Management Of Shoulder Pain Research Articles

Treatment of shoulder pain in spastic hemiplegia by reducing spasticity of the subscapular muscle: a randomised, double blind, placebo controlled study of botulinum toxin A

Objective: This randomised, double blind, placebo controlled, two parallel group study was conducted to assess the beneficial effect of injection of botulinum toxin A (Dysport) into the subscapularis muscle on...

Phototransduction in a Transgenic Mouse Model of Nougaret Night Blindness

The Nougaret form of dominant stationary night blindness is linked to a G38D mutation in the rod transducin-alpha subunit (Talpha). In this study, we have examined the mechanism of Nougaret night blindness using transgenic mice expressing TalphaG38D. The biochemical, electrophysiological, and vision-dependent behavioral analyses of the mouse model revealed a unique phenotype of reduced rod sensitivity, impaired activation, and slowed recovery of the phototransduction cascade. Two key deficiencies in TalphaG38D function, its poor ability to activate PDE6 (cGMP phosphodiesterase) and decreased GTPase activity, are found to be the major mechanisms altering visual signaling in transgenic mice. Despite these defects, rod-mediated sensitivity in heterozygous mice is not decreased to the extent seen in heterozygous Nougaret patients.

Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: Secondary data analysis of the National Ambulatory Medical Care Survey

BackgroundAlthough shoulder pain is a commonly encountered problem in primary care, there are few studies examining its presenting characteristics and clinical management in this setting.MethodsWe performed secondary data analysis of 692 office visits for shoulder pain collected through the National Ambulatory Medical Care Survey (Survey years 1993–2000). Information on demographic characteristics, history and place of injury, and clinical management (physician order of imaging, physiotherapy, and steroid intraarticular injection) were examined.ResultsShoulder pain was associated with an injury in one third (33.2% (230/692)) of office visits in this population of US primary care physicians. Males, and younger adults (age ≤ 52) more often associated their shoulder pain with previous injury, but there were no racial differences in injury status. Injury-related shoulder pain was related to work in over one-fifth (21.3% (43/202)) of visits.An x-ray was performed in 29.0% (164/566) of office visits, a finding that did not differ by gender, race, or by age status. Other imaging (CT scan, MRI, or ultrasound) was infrequently performed (6.5%, 37/566).Physiotherapy was ordered in 23.9% (135/566) of visits for shoulder pain. Younger adults and patients with a history of injury more often had physiotherapy ordered, but there was no significant difference in the ordering of physiotherapy by gender or race. Examination of the use of intraarticular injection was not possible with this data set.ConclusionThese data from the largest sample of patients with shoulder pain presenting to primary care settings offer insights into the presenting characteristics and clinical management of shoulder pain at the primary care level. The National Ambulatory Medical Care Survey is a useful resource for examining the clinical management of specific symptoms in U.S. primary care offices.

Conservative management of shoulder pain in swimming

Swimming fast is a complex skill that requires physical attributes to maximize propulsive force whilst minimizing drag forces. The models that have historically been used to explain the incidence of shoulder pain in swimmers have been very mechanical in nature. The interplay between the requirement of the sport, the shoulder's mechanical restraints, the biomechanical effect of the kinetic chain, and the powerful influence of the neuromuscular system must be appreciated in pathological and rehabilitation models. The interaction between flexibility, strength, fatigue, muscle inhibition, proprioception, muscle patterning and pain is complicated and poorly understood. It is, however, in these complex intertwining relationships that the origin of shoulder pain in swimming must lay and therefore where the conservative management of that pain must have its effect.

Use of an integrated care pathway: a third round audit of the management of shoulder pain in neurological conditions.

To complete a third round audit of management of shoulder pain using an integrated care pathway, to evaluate pro forma documentation and to determine outcome. Thirty-four patients with upper limb paresis admitted to a rehabilitation unit during a 22-month period had shoulder pain and were included in the integrated care pathway. Retrospective review of pro forma documentation against pre-determined standards. Compared with the second round audit, performance against 5 out of 9 standards for initial assessment and documentation had improved, and ranged from 56% to 94%. Achievement of 9 further standards relating to continued management ranged from 44% to 97%. Variance was not always well recorded. Shoulder pain resolved or improved in 18/34 (53%) of patients. Introducing the pro forma improved standards of documentation and demonstrated a positive outcome in over half the patients. Some problems with developing and maintaining integrated care pathways in the context of rehabilitation are discussed.

