Bicipital Tendinitis Research Articles

Efficacy and safety of extracorporeal shock wave therapy for upper limb tendonitis: a systematic review and meta-analysis of randomized controlled trials.

This study synthesized the highest level of evidence to analyse the effectiveness and safety of using extracorporeal shock wave therapy (ESWT) to treat upper limb tendonitis, which was unknown. We conducted a systematic review and meta-analysis of 18 randomized controlled trials (RCTs) in PubMed, Embase, Web of Science, Medline, and the Cochrane Library. Two researchers performed the screening, data extraction, literature quality assessment, and heterogeneity analysis of the searched RCTs. The main types of morbidity included rotator cuff tendonitis, lateral epicondylitis, finger tendonitis, and long bicipital tendonitis. The results of the meta-analysis showed that ESWT was effective in relieving pain in all four types of tendonitis. In addition, ESWT was more effective in relieving pain in patients with upper limb tendonitis than placebo at the 3- and 6-month follow-ups, especially with radial ESWT (RESWT). Data analysis of the forest plot showed that the experimental group with ESWT as an intervention had a significant improvement in function in patients with rotator cuff tendonitis at the 3-month follow-up. However, subgroup analysis showed that low-energy ESWT was effective in improving function in patients with calcified and non-calcified rotator cuff tendonitis, whereas it was not effective in relieving pain. ESWT can effectively improve the functional activity in patients with rotator cuff tendonitis and may produce positive analgesic effects in patients with upper limb tendonitis. The incidence of adverse effects is low. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023403594, identifier: PROSPERO, CRD42023403594.

Comparison between Intra-Articular Steroid Injection and Supra-Scapular Nerve Block in the Management of Frozen Shoulder.

To compare the efficacy of intra-articular steroid injection with ultrasound-guided supra-scapular nerve block in the management of frozen shoulder in terms of shoulder pain and disability index score and range of motion. This randomized controlled trial was conducted in orthopedic department, PIMS, Islamabad from 1st January, 2020 to 30th June, 2020. A total of 72 patients were randomly equally (n=36 each) allocated to Group-A (intra-articular steroid injection) and Group-B (supra-scapular nerve block). Adults above 18 years of both genders having diffuse shoulder pain were included. Cases of shoulder pain localized because of bicipital tendinitis, rotator cuff tear, pain due to acute trauma and those with osteoarthritis were excluded. Data was analyzed in SPSS version 22.0. Patients average age was 60.1 ± 6.29 in IASI and 58.0 ± 5.83 years in SSNB Group-And there were 19 (52.8%) males in IASI group compared to 15 (41.7%) in SSNB. At three weeks mean pain was significantly less in SSNB (57.1 ± 9.53 vs 49.4 ± 9.02) compared to IASI group (p-value, <0.001). The mean disability index was significantly low in SSNB (51.5 ± 5.10 vs 63.9 ± 5.14) versus IASI group (p-value, <0.001). At one week, three weeks and six weeks, mean external rotation was better in SSNB than IASI group (p-value, <0.001). The mean abduction was also better in SSNB group. Ultrasound guided supra-scapular nerve block is better than intra-articular steroid injection in managing frozen shoulder.

An Unusual Localization of Spinoglenoid Cysts in the Shoulder; Case Report and Comprehensive Literature Analysis

Objective: A spinoglenoid cyst represents a distinctive clinical entity within the realm of shoulder pathology, characterized by the development of a cystic structure in the spinoglenoid notch. Situated in the intricate anatomy of the shoulder, this cyst often involves compression of the suprascapular nerve, introducing a spectrum of symptoms that range from localized discomfort to functional impairment. As an area of increasing interest in orthopedic and neurological literature, the spinoglenoid cyst poses diagnostic and therapeutic challenges. Case: Patient 1: A 31-year-old male presented with right shoulder pain and a positive Hawkins sign. He had a history of bicipital tendinitis. T2-weighted MRI (T2WI) showed a hyperintense 14x16mm spinoglenoid cyst. Patient 2: Another 31-year-old male presented with shoulder pain, positive Hawkins and Neer signs, and pain induced upon shoulder range of motion. T2-weighted MRI (T2WI) revealed a 16x11mm hyperintense ganglion cyst with hypointense septae. Patient 3: A 42-year-old male presented with shoulder pain that started a month ago. He had a history of rotator cuff syndrome, shoulder impingement syndrome, and adhesive capsulitis in the shoulder, along with positive Hawkins and Neer signs. T2-weighted MRI (T2WI) identified a 25x15x28mm hyperintense ganglion cyst. Conclusion: The cases presented highlight the diagnostic challenges posed by spinoglenoid cysts and the importance of advanced imaging techniques, particularly MRI, in confirming their presence and understanding their characteristics. The diverse clinical manifestations, ranging from chronic shoulder pain to neurological deficits, emphasize the need for a nuanced and individualized approach to diagnosis and management.

