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Olson JJ, Hill JR, Wang J, Sefko JA, Teefey SA, Middleton WD, Keener JD. Predictors of pain development for contralateral asymptomatic degenerative rotator cuff tears based on features of an ipsilateral painful cuff tear: a prospective longitudinal cohort study. J Shoulder Elbow Surg 2024; 33:234-246. [PMID: 37844830 DOI: 10.1016/j.jse.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/21/2023] [Accepted: 09/03/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Prior rotator cuff disease natural history studies have focused on tear-related factors that predict disease progression within a given shoulder. The purpose of this study was to examine both patient- and tear-related characteristics of a painful rotator cuff tear that predict future pain development and functional impairment in a shoulder with a contralateral asymptomatic cuff tear. METHODS This was a prospective longitudinal cohort study of patients aged ≤65 years who underwent surgery for a painful degenerative rotator cuff tear and possessed an asymptomatic contralateral tear. Patients were followed up prospectively by shoulder ultrasound, physical examination, and functional score assessment. The primary outcome was change in the American Shoulder and Elbow Surgeons (ASES) score at 2 years. Secondary outcomes included the Western Ontario Rotator Cuff Index (WORC) score, Patient-Reported Outcomes Measurement Information System (PROMIS) score, Hospital Anxiety Depression Scale (HADS) depression and anxiety scores, and Veterans RAND-12 (VR-12) mental component score (MCS). RESULTS Sixty-five patients were included, with a mean follow-up period of 37 months (range, 24-42 months). In 17 patients (26%), contralateral shoulder pain developed at a median of 15.2 months (interquartile range [IQR], 10.5 months). No difference in age, sex, Charlson Comorbidity Index, or occupational demand was noted between patients in whom pain developed and those in whom pain did not develop. In the presenting painful shoulder, there was no difference in baseline tear size, muscle degeneration, or biceps pathology between groups. The mean baseline tear length (8.6 mm vs. 3.8 mm, P = .0008) and width (8.4 mm vs. 3.2 mm, P = .0004) were larger in asymptomatic shoulders in which pain subsequently developed compared with those in which pain did not develop. However, there was no difference in mean tear enlargement (P = .51 for length and P = .90 for width). There were no differences in baseline ASES, WORC, Patient-Reported Outcomes Measurement Information System (PROMIS), or HADS depression and anxiety scores between shoulders in which pain developed and those in which pain did not develop; however, patients in whom pain developed reported a lower baseline VR-12 MCS (53.3 vs. 57.6, P = .04). Shoulders in which pain developed had higher visual analog scale pain scores (2.9 [standard deviation (SD), 2.5] vs. 0.6 [SD, 1.0]; P = .016), lower ASES scores 75 [SD, 33] vs. 100 [SD, 11.6]; P = .001), and significant changes in all WORC scales with pain onset compared with those that remained asymptomatic. The study showed no significant difference in changes in the HADS anxiety and depression scores but found a significant increase in the VR-12 MCS in patients in whom pain developed (7.1 [interquartile range, 12.6] vs. -1.9 [interquartile range, 8.7]; P = .036). CONCLUSION In one-quarter of patients with painful cuff tears, pain developed in a contralateral asymptomatic cuff tear that resulted in a measurable decline in function within 3 years. Our analysis showed that only the baseline tear size of the asymptomatic shoulder was predictive of pain development. There were no tear-related features of the presenting painful rotator cuff tear or indices of mental health and physical function or occupational demand that were predictive of future pain development at short-term follow-up.
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Affiliation(s)
- Jeffrey J Olson
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - J Ryan Hill
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Jinli Wang
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Julianne A Sefko
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Sharlene A Teefey
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Jay D Keener
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.
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Metayer B, Fouasson-Chailloux A, Le Goff B, Darrieutort-Laffite C. A prospective study of 100 patients with rotator cuff tendinopathy showed no correlation between subacromial bursitis and the efficacy of ultrasound-guided corticosteroid injection. Eur Radiol 2024; 34:300-307. [PMID: 37540320 DOI: 10.1007/s00330-023-09989-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/24/2023] [Accepted: 06/07/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES The objective of this study was to determine whether the presence of subacromial bursitis in patients with rotator cuff tendinopathy (RCT) was associated with a better outcome after ultrasound (US)-guided subacromial corticosteroid injection. METHODS A single-center prospective study was performed including patients referred for subacromial injection to manage RCT. At baseline, all patients received an US-guided intra-bursal injection of betamethasone (1 ml). The primary endpoint was reduced pain 3 months (M3) after the procedure: a good responder was defined by a decrease in Visual Analogue Scale pain of more than 30%. Secondary endpoints included functional recovery assessed by the Oxford Shoulder Score (OSS) and clinical success at 6 weeks (W6). We also explored the association between good clinical response and other factors, such as US or X-ray features. RESULTS One hundred patients were included and 49 presented with subacromial bursitis. At M3, 60% of patients (54/100) were considered good responders. The rate of good responders did not differ between the bursitis and non-bursitis groups (p = 0.6). During follow-up, OSS improved over time whether bursitis was present or not. We did not find any US or X-ray features significantly associated with a favorable clinical outcome. CONCLUSION The presence of subacromial bursitis did not influence clinical outcomes at 3 months post-subacromial injection in patients suffering from RCT. CLINICAL RELEVANCE STATEMENT The presence of subacromial bursitis did not influence clinical outcomes at 3 months post-subacromial corticosteroid injection in patients with rotator cuff tendinopathy. For patient management, looking for ultrasonographic signs of bursitis does not appear relevant for the indication of the injection. KEY POINTS • Ultrasound-guided subacromial corticosteroid injections led to a significant improvement in 60% of patients suffering from rotator cuff tendinopathy. • The presence of subacromial bursitis was not associated with better improvement at 3 months post-injection. • Except for the Minnesota score referring to job satisfaction, we did not find any baseline clinical, X-ray, or ultrasound characteristics associated with a successful outcome.
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Affiliation(s)
- Benoit Metayer
- Service de Rhumatologie, CH de Cholet, Cholet, France
- Service de Rhumatologie, CHU Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique Et Réadaptation Locomotrice Et Respiratoire, CHU Nantes, Nantes, France
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000, Nantes, France
| | - Benoit Le Goff
- Service de Rhumatologie, CHU Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000, Nantes, France
| | - Christelle Darrieutort-Laffite
- Service de Rhumatologie, CHU Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France.
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000, Nantes, France.
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Nemoto Y, Tajima S, Saito K, Satoi A, Matsui T, Kimura S, Nakamura F. [Pouchitis showed complete response to ustekinumab]. Nihon Shokakibyo Gakkai Zasshi 2024; 121:307-314. [PMID: 38599841 DOI: 10.11405/nisshoshi.121.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Pouchitis is the most common long-term complication following ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis. Although several agents, including probiotics, steroids, and immunomodulators, have been used, the treatment of pouchitis remains challenging. Owing to the proven efficacy of biological therapy in inflammatory bowel disease, there is now growing evidence suggesting the potential benefits of biological therapy in refractory pouchitis. Here, we report the case of a 64-year-old woman with pouchitis due to ulcerative colitis who was successfully treated with ustekinumab (UST). The patient developed ulcerative pancolitis at the age of 35. Total colectomy and IPAA with J-pouch anastomosis were performed when the patient was 47 years old. Ileotomy closure was performed 6 months later. Postoperatively, the patient developed steroid-dependent pouchitis. Three years later, she developed steroid-induced diabetes. The patient has been taking 3mg of steroid for 20 years;therefore, her lifetime total steroid dose was 21g. The patient had over 20 episodes of bloody diarrhea a day. The last pouchoscopy in 20XX-9 revealed inflammatory stenosis with deep ulcerations of the afferent limb just before the ileoanal pouch junction. In July 20XX, when we took over her treatment, the policy of treatment was to withdraw her from steroids. Pouchoscopy revealed a widened but still tight afferent limb through which the scope could easily pass, and the ileoanal pouch still showed erosive ileitis without ulcers. Thiopurine administration and steroid tapering were initiated. Steroid tapering increased the erythrocyte sedimentation rate (ESR). As ESR increased, her arthritis exacerbated. Six months after the end of steroid administration, the patient consented to UST treatment. On April 20XX+1, the patient received her first 260-mg UST infusion. At this point, she experienced 14-15 episodes of muddy bloody stools. She had no abdominal pain;however, she experienced shoulder pain. Gradually, UST affected both pouchitis and arthritis. UST treatment was continued at 90mg subcutaneously every 12 weeks without abdominal pain recurrence. Eight months after the first UST infusion, nonsteroidal anti-inflammatory drugs were no longer necessary for shoulder pain. Follow-up pouchoscopy performed 14 months after UST optimization revealed a normal afferent limb without ulcerations in either segment. Pouchitis remission was maintained for over 2 years.
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Affiliation(s)
- Yukako Nemoto
- Department of Gastroenterology, Kohsei Chuo General Hospital
- Department of Gastroenterology, Toho University Ohashi Medical Center
| | - Shinya Tajima
- Department of Gastroenterology, Toho University Ohashi Medical Center
| | - Kota Saito
- Department of Gastroenterology, Toho University Ohashi Medical Center
| | - Arata Satoi
- Department of Gastroenterology, Kohsei Chuo General Hospital
- Department of Gastroenterology, Toho University Ohashi Medical Center
| | - Takashi Matsui
- Department of Gastroenterology, Kohsei Chuo General Hospital
- Department of Gastroenterology, Toho University Ohashi Medical Center
| | - Sei Kimura
- Department of Gastroenterology, Kohsei Chuo General Hospital
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Gale KJ, Sanchez S, Sorenson TJ, Elftmann TD. Severe Referred Shoulder Pain Following Revision Fundoplication From a Stich on the Diaphragm. Am Surg 2023; 89:4866-4868. [PMID: 33847159 DOI: 10.1177/00031348211011110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Complications following fundoplication surgery for hiatal hernias are rare. Herein, we present the case of a 61-year-old woman who underwent a Nissen fundoplication, complicated by dysphagia, and a revision modified Toupet fundoplication for a hiatal hernia, after which she began to experience severe prandial referred left shoulder pain that was refractory to medical management. We hypothesized that a diaphragmatic suture placed during the revision fundoplication could be the source of the pain, and we elected to remove the suture, resulting in resolution of the pain. This pain remained resolved at the most recent follow-up on postoperative week six, and the patient had no further concerns.
