Using Dry Needling to Improve the Quality of Life of Patients With Shoulder Dysfunction Following Neck Dissection: An Innovative Case Report

The spinal accessory nerve manipulation or sacrifice during neck dissection results in trapezius muscle denervation and atrophy, leading to shoulder disability. Patients start experiencing pain and weakness while moving their shoulders, including elevation, rotation, and abduction, as well as reduced range of motion (ROM) and dropping of the shoulders. There are several ways to treat the condition, including using painkillers or undergoing physical therapy. Physical therapy plays a major role in improving shoulder function. Dry needling (DN) is an emerging treatment modality that involves eliciting a local twitch response in the region of myofascial trigger points, which can reduce pain and increase the ROM. This case report documents how DN improved shoulder function in a 51-year-old female who had pain when moving the shoulders and limited ROM after undergoing a modified radical neck dissection.

The Association Between Shoulder Pain and Disability Among Saudi Office Workers

Background and objective Shoulder pain stands out as the most prevalent musculoskeletal issue that office workers face. This type of pain has been observed to be linked to various aspects of one's job. To address this concern, the current research endeavors to examine the impact of digital device use on the intensity of shoulder pain and the extent of disability experienced by office employees in Saudi Arabia. This study is driven by two principal objectives. Firstly, it aims to assess the overall occurrence of shoulder discomfort and functional limitations among the Saudi office worker population. Secondly, it seeks to draw comparisons between the parameters of the shoulder pain and disability scale and the amount of time spent using electronic screens. Methodology This cross-sectional descriptive study was conducted in Riyadh, Saudi Arabia. We recruited 150 participants to measure shoulder pain and disability among office workers. The study was carried out to determine the general frequency of shoulder discomfort and impairment by using the Shoulder Pain and Disability Index (SPADI). The survey was conducted online in June 2022 via Google Forms. The survey questions included data regarding age, sex, year of study, exercise, and duration of computer time per day (hours).  Results This study recruited 150 participants to measure shoulder pain and disability among office workers. The mean age of the cohort was 42.56 ± 2.56 years. Among the total participants, 90 (60%) were male, and 60 (40%) were female. We observed that pain parameters had a negative correlation of -0.008 with screen time. The participants who had high shoulder pain and disability scores were older in age and spent less than two hours on screens, which affects the correlation results, and hence we recommend performing a study involving the younger population working on screen for more than four hours to find the better correlation. At the same time, the shoulder disability score reported a correlation of 0.05, and the overall correlation between SPADI and screen time was observed to be 0.04. Based on these findings, the present study observed a weak correlation between SPADI and screen time. Conclusion These results suggest that while there may be some association between screen time and shoulder pain and disability, it is not substantial. Therefore, it is unlikely that screen time alone significantly contributes to the occurrence or severity of shoulder pain and disability among office workers. Additional factors and variables may need to be explored in future research to gain a more comprehensive understanding of this issue.

The relationship between shoulder pain and shoulder disability in women: The mediating role of sleep quality and psychological disorders

The number of patients complaining of shoulder pain is gradually increasing, and women with shoulder pain in particular tend to present with psychological disorders and poor sleep quality. Therefore, the purpose of this study was to investigate whether psychological disorder and poor sleep quality mediated the relationship between shoulder pain and shoulder disability in women. This is a descriptive survey study of 222 women from 3 community centers in Seoul and Gyeonggi-do regions in South Korea. Data about shoulder pain, shoulder disability, sleep quality, depression, anxiety, and stress were collected using structured questionnaires between May 10 and June 7, 2021, and were analyzed by serial mediation analysis. The direct effect of shoulder pain on shoulder disability was statistically significant. Serial mediation model showed that sleep quality and psychological disorders (depression, anxiety, and stress) were sequential mediators between shoulder pain and shoulder disability among women. The relationship between shoulder pain and shoulder disability among women was partially mediated by sleep quality and psychological disorders (depression, anxiety, and stress). The results emphasize the importance of sleep quality and psychological factors in shoulder disability and suggest the use of strategies to improve sleep quality and alleviate psychological factors when developing an intervention program to mitigate shoulder disability in women with shoulder pain.

Functional Disability Associated With Proximal Clavicle Resection and Pectoralis Flap Transposition for Sternoclavicular Joint Infections

BACKGROUND

Sternoclavicular joint infections (SCJI) are increasing with the opioid crisis and increased intravenous drug abuse (IVDA). Proximal clavicle resection with subsequent pectoralis muscle transposition is part of the treatment of such infections, but the long-term effects on shoulder function are not clear.