Prevention and management of shoulder pain in the hemiplegic patient

Executive summaryObjective The objective of this review was to summarise the best available research related to the prevention and management of shoulder pain in the hemiplegic patient.Inclusion criteria This review considered all studies that included hemiplegic patients post‐cerebral vascular accident (CVA). Interventions of interest were any treatments or programs used to manage or prevent shoulder pain secondary to hemiplegia. The primary outcomes of interest were those related to pain. This review considered any randomised controlled trials (RCT) that evaluated the effectiveness of interventions that addressed shoulder pain in hemiplegic patients. In the absence of RCT, other research designs such as non‐randomised controlled trials, time series and case series were also considered for inclusion in a narrative summary.Search strategy The search sought to find both published and unpublished studies. Databases were searched up to February 2002 and included Medline, CINAHL, Current Contents, Cochrane Library, Expanded Academic Index, Electronic Collections Online, Turning Research Into Practice (TRIP), Dissertation Abstracts and Proceedings First. The reference lists of all studies identified were searched for additional studies.Assessment of methodological quality All studies were checked for methodological quality by two reviewers and data was extracted using a data extraction tool.Results Current research evaluating the effectiveness of treatment interventions on hemiplegic shoulder pain is very limited. The studies were very diverse in their nature of research. There has been no replication of studies, with the studies found using different populations, interventions or outcome measures. Not one study could be compared with another. Meta‐analysis was unable to be performed not only because of inadequate reporting of results, but more often due to differences between the studies’ participants and the range of interventions used. The diversity in interval post‐CVA also makes it difficult to make any comparisons between studies. For this reason the review is in narrative form.Conclusions With this limited evidence, no single intervention has been identified that offers a dramatic effect in terms of treating pain in the hemiplegic shoulder. There is potential for some benefits for the patient's functional and comfort status, thereby improving their quality of life and maximising their social participation.Preventive interventions demonstrated that a shoulder positioning policy had no statistically significant effect on pain. Strapping within 48 h significantly delayed the onset of pain and current research evaluating exercise is not limited to just one area of exercise, but a diverse range, making it difficult to make any comparisons. Some studies did suggest evidence of improvement, albeit limited. However, some of the exercise techniques aggravated shoulder pain. Treatment interventions demonstrated that electromyogram biofeedback cannot be evaluated as a stand‐alone therapy as it is used in conjunction with relaxation therapy. Intra‐articular Triamcinolone Acetonide injections in a small RCT have not been proven to be beneficial, and are associated with a high incidence of side‐effects. Different exercise techniques may aggravate shoulder pain more than others (e.g. Bobath technique compared to cryotherapy). The systematic review on the effectiveness of functional electrical stimulation was used for prevention and treatment and concluded that there is currently no evidence for effect.

Prevention and management of shoulder pain in the hemiplegic patient

Objective The objective of this review was to summarise the best available research related to the prevention and management of shoulder pain in the hemiplegic patient. Inclusion criteria This review considered all studies that included hemiplegic patients post-cerebral vascular accident (CVA). Interventions of interest were any treatments or programs used to manage or prevent shoulder pain secondary to hemiplegia. The primary outcomes of interest were those related to pain. This review considered any randomised controlled trials (RCT) that evaluated the effectiveness of interventions that addressed shoulder pain in hemiplegic patients. In the absence of RCT, other research designs such as non-randomised controlled trials, time series and case series were also considered for inclusion in a narrative summary. Search strategy The search sought to find both published and unpublished studies. Databases were searched up to February 2002 and included Medline, CINAHL, Current Contents, Cochrane Library, Expanded Academic Index, Electronic Collections Online, Turning Research Into Practice (TRIP), Dissertation Abstracts and Proceedings First. The reference lists of all studies identified were searched for additional studies. Assessment of methodological quality All studies were checked for methodological quality by two reviewers and data was extracted using a data extraction tool. Results Current research evaluating the effectiveness of treatment interventions on hemiplegic shoulder pain is very limited. The studies were very diverse in their nature of research. There has been no replication of studies, with the studies found using different populations, interventions or outcome measures. Not one study could be compared with another. Meta-analysis was unable to be performed not only because of inadequate reporting of results, but more often due to differences between the studies' participants and the range of interventions used. The diversity in interval post-CVA also makes it difficult to make any comparisons between studies. For this reason the review is in narrative form. Conclusions With this limited evidence, no single intervention has been identified that offers a dramatic effect in terms of treating pain in the hemiplegic shoulder. There is potential for some benefits for the patient's functional and comfort status, thereby improving their quality of life and maximising their social participation. Preventive interventions demonstrated that a shoulder positioning policy had no statistically significant effect on pain. Strapping within 48 h significantly delayed the onset of pain and current research evaluating exercise is not limited to just one area of exercise, but a diverse range, making it difficult to make any comparisons. Some studies did suggest evidence of improvement, albeit limited. However, some of the exercise techniques aggravated shoulder pain. Treatment interventions demonstrated that electromyogram biofeedback cannot be evaluated as a stand-alone therapy as it is used in conjunction with relaxation therapy. Intra-articular Triamcinolone Acetonide injections in a small RCT have not been proven to be beneficial, and are associated with a high incidence of side-effects. Different exercise techniques may aggravate shoulder pain more than others (e.g. Bobath technique compared to cryotherapy). The systematic review on the effectiveness of functional electrical stimulation was used for prevention and treatment and concluded that there is currently no evidence for effect.