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Affiliation(s)
- Kevin J Gale
- Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Santana Sanchez
- Medical School, University of Minnesota, Minneapolis, MN, USA
| | | | - Todd D Elftmann
- Department of Surgery, Ridgeview Medical Center, Waconia, MN, USA
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Kurata H, Sano H, Inawashiro T, Sasaki D, Noguchi M, Irie T, Suzuki K, Nishinaka N, Abe H. Persistent anterior shoulder pain after the Oudard-Iwahara-Yamamoto procedure in a patient with anterior shoulder instability: A case report. J Orthop Sci 2023; 28:1445-1449. [PMID: 34120826 DOI: 10.1016/j.jos.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 03/21/2021] [Accepted: 04/13/2021] [Indexed: 11/26/2022]
Affiliation(s)
| | - Hirotaka Sano
- Division of Orthopedics, Sendai City Hospital, Japan.
| | | | - Daizo Sasaki
- Division of Orthopedics, Sendai City Hospital, Japan.
| | | | - Taichi Irie
- Division of Orthopedics, Sendai City Hospital, Japan.
| | - Kazuhide Suzuki
- Department of Sports Medicine, Asao General Hospital, Japan.
| | - Naoya Nishinaka
- Department of Orhopaedic Surgery, Showa University Fujigaoka Hospital, Japan.
| | - Hiroo Abe
- Division of Orthopedics, Sendai City Hospital, Japan.
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Miyano M, Tsukuda Y, Hiratsuka S, Hamasaki M, Iwasaki N. Chronic shoulder injury related to vaccine administration following coronavirus disease 2019 vaccination: a case report. J Med Case Rep 2023; 17:456. [PMID: 37845692 PMCID: PMC10580499 DOI: 10.1186/s13256-023-04198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Shoulder injury related to vaccine administration, defined as shoulder pain and limited range of motion occurring after administration in the upper arm, has been previously reported. The symptom resolved completely after treatment with oral nonsteroidal anti-inflammatory drugs or an intraarticular steroid injection, however there have been few reports of long-term symptoms following coronavirus disease 2019 vaccination. This case report describes a healthy, middle-aged, healthcare worker who developed post-vaccination subacromial-subdeltoid bursitis that lasted for more than 6 months after Pfizer-BioNTech coronavirus disease 2019 vaccination. CASE PRESENTATION A 55-year-old Japanese woman with no significant medical history was vaccinated in the standard site, with the needle direction perpendicular to the skin. Within a few hours after the second vaccination, severe shoulder pain and limited range of motion appeared. Although shoulder range of motion improved, her shoulder pain did not improved for several months, and she consulted an orthopedic doctor 5 months later. Radiographs of her left shoulder did not provide helpful diagnostic information. High intensity in the subacromial-subdeltoid space was seen on short TI inversion recovery of magnetic resonance imaging, showing subacromial-subdeltoid bursitis. She was diagnosed with a shoulder injury related to vaccine administration. The patient was started on an oral anti-inflammatory drug, and the left subacromial space was injected with 2.5 mg of betamethasone with 3 ml of 1% lidocaine without epinephrine every 2 weeks. One month after starting this treatment, since her shoulder pain had not improved, the oral anti-inflammatory drug was switched to tramadol hydrochloride acetaminophen. However, 3 months after switching medication, the shoulder pain continued, and she worked so as to have minimal impact on her shoulder. CONCLUSION A case of subacromial-subdeltoid bursitis following a second dose of the Pfizer-BioNTech coronavirus disease 2019 vaccine that lasted many months is reported. Injection technique is a modifiable risk factor, the adverse effects of which could potentially be mitigated with appropriate and relevant training of healthcare providers. To prevent this type of case, the appropriate landmark, needle length, and direction should be confirmed.
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Affiliation(s)
- Masahiro Miyano
- Department of Orthopaedic Surgery, Otaru General Hospital, Wakamatsu 1-1-1, Otaru, Hokkaido, 047-8550, Japan
| | - Yukinori Tsukuda
- Department of Orthopaedic Surgery, Otaru General Hospital, Wakamatsu 1-1-1, Otaru, Hokkaido, 047-8550, Japan.
| | - Shigeto Hiratsuka
- Department of Orthopaedic Surgery, Otaru General Hospital, Wakamatsu 1-1-1, Otaru, Hokkaido, 047-8550, Japan
| | - Masanari Hamasaki
- Department of Orthopaedic Surgery, Otaru General Hospital, Wakamatsu 1-1-1, Otaru, Hokkaido, 047-8550, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Fernandes MR, Assis FMD, Spagnol JE, Chaves VB. Immobilization, Lymphedema, and Obesity are Predictive Factors in the Development of Adhesive Capsulitis in Breast Cancer Patients. Rev Bras Ginecol Obstet 2023; 45:e594-e602. [PMID: 37944926 PMCID: PMC10635792 DOI: 10.1055/s-0043-1772479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 07/14/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Adhesive capsulitis is a condition characterized by shoulder pain and stiffness. Breast cancer treatment has been linked to the development of this condition, but its mechanisms are still little known. This study's objective was to identify predictors factors associated with the development of adhesive capsulitis in breast cancer patients. METHODS A case control study was performed with women undergoing treatment for breast cancer in a single center. The sampling was nonprobabilistic and consecutive. Adhesive capsulitis was defined as constant pain associated with decreased active and passive shoulder movement in anterior elevation, external rotation at 0°/90° abduction, and internal rotation at 90° abduction. The study group consisted of patients with shoulder pain and range of motion limitations, while the control group consisted of women without any shoulder abnormalities. Sociodemographic and clinical variables were collected. A univariate logistic regression was used to assess the influence of variables on the studied outcome. For p < 0.20, a multivariate logistic regression was used. The probability of null hypothesis rejection was 5%. RESULTS A total of 145 women were assessed, with 39 (26.9%) on the study group and 106 (73.1%) on the control group. The majority was under 60 years old. In the multivariate analysis, variables correlated to the outcome under study were shoulder immobilization (OR = 3.09; 95% CI: 1.33-7.18; p = 0.009), lymphedema (OR = 5.09; 95% CI: 1.81-14.35; p = 0.002), and obesity (OR = 3.91; 95% CI: 1.27-12.01; p = 0.017). CONCLUSION Lymphedema, postsurgery immobilization, and obesity are predictive factors for the development of adhesive capsulitis in breast cancer patients.
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Saito T, Hamada J, Sasanuma H, Iijima Y, Takeshita K. Favourable clinical outcome of shoulder manipulation for chronic calcific tendinitis associated with shoulder stiffness: A case report. J Orthop Sci 2023; 28:1193-1195. [PMID: 33546934 DOI: 10.1016/j.jos.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/26/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Tomohiro Saito
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan.
| | - Junichiro Hamada
- Department of Orthopaedic Surgery, Kuwano Kyoritsu Hospital, Fukushima, Japan
| | - Hideyuki Sasanuma
- Department of Orthopaedic Surgery, Tochigi Medical Center, Tochigi, Japan
| | - Yuki Iijima
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
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Hsieh LF, Kuo YC, Lin YT, Liu YF, Wang HC. Ultrasonographic imaging findings of the shoulder in patients with Parkinson disease. J Orthop Sci 2023; 28:1004-1010. [PMID: 35945122 DOI: 10.1016/j.jos.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/06/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Shoulder disorders, including frozen shoulder, bursitis, and rotator cuff lesions, are common musculoskeletal problems in patients with Parkinson disease (PD). Because musculoskeletal ultrasound (US) can clearly image shoulder joints, we aimed to evaluate shoulder joints using US in patients with PD and healthy participants and correlation between US and PD severity. METHODS This is a prospective case-control study. 50 patients with PD and 50 healthy subjects from the outpatient department were administered US for bilateral shoulders. For data analysis, we chose the more severely affected side in the PD group for matching with the corresponding shoulder in the control group according to age, sex, and body mass index. Pain and disability were measured using the Visual Analogue Scale (VAS) for pain, Shoulder Pain and Disability Index (SPADI), and the Shoulder Disability Questionnaire (SDQ). RESULTS The PD group had higher VAS pain scores during activity (p = 0.003) and rest (p < 0.001), as well as the SPADI and SDQ scores (p < 0.001). In US findings, biceps long head tendon sheath effusion (p = 0.001), humeral head cortical irregularity (p = 0.012), and abnormality in the supraspinatus tendon (p = 0.003) were significantly greater in the PD group. Intra-group analysis in the PD group demonstrated a significant difference in passive flexion (p = 0.019) and supraspinatus tendinopathy (p = 0.033) on US examination during different disease stages. CONCLUSIONS Patients with PD had more supraspinatus tendinopathy on US findings than control subjects. The lesion was significantly associated with disease severity. CLINICAL TRIAL NUMBER NCT02702232.
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Affiliation(s)
- Lin-Fen Hsieh
- Department of Physical Medicine and Rehabilitation, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ying-Chen Kuo
- Department of Physical Medicine and Rehabilitation, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yu-Ting Lin
- Department of Physical Medicine and Rehabilitation, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ya-Fang Liu
- Department of Research, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Han-Cheng Wang
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan.
