of this study provide preliminary evidence for the application of a single session of INIT on UT MTrPs in reducing activity in the scapular muscles, improving shoulder pain, and PPT in chronic unilateral shoulder pain.
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Affiliation(s)
| | | | - Kavitha Vishal
- Corresponding author: Kavitha Vishal, MPT, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Madhav Nagar, Manipal, Karnataka, India 576104
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Lee HJ, Lee JH, Yi KH, Kim HJ. Intramuscular Innervation of the Supraspinatus Muscle Assessed Using Sihler’s Staining: Potential Application in Myofascial Pain Syndrome. Toxins (Basel) 2022; 14:toxins14050310. [PMID: 35622557 PMCID: PMC9143847 DOI: 10.3390/toxins14050310] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
Despite the positive effects of botulinum neurotoxin (BoNT) injection into the neural arborized area, there is no anatomical evidence in the literature regarding the neural arborization of the supraspinatus muscle. The present study aimed to define the intramuscular neural arborized pattern of the supraspinatus muscle using the modified Sihler’s staining method to facilitate the establishment of safe and effective injection sites in patients with myofascial pain in the supraspinatus muscle. Seventeen supraspinatus muscles from 15 embalmed cadavers were dissected. Precise suprascapular nerve entry locations were also observed. Intramuscular neural arborization was visualized by Sihler’s staining. The supraspinatus muscle was divided into four portions named A, B, C, and D. The nerve entry points were observed in 88.2% (15 of 17 cases) of section B and 76.5% (13 of 17 cases) of section C of the supraspinatus muscle, respectively. The concentration of intramuscular neural arborization was highest in section B of the supraspinatus muscle, which was the center of the supraspinatus muscle. When the clinician performs a trigger point and a BoNT injection into the supraspinatus muscle, injection within the medial 25–75% of the supraspinatus muscle will lead to optimal results when using small amounts of BoNT and prevent undesirable paralysis.
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Affiliation(s)
- Hyung-Jin Lee
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Ji-Hyun Lee
- BK21 FOUR Project, Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, Yonsei University College of Dentistry, Seoul 03722, Korea; (J.-H.L.); (K.-H.Y.)
| | - Kyu-Ho Yi
- BK21 FOUR Project, Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, Yonsei University College of Dentistry, Seoul 03722, Korea; (J.-H.L.); (K.-H.Y.)
- COVID-19 Division, Wonju City Public Health Center, Wonju-Si 26417, Korea
| | - Hee-Jin Kim
- BK21 FOUR Project, Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, Yonsei University College of Dentistry, Seoul 03722, Korea; (J.-H.L.); (K.-H.Y.)
- Department of Materials Science & Engineering, College of Engineering, Yonsei University, Seoul 03722, Korea
- Correspondence:
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13
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Pintas S, Zhang A, James KJ, Lee RM, Shubov A. Effect of Inpatient Integrative Medicine Consultation on 30-Day Readmission Rates: A Retrospective Observational Study at a Major U.S. Academic Hospital. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:241-249. [PMID: 35294299 DOI: 10.1089/jicm.2021.0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: The prevalence of inpatient integrative medicine (IM) consult services is increasing among academic health care institutions. The diversity of services between institutions, as well as the novel nature of such interventions, makes it challenging for health care administrators to determine the cost/benefit of adding such a program to their institution. The main purpose of this study was to examine the performance of the new University of California, Los Angeles (UCLA) East-West (EW) consult service as measured by 30-day readmission rates and lengths of stay. Design: This is a retrospective observational case-control study with participants matched to themselves. Setting: UCLA Santa Monica Hospital, a 281-bed academic tertiary care hospital near Los Angeles, California. Subjects: Patients who had received an EW consultation during the inaugural 20 months of the program (2018-2020), and who had been hospitalized in the prior 2 years from the date of their first EW consult. Intervention: Inpatient East-West consultation, which may include counseling, acupuncture and/or trigger point injections depending on medical necessity. Outcome Measures: Thirty-day readmission rates and lengths of hospital admission were compared between the hospitalization that included an EW consult (which included the use of acupuncture and/or trigger point injections when appropriate) and any prior admissions during the 2 years before that EW consult. Secondary outcomes included quantitative analysis of average number of treatments and qualitative assessment of integrative treatment(s) received, conditions treated, and reasons that EW treatment may have been deferred during a consult. Results: One hundred sixty-five unique patients met the study criteria. The EW consultation was associated with clinically relevant, statistically significant decreased 30-day readmission rates (33.0% vs. 4.6%, p < 0.001, odds ratio [OR] 0.10, 95% confidence interval [CI] 0.06-0.17). This effect was similar when limiting the analysis to pain-related admissions (32.3% vs. 3.4%, p < 0.001, OR = 0.07, 95% CI 0.03-0.16). Hospital admissions with EW consults were found to have a statistically significant increased length of stay (7.03 days vs. 5.40 days, p < 0.001). Conclusion: The EW medicine, an example of IM, correlates with a reduced risk of 30-day readmission and with modestly increased lengths of stay.
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Affiliation(s)
- Stephanie Pintas
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Annie Zhang
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Department of Medicine, UCLA Santa Monica Hospital, Santa Monica, California, USA.,Department of Medicine, UCLA Center for East West Medicine, Los Angeles, California, USA
| | - Kevin J James
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Roger M Lee
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Department of Medicine, UCLA Santa Monica Hospital, Santa Monica, California, USA
| | - Andrew Shubov
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Department of Medicine, UCLA Santa Monica Hospital, Santa Monica, California, USA.,Department of Medicine, UCLA Center for East West Medicine, Los Angeles, California, USA
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14
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Wei X, Shi G, Tu J, Zhou H, Duan Y, Lee CK, Wang X, Liu C. Structural and Functional Asymmetry in Precentral and Postcentral Gyrus in Patients With Unilateral Chronic Shoulder Pain. Front Neurol 2022; 13:792695. [PMID: 35250808 PMCID: PMC8892006 DOI: 10.3389/fneur.2022.792695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/13/2022] [Indexed: 12/25/2022] Open
Abstract
Objective The purpose of this study was to explore the structural and functional asymmetry of precentral and postcentral gyrus in patients with unilateral chronic shoulder pain (CSP) utilizing MRI. Patients and Methods We collected structural and resting-state functional MRI (rs-fMRI) data in 22 left-sided, 15 patients with right-sided CSP, and 24 healthy controls (HCs). Here, we performed the structural asymmetry and seed-based functional connectivity (FC) analyses. We extracted regional cortical thickness and surface area measurements from T1-weighted MRI images, using asymmetry indexes (AIs) to assess asymmetries. We used Data Processing and Analysis for Brain Imaging software for seed-based FC analysis and selected unilateral-precentral and postcentral as the regions of interest. Then, we performed group comparisons of the neuroimaging metrics, and also explored the relationships between brain asymmetry and clinical variables. Results We found significant differences in surface area AIs of the precentral among three groups, the AI values were negatively correlated with the visual analog scale score and positively correlated with Constant–Murley scores (CMS) in the left-sided CSP group. Further, FC of left postcentral with cingulate gyrus and left paracentral lobule showed significant group differences; FC of right postcentral with left caudate, left paracentral, and left postcentral were different among groups; FC of right precentral with the cingulate gyrus, precuneus, and left paracentral revealed significant group differences. Besides, there was a positive correlation between right precentral-cingulate gyrus FC and CMS in the right-sided CSP group. Conclusion Surface area and FC patterns asymmetry exist in precentral and postcentral gyrus in patients with unilateral CSP. Asymmetry trend is associated with pain severity and shoulder joint function impairment. Brain structural and functional asymmetry may be an important indicator for understanding the potential mechanism of chronic pain.