Physiotherapy Management for Cases of Tendinitis Bicipitalis in Indonesian Para Powerlifting Athletes: Case Report

Bicipitalis tendinitis is an inflammation of the biceps tendon, which is the connective tissue between the biceps muscle and the humerus bone. This inflammation can cause pain, swelling and limited movement. The prevalence of bicipital tendinitis in Indonesia in 2023 is estimated at 2.5% of the general population. the prevalence of bicipital tendinitis in adults aged 18-65 years is 2.5% that athletes who use the bicep muscle more often, such as weightlifters, have a higher risk of suffering from bicipital tendinitis. If left untreated, it will hamper exercise and daily activities.The sample in this study amounted to 1 client. Data collection methods by means of subjective examination, objective examination, motion examination, examination of cognitive abilities, personal and interpersonal skills, functional examination and activity environment, and specific examination. This type of descriptive case study research uses participatory observation methods, physiotherapy intervention procedures with Ultrasound, TENS and Hold Relax exercise. The subject in this study was An. Sh is a 33 year old para-powerlifting athlete by profession, the patient is 177 cm tall and weighs 70 kg. The patient came to the NPC Indonesia physiotherapy clinic on August 25, 2023 because the patient complained of pain in the right front shoulder. muscle examination obtained normal results in all physical examinations except for the pain examination performed with Visual Analoque Scale (VAS) obtained silent pain 2/10, tenderness 5/10 and motion pain 6/10. The physiotherapist conducted a specific examination obtained positive Yergason Test results and a positive Speeds Test indicating the occurrence of dextra Bicipitalis Tendinitis. The results after being given intervention in Bicipitalis Tendinitis patients with Ultrasound, TENS and Hold Relax exercise for 6 times therapy in 2 weeks are a significant decrease in pain and an increase in activity.

Determination of various etiological factors for diagnosis of non traumatic scapulo costal syndrome

Background: Scapulocostal syndrome, also known as "snapping scapula," is an under-recognized problem involving overhead or throwing motion of the upper extremities. It is often described as a snapping or grinding sensation accompanied with pain as the scapula touches the chest wall and an audible or palpable click near the anteromedial scapula. Method: A prospective observational study was performed at one of the biggest tertiary care centres of central India from September 2021 to March 2023. A total of 50 patients were included in this study. Patient were evaluated clinically in OPD for pain in Scapulothoracic region. All the suspected patients underwent various investigations like X-ray, ultrasonography, electromyography, nerve conduction velocity study, magnetic resonance imaging (MRI) depending on the condition to reach a diagnosis. The data was recorded and evaluated. Results: A total of 50 patients were included in the study, 30 were females and 20 males, 50 % of our patients were diagnosed with supraspinatus tendinosis, 8 patients were found to have bicipital tendinitis, 3 patients had acromioclavicular joint arthritis, 2 patients developed pain because of glenohumeral joint arthropathy, subscapularis tendinitis. There were some other conditions as well diagnosed in few patients with the help of various investigations. Conclusions: It was found that there were various reasons for pain in patients diagnosed clinically with scapulocostal syndrome. Dominant hand affection was more common. The clinical investigations play a major role in diagnosing these conditions and planning the treatment.