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Rasmussen-Barr E, Nordin M, Skillgate E. Are respiratory disorders risk factors for troublesome neck/shoulder pain? A study of a general population cohort in Sweden. Eur Spine J 2023; 32:659-666. [PMID: 36585528 DOI: 10.1007/s00586-022-07509-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/08/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE The etiology of neck/shoulder pain is complex. Our purpose was to investigate if respiratory disorders are risk factors for troublesome neck/shoulder pain in people with no or occasional neck/shoulder pain. METHODS This prospective cohort study was based on the Stockholm Public Health Cohorts (SPHC) 2006/2010 and the SPHC 2010/2014. We included adults who at baseline reported no or occasional neck/shoulder pain in the last six months, from the two subsamples (SPHC 06/10 n = 15 155: and SPHC 2010/14 n = 25 273). Exposures were self-reported asthma at baseline in SPHC 06/10 and Chronic Obstructive Pulmonary Disease (COPD) at baseline in SPHC 10/14. The outcome was having experienced at least one period of troublesome neck/shoulder pain which restricted work capacity or hindered daily activities to some or to a high degree during the past six months, asked for four years later. Binomial regression analyses were used to calculate risk ratios (RR) with 95% confidence intervals (95% CI). RESULTS Adjusted results indicate that those reporting to suffer from asthma at baseline had a higher risk of troublesome neck/shoulder pain at follow-up four years later (RR 1.48, 95% CI 1.10-2.01) as did those reporting to suffer from COPD (RR 2.12 95%CI 1.54-2.93). CONCLUSION Our findings indicate that those with no or occasional neck/shoulder pain and reporting to suffer from asthma or COPD increase the risk for troublesome neck/shoulder pain over time. This highlights the importance of taking a multi-morbidity perspective into consideration in health care. Future longitudinal studies are needed to confirm our findings.
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Affiliation(s)
- E Rasmussen-Barr
- Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden.
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, 144 83, Huddinge, Sweden.
| | - M Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center (OIOC), New York University, 63 Downing Street, New York, NY, 10014, USA
| | - E Skillgate
- Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of Health Promotion Science, Musculoskeletal and Sports Injury Epidemiology Center, Sophiahemmet, University, Box 5605, 114 85, Stockholm, Sweden
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Kim SC, Kim KH, Park JH, Bukhary H, Kim IS, Lee SM, Yoo JC. Microinstability characterised by small and easily overlooked anterior labral or Hill-Sachs lesions can be managed with arthroscopic anterior labral repair. Knee Surg Sports Traumatol Arthrosc 2022; 30:3818-3826. [PMID: 35344057 DOI: 10.1007/s00167-022-06941-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Some young individuals present with shoulder pain without a definite history or complaint of instability. However, careful history taking, physical examination, and high-quality magnetic resonance imaging may reveal evidence of instability of which the patient is unaware. Therefore, a clearer definition of these ambiguous patients is needed. This study aimed to report the characteristics and surgical outcomes of patients with microinstability compared to those of patients with classic recurrent anterior shoulder instability. METHODS From 2005 to 2018, 35 patients with microinstability (group M) underwent arthroscopic anterior labral repair (AALR) and were compared to 35 sex- and age-matched patients with classic recurrent anterior shoulder instability (group C) who also underwent AALR. Baseline characteristics, preoperative apprehension test findings, preoperative imaging for the presence of anterior labral and Hill-Sachs lesions, preoperative and postoperative (over 2 years) range of motion (ROM) and functional scores, final complications, and patient satisfaction were analysed. RESULTS The most common chief complaints in groups M and C were pain (29/35) and both pain and instability (27/35), respectively. Only pain during the apprehension test was predominant in group M (M vs. C, 27 vs. 1, p < 0.001). High incidence of chronic repetitive injuries (26/35) and acute trauma (28/35) were observed in groups M and C, respectively. Over half of the patients in group M showed anterior labral lesions on magnetic resonance arthrography (MRA, 18/35), and 21 patients had Hill-Sachs lesions on MRA/three-dimensional computed tomography. Finally, 29 patients showed either anterior labral or Hill-Sachs lesions on preoperative imaging. The lesion severity was higher in group C than that in group M. All patients underwent AALR with/without the remplissage procedure, with no significant differences in final clinical outcomes, complications, and patient satisfaction between the groups. CONCLUSIONS Microinstability is diagnostically challenging and can be diagnosed in young patients with ambiguous shoulder pain during motion, without instability. Pain on anterior apprehension test and subtle labral and/or Hill-Sachs lesion on imaging study could be diagnostic clues. This condition can be managed with arthroscopic anterior labral repair with or without the remplissage procedure. The possibility of microinstability in young patients with shoulder pain should always be considered, and small anterior labral or Hill-Sachs lesions should be closely monitored. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Su Cheol Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Kyoung Ho Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jong Hun Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hashem Bukhary
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Il Su Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Sang Min Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Byun H, Jang Y, Kim JY, Kim JM, Lee CH. Effects of preoperative personal education on shoulder function and lymphedema in patients with breast cancer: A consort. Medicine (Baltimore) 2022; 101:e30810. [PMID: 36197257 PMCID: PMC9509096 DOI: 10.1097/md.0000000000030810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To compare the incidence and severity of ipsilateral shoulder dysfunction and lymphedema of 2 groups of patients needing to undergo unilateral breast cancer surgery, one of which had only received printed education materials and the other group which had received educational materials plus preoperative education. METHODS We selected 61 patients who had been diagnosed with unilateral breast cancer and planned to undergo surgery. Before surgery, patients were randomly assigned, either to a control group that only received printed education materials about exercise for shoulder pain relief and lymphatic edema prevention following breast cancer surgery, or to an experimental group that received the printed education material with personal education. Participants were evaluated at 1, 3, 6, and 12 months after the surgery. To evaluate the impairment of shoulder function, we measured the passive shoulder range of motion (ROM), the degree of pain as visual analog scale (VAS), the short version of the disability of arm, shoulder, and hand (short DASH) scores, and the shoulder pain and disability index (SPADI). We checked arm circumferences to evaluate lymphedema. RESULTS There was no significant difference in demographic or clinical variables between the control and experimental groups. The experimental group showed significantly less limitation in abduction (P = .042) and forward flexion (P = .039) in the 6 months following surgery. Change in the VAS, short DASH, and SPADI scores were 1.633 (P < .001), 2.167 (P < .001), and 4.1 (P = .003) at 1 month following surgery, respectively. These then decreased with time. These changes started before shoulder ROM and arm circumference changes had occurred, which had started 3 months following surgery. CONCLUSIONS Preoperative education might be helpful for the prevention of a shoulder ROM limitation, and we need to focus on pain and disability in patients immediately following breast cancer surgery, and then on ROM and lymphedema.
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Affiliation(s)
- Hayoung Byun
- Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Yunjeong Jang
- Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jae-Myung Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Chang Han Lee
- Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
- Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
- *Correspondence: Chang Han Lee, Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital and Institute of Health Science, Gyeongsang National University College of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea (e-mail: )
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Kim SH, Lee SH, Shin DA. Could Machine Learning Better Predict Postoperative C5 Palsy of Cervical Ossification of the Posterior Longitudinal Ligament? Clin Spine Surg 2022; 35:E419-E425. [PMID: 35020623 PMCID: PMC9162065 DOI: 10.1097/bsd.0000000000001295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to investigate whether machine learning (ML) can perform better than a conventional logistic regression in predicting postoperative C5 palsy of cervical ossification of the posterior longitudinal ligament (OPLL) patients. SUMMARY OF BACKGROUND DATA C5 palsy is one of the most common postoperative complications after surgical treatment of OPLL, with an incidence rate of 1.4%-18.4%. ML has recently been used to predict the outcomes of neurosurgery. To our knowledge there has not been a study to predict postoperative C5 palsy of cervical OPLL patient with ML. METHODS Four sampling methods were used for data balancing. Six ML algorithms and conventional logistic regression were used for model development. A total of 35 ML prediction model and 5 conventional logistic prediction models were generated. The performances of each model were compared with the area under the curve (AUC). Patients who underwent surgery for cervical OPLL at our institute from January 1998 to January 2012 were reviewed. Twenty-five variables of each patient were used to make a prediction model. RESULTS In total, 901 patients were included [651 male and 250 female, median age: 55 (49-63), mean±SD: 55.9±9.802]. Twenty-six (2.8%) patients developed postoperative C5 palsy. Age (P=0.043), surgical method (P=0.0112), involvement of OPLL at C1-3 (P=0.0359), and postoperative shoulder pain (P≤0.001) were significantly associated with C5 palsy. Among all ML models, a model using an adaptive reinforcement learning algorithm and downsampling showed the largest AUC (0.88; 95% confidence interval: 0.79-0.96), better than that of logistic regression (0.69; 95% confidence interval: 0.43-0.94). CONCLUSIONS The ML algorithm seems to be superior to logistic regression for predicting postoperative C5 palsy of OPLL patient after surgery with respect to AUC. Age, surgical method, and involvement of OPLL at C1-C3 were significantly associated with C5 palsy. This study demonstrates that shoulder pain immediately after surgery is closely associated with postoperative C5 palsy of OPLL patient.
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Affiliation(s)
- Soo Heon Kim
- Department of Neurosurgery, Yonsei University College of Medicine
| | - Sun Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Yonsei University College of Medicine
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Poudel P, Oli P, Ojha P, Yadav RS, Poudel BR. Takayasu Arteritis Masquerading as Shoulder Pain: A Case Report. JNMA J Nepal Med Assoc 2022; 60:393-395. [PMID: 35633206 PMCID: PMC9252243 DOI: 10.31729/jnma.7443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 11/01/2022] Open
Abstract
Takayasu arteritis is a rare progressive chronic granular inflammation of the vessels that mainly affects the aorta and its branches. It is widely distributed in the world population and mainly involves young Asian women, manifesting as a systemic illness with myriads of cardiovascular signs and symptoms. The current case focuses on a young girl who had shoulder pain and weakness as the only manifestation of underlying Takayasu arteritis. Early clinical identification of the disease and control with disease-modifying anti-rheumatic drugs could improve the outcome and prevent devastating sequelae.