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Affiliation(s)
- Xiaoya Wei
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Guangxia Shi
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jianfeng Tu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Hang Zhou
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yanshan Duan
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chin Kai Lee
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xu Wang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
- Xu Wang
| | - Cunzhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Cunzhi Liu
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15
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Aksan Sadikoglu B, Analay Akbaba Y, Taskiran H. Effects of ischemic compression and instrument-assisted soft tissue mobilization techniques in trigger point therapy in patients with rotator cuff pathology: randomized controlled study. Somatosens Mot Res 2021; 39:70-80. [PMID: 34818976 DOI: 10.1080/08990220.2021.2005015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the ischaemic compression (IC) and instrument-assisted soft tissue mobilization (IASTM) in the treatment of MTrPs in addition to standard rehabilitation program in patients with rotator cuff tears. METHODS Participants with rotator cuff tears were included the study (n = 46). Patients were randomly divided into two groups; which were Group 1 (IC + standard rehabilitation program (n = 23)), and Group 2 (IASTM + standard rehabilitation program (n = 23)) groups. Pain were assessed by visual analog scale (VAS). Range of motion (ROM) was assessed by a universal goniometer. Active MTrPs were assessed according to the Travel and Simons criteria. Pressure pain threshold (PPT) were assessed by a digital algometer. Function were evaluated by the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) and American Shoulder and Elbow Surgeons Standardised Shoulder Assessment (ASES) Form. Anxiety and depression were evaluated by the Hospital Anxiety and Depression (HAD) scale. Satisfaction was assessed by the Global Rating of Change scale after 6 weeks treatment. RESULTS After the treatment, pain, ROM and the DASH, ASES, HAD scores improved in both groups (p < 0.05). The active MTrPs of 2 muscles, PPT of 4 muscles and DASH in Group 1 significantly improved compared to Group 2 (p < 0.05). CONCLUSION Although patients with low functionality accumulated in the IC group, the IC is more effective than the IASTM in increasing the PPT and functional improvement according to the results of the DASH score.
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Affiliation(s)
- Busra Aksan Sadikoglu
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey
| | - Yildiz Analay Akbaba
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hanifegul Taskiran
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey
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16
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Lai YC, Tsai SH, Chiou HJ. Ultrasound-guided dextrose solution perimysium dissection for posterior shoulder myofascial pain. J Chin Med Assoc 2021; 84:650-654. [PMID: 33883463 DOI: 10.1097/jcma.0000000000000541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To assess the efficacy and safety of perimysium dissection for posterior shoulder myofascial pain. METHODS This retrospective single-arm study was performed at a medical center between April 2016 and August 2017. Fifty-seven participants with refractory chronic posterior shoulder pain of myofascial origin underwent ultrasound (US)-guided perimysium dissection with hypertonic dextrose solution. Visual analog scale (VAS) scores and complication rate were evaluated before treatment and 4 weeks after treatment. RESULTS US-guided perimysium dissection with dextrose solution resulted in excellent treatment efficacy and safety. Nineteen participants (33.3%) were free of pain after treatment, and 32 (56.1%) had >50% improvement in pain score. Forty-nine participants had complete VAS records. Overall mean pre- and posttreatment VAS scores were 7.18 ± 1.60 and 1.91 ± 2.04 (mean difference -5.27, 95% CI -5.99 to -4.55, p < 0.0001), respectively, including 7.26 ± 1.44 and 1.84 ± 1.98 (mean difference -5.43, 95% CI -6.33 to -4.52, p < 0.0001) for those with infraspinatus myofascial pain, and 7.00 ± 1.96 and 2.07 ± 2.26 (mean difference -4.93, 95% CI -6.23 to -3.62, p < 0.0001) for those in the teres minor subgroup. No complications were reported in any of the participants. One participant received retreatment for teres minor myofascial pain. CONCLUSION US-guided perimysium dissection is an easy, safe, and effective injection method to manage posterior myofascial shoulder pain.
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Affiliation(s)
- Yi-Chen Lai
- Division of Breast Imaging & Ultrasound, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Sheng-Han Tsai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Urology, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Hong-Jen Chiou
- Division of Breast Imaging & Ultrasound, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
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17
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Abstract
PURPOSE OF REVIEW This review focuses on the current insights and developments in neuralgic amyotrophy (NA), an auto-immune multifocal peripheral nervous system disorder that leaves many patients permanently impaired if not recognized and treated properly. RECENT FINDINGS NA is not as rare as previously thought. The phenotype is broad, and recent nerve imaging developments suggest that NA is the most common cause of acute anterior or posterior interosseous nerve palsy. Phrenic nerve involvement occurs in 8% of all NA patients, often with debilitating consequences. Acute phase treatment of NA with steroids or i.v. immunoglobulin may benefit patients. Long-term consequences are the rule, and persisting symptoms are mainly caused by a combination of decreased endurance in the affected nerves and an altered posture and movement pattern, not by the axonal damage itself. Patients benefit from specific rehabilitation treatment. For nerves that do not recover, surgery may be an option. SUMMARY NA is not uncommon, and has a long-term impact on patients' well-being. Early immunomodulating treatment, and identifying phrenic neuropathy or complete nerve paralysis is important for optimal recovery. For persistent symptoms a specific treatment strategy aiming at regaining an energy balance and well-coordinated scapular movement are paramount.
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18
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Shanmugam S, Mathias L, Manickaraj N, Kumar KUD, Kandakurti PK, Dorairaj SK, Muthukrishnan R. Intramuscular Electrical Stimulation Combined with Therapeutic Exercises in Patients with Shoulder Adhesive Capsulitis: A Randomised Controlled Trial. Int J Surg Protoc 2021; 25:71-83. [PMID: 34056148 PMCID: PMC8139297 DOI: 10.29337/ijsp.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background: Myofascial trigger points (MTrPs) precipitate the shoulder pain severity and disability in patients with shoulder adhesive capsulitis (SAC). This study aims to compare the effectiveness of intramuscular electrical stimulation (IMES) combined with therapeutic exercises versus dry needling (DN) combined with therapeutic exercises in improving the clinical outcomes in patients with SAC. Methods and Materials: In this randomized controlled trial, IMES (n = 45) and DN (43) groups had received respectively IMES, and DN twice weekly for three consecutive weeks. Both groups received therapeutic exercises 1520 minutes, five days in a week during the second and third week. Pain, disability, kinesiophobia, number of active and latent MTrPs, shoulder abduction and external rotation range of motion were assessed at baseline, week-1, week-2, week-3 and follow-up at 3 months. A repeated measures ANOVA performed to find out the significant differences in the clinical outcomes between the groups. Results: The results of repeated measures of ANOVA shows that the post intervention timelines assessment scores of VAS, DASH, shoulder abduction and external rotation ROM, number of active and latent MTrPs and kinesiophobia were significantly (p. < 0.05) improved in both groups. However, IMES group had achieved a greater improvement over DN group (p. < 0.05) on the shoulder pain severity and disability, shoulder range of motion, number of active and latent MTrPs and kinesiophobia. Despite the significant statistical differences between the groups, IMES group did not achieve the minimal clinically important differences of 1.5cm and 11-points respectively for the VAS and DASH scores. No serious adverse effects occurred during the three weeks of treatment. Conclusion: IMES combined with therapeutic exercises is an effective treatment to reduce the shoulder pain severity and upper limb disability by deactivating the active and latent MTrPs and improving the shoulder abduction and external rotation range of motion in patients with SAC.
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Affiliation(s)
- Sukumar Shanmugam
- College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates.,Nitte Institute of Physiotherapy, Nitte Deemed to be University, Mangaluru, India
| | - Lawrence Mathias
- K S Hegde Medical Academy, Nitte Deemed to be University, Mangaluru, India
| | | | - K U Dhanesh Kumar
- Nitte Institute of Physiotherapy, Nitte Deemed to be University, Mangaluru, India
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Yu H, Côté P, Wong JJ, Shearer HM, Mior S, Cancelliere C, Randhawa K, Ameis A, Carroll LJ, Nordin M, Varatharajan S, Sutton D, Southerst D, Jacobs C, Stupar M, Taylor-Vaisey A, Gross DP, Brison RJ, Paulden M, Ammendolia C, Cassidy JD, Marshall S, Bohay RN, Stapleton J, Lacerte M. Noninvasive management of soft tissue disorders of the shoulder: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration. Eur J Pain 2021; 25:1644-1667. [PMID: 33942459 DOI: 10.1002/ejp.1788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Objective of this study is to develop an evidence-based guideline for the noninvasive management of soft tissue disorders of the shoulder (shoulder pain), excluding major pathology. METHODS This guideline is based on high-quality evidence from seven systematic reviews. Multidisciplinary experts considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience is clinicians; target population is adults with shoulder pain. RESULTS When managing patients with shoulder pain, clinicians should (a) rule out major structural or other pathologies as the cause of shoulder pain and reassure patients about the benign and self-limited nature of most soft tissue shoulder pain; (b) develop a care plan in partnership with the patient; (c) for shoulder pain of any duration, consider low-level laser therapy; multimodal care (heat/cold, joint mobilization, and range of motion exercise); cervicothoracic spine manipulation and mobilization for shoulder pain when associated pain or restricted movement of the cervicothoracic spine; or thoracic spine manipulation; (d) for shoulder pain >3-month duration, consider stretching and/or strengthening exercises; laser acupuncture; or general physician care (information, advice, and pharmacological pain management if necessary); (e) for shoulder pain with calcific tendinitis on imaging, consider shock-wave therapy; (f) for shoulder pain of any duration, do not offer ultrasound; taping; interferential current therapy; diacutaneous fibrolysis; soft tissue massage; or cervicothoracic spine manipulation and mobilization as an adjunct to exercise (i.e., range of motion, strengthening and stretching exercise) for pain between the neck and the elbow at rest or during movement of the arm; (g) for shoulder pain >3-month duration, do not offer shock-wave therapy; and (h) should reassess the patient's status at each visit for worsening of symptoms or new physical, mental, or psychological symptoms, or satisfactory recovery. CONCLUSIONS Our evidence-based guideline provides recommendations for non-invasive management of shoulder pain. The impact of the guideline in clinical practice requires further evaluation. SIGNIFICANCE Shoulder pain of any duration can be effectively treated with laser therapy, multimodal care (i.e., heat/cold, joint mobilization, range of motion exercise), or cervicothoracic manipulation and mobilization. Shoulder pain (>3 months) can be effectively treated with exercises, laser acupuncture, or general physician care (information, advice, and pharmacological pain management if necessary).