Ultrasound monitoring of the regenerative treatment of Biceps Tendonitis and Tenosynovitis in dogs by stem cells injections

Injuries and the overloading of the bicipital muscle tendon in dogs are a common cause of Bicipital Tendinitis and Tenosynovitis (BBT). The aim of the study was to evaluate the advantage of ultrasound monitoring during regenerative treatment of BBT together with treatment assessment by dog owners. 32 dogs of both sexes were used in the study. The dogs were treated with adipose-derived mesenchymal stem cells with platelet-rich plasma (ADMSC + PRP) administered twice in a dose of 0.5 ml (15.0 × 106 cells/ml). The ADMSC + PRP was injected into the tendon sheath of the biceps and 0.5 ml was injected into the brachial joint cavity. During the research, pain evaluation was performed according to the Canine Brief Pain Inventor – Penn CHART (CBPI), ultrasound scans were also performed. Some of the changes in ultrasound images are permanent and the recovery is gradual and incomplete. The research showed a correlation between the results of the ultrasound scans and the owners of the CBPI questionnaire, this was correlated with the effects of regenerative therapy. Studies have shown the regenerative effect of ADMSC + PRP on the tendon sheath and biceps tendon of the brachii after 4 months.

Ultrasonographic Findings of Periarthritis of Shoulder Joint in the Out Patients Department

Background: To detect periarticular lesions around the shoulder, musculoskeletal ultrasonography is very much useful. Recent improvements in Ultrasonographic technology have led to a higher sensitivity and accuracy of musculoskeletal sonography. Objective: To present the distribution and representation of shoulder ultrasonographic (US) examination findings in patients with clinical diagnosis of shoulder periarthritis. Materials and Methods: A cross sectional descriptive type of study at Single center setting conducted in OPD of department of Physical Medicine&amp; Rehabilitation, BSMMU, Dhaka on thirty-five patients with the clinical diagnosis of periarthritis of shoulder. Data was collected using an interview- administered questionnaire. All baseline investigations were done. Ultrasonogram was done by experienced Sonologists who were unaware about clinical data. Results: The primary end point was reached in 85 percent of patient presented sonographic alteration suffering from periathritis of shoulder. The structure most frequently involved was bicipital tendinitis (32%) and Supraspinatus tendinitis (28%). Sub acromial Bursitis (14%) and Acromioclavicular Osteoathritis (11%) were also involved. About 15% individual presents no abnormalities. Different varieties of changes in the various structures had been detected. Conclusion: Proper identification and assessment of the alteration of periarticular structure helps to approach for management and rehabilitation of Periarthritis of shoulder thus disability can be reduced. KYAMC Journal Vol. 13, No. 03, October 2022: 134-138

Traumatology and functional recovery of the shoulder specific to the game of Volleyball

Abstract: Worldwide, the game of volleyball is a very popular sport regardless of the demographic categories analyzed. In recent years, the dynamics of the game of volleyball is continuously increasing, notable increases being observed among the female gender. Shoulder injuries are common among athletes, for example in baseball, 12% to 19% of injuries encountered are located in the shoulder, while in swimming, the percentage of shoulder injuries is estimated to be between 23% and 38%. The research is based on the case study carried out on a 28-year-old male subject, with 15 years of sports experience, a volleyball player, with a previous history of shoulder joint through the presence of bicipital tendinitis, contractures in the trapezius muscle, as well as in the the sternocleidomastoid muscle. The analysis of the dynamics of the evolution of the subject included in the research and the interpretation of the results led to the confirmation of the hypothesis, so that, reaching all the well-established recovery objectives, we can conclude that the symptomatology, in our case, rotator cuff muscle injury, can be combated by using kinetotherapeutic methods , which demonstrated the highest level of success achieved, when the subject can be taken even from the immobilization stage. Also, a much faster progress was observed from the point of view of socio-professional reintegration. Keywords: Volleyball, Shoulder, Recovery.

Treatment Outcome of Displaced Proximal Humeral Fractures with Joshi’s External Stabilization System: A Prospective Study