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Affiliation(s)
- Prabhat Poudel
- Nepal Medical College Teaching Hospital, Attarkhel, Kathmandu, Nepal
- Correspondence: Dr Prabhat Poudel, Nepal Medical College Teaching Hospital, Attarkhel, Kathmandu, Nepal. , Phone: +977-9843341484
| | - Paras Oli
- Nepal Medical College Teaching Hospital, Attarkhel, Kathmandu, Nepal
| | - Prashant Ojha
- Department of Nephrology, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Radhay Shyam Yadav
- Department of Internal Medicine, Nepal Medical College Teaching Hospital, Attarkhel, Kathmandu, Nepal
| | - Binaya Raj Poudel
- Department of Internal Medicine, Nepal Medical College Teaching Hospital, Attarkhel, Kathmandu, Nepal
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Rahbar M, Ranjbar Kiyakalayeh S, Mirzajani R, Eftekharsadat B, Dolatkhah N. Effectiveness of acromioclavicular joint mobilization and physical therapy vs physical therapy alone in patients with frozen shoulder: A randomized clinical trial. Clin Rehabil 2021; 36:669-682. [PMID: 34964679 DOI: 10.1177/02692155211070451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this trial was to compare the efficacy of acromioclavicular joint mobilization and standard physical-therapy versus physical-therapy alone in the treatment of the frozen shoulder. DESIGN Single-blind randomized clinical trial. SETTING Outpatient setting. SUBJECTS Patients with frozen shoulder. INTERVENTION Participants were randomly allocated into mobilization + physical-therapy (n = 28), and physical-therapy alone (n = 28) groups for one month. MAIN MEASURES The primary outcomes were the shoulder pain and disability index and the shoulder range of motion. The secondary outcome was the visual analogue scale. Measures were performed at the baseline, immediately and one month after the beginning of the treatment. RESULTS Visual analogue scale and the shoulder pain and disability index improved more significantly in the mobilization group compared to the physical-therapy group immediately [-4.63 (-5.58--3.67) vs. -2.22 (-2.96--1.47), P < 0.001 and -23.08 (-28.63--17.53) vs. -13.04 (-17.93--8.16), P = 0.008, respectively] and one month after the beginning of the treatment [-5.58 (-6.45--4.72) vs. -3.61 (-4.60--2.62), P < 0.001 and -33.43 (-40.85--26.01) vs. -20.03 (-26.00--14.07), P = 0.001, respectively]. Active abduction range of motion was also improved more significantly immediately after the treatment in the mobilization group compared to the physical-therapy group [25.83 (11.45-40.13) vs. 10.17 (1.02-19.15), P = 0.025], however there were no significant differences between two groups concerning other measured range of motions. CONCLUSIONS Adding acromioclavicular mobilization to standard physical-therapy was more efficient in decreasing pain and disability and improving active abduction range of motion compared to standard physical-therapy in frozen shoulder patients.
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Affiliation(s)
- Mohammad Rahbar
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Reza Mirzajani
- Palliative Care Medicine Department, Faculty of Medicine, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bina Eftekharsadat
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, 48432Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Dolatkhah
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, 48432Tabriz University of Medical Sciences, Tabriz, Iran
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Kamonseki DH, Haik MN, Ribeiro LP, de Almeida RF, de Almeida LA, Fonseca CL, Camargo PR. Measurement properties of the Brazilian versions of Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in individuals with shoulder pain. PLoS One 2021; 16:e0260452. [PMID: 34852000 PMCID: PMC8635377 DOI: 10.1371/journal.pone.0260452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/09/2021] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To verify the measurement properties of the Brazilian versions of Fear-avoidance Beliefs Questionnaire (FABQ) and Tampa Scale of Kinesiophobia (TSK) in individuals with shoulder pain. METHODS Individuals with shoulder pain (>18 years) were included in this study. Structural validity was verified by exploratory factor analysis, which was used to identify dimensionality of the FABQ and TSK. Test-retest reliability was assessed with intraclass correlation coefficient(3,1) and internal consistency with Cronbach's alpha. Floor or ceiling effects were also investigated. Responsiveness was verified by effect sizes and area under the receiver operating characteristic curve (AUC). RESULTS Exploratory factor analysis identified two and one factor in the FABQ and TSK, respectively. FABQ and TSK presented moderate to good reliability and adequate internal consistency (Cronbach's alpha > 0.70). The floor effect was present in one factor of the FABQ. The FABQ and TSK showed small to moderate effect sizes and did not show adequate AUC. CONCLUSION FABQ and TSK are multidimensional and unidimensional instruments, respectively. Those instruments presented moderate to good reliability and the responsiveness was considered to be suboptimal in individuals with shoulder pain.
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Affiliation(s)
- Danilo Harudy Kamonseki
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos, (SP), Brazil
| | - Melina Nevoeiro Haik
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos, (SP), Brazil
| | - Larissa Pechincha Ribeiro
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos, (SP), Brazil
| | - Rafaela Firmino de Almeida
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos, (SP), Brazil
| | - Lucas Araújo de Almeida
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos, (SP), Brazil
| | | | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos, (SP), Brazil
- * E-mail:
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Libardoni TDC, Armijo-Olivo S, Bevilaqua-Grossi D, de Oliveira AS. Relationship Between Intensity of Neck Pain and Disability and Shoulder Pain and Disability in Individuals With Subacromial Impingement Symptoms: A Cross-Sectional Study. J Manipulative Physiol Ther 2020; 43:691-699. [PMID: 32861520 DOI: 10.1016/j.jmpt.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/14/2018] [Accepted: 01/24/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to verify a possible relationship between shoulder disability and shoulder pain intensity and the variables related to cervical-spine dysfunction, and determine which of these can differentiate moderate to severe shoulder pain (>4 on a numerical rating scale [NRS]) from mild shoulder pain (≤4 on the NRS) in individuals with subacromial impingement symptoms. METHODS One hundred and forty volunteers with shoulder pain were evaluated. Demographic information and variables related to the shoulder and neck were collected. Self-reported pain and disability of the shoulder and cervical spine were measured using the Shoulder Pain and Disability Index (SPADI) and Neck Disability Index (NDI) questionnaires, respectively. An NRS was used to measure pain in the shoulder and cervical spine. A purposeful modeling strategy was used to determine the best model to predict shoulder disability and shoulder pain (dependent variables). Multiple logistic regression analysis followed by receiver operating curve analysis was used to determine which variables better differentiated moderate to severe shoulder pain from mild shoulder pain. RESULTS Variables such as Neck Disability Index (NDI) score (β = 1.09, P = .00) and age (β = -0.19, P = .03) were associated with the total SPADI score. Neck pain was significantly associated with shoulder pain (β = 0.40, P = .00). The combination of variables predicting moderate to severe shoulder pain was total SPADI score (odds ratio [OR] = 1.15, P = .003), neck pain (OR = 3.20, P = .04), and age (OR = 1.01, P = .05). CONCLUSION Our results demonstrate the important connection between shoulder- and neck-related symptoms in individuals with subacromial impingement symptoms.
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Affiliation(s)
- Thiele de Cássia Libardoni
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Susan Armijo-Olivo
- Faculty of Rehabilitation Medicine/Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Institute of Health Economics, Edmonton, Alberta, Canada
| | - Débora Bevilaqua-Grossi
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Sorensen CJ, Hastings MK, Lang CE, McGill JB, Clark BR, Bohnert KL, Mueller MJ. Relationship of shoulder activity and skin intrinsic fluorescence with low level shoulder pain and disability in people with type 2 diabetes. J Diabetes Complications 2017; 31:983-987. [PMID: 28392042 PMCID: PMC5438882 DOI: 10.1016/j.jdiacomp.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 11/26/2022]
Abstract
AIM People with type 2 diabetes (T2DM) have a high incidence of musculoskeletal disorders thought to be influenced by high non-enzymatic advanced glycated end-products (AGEs). The goals of this study were to determine differences in shoulder activity level and AGEs in people with T2DM compared to matched controls, and to determine factors associated with shoulder pain and disability. METHODS Eighty-one participants, T2DM (n=52) and controls (n=29), were examined for magnitude and duration of shoulder activity (measured using accelerometers), skin intrinsic florescence (SIF) as a surrogate measure of AGE level, and the Shoulder Pain and Disability Index (SPADI) as a self-report of shoulder pain and disability. RESULTS Compared with controls, T2DM participants had 23% less shoulder activity (p=0.01), greater SIF level (3.6±1.7 vs 2.7±0.6AU, p=0.01), less shoulder strength (p<0.05), and the duration of their shoulder activity was moderately associated (r=0.40; p<0.01) with reported shoulder pain and disability. Shoulder pain and disability were not related to SIF level. CONCLUSIONS Persons with T2DM have higher SIF levels and shoulder symptoms and disability indices than controls. Research is needed to determine if a shoulder mobility intervention to increase strength and mobility can help decrease shoulder pain and disability.
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Affiliation(s)
- Christopher J Sorensen
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO.
| | - Mary K Hastings
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO; Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO; Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Janet B McGill
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - B Ruth Clark
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Kathryn L Bohnert
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michael J Mueller
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO
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Garcia GH, Taylor SA, Mahony GT, DePalma BJ, Grawe BM, Nguyen J, Dines JS, Dines DM, Warren RF, Craig EV, Gulotta LV. Reverse Total Shoulder Arthroplasty and Work-Related Outcomes. Orthopedics 2016; 39:e230-5. [PMID: 26811957 DOI: 10.3928/01477447-20160119-03] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/21/2015] [Indexed: 02/03/2023]
Abstract
The average retirement age is increasing, and the indications for reverse total shoulder arthroplasty (RTSA) are being broadened. The goal of the current study was to determine objective findings for rate of return to work and time to return to work after RTSA. The authors performed retrospective data collection for consecutive patients who underwent RTSA at their institution between 2007 and 2013. All patients were asked to complete a questionnaire about their work history and their ability to participate in work-related activities. A total of 40 patients reported working before surgery. Average patient age was 74.7 years (range, 56-82 years). Average follow-up was 2.6 years (range, 1-4.7 years). Average American Shoulder and Elbow Surgeons score improved from 34.0 to 81.7 (P<.001). Average visual analog scale pain score decreased from 6.5 to 0.7 (P<.001). Most patients (65.4%) classified their job as sedentary, 34.6% classified their job as light work, and no patients classified their job as heavy work. Of patients who worked preoperatively, 65% (n=26) returned to work after RTSA. Only a previous diagnosis of heart disease affected return to work (P=.04). Overall, average time to return to work was 2.3 months (range, 0.5-11 months). Patients with sedentary jobs returned to work more quickly (1.4 months) than those with light work (4.0 months). A total of 96.2% of patients reported good to excellent surgical outcomes. Of patients who worked before RTSA, 65% were still working at final follow-up. Only 5% of patients retired for reasons attributed to the operated shoulder. On average, patients returned to work less than 3 months after surgery.