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Affiliation(s)
- Hainan Yu
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada.,Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Pierre Côté
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada.,Canada Research Chair in Disability Prevention and Rehabilitation, Ontario Tech University, Oshawa, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jessica J Wong
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada.,Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Heather M Shearer
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Silvano Mior
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Carol Cancelliere
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | | | - Arthur Ameis
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Linda J Carroll
- School of Public Health and Injury Prevention Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, New York, NY, USA
| | - Sharanya Varatharajan
- Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.,Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Deborah Sutton
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada
| | - Danielle Southerst
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada
| | - Craig Jacobs
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada.,Division of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Maja Stupar
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada
| | - Anne Taylor-Vaisey
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Ontario, Canada
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.,Rehabilitation Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Robert J Brison
- Clinical Research, Kingston General Hospital, Kingston, Ontario, Canada.,Department of Emergency Medicine, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Mike Paulden
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carlo Ammendolia
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Work and Health, Toronto, Ontario, Canada
| | - J David Cassidy
- Divison of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Richard N Bohay
- Western University, London, Ontario, Canada.,College of Dentistry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Michel Lacerte
- Université de Montréal, Montreal, Quebec, Canada.,Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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20
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Kamonseki DH, Haik MN, Camargo PR. Scapular movement training versus standardized exercises for individuals with chronic shoulder pain: protocol for a randomized controlled trial. Braz J Phys Ther 2021; 25:221-229. [PMID: 32855073 PMCID: PMC7990736 DOI: 10.1016/j.bjpt.2020.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Scapular focused exercise interventions are frequently used to treat individuals with shoulder pain. However, evidence for changes in scapular motion after intervention is limited. OBJECTIVE To compare the effects of scapular movement training versus standardized exercises for individuals with shoulder pain. METHODS This will be a single-blinded randomized controlled trial. Sixty-four individuals with shoulder pain for at least 3 months, scapular dyskinesis, and a positive scapular assistance test will be randomly allocated to one of two groups: Scapular Movement Training (group 1) and Standardized Exercises (group 2). Group 1 will receive education about scapular position and movement, and be trained to modify the scapular movement pattern. Group 2 will perform stretching and strengthening exercises. Both groups will be treated twice a week for eight weeks. Three-dimensional scapular kinematics and muscle activity of the serratus anterior and upper, middle, and lower trapezius during elevation and lowering of the arm will be assessed at baseline and after 8 weeks of treatment. Pain intensity, function, fear avoidance beliefs, and kinesiophobia will be assessed at baseline and after 4 and 8 weeks of treatment, and 4 weeks after the end of treatment. CONCLUSIONS The results of this study may contribute to a better understanding of the efficacy of scapular focused treatments for individuals with shoulder pain. CLINICAL TRIAL REGISTRATION NCT03528499.
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Affiliation(s)
- Danilo Harudy Kamonseki
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Melina Nevoeiro Haik
- Department of Physical Therapy, Center of Health and Sport Science, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil
| | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil.
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21
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Li L, Stoop R, Clijsen R, Hohenauer E, Fernández-de-Las-Peñas C, Huang Q, Barbero M. Criteria Used for the Diagnosis of Myofascial Trigger Points in Clinical Trials on Physical Therapy: Updated Systematic Review. Clin J Pain 2020; 36:955-967. [PMID: 32841969 DOI: 10.1097/ajp.0000000000000875] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this study was to conduct an updated systematic review of diagnostic criteria for myofascial trigger points (MTrPs) used in clinical trials of physical therapy interventions from 2007 to 2019. METHODS MEDLINE and Physiotherapy Evidence Database (PEDro) were searched using the following MeSH keywords: "trigger points," "trigger point," "myofascial trigger point," "myofascial trigger points," "myofascial pain," and "myofascial pain syndrome." The MeSH keywords were combined by using Boolean operators "OR"/"AND." All physiotherapy clinical trials including patients with musculoskeletal conditions characterized by at least 1 active MTrP or latent MTrP in any body area were selected. We pooled data from an individual criterion and criteria combinations used to diagnose MTrPs. The protocol was developed in accordance with the PRISMA-P guidelines. RESULTS Of 478 possibly relevant publications, 198 met the inclusion criteria. Of these 198 studies, 129 studies (65.1%) stated specifically the diagnostic criteria used for MTrPs in the main text, 56 studies (28.3%) failed to report any method whereby MTrP was diagnosed, and 13 studies (6.6%) adopted expert-based definitions for MTrPs without specification. Of 129 studies, the 6 criteria applied most commonly were: "spot tenderness" (n=125, 96.9%), "referred pain" (95, 73.6%), "local twitch response" (63, 48.8%), pain recognition (59, 45.7%), limited range of motion" (29, 22.5%), and "jump sign" (10, 7.8%). Twenty-three combinations of diagnostic criteria were identified. The most frequently used combination was "spot tenderness," "referred pain," and "local twitch response" (n=28 studies, 22%). CONCLUSIONS A number of the included studies failed in properly reporting the MTrP diagnostic criteria. Moreover, high variability in the use of MTrP diagnostic was also observed. Spot tenderness, referred pain, and local twitch response were the 3 most popular criteria (and the most frequently used combination). A lack of transparency in the reporting of MTrP diagnostic criteria is present in the literature. REGISTRY This systematic review was registered under the Centre for Reviews and Dissemination, PROSPERO number: CRD42018087420.
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Affiliation(s)
- Lihui Li
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- School of Medicine, Southern University of Science and Technology, Shenzhen
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai, China
| | - Rahel Stoop
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- International University of Applied Sciences THIM, Landquart, Switzerland
| | - Ron Clijsen
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- International University of Applied Sciences THIM, Landquart, Switzerland
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Erich Hohenauer
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
- International University of Applied Sciences THIM, Landquart, Switzerland
- Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Qiangmin Huang
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai, China
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno
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Imani M, Abbasi L, Taghizadeh S, Amiri M. Comparison of the effect of two different types of dry-needling techniques on subacromial impingement syndrome. J Bodyw Mov Ther 2020; 25:35-40. [PMID: 33714508 DOI: 10.1016/j.jbmt.2020.10.018] [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: 05/16/2020] [Revised: 09/24/2020] [Accepted: 10/15/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Infraspinatus is one of the main muscles that is involved in the subacromial impingement syndrome. Dry needling and routine physical therapy can improve this syndrome. However, the dry needling technique is not well defined. DESIGN randomized controlled clinical trial, single-blind study. METHOD Sixty-six patients diagnosed with shoulder impingement syndrome were recruited and randomly divided into three groups. INTERVENTIONS In 1st group; patients received deep dry needling technique in addition to routine physical therapy, in Hong's group; patients received Hong's dry needling technique in addition to routine physiotherapy and in third group; patient just received routine physical therapy. MAIN OUTCOME MEASURE(S) Before, immediately after and 4 weeks after the intervention, pain, disability and the pressure pain threshold were measured. RESULTS The findings of this study indicated that in DDN group, pain and disability reduction was significantly more than two other groups. Although, the pressure pain tolerance increased in all three groups after treatment, but the increase between groups was not significantly different. All study groups showed reduction in pain, while there was no significant difference between the three groups. CONCLUSION Pain and disability reduction in the DDN group compared to the other two groups may reveal the treatment with deep dry needling technique along with routine physiotherapy is more effective than receiving dry needling with Hong's technique or routine physiotherapy alone. However, there was no significant difference between the three groups in pressure pain tolerance threshold and pain reduction.