Introduction: Proximal humeral fracture accounts for four to five percentage of all fractures. Undisplaced fractures can be managed conservatively however, for displaced fractures; no particular method is a panacea. In our study we treated displaced proximal humeral fracture with Joshi’s external stabilizing system.&#x0D; Aims: To evaluate functional outcome of displaced proximal humerus fractures managed byJoshi’s external stabilizing system.&#x0D; Methods: This prospective study includedall patients with displaced proximal humerus fracture (Neer’s type two and three); treated with JESS from August 2018 to August 2021at Nepalgunj Medical College, Kohalupurand functional outcome was evaluated using Neer’s criteria at final follow-up. Ethical clearance was obtained from Institutional Review Committee.&#x0D; Results: A total of 40 patients, 23 males and 17 females with mean age of 41.2 years (range from 18 to 60) were included. Mean follow-up duration was 24 ± 1.7 weeks. All fractures united at an average of 13 ± 1.7 weeks. Twenty-nine patients (72.5%) had an excellent result with average score of 92.7 ± 2.3 and remaining 11(27.5%) had satisfactory functional outcome with average score of 84.7 ± 1.7 according to Neer’s criteria. Three patients had bicipital tendonitis that resolved within eight weeks of implant removal while two had pin tract infection which resolved with oral antibiotics and dressing.&#x0D; Conclusion: Joshi’s external stabilizing system is an effective treatment option in patients with displaced proximal humeral fractures.

Effectiveness of muscle energy technique on shoulder range of motion in individuals with bicipital tendinitis, randomised clinical trial

Background: Biceps tendinitis is inflammation of the tendon around the long head of the biceps muscle. Pathology of the biceps tendon is most often found in patients 18 to 35 years of age who are involved in sports. Muscle energy technique is a manual therapy procedure which involves the voluntary contraction of a muscle in a precisely controlled direction. MET may be used to decrease pain, stretch tight muscles and fascia, reduce muscle tonus, improve local circulation, strengthen musculature and mobilize joint restrictions.Objectives: To assess persons for bicipital tendinitis, to determine the effect of muscle energy technique in acute and chronic symptoms of bicipital tendinitis and to find out the risk factors for development of bicipital tendinitis.Methodology: Informed consent was taken from each of the subject prior to Participation. All Instruction was given to the subjects about techniques performed. The study was conducted in and around Karad. Subjects were selected according to inclusion and exclusion criteria.Results: The study used outcome measures, visual analogue scale (VAS), Range of motion (ROM) and shoulder pain and disability index (SPADI). All three scores revealed statistically significant results (p < 0.05) reduction in pain after post interventional.Conclusion: This study concluded that there was an improvement in the bicipital tendinitis patients after undergoing 3 weeks of core muscle energy technique protocol. This indirectly improved their shoulder performance by reducing pain to shoulder and improving their dynamic balance.

Does your sleeping position affect your shoulder pain?

Aim: This study aimed to evaluate patients with shoulder pain according to their sleeping positions based on their clinical and magnetic resonance imaging (MRI) findings and to determine possible factors affecting shoulder pain.&#x0D; Material and Method: A total of 115 patients were included in the study. The severity of shoulder pain was evaluated with the visual analog scale (VAS), shoulder function was evaluated with the simple shoulder test, and the ability to perform physical activities was evaluated with the QuickDASH questionnaire. The biceps tendon, rotator cuff (RC), subacromial-subdeltoid bursa, glenohumeral joint (GHJ), and acromioclavicular joint (ACJ) were evaluated using MRI.&#x0D; Results: Of the patients with shoulder pain, 66.1% were female, 50.4% were primary school graduates, 53.9% were housewives, and 41.7% had a systemic disease. The mean age of the patients was 50.48±13.61 years while the median BMI and VAS values were 26.1 (18.2-41.4) and 8 (2-10), respectively. Considering the sleeping positions, it was found that 39.1% (most common) of the patients were sleeping in the fetus position, and considering the results of patients’ MRI examinations, the most common problem was related to the pathologies of the supraspinatus tendon (42.6%). It was found that sleep quality, which was poor in all patients, was worse in females (p=0.311), in those over 50 years of age (p=0.007), and those with a systemic disease (0.325). It was discovered that Pittsburgh's sleep quality index score was generally worse in those who slept in the soldier position and in the log position (p&gt;0.05). The rates of pathologies of the supraspinatus tendon were found to be the highest in those that slept in the fetus position (p=0.931). It was also found that the rates of impingement, bicipital tendinitis, combined problems, and adhesive capsulitis did not differ significantly according to sleeping positions. Although occupational variables for supraspinatus degeneration remained significant in the model, having a desk job statistically significantly increased the probability of supraspinatus degeneration by 3.38 times when compared to being a housewife (95% CI=1.143-9.996; p=0.028) and it was identified that the probability of acromioclavicular degeneration increased by 1.16 times for every 1-unit increase in BMI.&#x0D; Conclusion: Different sleeping positions may predispose to different shoulder pathologies and shoulder pain, and shoulder pathologies may lead to deterioration of sleep quality, especially in older patients. For this reason, suggesting correct and appropriate sleeping positions may be a useful treatment method in reducing pain and disability and increasing sleep quality.