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Huang YC, Leong CP, Wang L, Chen MJ, Chuang CY, Liaw MY, Wang LY. The effects of hyaluronic acid on hemiplegic shoulder injury and pain in patients with subacute stroke: A randomized controlled pilot study. Medicine (Baltimore) 2016; 95:e5547. [PMID: 27930553 PMCID: PMC5266025 DOI: 10.1097/md.0000000000005547] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hemiplegic shoulder pain (HSP) is one of the most common comorbidities in stroke patients with flaccid shoulders. The pain limits functional motor recovery and affects the activities of daily living after acute stroke. This study investigated the effects of hyaluronic acid (HA) injection on pain reduction and motor function in subacute stroke patients with HSP and injury. METHODS A randomized, double-blinded controlled trial was conducted in a medical center. Twenty-six subacute stroke patients were enrolled and randomly divided into 2 groups: the experimental group (n = 16) received ultrasound-guided, subacromial HA injections once per week for 3 weeks and conventional rehabilitation, whereas the control group (n = 10) received 0.9% sodium chloride injections once per week for 3 weeks and conventional rehabilitation. Shoulder pain and motor function were evaluated before and after the intervention using the visual analog scale (VAS) and the Fugl-Meyer assessment for the upper extremity (FMA-UE), respectively. RESULTS In the experimental group, significant differences were found in VAS (P = 0.003), shoulder flexion (P = 0.03) and abduction (P = 0.02), and FMA-UE (P = 0.003) after treatment. In the control group, there were significant differences in VAS (P = 0.007), shoulder flexion (P = 0.035), and FMA-UE (P = 0.042) after treatment. The comparison of the changes in the parameters between the experimental and control groups, after each intervention, revealed a significant difference in VAS (P = 0.001). CONCLUSION Subacromial HA injection could result in positive effects on shoulder pain and shoulder abduction in subacute stroke patients with HSP and injury.
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Affiliation(s)
- Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation
| | | | - Lin Wang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mei-Ju Chen
- Department of Physical Medicine and Rehabilitation
| | | | - Mei-Yun Liaw
- Department of Physical Medicine and Rehabilitation
| | - Lin-Yi Wang
- Department of Physical Medicine and Rehabilitation
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Abstract
Objective: To determine whether symptoms and clinical signs can predict persistent neck/shoulder pain, future medical care-seeking and sickness absence. Design: A population-based cohort was followed prospectively over a 5—6 year period. Setting: Subjects from the district of Norrtälje (Sweden). Subjects: Subjects with self-rated neck/shoulder pain were included ( n = 1471). Main measures: Cox regression analyses were used to test the predictive value of single and combinations of symptoms and clinical signs obtained with questionnaires and simple tests concerning persistent neck/shoulder pain, future medical care-seeking and sickness absence. Results: Several symptoms and clinical signs were associated with the outcomes of interest: the relative risk (RR) for persistent neck/shoulder pain was 1.38 (95% confidence interval (CI) 1.14—1.52) for subjects with pain for over three months at baseline and concerning future medical care-seeking RR was 2.10 (95% CI 1.73—2.54) for subjects who had previously sought medical care. An episode of sickness absence during the year of enrolment increased the risk for future sickness absence (RR = 2.42, 95% CI 1.95—3.00). Having five or seven concurrent symptoms and clinical signs was common and more strongly associated with persistent pain (RR = 1.77, 95% CI 1.39 — 2.27) and future medical care-seeking (RR = 4.51, 95% CI 2.54—9.94), respectively, but not concerning sickness absence. Conclusion: By simply counting the number of concurrent symptoms and clinical signs, it is possible to predict persistent neck/shoulder pain and future medical care-seeking, but not sickness absence.
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Affiliation(s)
- Wilhelmus Johannes Andreas Grooten
- Department of Public Health Sciences, Division of Occupational Medicine, Karolinska Institutet and Department of Occupational and Environmental Health, Stockholm County Council, Stockholm, Sweden.
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Koyasu K, Kinkawa M, Ueyama N, Tanikawa Y, Adachi K, Matsuo H. The prevalence of primary neck and shoulder pain, and its related factors in Japanese postpartum women. CLIN EXP OBSTET GYN 2015; 42:5-10. [PMID: 25864273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE This study investigated the prevalence, location, and severity of neck and shoulder pain (NSP), its disturbance of quality of life (QOL), and the factors related to NSP in Japanese postpartum women. MATERIALS AND METHODS The study involved 308 postpartum women who had a medical examination one month after delivery. The questionnaire consisted of the background and details of NSP. Mood states were evaluated using the Profile of Mood States-Brief (POMS-B), Japanese Version. RESULTS The prevalence of NSP was 73.1%, one-fourth of which occurred after birth. The most common area was the superior part of the trapezium muscles. Prevalence was associated with past history of premenstrual syndrome (PMS), anemia during pregnancy, time per breastfeeding, and the mean POMS-B Fatigue score. Total breastfeeding time a day, the mean POMS-B score for Fatigue, Confusion, Anger-Hostility, and Depression were significantly higher for "worse" after birth than those for "no-change/relief". The disturbance of daily life due to NSP in postpartum women with past history of PMS and Hiesho were significant higher than that for women without those. CONCLUSIONS The prevalence of NSP in postpartum women was very high. The factors which affect NSP were the mental states, breastfeeding, past history of PMS, and anemia during pregnancy.
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Blonna D, Bellato E, Marini E, Barbasetti N, Mattei L, Fissore F, Arrigoni C, Castoldi F. Is fibromyalgia a cause of failure in the treatment of a painful shoulder? Musculoskelet Surg 2013; 97 Suppl 1:15-22. [PMID: 23588827 DOI: 10.1007/s12306-013-0255-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 02/05/2013] [Indexed: 06/02/2023]
Abstract
PURPOSE This study aims to review the incidence of fibromyalgia in a cohort of patients who were treated for shoulder pain and address whether a concomitant fibromyalgia could have had detrimental effect on outcomes. METHODS The treatment of 286 consecutive patients for shoulder pain was reviewed. RESULTS Eighteen patients (6.3 %) were diagnosed as having fibromyalgia, but in 13 of them (72 %), the diagnosis was initially missed. Five patients received a total of 11 surgeries for treatment of the shoulder. At an average follow-up of 15 months (range 12-27), the average new Oxford shoulder score (OS score) was 49 % (range 6-87 %). The average physical component of the Short-Form-12 Healthy Survey (SF-12) was 36 (range 21-55), and the mental component 30 (range 15-46). The Summary Outcome Determination score (SOD score) was 1.3 (range-3 to 6). CONCLUSIONS Fibromyalgia occurs relatively frequently in patients who complain of shoulder pain and it can be a cause of failure in the treatment of concomitant painful shoulder conditions.
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Affiliation(s)
- D Blonna
- Department of Orthopaedics and Traumatology, Mauriziano Umberto I Hospital, University of Turin Medical School, Largo Turati 62, Turin, Italy
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Tekeoglu I, Ediz L, Hiz O, Toprak M, Yazmalar L, Karaaslan G. The relationship between shoulder impingement syndrome and sleep quality. Eur Rev Med Pharmacol Sci 2013; 17:370-374. [PMID: 23426540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to examine potential relationship between subjective sleep quality and degree of pain in patients with shoulder impingement syndrome (SIS). MATERIALS AND METHODS Fourty patients with shoulder impingement syndrome were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Shoulder Disability Questionnaire (SDQ). Forty three of age and sex matched healthy subjects were included in the control group. RESULTS There was a significant difference between the patient and control groups in terms of all PSQI global scores and subdivisions (p < 0.01). The pain scores assessed by SDQ were positively correlated with the scores for subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, and sleep disturbance (r = 0.49/p < 0.01, r = 0.44/p < 0.01, r = 0.36/p < 0.05, r = 0.40/p < 0.05, and r = 0.37/p < 0.05 respectively). The comparison of total SDQ pain and global PSQI scores also revealed a significant correlation (r = 0.54/p < 0.01). CONCLUSIONS Subjective sleep disturbance connected to shoulder pain was found obviously in patients with SIS. For this reason, patients with shoulder pain due to SIS may benefit from the pain killers and cognitive-behavioral interventions that specifically target sleep disturbances. Further studies which contain polysomnographic assessments, as well as determine psychologic status are still needed to put forth sleep quality in patients with SIS.
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Affiliation(s)
- I Tekeoglu
- Department of Rheumatology/Rehabilitation, School of Medicine, Yüzüncü Yil University,Van, Turkey
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26
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Mari Z, Darwin KC, Hallett M. Painful shoulder--moving deltoid syndrome. Mov Disord 2012; 27:918-9. [PMID: 22499267 DOI: 10.1002/mds.24975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 01/19/2012] [Accepted: 02/27/2012] [Indexed: 11/12/2022] Open
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27
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Anderson VB. The intra-rater reliability of measured thoracic spine mobility in chronic rotator cuff pathology. J Musculoskelet Neuronal Interact 2011; 11:314-319. [PMID: 22130140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The relationship between thoracic spine dysfunction and painful shoulder pathologies is poorly understood. This study sought to determine the intra-rater reliability of a protocol aimed at assessing the active mobility of the thoracic spine in individuals with chronic rotator cuff pathology. METHODS Ten individuals (6 men and 4 women) with chronic rotator cuff pathology were recruited and screened according to strict criteria. Voluntary active thoracic spine motion was recorded in two planes using a multidimensional motion analysis system. Each assessment was undertaken on two occasions, two days apart. RESULTS The dominant upper-limb was affected in the majority of cases. There were no statistically significant differences between sessions during measurement of thoracic extension (p = 0.93), lateral flexion towards the affected side (p = 0.09), and lateral flexion away from the affected side (p = 0.38). Intraclass correlation coefficients for each of the thoracic spine movements ranged from 0.968 to 0.995. No significant difference was observed between thoracic lateral flexion between sides. CONCLUSIONS Excellent intra-rater reliability of the test protocol was observed among individuals with chronic rotator cuff pathology. Future studies assessing impairment among these disorders should interpret results in light of these reliability measurements.