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Affiliation(s)
- Mehrdad Imani
- Student Research Committee, Department of Physiotherapy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Abbasi
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Shohreh Taghizadeh
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Amiri
- Student Research Committee, Department of Physiotherapy, Shiraz University of Medical Sciences, Shiraz, Iran
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23
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Brennan K, Elifritz KM, Comire MM, Jupiter DC. Rate and maintenance of improvement of myofascial pain with dry needling alone vs. dry needling with intramuscular electrical stimulation: a randomized controlled trial. J Man Manip Ther 2020; 29:216-226. [PMID: 32990529 DOI: 10.1080/10669817.2020.1824469] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
STUDY DESIGN Prospective, randomized. OBJECTIVES To determine the difference in rate and maintenance of improvement of pain and disability for Dry Needling (DN) compared to Dry Needling with Intramuscular Electrical Stimulation (DN/IMES), in Myofascial Pain Syndrome (MPS). BACKGROUND DN and neuromuscular electrical stimulation (NMES) have been shown to be efficacious in treating MPS. DN/IMES for MPS treatment has not been studied extensively, but initial results are promising. METHODS Forty-five subjects were randomly assigned to the DN (n = 25) or DN/IMES (n = 20) group. Both groups received six consecutive weekly treatments and completed NDI and NPRS questionnaires (week 0, 3, 6, and 12). RESULTS Both DN and DN/IMES groups showed significant improvement between weeks 0-6 on NDI (p = 0.008 and 0.00002, respectively) and NPRS scores (0 = 0.017 and p = 0.018, respectively). DN/IMES group showed significant within group changes on the NPRS between weeks 0-3 (p = 0.029). No changes were noted in the DN or DN/IMES groups between week 6-12 on NDI (p = 0.497 and p = 0.714, respectively) or NPRS (p = 0.801 and p = 0.164, respectively). CONCLUSION DN and DN/IMES demonstrated improvement and maintenance in disability and pain for 6 weeks. No differences in improvement of disability or pain existed between the groups at week 6 or 12.
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Affiliation(s)
- Kindyle Brennan
- Doctor of Physical Therapy Program, University of Mary Hardin-Baylor, Belton, TX, USA
| | - Katherine M Elifritz
- Department of Physical Therapy, Virginia Sportsmedicine Institute, Arlington, VA, USA
| | - Megan M Comire
- Department of Physical Therapy, Inspire Physical Therapy, College Station, TX, USA
| | - Daniel C Jupiter
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.,Graduate School of Biomedical Sciences, University of Texas Medical Branch, Galveston, TX, USA
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24
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Pepin ME, Chan D. Applying a clinical decision-making model to a patient with severe shoulder pain ultimately diagnosed as neuralgic amyotrophy. Physiother Theory Pract 2020; 38:1078-1089. [PMID: 32892675 DOI: 10.1080/09593985.2020.1815260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE AND PURPOSE Shoulder symptoms are often encountered in physical therapy and a myriad of etiologies can cause these symptoms, either locally or remotely. The purpose of this case report is to describe the physical therapist's differential diagnostic process for a patient with acute and severe onset of shoulder pain. Case Description: The patient was a 37-year-old female with sudden onset of right shoulder pain that awakened her at night. Pain was associated with decreased range of motion and shoulder weakness. Faced with an uncertain diagnosis, the physical therapist followed a systematic approach to clinical decision-making. Outcomes: Neuralgic amyotrophy was the primary diagnostic hypothesis but other causes of shoulder pain could not be ruled out. Conclusion: The clinical decision-making process helped the physical therapist narrow down the differential diagnosis list and make a decision to send the patient for further testing. Magnetic resonance imaging and electromyogram confirmed the diagnosis of neuralgic amyotrophy.
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Affiliation(s)
- Marie-Eve Pepin
- Physical Therapy Program, Wayne State University, Detroit, MI, USA
| | - Derek Chan
- Center for Athletic Medicine, Henry Ford Health Care System, Detroit, MI, USA
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25
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Alayat MS, Battecha KH, ELsodany AM, Ali MI. Pulsed ND:YAG laser combined with progressive pressure release in the treatment of cervical myofascial pain syndrome: a randomized control trial. J Phys Ther Sci 2020; 32:422-427. [PMID: 32753780 PMCID: PMC7344286 DOI: 10.1589/jpts.32.422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/03/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate the effect of pulsed Nd:YAG laser combined with the progressive
pressure release technique (PPRT) and exercises in the treatment of myofascial trigger
points (MTrPs) in patients with myofascial pain syndrome (MPS). [Participants and Methods]
A total of 50 patients with MTrPs in the upper trapezius muscle participated in the study.
The patients were randomly assigned to two groups and treated with laser plus PPRT (Laser
+ PPRT group) or placebo laser and exercises (PL + PPRT group). The laser was applied for
eight MTrPs with a 50 J/point. PPRT was applied for 30 seconds for each point. Exercises
included strengthening and stretching exercises applied three times per week for four
weeks. A visual analogue scale (VAS) and pressure pain threshold (PPT) were used to
measure pain and pain threshold, respectively. A cervical range of motion device (CROM)
was used to measure the cervical range of motion. [Results] Both treatment groups showed
significant improvement in CROM, PPT, and VAS post-treatment with a more significant
effect in the Laser + PPRT group compared to the PL + PPRT group. [Conclusion] PPRT and
exercises alone or that in combination with laser therapy were effective in the treatment
of active MTrPs in patients with MPS.
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Affiliation(s)
- Mohamed Salaheldein Alayat
- Faculty of Applied Medical Science, Umm Al-Qura University: 4888 Bathaa Qurish, Mecca 21955, Saudi Arabia
| | - Kadrya Hosney Battecha
- Faculty of Applied Medical Science, Umm Al-Qura University: 4888 Bathaa Qurish, Mecca 21955, Saudi Arabia
| | - Ahmed Mohamed ELsodany
- Faculty of Applied Medical Science, Umm Al-Qura University: 4888 Bathaa Qurish, Mecca 21955, Saudi Arabia
| | - Mohamed Ibrahim Ali
- Faculty of Applied Medical Science, Umm Al-Qura University: 4888 Bathaa Qurish, Mecca 21955, Saudi Arabia
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26
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Seven Key Themes in Physical Therapy Advice for Patients Living With Subacromial Shoulder Pain: A Scoping Review. J Orthop Sports Phys Ther 2020; 50:285-a12. [PMID: 32476583 DOI: 10.2519/jospt.2020.9152] [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
OBJECTIVE To systematically scope the reported advice and education in physical therapy management of patients with subacromial shoulder pain, and to define key themes of the advice and education. DESIGN Scoping review. LITERATURE SEARCH We searched MEDLINE, Scopus, Web of Science, and CINAHL, with publication dates from 2007 to September 2019. STUDY SELECTION CRITERIA We included quantitative and qualitative research that reported on physical therapy interventions for subacromial shoulder pain. DATA SYNTHESIS We performed a qualitative synthesis that identified items included in patient advice and education. RESULTS Of 89 original studies included, there were 61 randomized controlled trials; 5 prospective studies; 16 nonrandomized observational intervention studies or case series; and 7 surveys, audits of physical therapy patient records, and focus groups with physical therapists. We identified 7 key themes for advice and education: exercise intensity and pain response, activity modification advice, posture advice, pain self-management advice, pathoanatomical and diagnosis information, behavioral approaches, and pain biology advice. CONCLUSION While advice focused predominantly on the local tissue pathology model, 10% of studies included information about pain neuroscience education, psychosocial factors, motor imagery, or behavior change. J Orthop Sports Phys Ther 2020;50(6):285-293. doi:10.2519/jospt.2020.9152.