Clinical and radiological assessment of hemiplegic shoulder pain in stroke patients

BackgroundHemiplegic shoulder pain (HSP) is one of the most common complications of stroke. This work aimed to evaluate and analyze the clinical and radiological features of painful shoulder in hemiplegic stroke patients with evaluating the diagnostic role of shoulder ultrasound and shoulder MR imaging in assessment of the causes of shoulder pain.Methods210 stroke patients with shoulder affection within 3 years of stroke development were enrolled. Clinical assessment including Medical Research Council scoring, The Brunnström motor recovery and Ashworth Scale. Shoulder ultrasound and MR imaging were done for 74 patients with painful hemiplegic shoulder.ResultsThe prevalence of HSP was 35.2% with statistically significantly higher proportion of shorter disease duration, lower muscle power, lower BMR stage with higher proportion of bicipital tendinitis and complex regional pain syndrome in major versus moderate dependence (P < 0.001, P < 0.001, P < 0.001, P = 0.011 and P = 0.001 respectively). On multivariate analysis only short disease duration was statistically significant independent predictor. Participants with disease duration ≤ 2 months have 21.9 times higher odds to exhibit major rather than moderate dependence. By imaging there was high prevalence of joint effusion (47.3%), bicipital tendinitis (44.6%), bursitis (31%) and adhesive capsulitis (29.7%) in painful hemiplegic shoulder with a very good agreement between MRI and US in diagnosis.ConclusionHSP has a high prevalence in stroke patient with increased morbidity due to various factors and US can be used as an alternative or a complementary to MRI for diagnosis of hemiplegic shoulder pain.

Ultrasonography as diagnostic tool in rotator cuff injuries of shoulder

Introduction: Rotator Cuff injuries are quite common in adults with or without trauma. These are suspected on clinical history and examination and commonly confirmed by Ultrasonography and MRI of shoulder. This study aims to use Ultrasonography of shoulder as the main diagnostic tool for such injuries. Material and Methods: A total of 30 patients suspected to have complete or incomplete tear of Rotator Cuff were subjected to Clinical Examination of Shoulder including specific tests for Rotator Cuff Muscles, X-ray and Ultrasonography of shoulder. Diagnosis by clinical examination and Ultrasonography was compared. Observation and Results: Out of 30 cases studied, on clinical examination, 10 cases had complete tear of supraspinatus, 19 cases had incomplete tear of supraspinatus with or without subscapularis, and 1 case had isolated subscapularis tear. Ultrasonography noted full thickness tear of supraspinatus in 8 cases, incomplete tear of supraspinatus with or without subscapularis, in 20 cases, bicipital tendinitis in 01 case and subacromial subdeltoid bursitis in 01 case. Conclusion: Ultrasonography confirms the clinical diagnosis of rotator cuff tear with satisfactory sensitivity and specificity. It can be used as a first line diagnostic tool for diagnosis of Rotator cuff tear as it confirms the clinical suspicion and its results are comparable to MRI. Keywords: Rotator Cuff tear, Ultrasonogprahy, Shoulder.

Effect of ultrasound and four hourly cryotherapy application in the treatment of bicipital tendinitis- a randomised clinical trial

The purpose of this appraisal was to consider the effect of ultrasound and four hourly cryotherapy application in the treatment of bicipital tendinitis. In this prospective randomized clinical assessment, Thirty individuals were enrolled in the group A, and thirty specific individuals were picked into the get-together B group. In group A, Ultrasound for 7 mins – 2:8 – 1.5 w/cm2 and for group B, Sham Ultrasound for 7 mins – 2:8 – 1.5 w/cm2 with cryotherapy for 20 min 4hourly given. Pain severity, Pressure Pain Threshold and functional disability were assessed in all participants before and after two weeks of treatment. Group A had 12 males, and 15 females and Group B had nine males and 18 females. Pre and post interventional mean and standard deviation for group A was 7.37+1.21 and 7.33+1.30. Whereas pre and post interventional mean and standard deviation for group B was 7.33+1.30 and 1.70+0.60. Pre interventional analysis of data of group A and B showed no significant difference. Whereas post interventional analysis of data showed an extremely significant difference between group A and group B. Results revealed that participants with bicipital tendinitis respond more favourably to ultrasound therapy with cryotherapy for 20min four-hourly than ultrasound alone.