METHODS

This report presents a consecutive series of 15 cases of SCJI treated with proximal clavicle resection and pectoralis muscle flap coverage. Patient-reported outcomes were recorded using the Shoulder Disability Questionnaire (SDQ) developed by van der Heijden et al.

RESULTS

The average age of patients was 50 years (range, 23-73 years), with nearly half being male (7/15). Of these patients, 3 were lost to follow-up, 1 was excluded due to subsequent shoulder surgery for an unrelated problem, and another was excluded due to subsequent medical issues that precluded a reliable history. Recurrence was noted in 1 patient with ongoing IVDA. Average length of follow-up was 12 months (range, 8-19 months). The long-term shoulder disability was minimal (mean score of 6 ± 9). Among patients with IVDA, however, the long-term shoulder disability was significantly higher (mean score of 33 ± 16, P < .05).

CONCLUSIONS

In cases where the SCJI was attributed to IVDA, the long-term shoulder disability score was significantly higher, despite resolution of infection. Possible explanations include the self-reporting nature of the SDQ and the well-documented issues with chronic pain in patients with opioid dependency.  Of the patients lost to follow-up, 2 of 3 had infections attributed to IVDA, highlighting the difficulty of meaningful follow-up in this vulnerable patient population.

Prevalence of neuro-musculoskeletal pain and dysfunction in open-heart surgical patients preoperatively and at 6 and 12 weeks postoperatively: a prospective longitudinal observation study

Chronic neuro-musculoskeletal pain is an important complication of open-heart surgery (OHS). To better understand the development and natural course of neuro-musculoskeletal pain in the immediate post-OHS period, this prospective longitudinal study assessed the prevalence and degree of pain and shoulder disability, and areas of pain pre- and post-OHS. Usual medical, nursing, and physiotherapy care was provided including early extubation, education, walking, sitting out of bed, and upper, lower limb, and trunk exercises from day 1 post-operation. Of 114 elective patients who provided consent, 98 subjects were surveyed preoperatively, and at week 6 and week 12 post-OHS. Open and closed questions encompassed numerical rating of pain scales for various body areas summed as a total pain score (TPS), the shoulder disability score (SDS), exercise compliance, and sternal clicking. Usual care comprised mobility exercises, walking program, and cardiac rehabilitation referral. Survey return rates were 100%, 88%, and 82%, respectively. Of the 76 (78%) subjects with complete data sets, 68% subjects reported a history of previous neuro-musculoskeletal injuries/conditions preoperatively while prevalence for neuro-musculoskeletal pain was 64%, 88%, and 67% and 38%, 63%, and 42% for shoulder disability, at the three assessments. In all, 11% subjects reported sternal clicking at week 6 and 7% at week 12. Pain commonly occurred in the lower back and neck preoperatively, and in front of the chest, neck, rib cage, upper back, and left shoulder at week 6. Rib cage pain alone remained significantly greater than preoperative levels by week 12 post-OHS. Preoperative SDS was positively correlated with post-OHS length of stay; women had higher SDSs than men at week 6 and week 12 and week 12 SDS was negatively correlated with height. Surgical risk score was negatively correlated with change in SDS and TPS from pre-operation to week 12. In conclusion, neuro-musculoskeletal pain and shoulder disability were common preoperatively and while prevalence increased at week 6 post-OHS, overall preoperative levels were restored by week 12.

Identification of three anatomical patterns of the spinal accessory nerve in the neck by neurophysiological mapping

Background

In spite of preservation of the accessory nerve there is still considerable proportion of patients with partial nerve damage during modified radical neck dissection (MRND).

Methods

The nerve was identified during the surgery and its branches for the trapezius muscle mapped with nerve monitor.

Results

The accessory nerve was mapped during 74 hemineck dissections and three patterns were identified. In type 1 nerve exits at the posterior end of the sternocleidomastoid muscle (SCm) and then it enters the level V (66%). In type 2 the nerve for trapezius muscle branches off before entering the SCm (22%). In type 3 the nerve exits at the posterior part of the SCm and it joins to the cervical plexus (12%). The nerve than exits this junction more medially as a single trapezius branch.

Conclusions

The description of three anatomical patterns in level II and V could help preserving the trapezius branch during MRND.