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Different Degree Centrality Changes in the Brain after Acupuncture on Contralateral or Ipsilateral Acupoint in Patients with Chronic Shoulder Pain: A Resting-State fMRI Study. Neural Plast 2020; 2020:5701042. [PMID: 32377180 PMCID: PMC7197008 DOI: 10.1155/2020/5701042] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/07/2019] [Accepted: 11/19/2019] [Indexed: 12/14/2022] Open
Abstract
Chronic shoulder pain (CSP) is the third most common musculoskeletal problem. For maximum treatment effectiveness, most acupuncturists usually choose acupoint in the nonpainful side, to alleviate pain or improve shoulder function. This method is named opposite needling, which means acupuncture points on the right side are selected for diseases on the left side and vice versa. However, the underlying neural mechanisms related to treatment are currently unclear. The purpose of this study was to determine whether different mechanisms were observed with contralateral and ipsilateral acupuncture at Tiaokou (ST 38) in patients with unilateral CSP. Twenty-four patients were randomized to the contralateral acupuncture group (contra-group) and the ipsilateral acupuncture group (ipsi-group). The patients received one acupuncture treatment session at ST 38 on the nonpainful or painful sides, respectively. Before and after acupuncture treatment, they underwent functional magnetic resonance scanning. The treatment-related changes in degree centrality (DC) maps were compared between the two groups. We found alleviated pain and improved shoulder function in both groups, but better shoulder functional improvement was observed in the contra-group. Increased DC in the anterior/paracingulate cortex and decreased DC in bilateral postcentral gyri were found in the contra-group, while decreased DC in the bilateral cerebellum and right thalamus was observed in the ipsi-group. Furthermore, the DC value in the bilateral anterior/paracingulate cortex was positively correlated with the treatment-related change in the Constant–Murley score. The current study reveals different changes of DC patterns after acupuncture at contralateral or ipsilateral ST 38 in patients with CSP. Our findings support the hypothesis of acupoint specificity and provide the evidence for acupuncturists to select acupoints for CSP.
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McRobert CJ, Hill JC, Hay EM, van der Windt DA. Identifying potential moderators of first-line treatment effect in patients with musculoskeletal shoulder pain: a systematic review. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1752304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Cliona J. McRobert
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
- School of Health Sciences, Institute of Clinical Sciences, University of Liverpool, Liverpool, UK
| | - Jonathan C. Hill
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - Elaine M. Hay
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
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Doğan N, Şengül İ, Akçay-Yalbuzdağ Ş, Kaya T. Kinesio taping versus dry needling in the treatment of myofascial pain of the upper trapezius muscle: A randomized, single blind (evaluator), prospective study. J Back Musculoskelet Rehabil 2020; 32:819-827. [PMID: 30883331 DOI: 10.3233/bmr-181162] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although a number of therapeutic interventions for trigger-point inactivation have been studied, it remains controversial which intervention is better. OBJECTIVE To compare the effectiveness of the kinesio taping and dry needling methods in patients with trigger-point related myofascial pain syndrome of the upper trapezius muscle. METHODS A total of 42 patients were randomly allocated to the kinesio taping group (n= 23) and dry needling group (n= 19). The patients were assessed for pain, pressure pain threshold (PPT), cervical range of motion (CROM), and function at baseline, at short- and medium-term stages after treatment. To investigate the effects of the interventions over time, two-way repeated measures analysis of variance (ANOVA) was used. RESULTS There was a significant improvement in pain intensity at rest and cervical motion, in the PPT readings (p< 0.05), in CROM (p< 0.05), and in function (p< 0.05) in both groups, with no superiority either (p> 0.05). CONCLUSIONS Kinesio taping may be a choice of trigger point inactivation in patients who do not want to be needled or who show contraindication(s) to treatments other than kinesio taping.
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Affiliation(s)
- Nesibe Doğan
- Department of Physical Medicine and Rehabilitation, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - İlker Şengül
- Department of Physical Medicine and Rehabilitation, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey.,Department of Physical Medicine and Rehabilitation, Medical Faculty of İzmir Katip Çelebi University, İzmir, Turkey
| | - Şeniz Akçay-Yalbuzdağ
- Department of Physical Medicine and Rehabilitation, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Taciser Kaya
- Department of Physical Medicine and Rehabilitation, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
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30
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Effect of manual compressive therapy on latent myofascial trigger point pressure pain thresholds. J Bodyw Mov Ther 2019; 23:792-798. [PMID: 31733763 DOI: 10.1016/j.jbmt.2019.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study compared the effects of 90 s of manual compressive therapy (MCT) on latent myofascial trigger points (LTPs) for 3 sessions per week for 4 weeks to determine changes in individual pressure pain threshold (PPT). A total of 30 (15 males, 15 females; age = 22 ± 4 y/o, height = 175 ± 18 cm, weight = 162.5 ± 57.5 kg) symptomatic subjects with LTPs volunteered for the study. METHODS PPT was measured at baseline and pre- and post-treatment for all 12 sessions with a pressure algometer across the 4-week treatment time frame. The MCT was applied to the control group on their LTP at pressure intended to provide a sham condition (1/10 on verbalized analog scale (VAS)). Two experimental groups had MCT applied either directly on the LTP (d-TP) or in close-proximity to their LTP (cp-TP) at moderate pressure (7/10 on VAS). RESULTS There was a significant increase in PPT from the first through twelfth treatment sessions (p < 0.001, partial η2 = 0.914). A significant increase in PPTs between treatment groups was acutely observed from pre- to post-therapy tests (p = 0.001, partial η2 = 0.146). The differences between pre- versus post-treatment PPT measures indicated significant differences (d-TP vs. control, p < 0.001; cp-TP vs. control, p = 0.007). No differences were observed between experimental groups (p = 0.215). CONCLUSIONS PPT continued to increase after several weeks of MCT when applied directly on or within 2.5 cm of an identified LTP compared to control.
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Akbaba YA, Mutlu EK, Altun S, Turkmen E, Birinci T, Celik D. The effectiveness of trigger point treatment in rotator cuff pathology: A randomized controlled double-blind study. J Back Musculoskelet Rehabil 2019; 32:519-527. [PMID: 30932877 DOI: 10.3233/bmr-181306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Studies have emphasized the importance of the presence of myofascial trigger points (MTrPs) in patients with rotator cuff pathologies and the high frequency of MTrPs in rotator cuff muscles. OBJECTIVE Evaluate the effectiveness of the treatment of active MTrPs in patients with rotator cuff pathologies. METHODS Fifty-three patients with rotator cuff tear were randomized into two groups. All patients received the same standard conservative treatment twice a week for 6 weeks. Patients in Group 1 additionally received ischemic compression (IC) of MTrPs. Pain, range of motion (ROM), function, and anxiety and depression were assessed. MTrPs in rotator cuff muscles were assessed manually, and the number of MTrPs on the shoulder complex was counted. RESULTS There were no significant differences between the groups in terms of changes in resting/activity/night pain, ROM, function, or anxiety and depression (p> 0.05). Pain scores improved only in Group 1. However, the total number of MTrPs was significantly decreased in Group 1 (p= 0.001). CONCLUSION A six-week course of IC helps treat active MTrPs. A standard conservative treatment program reduced pain and increased function; the addition of MTrP treatment did not improve clinical outcomes in patients with rotator cuff pathologies.
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Affiliation(s)
- Yildiz Analay Akbaba
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ebru Kaya Mutlu
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Suleyman Altun
- Clinics of Orthopedics and Traumatology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ezgi Turkmen
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Education, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tansu Birinci
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Derya Celik
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Pecos-Martin D, Ponce-Castro MJ, Jiménez-Rejano JJ, Nunez-Nagy S, Calvo-Lobo C, Gallego-Izquierdo T. Immediate effects of variable durations of pressure release technique on latent myofascial trigger points of the levator scapulae: a double-blinded randomised clinical trial. Acupunct Med 2019; 37:141-150. [PMID: 31060367 DOI: 10.1136/acupmed-2018-011738] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Latent myofascial trigger points (MTrPs) of the levator scapulae have a high prevalence and may influenceconditions of the neck and shoulder. The pressure release technique is one of the most recommended manual therapy techniques. The aim of this study was to determine the effect of varying durations of the pressure release technique application on latent MTrPs of the levator scapulae. METHODS In a three-arm (1:1:1 ratio), double-blinded, parallel, randomised clinical trial, 60 healthy university students (23 men, 37 women) with a mean±SD age of 20.0±2.67 years were recruited. Subjects were assigned to receive pressure release in one latent MTrP of the levator scapulae lasting 30s (T30s; n=17), 60s (T60s; n=22) or 90s (T90s; n=21). Active cervical range of movement (CROM), strength, pressure pain threshold (PPT) and neck pain intensity at full stretch were measured immediately before and after treatment. RESULTS Mixed-model analyses of variance showed statistically significant differences for PPT (P=0.045; partial Eta2=0.103), comparing T60s versus T30s (P=0.009; Cohen's d=1.044) and T90s versus T30s groups (P=0.001; Cohen's d=1.253), and for left side bending strength (P=0.043; partial Eta2=0.105), comparing T90s versus T30s (P=0.023; Cohen's d=0.907). The rest of the comparisons did not present any significant differences (P⩾0.05). CONCLUSIONS The 60 s and 90 s applications of the pressure release technique may be recommended to increase PPT and strength, respectively, in latent MTrPs of the levator scapulae in the short term. TRIAL REGISTRATION NUMBER NCT03006822.