Dose-Response Relationship between Physical Workload and Specific Shoulder Diseases-A Systematic Review with Meta-Analysis.

Several epidemiological studies have found an association between shoulder-loaded work activities and specific shoulder diseases. No study has derived the dose-response relationship and resulting doubling dose, important for the recognition of occupational diseases. This systematic review is an update of the van der Molen et al. (2017) review. Based on its methodologies, we identified new studies published up to November 2018. The dose-response relationship between physical occupational demands (hands at/above shoulder level, repetitive movements, forceful work, hand-arm vibrations) and specific shoulder diseases (defined as ICD-10 M 75.1-5: rotator cuff syndrome, bicipital tendinitis, calcific tendinitis, impingement, and bursitis) was derived. No evidence for sex-specific differences in the dose-response relationship was found. If there were at least two studies with comparable exposures, a meta-analysis was carried out. The pooled analysis resulted in a 21% risk increase (95% CI 4–41%) per 1000 h of work with hands above shoulder level. A meta-analysis was not possible for other occupational burdens due to the low number of studies and differing exposure measurements; an estimate of the doubling dose was made based on the cohort study of Dalbøge et al. (2014). To conclude, the present systematic review with meta-analysis contributes to knowledge of the level of exposure at which specific shoulder diseases—particularly rotator cuff lesions—should be recognized as an occupational disease.

Technique description: Incisionless ultrasound-assisted biceps tenotomy in dogs.

Background:Bicipital tendinitis and/or tendinopathy is a common cause of forelimb lameness in dogs, particularly in larger and more active patients. Although conservative treatment aimed at resolving discomfort and preserving the tendon remains the primary therapeutic goal, in certain cases it is necessary to surgically transect the tendon to eliminate pain and lameness. Transection of the tendon can be performed by open arthrotomy, arthroscopically, or percutaneously using a scalpel blade. This paper examines the utility of a modified percutaneous approach using a hypodermic needle in place of a scalpel blade, under ultrasound-guided assistance.Aim:To develop and describe a surgical technique for performing a percutaneous biceps tenotomy using a hypodermic needle under ultrasound guidanceMethod:The technique was piloted using the shoulders of 12 cadaver dogs initially and once developed, then applied to another 12 cadavers. The final procedure was performed on a total of 22 shoulders. Assessments were recorded on time to complete the procedure, completeness of bicipital tendon transection, and presence of any iatrogenic damage to associated joint structures.Results:Procedure time averaged fewer than 2 minutes. Complete transection was achieved in 20 out of 22 of the shoulders, with evidence of incomplete transection discernable by ultrasound imaging in the remaining two shoulders. One cadaver shoulder experienced iatrogenic damage secondary to incorrect hypodermic needle angulation.Conclusion:Percutaneous biceps tenotomy using a hypodermic needle is an efficient and straightforward procedure. The lack of a surgical incision makes it the least invasive technique devised so far. Ultrasound imaging allows the practitioner to assess the completeness of the transection increasing precision.

Effectiveness of kinesio taping in bicipital tendinitis treatment: A randomized controlled trial

Effectiveness of kinesio taping in bicipital tendinitis treatment: A randomized controlled trial

WHO/ILO work-related burden of disease and injury: Protocol for systematic reviews of exposure to occupational ergonomic risk factors and of the effect of exposure to occupational ergonomic risk factors on osteoarthritis of hip or knee and selected other musculoskeletal diseases