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Affiliation(s)
- V B Anderson
- Centre for Health Exercise and Sports Medicine, The University of Melbourne, Australia
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Mundt AKG, Helkimo M, Magnusson T. Sleeping position and reported quality of sleep. A comparison between subjects demanding treatment for temporomandibular disorders and controls. Swed Dent J 2011; 35:187-193. [PMID: 22372306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aims of the present study were to investigate if there are differences concerning preferred body posture during sleep between 100 patients, 66 women and 34 men, mean age: 49 years (range: 20-85 years) referred to a specialist clinic because of TMD and 100 matched controls from a public dental clinic. The participants were asked to answer a questionnaire with questions about TMD symptoms and neck or shoulder pain. They were also asked about preferred sleeping position as well as about perceived sleep quality. No differences could be found between the two groups in respect of sleeping position. However, significantly more individuals in the TMD group compared to the controls had changed their preferred sleeping position due to their face and/or jaw and/ or neck-shoulder symptoms. Subjects in the TMD group also more frequently stated that they often felt insufficiently rested at awakening and/or felt tired or sleepy in the daytime because of symptoms from face/jaws. A significant number in the control group reported TMD symptoms indicating a latent need for TMD treatment. It is concluded that sleep position seems to have little or no significance for the development or maintenance of TMD symptoms. However, the study indicates that TMD symptoms and associated neck- and shoulder pain affect the quality of sleep.
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Affiliation(s)
- Anna-Kerstin Göthe Mundt
- Department of Stomatognathic Physiology, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
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Abstract
Upper extremity weakness can be the result of a myriad of conditions ranging from contractile tissue injury, joint injury, or injury to central or peripheral nervous system components. Accurate diagnosis is important in establishing an optimal treatment regimen and sound prognosis. This report provides an overview of the diagnosis and treatment of Parsonage-Turner Syndrome, a relatively rare cause of upper extremity weakness and dysfunction.
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31
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Boughammoura-Bouatay A, Chebel S, Aissi M, Koubaa M, Frih-Ayed M. [Lobstein's disease presenting with seizures]. Rev Neurol (Paris) 2007; 163:834-6. [PMID: 17878811 DOI: 10.1016/s0035-3787(07)91467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Osteogenesis imperfecta (OI) is a group of hereditary disorders most often due to an anomaly of collagen biosynthesis. Divers clinical manifestations are reported. Neurological manifestations are exceptional. A 40-year-old man with a history of multiple bone fractures was admitted for a generalized tonic-clonic seizure. There was no metabolic disorder, the patient however complained of bilateral shoulder pain. Standard radiography and shoulder MRI revealed bilateral humeral fractures. The electroencephalogram and the brain MRI showed no abnormalities. He was given valproate acid and eight months later was free of crises. Search for an etiological favored the diagnosis of Lobstein disease.
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Paul A, Lewis M, Saklatvala J, McCall I, Shadforth M, Croft P, Hay E. Cervical spine magnetic resonance imaging in primary care consulters with shoulder pain: a case control study. Ann Rheum Dis 2007; 66:1363-8. [PMID: 17289758 PMCID: PMC1994306 DOI: 10.1136/ard.2006.064881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the association between shoulder region pain presenting in primary care and cervical spine magnetic resonance imaging (MRI) abnormalities. METHODS A matched case-control study of 48 pairs of participants. Patients had presented to primary care with a new episode of shoulder pain. Controls had no history of pain in the shoulder region and were individually matched with cases by age, gender and referring clinician. All participants underwent a structured clinical assessment and cervical spine MRI. Scans were scored by experienced musculoskeletal radiologists blinded to case-control status. RESULTS Median age of participants was 51 years (range 19-79) and 21 (44%) were female. "Neck pain in the past week" was reported by 25 (52%) cases and seven (15%) controls (odds ratio, OR, 10.0; 95% confidence interval, CI, 2.4, 88.2). Cervical spine MRI from C3/4 to C6/7 revealed: 18 (38%) of both cases and controls had disc height loss >/=50% at any level; 10 (21%) cases and eight (17%) controls had disc disease with neural compromise; 11 (23%) cases and 16 (33%) controls had foraminal stenosis; nine (19%) of both cases and controls had canal narrowing. At least one of the above findings was present in 24 (50%) cases and 23 (48%) controls (OR 1.1; 95% CI 0.4, 3.4). CONCLUSIONS Cervical spine MRI abnormalities were similar in both cases and controls, despite significantly more self-reported neck pain in cases with shoulder pain. Other possible mechanisms, such as muscular strain or postural problems, may explain the observed clinical association between shoulder region pain and neck associated symptoms.
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Affiliation(s)
- Anindita Paul
- Staffordshire Rheumatology Centre, The Haywood, Stoke on Trent, Staffordshire ST6 7AG, UK
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Abstract
BACKGROUND AND PURPOSE Postpoliomyelitis sequelae, such as gait instability and progressive weakness, predispose people with postpolio syndrome to secondary disabilities. With aging, people who depend on their upper extremities to accommodate lower-extremity deficits may anticipate overuse injuries. The purpose of this case report is to describe the use of mobilization and exercise in postoperative rehabilitation of rotator cuff surgery on a patient with postpolio syndrome. CASE DESCRIPTION A 48-year-old woman with postpolio syndrome had rotator cuff surgical repair followed by physical therapy intervention. Maitland mobilization and mild functional exercises were chosen to avoid triggering fatigue. OUTCOMES Measurements taken preoperatively, before and after physical therapy intervention, and 2 years after intervention showed return to independent status with excellent retention. DISCUSSION No fatigue or overuse weakness was encountered. This is the first case report to document physical therapy following rotator cuff repair in a patient with postpolio syndrome.
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Affiliation(s)
- Mary Carlson
- Physical Therapy Program, University of Texas at El Paso, El Paso, TX 79902, USA.
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Hirata K, Tatsumoto M, Araki N, Takeshima T, Igarashi H, Shibata K, Sakai F. Multi-center randomized control trial of etizolam plus NSAID combination for tension-type headache. Intern Med 2007; 46:467-72. [PMID: 17443036 DOI: 10.2169/internalmedicine.46.6226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Benzodiazepines are commonly used for the treatment of tension-type headache (TTH), however, there are few randomized controlled trials recommending the use of these drugs in Japan. This study was undertaken to evaluate the efficacy of etizolam, a thienodiazepine derivative, in combination with a non-steroidal anti-inflammatory drug (NSAID) as an acute treatment for TTH. METHODS The study design was a multi-center randomized control trial and included 144 patients. The diagnosis of TTH was based on the criteria of the International Classification of Headache Disorders-1 and all patients were diagnosed with episodic tension-type headache (ETTH). Changes in the severity of headache and shoulder pain were graded using a Visual Analogue Scale (VAS) before and after administration of drugs. Patients were randomized into NSAID alone (NSAID, mefenamic acid, 250 mg) group and NSAID (mefenamic acid, 250 mg) plus etizolam (0.5 mg) (NSAID-ET) group prior to treatment. RESULTS Although both groups showed a significant drop in VAS for headache and shoulder pain (p<0.01), there was no overall significant difference between the NSAID-ET and NSAID groups. However, headache was improved significantly in female patients (p<0.05), and shoulder pain was improved in young and female patients (p<0.05, p<0.04) in the NSAID-ET group. CONCLUSION This study indicates that the combination treatment of etizolam and NSAID is useful in young or female patients.
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Affiliation(s)
- Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi.
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Abstract
OBJECTIVE The objective of our study was to compare the level of disability induced by shoulder pain as reported by patients on the L'Insalata Self-Administered Questionnaire (SAQ) with shoulder MRI results. MATERIALS AND METHODS One thousand seventy-nine consecutive patients referred for shoulder MRI were asked to complete the L'Insalata SAQ. Results from the L'Insalata SAQ and MRI were cross-tabulated and analyzed with multivariable linear regression. RESULTS No statistical relationship could be found between the level of pain, impairment, and disability as reported on the L'Insalata SAQ and the location and size of full-thickness tears of the rotator cuff as observed on MRI. Pain and disability are significantly linked to the presence of supraspinatus tendon lesions and the presence of bursitis, but these factors contribute little to the symptoms. Patients with biceps tendinopathy did not experience increased pain when compared with patients without biceps tendinopathy or with biceps tendon rupture. CONCLUSION No statistical relationship was found between the level of pain and disability and the size and location of full-thickness tears of the rotator cuff.
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Affiliation(s)
- Olivier P Krief
- Service Radiologie, Polyclinique Atlantique, Rue Claude Bernard, BP419, Saint Herblain, Cedex 44819, France.
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Ge HY, Fernández-de-las-Peñas C, Arendt-Nielsen L. Sympathetic facilitation of hyperalgesia evoked from myofascial tender and trigger points in patients with unilateral shoulder pain. Clin Neurophysiol 2006; 117:1545-50. [PMID: 16737848 DOI: 10.1016/j.clinph.2006.03.026] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Revised: 03/23/2006] [Accepted: 03/30/2006] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To provide evidence for the sympathetic-sensory interaction within a trigger point, which may contribute to local and referred pain and sympathetic symptoms in myofascial pain syndrome. METHODS Pressure pain threshold (PPT) was measured from a trigger point in the painful side, from a tender point in the non-painful side in the infraspinatus muscles, and from a normal control point in the tibialis anterior muscle in 21 patients with unilateral shoulder pain. In addition, pressure threshold for eliciting referred pain (referred pain threshold, PTRP) was determined, then the intensity was measured of local and referred pain evoked by a pressure equal to 1.5 times PRPT, applied at the trigger point, in 11 patients. All measurements were taken during normal respiration and elevated intrathoracic pressure (EITP). RESULTS PPT was significantly lower at the trigger than tender points during normal respiration (P=0.001). PPT decreased significantly at both the tender and trigger points during EITP compared with normal respiration (P<0.001). Significant decreases in referred pain threshold and increases in local and referred pain intensities were seen during EITP than normal respiration (all, P<0.01). CONCLUSIONS These results provide evidence of sympathetic facilitation of mechanical sensitization and the local and referred muscle pain. SIGNIFICANCE Sympathetic hyperactivity needs to be considered during the clinical evaluation and management of myofascial pain syndrome.