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Affiliation(s)
- Daniel Pecos-Martin
- 1 Physiotherapy and Pain Group, Department of Physiotherapy and Nursing, Alcalá University, Alcalá de Henares, Spain
| | - Manuel José Ponce-Castro
- 2 Faculty of Physical Therapy, Nursing and Podiatry, University of Sevilla, Sevilla, Sevilla, Spain
| | | | - Susana Nunez-Nagy
- 4 Physiotherapy and Nursing Departament, Alcalá University, Alcalá de Henares, Spain
| | - César Calvo-Lobo
- 5 Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, Ponferrada, Spain
| | - Tomás Gallego-Izquierdo
- 1 Physiotherapy and Pain Group, Department of Physiotherapy and Nursing, Alcalá University, Alcalá de Henares, Spain
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Denneny D, Frawley HC, Petersen K, McLoughlin R, Brook S, Hassan S, Williams AC. Trigger Point Manual Therapy for the Treatment of Chronic Noncancer Pain in Adults: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2019; 100:562-577. [DOI: 10.1016/j.apmr.2018.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 11/25/2022]
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Somerville K, Walston Z, Marr T, Yake D. Treatment of shoulder pathologies based on irritability: a case series. Physiother Theory Pract 2019; 36:1266-1274. [DOI: 10.1080/09593985.2019.1571136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Tye Marr
- PT Solutions Physical Therapy, Atlanta, GA, USA
| | - Dale Yake
- PT Solutions Physical Therapy, Atlanta, GA, USA
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Moraska AF, Hickner RC, Rzasa-Lynn R, Shah JP, Hebert JR, Kohrt WM. Increase in Lactate Without Change in Nutritive Blood Flow or Glucose at Active Trigger Points Following Massage: A Randomized Clinical Trial. Arch Phys Med Rehabil 2018; 99:2151-2159. [DOI: 10.1016/j.apmr.2018.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 01/03/2023]
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Calvo-Lobo C, Pacheco-da-Costa S, Hita-Herranz E. Efficacy of Deep Dry Needling on Latent Myofascial Trigger Points in Older Adults With Nonspecific Shoulder Pain: A Randomized, Controlled Clinical Trial Pilot Study. J Geriatr Phys Ther 2018; 40:63-73. [PMID: 25794307 PMCID: PMC5367514 DOI: 10.1519/jpt.0000000000000048] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background: Nonspecific shoulder pain has a high prevalence in older adults and causes functional alterations. Furthermore, there are difficulties in establishing a clinical diagnosis, effective treatments are lacking, and little evidence has been found regarding the use of invasive physical therapy techniques in this age group. Purpose: To determine the efficacy of a single physical therapy intervention with deep dry needling (DDN) on latent and active myofascial trigger points (MTrPs) in older adults with nonspecific shoulder pain. Methods: This pilot study is a single-blind, randomized, controlled clinical trial that included 20 participants, aged 65 years and older, who were diagnosed with nonspecific shoulder pain. The study was approved by the Clinical Research Ethics Committee of the area. Participants were recruited at their homes or at a care center and were randomly assigned into either an experimental group (n = 10), which received a session of DDN on 1 active and 1 latent MTrP of the infraspinatus muscle, or a control group (n = 10), which received a session of DDN on only 1 active MTrP. A blind examiner assessed the pain intensity, pain pressure threshold on the anterior deltoid, and extensor carpi radialis brevis muscles and grip strength before, immediately after, and 1 week after the intervention. Results: Statistically significant differences (P < .05) in the pressure pain thresholds (PPTs) of the extensor carpi radialis brevis were found in the experimental group in both posttreatment assessments. Moreover, the effect size values (d Cohen) varied from small for grip strength (0.017-0.36) to moderate for the pain intensity (0.46-0.78) and PPT in the anterior deltoid (0.49-0.66) and to large for the PPT in the extensor carpi radialis brevis (1.06-1.58). Conclusions: A single physical therapy intervention with DDN on 1 latent MTrP, in conjunction with 1 active MTrP, in the infraspinatus muscle may increase the PPT of the extensor carpi radialis brevis muscle area immediately following and 1 week after the intervention in older adults with nonspecific shoulder pain.
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Affiliation(s)
- César Calvo-Lobo
- 1Physiotherapy Department, Faculty of Health, Exercise and Sport, European University of Madrid, Villaviciosa de Odón, Madrid, Spain. 2Nursing and Physiotherapy Department, Physiotherapy Teaching Unit, University of Alcalá, Alcalá de Henares, Madrid, Spain. 3Nursing and Physiotherapy Department, Nursing Teaching Unit, University of Alcalá, Alcalá de Henares, Madrid, Spain
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Ristori D, Miele S, Rossettini G, Monaldi E, Arceri D, Testa M. Towards an integrated clinical framework for patient with shoulder pain. Arch Physiother 2018; 8:7. [PMID: 29862049 PMCID: PMC5975572 DOI: 10.1186/s40945-018-0050-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/23/2018] [Indexed: 01/03/2023] Open
Abstract
Background Shoulder pain (SP) represents a common musculoskeletal condition that requires physical therapy care. Along the years, the usual evaluation strategies based on clinical tests and diagnostic imaging has been challenged. Clinical tests appear unable to clearly identify the structures that generated pain and interpretation of diagnostic imaging is still controversial. The current patho-anatomical diagnostic categories have demonstrated poor reliability and seem inadequate for the SP treatment. Objectives The present paper aims to (1) describe the different proposals of clinical approach to SP currently available in the literature; to (2) integrate these proposals in a single framework in order to help the management of SP. Conclusion The proposed clinical framework, based on a bio-psychosocial vision of health, integrates symptoms characteristics, pain mechanisms and expectations, preferences and psychosocial factors of patients that may guide physiotherapist to make a diagnostic triage and to choose the right treatment for the individual patient.
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Affiliation(s)
- Diego Ristori
- Via Veneto, 6, Subbiano, Arezzo Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Simone Miele
- Via Paolo VI, Cologne, Brescia Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Giacomo Rossettini
- Via de Gaspari, 9, Montecchio Maggiore, Vicenza Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Erica Monaldi
- Via Italo Svevo, 2 Codogno, Lodi, Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Diego Arceri
- Via Eugenio Scalfaro, 17, Catanzaro, Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Marco Testa
- Via Magliotto, 2 17100, Savona, Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
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Schneider R. Effectiveness of myofascial trigger point therapy in chronic back pain patients is considerably increased when combined with a new, integrated, low-frequency shock wave vibrotherapy (Cellconnect Impulse): A two-armed, measurement repeated, randomized, controlled pragmatic trial. J Back Musculoskelet Rehabil 2018; 31:57-64. [PMID: 28826166 DOI: 10.3233/bmr-169662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prevalence of chronic back pain poses major challenges for all health care systems and patients worldwide. Myofascial trigger therapy (MT), although a very popular standard non-pharmaceutical form of treatment, only shows small to medium effectiveness. OBJECTIVE To test a new vibrotreatment (Cellconnect Impulse) transmitting low-frequency, vertical shock waves in a routine clinical practice. METHODS Eligible patients were adults seeking physiotherapeutic treatment. They were randomly allocated to either six treatments of MT or to six treatments of combined MT and vibrotreatment. Outcome parameters were pain intensity, pain days, pain duration, and quality of life. RESULTS The pain relieving effects of the combined treatment were very large (d= 1.6). It clearly outperformed MT and considerably improved patients' health related quality of life. CONCLUSIONS Combining MT with Cellconnect Impulse enhances the physiotherapeutic effectiveness of treating chronic back pain.