BackgroundThe World Health Organization (WHO) and the International Labour Organization (ILO) are developing a joint methodology for estimating the national and global work-related burden of disease and injury (WHO/ILO joint methodology), with contributions from a large network of experts. In this paper, we present the protocol for two systematic reviews of parameters for estimating the number of disability-adjusted life years from osteoarthritis of hip or knee, and selected other musculoskeletal diseases respectively, attributable to exposure to occupational ergonomic risk factors to inform the development of the WHO/ILO joint methodology. ObjectivesWe aim to systematically review studies on exposure to occupational ergonomic risk factors (Systematic Review 1) and systematically review and meta-analyze estimates of the effect of exposure to occupational ergonomic risk factors on osteoarthritis of the hip or knee, and selected other musculoskeletal diseases respectively (Systematic Review 2), applying the Navigation Guide systematic review methodology as an organizing framework, conducting both systematic reviews in tandem and in a harmonized way. Data sourcesSeparately for Systematic Reviews 1 and 2, we will search electronic academic databases for potentially relevant records from published and unpublished studies, including Medline, EMBASE, Web of Science and CISDOC. We will also search electronic grey literature databases, Internet search engines and organizational websites; hand-search reference lists of previous systematic reviews and included study records; and consult additional experts. Study eligibility and criteriaWe will include working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State, but exclude children (<15 years) and unpaid domestic workers. The included occupational ergonomic risk factors will be any exposure to one or more of: force exertion; demanding posture; repetitiveness; hand-arm vibration; lifting; kneeling and/or squatting; and climbing. Included outcomes will be (i) osteoarthritis and (ii) other musculoskeletal diseases (i.e., one or more of: rotator cuff syndrome; bicipital tendinitis; calcific tendinitis; shoulder impingement; bursitis shoulder; epicondylitis medialis; epicondylitis lateralis; bursitis elbow; bursitis hip; chondromalacia patellae; meniscus disorders; and/or bursitis knee). For Systematic Review 1, we will include quantitative prevalence studies of any exposure to occupational ergonomic risk factors stratified by country, gender, age and industrial sector or occupation. For Systematic Review 2, we will include randomized controlled trials, cohort studies, case-control-studies and other non-randomized intervention studies with an estimate of the relative effect of any exposure with occupational ergonomic risk factors on the prevalence or incidence of osteoarthritis and/or selected musculoskeletal diseases, compared with the theoretical minimum risk exposure level (i.e., no exposure). Study appraisal and synthesis methodsAt least two review authors will independently screen titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. At least two review authors will assess risk of bias and the quality of evidence, using the most suited tools currently available. For Systematic Review 2, if feasible, we will combine relative risks using meta-analysis. We will report results using the guidelines for accurate and transparent health estimates reporting (GATHER) for Systematic Review 1 and the preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA) for Systematic Review 2.PROSPERO registration number: CRD42018102631.

76-Year-Old Man With New Bilateral Shoulder Pain

76-Year-Old Man With New Bilateral Shoulder Pain

Agreement of Musculoskeletal Ultrasound and Clinical Assessment of Shoulder Impairment in Manual Wheelchair Users With Various Duration of Spinal Cord Injury

ObjectivesTo determine (1) agreement of musculoskeletal ultrasound (MSK-US) findings of shoulder pathology and related shoulder special test results in individuals with varied durations of manual wheelchair (MWC) use after spinal cord injury (SCI); and (2) whether shoulder musculoskeletal impairments, per MSK-US and clinical examination, differed in individuals with SCI and varying durations of MWC use. DesignCross-sectional cohort study. SettingLaboratory setting. ParticipantsAdult volunteers (N=23) with SCI who used an MWC for community mobility. Individuals were stratified into 3 groups based on duration of MWC use: <5 years, 5 to 15 years, and >15 years. InterventionsNot applicable. Main Outcome MeasuresSpecial tests for shoulder impingement and bicipital tendonitis were performed. Bilateral shoulder MSK-US was performed, with the Ultrasound Shoulder Pathology Rating Scale (USPRS) quantifying biceps tendon, supraspinatus tendon, and greater tuberosity cortical surface impairments. ResultsNo agreement was found between MSK-US and related special tests. Special tests failed to identify impairment in 33.3% to 100% of those identified on MSK-US. The total USPRS score was highest in those with >15 years' MWC use. A higher proportion of dynamic impingement (supraspinatus and biceps) was found in those with >15 years' MWC use, with other MSK-US items having moderate effect sizes among duration-use groups. ConclusionsMSK-US identified shoulder impairments more frequently than commonly used special tests. A significant increase in the presence of MSK-US shoulder impairments was identified in the longest-duration group. This was not the case for special tests or pain. MSK-US is an easily administered, low-cost, noninvasive method for determining shoulder impairments and should be used in routine screening of individuals who use an MWC after SCI.