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Affiliation(s)
- Hong-You Ge
- Laboratory for Experimental Pain Research, Department of Health Science and Technology, Center for Sensory-Motor Interaction (SMI), Aalborg University, Fredrik Bajers Vej 7 D-3, DK-9220 Aalborg, Denmark.
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Abstract
Nineteen outpatients, nine women and ten men, all right-handed, ranging in age from 33 to 87 yrs, with an average age of 53.5 yrs, presented with complaints of lateral epicondylitis (i.e., tennis elbow). Each was subsequently identified as having a heretofore unrecognized loss of ipsilateral shoulder internal rotation. The authors suggest that in this scenario the occult shoulder periarthrosis is interlinked in a pathokinetic chain potentially predisposing to the presenting symptoms of tennis elbow. During a tennis serve, excessive wrist flexion may be substituted as to compensate for a restricted arc of shoulder internal rotation. The extensor carpi radialis longus and brevis cross both the elbow and wrist. Functionally, they have the capacity of reversing their osseous attachments, both at their origin and insertion, as these muscles cycle under load from a concentric/shortening to an eccentric/elongating contraction. Aging muscle, with its increased viscoelastic stiffness, may be "too slow" to accommodate this transition recoil, especially when repetitive. Instead, it is pathomechanically absorbed at the proximal elbow extensor tendon insertion.
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Affiliation(s)
- Myron M Laban
- Department of Physical Medicine and Rehabilitation, William Beaumont Hospital, Royal Oak, MI 48073-6769, USA
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Geraets JJXR, Goossens MEJB, de Groot IJM, de Bruijn CPC, de Bie RA, Dinant GJ, van der Heijden G, van den Heuvel WJA. Effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints. ACTA ACUST UNITED AC 2005; 51:87-94. [PMID: 15924511 DOI: 10.1016/s0004-9514(05)70037-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An operant behavioural and time-contingent graded exercise therapy program was developed to improve functional ability irrespective of pain experience in patients with chronic shoulder complaints. The clinical effectiveness of graded exercise therapy compared to usual care was evaluated in a randomised clinical trial. Assessments were carried out before and after 12 weeks of treatment. Performance of daily activities was measured by two outcome measures: the main complaints instrument and the Shoulder Disability Questionnaire (SDQ). Patients were eligible for participation if they had suffered from shoulder complaints for at least three months. Patients suffering from systemic diseases, referred pain or severe biomedical or psychiatric disorders were excluded. Patients (n = 176) were randomised and allocated either to graded exercise therapy (n = 87) or usual care (n = 89). Graded exercise therapy led to greater improvement in the performance of daily activities than usual care. However, only mean differences between groups in performance of activities related to the main complaints reached statistical significance (p = 0.049; 95% CI 0.0 to 15.0). The observed beneficial effects were considered to be small to moderate (calculated effect sizes: 0.30 for the main complaints instrument and 0.07 for the SDQ). Subgroup analysis showed larger improvements on the mean complaints instrument in patients not reporting pain reduction over time. Graded exercise therapy seems to be less effective in restoring performance of daily activities as assessed by the SDQ in patients showing a painful arc during physical examination. Results showed that graded exercise therapy is more effective in restoring the ability to daily activities in patients with chronic shoulder complaints than usual care, although beneficial effects are small.
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Bot SDM, van der Waal JM, Terwee CB, van der Windt DAWM, Scholten RJPM, Bouter LM, Dekker J. Predictors of outcome in neck and shoulder symptoms: a cohort study in general practice. Spine (Phila Pa 1976) 2005; 30:E459-70. [PMID: 16103840 DOI: 10.1097/01.brs.0000174279.44855.02] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An observational prospective cohort study in general practice. OBJECTIVES To describe the clinical course and to identify predictors of recovery, changes in pain intensity, and changes in functional disability in patients with neck or shoulder symptoms at 3- and 12-month follow-up. SUMMARY OF BACKGROUND DATA Knowledge on the clinical course and predictors of outcome in neck and shoulder symptoms is limited. Such knowledge would facilitate treatment decisions and may help to inform patients about their prognosis. METHODS Four hundred and forty-three patients who consulted their general practitioner with neck or shoulder symptoms participated in the study. Baseline scores of pain and disability, symptom characteristics, sociodemographic and psychological factors, social support, physical activity, general health, and comorbidity were investigated as possible predictors of recovery, changes in pain intensity, and changes in functional disability using multiple regression analyses. RESULTS The recovery rate was low; 24% of the patients reported recovery at 3 months and 32% reported recovery at 12-month follow-up. Duration of the symptoms before consulting the GP and a history of neck or shoulder symptoms increased the probability of an unfavorable outcome. Furthermore, less vitality and more worrying were consistently associated with poorer outcome after 3 and 12 months. The area under the receiver-operator characteristic curve for the model predicting recovery was 0.8 at 3 months and 0.75 at 12 months. The explained variance of the models on pain and functional disability ranged from 43 to 54%. CONCLUSIONS The results found in this study indicate that besides clinical characteristics, psychological factors also predict the outcome of neck and shoulder symptoms.
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Affiliation(s)
- Sandra D M Bot
- Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Abstract
OBJECTIVE To discuss the case of a 62-year-old woman with congestive heart failure (CHF), precipitated by a previous arteriovenous malformation, and to review the clinical presentation, pathophysiology, and treatment options for patients with CHF. CLINICAL FEATURES The patient complained of pain, rapid weight gain, and shortness of breath. The index event for this patient was known to be an arteriovenous malformation. Biventricular cardiomegaly with pulmonary venous hypertension was evident on chest radiographs. INTERVENTION AND OUTCOME The patient received both medical care (drug therapy) and chiropractic care (manipulation and soft tissue techniques to alleviate symptoms and discomfort). CONCLUSION Patients with known and undiagnosed CHF may visit the chiropractic physician; thus, knowledge of comprehensive care, differential diagnosis, and continuity of care are important. Chiropractic management may be helpful in alleviating patient discomfort. Further clinical investigations may help to clarify the role of complementary and alternative care in the diagnosis and treatment of CHF.
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Affiliation(s)
- Melanie D Osterhouse
- Department of Radiology, Logan College of Chiropractic, Chesterfield, MO 63006-1065, USA.
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Jiang T, Li J, Zhang ZK. [A primary research on the concomitant symptoms of temporomandibular joint pain]. Zhonghua Kou Qiang Yi Xue Za Zhi 2005; 40:219-22. [PMID: 15938885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To investigate the states of chronic symptoms of other parts of the body concomitant with temporomandibular joint (TMJ) pain. METHODS Fifty-one patients with TMJ pain and thirty-one control subjects without TMJ symptoms were chosen randomly. The TMJ symptoms and chronic symptoms of other regions were investigated at the base line. The TMJ pain patients were investigated again half year after treatment. Between-symptom correlations were analyzed using linear regression and Chi-squared analysis method (alpha = 0.05). RESULTS The chronic symptoms related to the TMJ pain at the base line were headache, back pain, numbness of hand, neck and shoulder pain, insomnia, dizziness, reduced hearing ability, eye pain and fatigue (P < 0.05). The incidences of the symptoms of patients were higher than those of the control subjects (P < 0.01). Half year later, the headache, neck and shoulder pain and fatigue were the symptoms improved with the TMJ pain treatment (P < 0.05). CONCLUSION The symptoms of adjacent regions of orofacial area such as neck and shoulder pain and headache are the main concomitant symptoms of the TMJ pain, and these symptoms may be improved by the treatment of TMJ.
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Affiliation(s)
- Ting Jiang
- Department of Prosthodontics, Peking University School of Stomatology, Beijing 100081, China.
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Unglaub F, Guehring T, Fuchs PC, Perez-Bouza A, Groger A, Pallua N. Nekrotisierende Fasziitis nach Injektionstherapie im Schultergelenk. Orthop�de 2005; 34:250-2. [PMID: 15703892 DOI: 10.1007/s00132-005-0766-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Necrotizing fasciitis is an inflammatory, rapidly progressive soft tissue infection usually caused by Streptococcus pyogenes or by a combination of aerobic and anaerobic microorganisms. Here we report the case of a patient who developed necrotizing fasciitis near the site of therapeutic injections. An orthopaedic surgeon in private practice had given the 74-year-old patient, who suffered from left shoulder pain, cortisone injections in his left shoulder joint. During the course of this therapy, the patient developed necrotizing fasciitis. Despite radical surgical debridement of the patient's back, left thorax and amputation of his left arm, the patient expired 15 h after arriving at our department. In cases such as these, patient survival depends upon an early diagnosis followed by immediate radical surgical intervention including complete opening of fascial compartments and excision of necrotic tissues.
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Affiliation(s)
- F Unglaub
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum Aachen.
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Abstract
A 40-yr-old woman received a series of three interlaminar epidural steroid injections for the treatment of axial neck pain secondary to degenerative disc disease. Immediately after her third injection, she experienced symptoms of a dural puncture-induced headache. This headache persisted on a daily basis for 3 mos, despite two epidural blood patches using an interlaminar approach, which was finally completely abated with a transforaminal blood patch. The headache was immediately relieved and remained alleviated through the follow-up interval of 1 yr. In this patient, a fluoroscopically guided transforaminal epidural blood patch proved to be more effective than the classic blind interlaminar approach in the treatment of post-dural puncture headache.