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Nascimento JDSD, Alburquerque-Sendín F, Vigolvino LP, Oliveira WFD, Sousa CDO. Inter- and Intraexaminer Reliability in Identifying and Classifying Myofascial Trigger Points in Shoulder Muscles. Arch Phys Med Rehabil 2018; 99:49-56. [DOI: 10.1016/j.apmr.2017.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/18/2017] [Accepted: 06/20/2017] [Indexed: 01/02/2023]
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Sohns S, Schnieder K, Licht G, von Piekartz H. [Manual trigger point therapy of shoulder pain : Randomized controlled study of effectiveness]. Schmerz 2017; 30:549-559. [PMID: 27295296 DOI: 10.1007/s00482-016-0113-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although chronic shoulder pain is highly prevalent and myofascial trigger points (mTrP) are thought to be found in the majority of patients with shoulder complaints, the influence on the pain mechanism remains unclear. There are only very few controlled clinical studies on the effects of manual trigger point compression therapy. OBJECTIVE This randomized controlled trial (RCT) compared the short-term effects of manual trigger point compression therapy (n = 6) with manual sham therapy (n = 6) in patients with unilateral shoulder pain due to myofascial syndrome (MFS). MATERIAL AND METHODS The measurement data were collected before and after two sessions of therapy. Pressure pain thresholds (PPT) of mTrP and symmetrically located points on the asymptomatic side were measured together with neutral points in order to detect a potential unilateral or generalized hyperalgesia. Additionally, the pain was assessed on a visual analog scale (VAS) at rest and during movement and the neck disability index (NDI) and disabilities of the arm, shoulder and hand (DASH) questionnaires were also completed and evaluated. RESULTS Both treatment modalities led to a significant improvement; however, the manual trigger point compression therapy was significantly more effective in comparison to sham therapy, as measured by different parameters. CONCLUSION The significant improvement of PPT values in the interventional group even at sites that were not directly treated, indicates central mechanisms in pain threshold modulation induced by manual compression therapy. The weaker but still measurable effects of sham therapy might be explained by the sham modality being a hands on technique or by sufficient stimulation of the trigger point region during the diagnostics and PPT measurements.
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Affiliation(s)
- S Sohns
- Fakultät Wirtschafts- und Sozialwissenschaften (Abt. Physiotherapie und Rehabilitationswissenschaften), Hochschule Osnabrück, Caprivistr. 30, 49076, Osnabrück, Deutschland
| | - K Schnieder
- Fakultät Wirtschafts- und Sozialwissenschaften (Abt. Physiotherapie und Rehabilitationswissenschaften), Hochschule Osnabrück, Caprivistr. 30, 49076, Osnabrück, Deutschland
| | - G Licht
- FORBs Facharztzentrum für Orthopädie und Rehabilitation des Bewegungssystems, Osnabrück, Deutschland
| | - H von Piekartz
- Fakultät Wirtschafts- und Sozialwissenschaften (Abt. Physiotherapie und Rehabilitationswissenschaften), Hochschule Osnabrück, Caprivistr. 30, 49076, Osnabrück, Deutschland.
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Tejera-Falcón E, Toledo-Martel NDC, Sosa-Medina FM, Santana-González F, Quintana-de la Fe MDP, Gallego-Izquierdo T, Pecos-Martín D. Dry needling in a manual physiotherapy and therapeutic exercise protocol for patients with chronic mechanical shoulder pain of unspecific origin: a protocol for a randomized control trial. BMC Musculoskelet Disord 2017; 18:400. [PMID: 28923050 PMCID: PMC5604494 DOI: 10.1186/s12891-017-1746-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 08/29/2017] [Indexed: 01/06/2023] Open
Abstract
Background Shoulder pain of musculoskeletal origin is the main cause of upper limb pain of non-traumatic origin. Despite being one of the most common reasons for consultation, there is no established protocol for treatment due to the complexity of its etiology. However, it has been shown that the presence of myofascial trigger points on the shoulder muscles is a common condition associated with patients suffering from shoulder pain. This protocol has been created which describes the design of a randomized controlled trial to evaluate the effectiveness of the inclusion of dry needling (DN) within a protocol of manual physiotherapy and therapeutic exercise in the treatment of chronic shoulder pain of unspecific origin. Methods Thirty-six participants aged 18–65 years will be recruited having mechanical chronic shoulder pain on unspecific origin and meeting the inclusion criteria. These will be randomized to one of two interventions, (i) DN, manual physiotherapy and therapeutic exercise or (ii) sham DN, manual physiotherapy and therapeutic exercise. The protocol will cover 6 weeks of treatment, with a 6-month follow-up. Our main outcome measure will be the Visual Analogue Scale for pain. Discussion This is the first study to combine the use of DN, manual physiotherapy and an exercise program with a 6-month follow-up, thus becoming a new contribution to the treatment of chronic shoulder pain, while new lines of research may be established to help determine the effects of DN on chronic shoulder pain and the frequency and proper dosage. Trial registrations International Standard Randomized Controlled Trial Number Register: ISRCTN30604244 (http://www.controlled-trials.com) 29 June 2016.
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Affiliation(s)
| | | | | | | | | | - Tomás Gallego-Izquierdo
- Department of Physical Therapy and Pain Group, Universidad de Alcalá, Alcalá de Henares, Spain
| | - Daniel Pecos-Martín
- Department of Physical Therapy and Pain Group, Universidad de Alcalá, Alcalá de Henares, Spain. .,Facultad de Enfermería y Fisioterapia, Universidad de Alcalá (Spain), Campus Científico-Tecnológico: CRTA. Madrid - Barcelona, km.33,600, Alcalá de Henares, Spain.
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De Groef A, Van Kampen M, Vervloesem N, Dieltjens E, Christiaens MR, Neven P, Vos L, De Vrieze T, Geraerts I, Devoogdt N. Effect of myofascial techniques for treatment of persistent arm pain after breast cancer treatment: randomized controlled trial. Clin Rehabil 2017; 32:451-461. [DOI: 10.1177/0269215517730863] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- An De Groef
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Marijke Van Kampen
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Nele Vervloesem
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Evi Dieltjens
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Marie-Rose Christiaens
- Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
- Department of Surgical Oncology, University of Leuven, Leuven, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Lore Vos
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Inge Geraerts
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
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Dissanayaka TD, Pallegama RW, Suraweera HJ, Johnson MI, Kariyawasam AP. Comparison of the Effectiveness of Transcutaneous Electrical Nerve Stimulation and Interferential Therapy on the Upper Trapezius in Myofascial Pain Syndrome: A Randomized Controlled Study. Am J Phys Med Rehabil 2017; 95:663-72. [PMID: 26945216 DOI: 10.1097/phm.0000000000000461] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of transcutaneous electrical nerve stimulation and interferential therapy (IFT) both in combination with hot pack, myofascial release, active range of motion exercise, and a home exercise program on myofascial pain syndrome patients with upper trapezius myofascial trigger point. DESIGN A total of 105 patients with an upper trapezius myofascial trigger point were recruited to this single-blind randomized controlled trial. Following random allocation of patients to three groups, three therapeutic regimens-control-standard care (hot pack, active range of motion exercises, myofascial release, and a home exercise program with postural advice), transcutaneous electrical nerve stimulation-standard care and IFT-standard care-were administered eight times during 4 wks at regular intervals. Pain intensity and cervical range of motions (cervical extension, lateral flexion to the contralateral side, and rotation to the ipsilateral side) were measured at baseline, immediately after the first treatment, before the eighth treatment, and 1 wk after the eighth treatment. RESULTS Immediate and short-term improvements were marked in the transcutaneous electrical nerve stimulation group (n = 35) compared with the IFT group (n = 35) and the control group (n = 35) with respect to pain intensity and cervical range of motions (P < 0.05). The IFT group showed significant improvement on these outcome measurements than the control group did (P < 0.05). CONCLUSION Transcutaneous electrical nerve stimulation with standard care facilitates recovery better than IFT does in the same combination.
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Affiliation(s)
- Thusharika Dilrukshi Dissanayaka
- From the Department of Physiotherapy, Faculty of Allied Health Sciences (TDD); Division of Physiology, Faculty of Dental Sciences (RWP); and Department of Physiology, Faculty of Medicine (APK), University of Peradeniya, Sri Lanka; Teaching Hospital, Peradeniya, Sri Lanka (HJS); and Faculty of Health and Social Sciences, Leeds Beckett University, City Campus, United Kingdom (MIJ)
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Okhovatian F, Zamani S, Azimi H. Hydatid cysts in trapezius muscles: A narrative review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.7.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aims: A hydatid cyst is an endemic parasitic disease that can be formed anywhere in the body, including muscles (3–5% of cases). The cyst can be misdiagnosed in early stages with muscular trigger points. Needling is the popular physical therapy approach in trigger point treatments. Misuse in needling can cause punctures in hydatid cysts and lead to death. The aim of this study was to summarise the available evidence on the manifestation of hydatid cysts in the trapezius muscle. Methods: A search was conducted for any reports of differential diagnosis or misdiagnosis of hydatid cysts and trigger points. Computerised literature searches were performed among publications between 1950 and December 2015 using the following databases: PubMed, Science Direct, SCOPUS, Ovid MEDLINE, CINAHL, Cochrane, and AMED. Results: Only three studies met the inclusion criteria. All three patients were females under 30 and all three had undergone surgery; two received medical treatment. No misdiagnosis with trigger points was reported and consequently there was no case of needling misuse in hydatid cysts either. However, it does not imply the absence of any clinical case. Conclusions: The current study intends to remind the importance of an accurate diagnosis before using needling as a trigger point treatment.
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Affiliation(s)
- Farshad Okhovatian
- Professor of Physiotherapy, Physiotherapy Research Centre, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Zamani
- Research student, School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Azimi
- Assistant professor, English Language Teaching Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sohns S, Schnieder K, Licht G, von Piekartz H. Manuelle Triggerpunkttherapie bei Schulterschmerzen. MANUELLE MEDIZIN 2017. [DOI: 10.1007/s00337-017-0263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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46
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Hawk C, Minkalis AL, Khorsan R, Daniels CJ, Homack D, Gliedt JA, Hartman JA, Bhalerao S. Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions. J Manipulative Physiol Ther 2017; 40:293-319. [DOI: 10.1016/j.jmpt.2017.04.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/03/2017] [Accepted: 04/07/2017] [Indexed: 12/18/2022]
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Dommerholt J, Grieve R, Hooks T, Finnegan M. A critical overview of the current myofascial pain literature - March 2017. J Bodyw Mov Ther 2017; 21:378-385. [PMID: 28532883 DOI: 10.1016/j.jbmt.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
After two years of having contributed to this overview series of articles, we sadly say goodbye to Dr. Rob Grieve. We would like to thank Dr. Grieve for his insightful contributions and analyses of the myofascial pain literature. Dr. Grieve would have preferred to continue, but his many university and research responsibilities had to take priority. We are looking forward to reviewing his future research endeavors in this article. We are pleased that Dr. Li-Wei Chou, MD, PhD has agreed to replace Dr. Grieve and join our team. Dr. Chou is Assistant Professor at China Medical University in Taichung, Taiwan and he has an impressive publication record with many research studies and book chapters. In this edition of the overview article, we once again have included articles from around the world with a combination of basic research and clinical studies and case reports. The majority of papers deal with dry needling, but there are also several more basic research studies and manual therapy papers.
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Affiliation(s)
- Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA.
| | - Rob Grieve
- Department of Allied Health Professions, Faculty of Health and Applied Sciences, University of the West of England, Blackberry Hill, Bristol, United Kingdom.
| | - Todd Hooks
- New Orleans Pelicans, New Orleans, LA, USA.
| | - Michelle Finnegan
- Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA.
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Effect of myofascial techniques for treatment of upper limb dysfunctions in breast cancer survivors: randomized controlled trial. Support Care Cancer 2017; 25:2119-2127. [DOI: 10.1007/s00520-017-3616-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/06/2017] [Indexed: 12/24/2022]
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Goldgrub R, Côté P, Sutton D, Wong JJ, Yu H, Randhawa K, Varatharajan S, Southerst D, Mior S, Shearer HM, Jacobs C, Stupar M, Chung CL, Abdulla S, Balogh R, Dogra S, Nordin M, Taylor-Vaisey A. The Effectiveness of Multimodal Care for the Management of Soft Tissue Injuries of the Shoulder: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. J Manipulative Physiol Ther 2017; 39:121-139.e1. [PMID: 26976375 DOI: 10.1016/j.jmpt.2016.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this systematic review was to evaluate the effectiveness of multimodal care for the management of soft tissue injuries of the shoulder. METHODS We conducted a systematic review and searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Two independent reviewers critically appraised studies using the Scottish Intercollegiate Guidelines Network criteria. We used best evidence synthesis to synthesize evidence from studies with low risk of bias. RESULTS We screened 5885 articles, and 19 were eligible for critical appraisal. Ten randomized controlled trials had low risk of bias. For persistent subacromial impingement syndrome, multimodal care leads to similar outcomes as sham therapy, radial extracorporeal shock-wave therapy, or surgery. For subacromial impingement syndrome, multimodal care may be associated with small and nonclinically important improvement in pain and function compared with corticosteroid injections. For rotator cuff tendinitis, dietary-based multimodal care may be more effective than conventional multimodal care (exercise, soft tissue and manual therapy, and placebo tablets). For nonspecific shoulder pain, multimodal care may be more effective than wait list or usual care by a general practitioner, but it leads to similar outcomes as exercise or corticosteroid injections. CONCLUSIONS The current evidence suggests that combining multiple interventions into 1 program of care does not lead to superior outcomes for patients with subacromial impingement syndrome or nonspecific shoulder pain. One randomized controlled trial suggested that dietary-based multimodal care (dietary advice, acupuncture, and enzyme tablets) may provide better outcomes over conventional multimodal care. However, these results need to be replicated.
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Affiliation(s)
- Rachel Goldgrub
- Graduate Student, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada
| | - Pierre Côté
- Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada; Director, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, ON, Canada.
| | - Deborah Sutton
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada
| | - Jessica J Wong
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Associate Clinical Research Scientist, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Instructor, Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada
| | - Hainan Yu
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada
| | - Kristi Randhawa
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Sharanya Varatharajan
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Danielle Southerst
- Research Coordinator, Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, ON, Canada
| | - Silvano Mior
- Professor, Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Adjunct Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - Heather M Shearer
- Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Clinical Research Manager, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Senior Clinical Research Scientist, Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada
| | - Craig Jacobs
- Director, Clinical Education and Patient Care, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada
| | - Maja Stupar
- Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Postdoctoral Fellow, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada
| | - Chadwick L Chung
- Assistant to the Director, Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada
| | - Sean Abdulla
- Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada
| | - Robert Balogh
- Assistant Professor, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada
| | - Shilpa Dogra
- Assistant Professor, Faculty of Health Sciences, Kinesiology, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada
| | - Margareta Nordin
- Professor, Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York, NY
| | - Anne Taylor-Vaisey
- Research Associate, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada
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Contribution of Dry Needling to Individualized Physical Therapy Treatment of Shoulder Pain: A Randomized Clinical Trial. J Orthop Sports Phys Ther 2017; 47:11-20. [PMID: 27937046 DOI: 10.2519/jospt.2017.6698] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Multicenter, parallel randomized clinical trial. Background Myofascial trigger points (MTrPs) are implicated in shoulder pain and functional limitations. An intervention intended to treat MTrPs is dry needling. Objectives To investigate the effectiveness of dry needling in addition to evidence-based personalized physical therapy treatment in the treatment of shoulder pain. Methods One hundred twenty patients with nonspecific shoulder pain were randomly allocated into 2 parallel groups: (1) personalized, evidencebased physical therapy treatment; and (2) trigger point dry needling in addition to personalized, evidence-based physical therapy treatment. Patients were assessed at baseline, posttreatment, and 3-month follow-up. The primary outcome measure was pain assessed by a visual analog scale at 3 months, and secondary variables were joint range-of-motion limitations, Constant-Murley score for pain and function, and number of active MTrPs. Clinical efficacy was assessed using intention-to-treat analysis. Results Of the 120 enrolled patients, 63 were randomly assigned to the control group and 57 to the intervention group. There were no significant differences in outcome between the 2 treatment groups. Both groups showed improvement over time. Conclusion Dry needling did not offer benefits in addition to personalized, evidencebased physical therapy treatment for patients with nonspecific shoulder pain. Level of Evidence Therapy, level 1b. Registered February 11, 2009 at www.isrctn.com (ISRCTN30907460). J Orthop Sports Phys Ther 2017;47(1):11-20. Epub 9 Dec 2016. doi:10.2519/jospt.2017.6698.
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