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Affiliation(s)
- Curtis W Slipman
- Penn Spine Center, Hospital of the University of Pennsylvania Health System, White Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Abstract
OBJECTIVES To report rotator cuff tendonitis as a complication of lymphedema and to discuss the possible etiology and treatment options. DESIGN Retrospective review of 8 cases. SETTING University hospital outpatient clinic. PARTICIPANTS A total of 8 breast cancer patients with a history of lymphedema and ipsilateral shoulder pain. INTERVENTION Patients with lymphedema and ipsilateral shoulder pain were diagnosed with rotator cuff tendonitis if all of the following 3 tests were positive: supraspinatus test, Neers impingement test, and Hawkins impingement test. Patients diagnosed with rotator cuff tendonitis were prescribed a nonsteroidal anti-inflammatory drug (NSAID) and physical therapy (PT). MAIN OUTCOME MEASURES Improvement in symptoms of shoulder pain at a 4- to 6-week follow-up, as measured by visual analog scale (VAS). RESULTS Seven of 8 patients reported a subjective decrease in their symptoms of shoulder pain at a 4- to 6-week follow-up. The average improvement in shoulder pain as measured by VAS was a 4.5-point decrease from the original pain score given. One of 8 patients had a full-thickness supraspinatus tendon tear and required additional decongestive therapy and PT to obtain relief of symptoms. CONCLUSIONS Rotator cuff tendonitis is a complication of lymphedema caused by internal derangement of tendon fibers, which may be subject to impingement, functional overload, and intrinsic tendinopathy. Conservative treatment with NSAIDs and PT is a safe and effective treatment.
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Affiliation(s)
- Joseph E Herrera
- New York-Presbyterian Hospital and Hospitals of Columbia and Cornell, New York, USA
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Abstract
OBJECTIVE To identify the most common medical complications experienced by stroke survivors during inpatient, tertiary-level stroke rehabilitation. DESIGN Prospective, descriptive analysis. SETTING A tertiary-level, 23-bed, inpatient stroke rehabilitation unit in Nova Scotia, Canada. PARTICIPANTS All stroke survivors (N=133) admitted for tertiary-level stroke rehabilitation during a 1-year period. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The attending physiatrist determined the presence or absence of specific complications during the interdisciplinary team conference held during the week of discharge for each patient. RESULTS The 4 most common medical complications were depression (26%), shoulder pain (24%), falls (20%), and urinary tract infection (UTI) (15%). Other less common complications included back and hip pain (5%), gastrointestinal disturbances (4%), and pneumonia (2%). Seizures, pressure ulcers, and shoulder-hand syndrome each occurred in 1.5% of the population. CONCLUSIONS Depression, shoulder pain, falls, and UTIs are common complications experienced by stroke survivors during inpatient rehabilitation. Heightened awareness of these potential complications may lead to prevention or to earlier recognition and improved management of these conditions.
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Affiliation(s)
- Deirdre E McLean
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, NS, Canada.
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Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES To describe the consequences of shoulder pain on activity and participation in spinal cord-injured paraplegic wheelchair users. To describe the prevalence and type of shoulder pain. SETTING Two spinal cord injury (SCI) centres in Sweden. METHODS All subjects with paraplegia due to an SCI of more than 1 year living in the counties of Uppsala and Linköping, Sweden were contacted by mail and asked to fill in a questionnaire (89 subjects). Those of the responding 56 subjects with current shoulder pain were asked to participate in further examination and interviews. A physiotherapist examined 13 subjects with shoulder pain in order to describe type and site of impairment. To describe consequences of shoulder pain on activity and participation, the Constant Murley Scale (CMS), the Wheelchair Users Shoulder Pain Index (WUSPI) the Klein & Bell adl-index and the Canadian Occupational Performance Measure (COPM) were used. RESULTS Out of all respondents, 21 had shoulder pain (37.5%). Data from 13 of those subjects were used in the description of type and consequences of shoulder pain. Findings of muscular atrophy, pain, impingement and tendinits were described. We found no difference in ADL-performance with, respectively without, shoulder pain (P=0.08) using the Klein & Bell adl-index. No correlation was found between the various descriptions of impairment, activity limitations and participation restriction (P>0.08). All together 52 problems with occupational performance due to shoulder pain were identified using the COPM. Of these, 54% were related to self-care activities. CONCLUSION The consequences of shoulder pain in paraplegic wheelchair users are mostly related to wheelchair activities. Since the wheelchair use itself presumably cause shoulder problems, this will become a vicious circle. More research is needed in order to reduce shoulder problems in wheelchair users.
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Affiliation(s)
- K A M Samuelsson
- Department of Neuroscience and Locomotion, Section of Rehabilitation Medicine, Faculty of Health Sciences, Linköping, Sweden
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Abstract
The purpose of this study was to assess the functional outcome of the terrible triad of the shoulder, a rare combination of anterior shoulder dislocation, massive rotator cuff tear, and neurologic injury. Six patients with this condition have been treated at our institution since 1990. The mean age was 57 years. All patients underwent rotator cuff repair (RCR). The mean time from injury to surgery was 5 months. Follow-up averaged 5.6 years. Functional outcome was recorded by use of the Shoulder Pain and Disability Index. Preoperative mean active forward elevation was 24 degrees, as compared with 98 degrees postoperatively. Strength improved from 3 lb to a mean of 12 lb in forward elevation and from 2 lb to 16 lb in external rotation. Clinically, 5 of 6 patients achieved recovery of their nerve injury. Total Shoulder Pain and Disability Index postoperative scores revealed good or excellent results in 4 of 6 patients. For this injury pattern, performing an RCR offers the patient the best chance for a favorable outcome. Waiting for neurologic recovery before performing RCR is not recommended.
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Affiliation(s)
- Stephen D Simonich
- Department of Orthopaedic Surgery, College of Medicine, University of Florida, Gainesville 32610-0246, USA
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Linton SJ, Boersma K. Early identification of patients at risk of developing a persistent back problem: the predictive validity of the Orebro Musculoskeletal Pain Questionnaire. Clin J Pain 2003; 19:80-6. [PMID: 12616177 DOI: 10.1097/00002508-200303000-00002] [Citation(s) in RCA: 353] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test the predictive utility of the Orebro Musculoskeletal Pain Screening Questionnaire in identifying patients at risk for developing persistent back pain problems. DESIGN Prospective, where participants completed the questionnaire and their cases were followed for 6 months to assess outcome with regard to pain, function, and absenteeism due to sickness. PARTICIPANTS One hundred seven patients, recruited from seven primary care units. RESULTS Discriminant analyses showed that the items on the questionnaire were significantly related to future problems. For absenteeism due to sickness, 68% of the patients were correctly classified into one of three groups, whereas an even distribution would have produced 33%. The analyses for function correctly classified 81%, and for pain 71%, into one of two groups, compared with a chance level of 50%. A total score analysis demonstrated that a cutoff score of 90 points had a sensitivity of 89% and a specificity of 65% for absenteeism due to sickness, and a sensitivity of 74% and a specificity of 79% for functional ability. CONCLUSIONS The results underscore that psychological variables are related to outcome 6 months later, and they replicate and extend earlier findings indicating that the Orebro Screening Questionnaire is a clinically reliable and valid instrument. The total score was a relatively good predictor of future absenteeism due to sickness as well as function, but not of pain. The results suggest that the instrument could be of value in isolating patients in need of early interventions and may promote the use of appropriate interventions for patients with psychological risk factors.
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Affiliation(s)
- Steven J Linton
- Department of Occupational and Environmental Medicine, Orebro University Hospital, Orebro, Sweden.
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Madeleine P, Lundager B, Voigt M, Arendt-Nielsen L. The effects of neck-shoulder pain development on sensory-motor interactions among female workers in the poultry and fish industries. A prospective study. Int Arch Occup Environ Health 2003; 76:39-49. [PMID: 12592581 DOI: 10.1007/s00420-002-0375-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2001] [Accepted: 06/28/2002] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this prospective laboratory study was to follow newly employed workers in the fish or poultry industry for 6 months and investigate possible changes in sensory manifestations and motor performance during low load, repetitive work simulation. It was investigated whether the changes were an effect of employment duration and of development of neck-shoulder complaints. METHODS Twelve newly employed female filleting employees without any sign of neck-shoulder tenderness/pain at the time of employment of 0 months took part in two laboratory recording sessions planned within 1 month of employment and after 6 months of employment at the plant. After 6 months, six workers out of 12 had developed pain and/or tenderness in the neck-shoulder region. The recording sessions evaluated sensory-motor aspects by measuring pressure pain threshold, work-task timing, cutting forces, surface electromyographic activity of four shoulder muscles, displacement of the centre of pressure, and 3D movements of the arm and trunk during simulation of low load, repetitive filleting. RESULTS Effects due to the duration of employment were observed in both groups, i.e. decreased sensibility to pressure, decrease in the duration of the work cycle, increased arm starting position with respect to the upright position, and decreased range of motion of the arm and trunk (P<0.05) after 6 months. Among the workers with neck-shoulder complaints, increased sensibility to pressure, lower force level, higher electromyographic activity, decreased amplitude of arm movement, and increased trunk posture and movement amplitude (P<0.05) were observed, compared with workers without complaints. CONCLUSIONS Differences in terms of sensory manifestations and motor control strategy were seen after 6 months of employment with or without neck-shoulder complaints. In general, changes in sensory manifestations and motor control strategy after 6 months work were most likely of importance, as they underlined a learning process as employment duration increased. Moreover, the present sensory-motor changes observed among workers with neck-shoulder complaints highlighted the potential physical risk factors associated with low load, repetitive work.
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Affiliation(s)
- Pascal Madeleine
- Center for Sensory-Motor Interaction (SMI), Aalborg University, Fredrik Bajers Vej 7, Building 3, 9220 Aalborg, Denmark.
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50
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Abstract
BACKGROUND An evidence-based approach to the management of shoulder pain after stroke is required, but systematic reviews have highlighted the small number of studies suitable for use in developing clinical guidelines. DESIGN This brief overview summarises obstacles to shoulder pain research that systematic reviews have identified, and compares their therapeutic recommendations to the Royal College of Physicians National Clinical Guidelines for Stroke. CONCLUSION Clinicians treating shoulder pain after stroke can refer to guidelines and systematic reviews, but there are differences in their conclusions regarding the use of steroid injections and electrical stimulation. There is unanimous agreement that further efforts are required to examine interventions singly and in combination.
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Affiliation(s)
- Christopher I M Price
- Centre for Health Services Research, University of Newcastle, Newcastle upon Tyne, UK.
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