Prevention and management of shoulder pain in the hemiplegic patient

The objective of this review was to summarise the best available research related to the prevention and management of shoulder pain in the hemiplegic patient. This review considered all studies that included hemiplegic patients post-cerebral vascular accident (CVA). Interventions of interest were any treatments or programs used to manage or prevent shoulder pain secondary to hemiplegia. The primary outcomes of interest were those related to pain. This review considered any randomised controlled trials (RCT) that evaluated the effectiveness of interventions that addressed shoulder pain in hemiplegic patients. In the absence of RCT, other research designs such as non-randomised controlled trials, time series and case series were also considered for inclusion in a narrative summary. The search sought to find both published and unpublished studies. Databases were searched up to February 2002 and included Medline, CINAHL, Current Contents, Cochrane Library, Expanded Academic Index, Electronic Collections Online, Turning Research Into Practice (TRIP), Dissertation Abstracts and Proceedings First. The reference lists of all studies identified were searched for additional studies. All studies were checked for methodological quality by two reviewers and data was extracted using a data extraction tool. Current research evaluating the effectiveness of treatment interventions on hemiplegic shoulder pain is very limited. The studies were very diverse in their nature of research. There has been no replication of studies, with the studies found using different populations, interventions or outcome measures. Not one study could be compared with another. Meta-analysis was unable to be performed not only because of inadequate reporting of results, but more often due to differences between the studies' participants and the range of interventions used. The diversity in interval post-CVA also makes it difficult to make any comparisons between studies. For this reason the review is in narrative form. With this limited evidence, no single intervention has been identified that offers a dramatic effect in terms of treating pain in the hemiplegic shoulder. There is potential for some benefits for the patient's functional and comfort status, thereby improving their quality of life and maximising their social participation.Preventive interventions demonstrated that a shoulder positioning policy had no statistically significant effect on pain. Strapping within 48 h significantly delayed the onset of pain and current research evaluating exercise is not limited to just one area of exercise, but a diverse range, making it difficult to make any comparisons. Some studies did suggest evidence of improvement, albeit limited. However, some of the exercise techniques aggravated shoulder pain. Treatment interventions demonstrated that electromyogram biofeedback cannot be evaluated as a stand-alone therapy as it is used in conjunction with relaxation therapy. Intra-articular Triamcinolone Acetonide injections in a small RCT have not been proven to be beneficial, and are associated with a high incidence of side-effects. Different exercise techniques may aggravate shoulder pain more than others (e.g. Bobath technique compared to cryotherapy). The systematic review on the effectiveness of functional electrical stimulation was used for prevention and treatment and concluded that there is currently no evidence for effect.

Shoulder pain after stroke: a research challenge.

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. 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. 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.

National Clinical Guidelines for Stroke: a concise update

The National Clinical Guidelines for Stroke cover the management of stroke from the acute illness through to transfer of care from hospital to the community, to longer-term problems including carer support and secondary prevention. They are designed to be read by all health and social service professionals, including those working in primary care.Since the guidelines were first published there have been some major developments in stroke research. These have now been incorporated into an updated supplement to the guidelines. The new updates include:•The recommendation that specialist stroke services should include a neurovascular clinic to enable patients with transient ischaemic attack (TIA) and minor stroke, (where the patient has not been admitted to hospital), to be investigated and treated within a maximum of two weeks.•Changes in the recommendations about the management of blood pressure after stroke following the publication of the HOPE and PROGRESS trials.•Although advances in therapy research do not warrant radical alterations to practice, two changes have been made. These recommend the use of resisted exercise to improve motor function in targeted muscles and that patients should be given as much opportunity to practice tasks as possible.•More precise recommendations on the management of depression.•The withdrawal of some recommendations concerning the management of shoulder pain, deep venous thromboses and biofeedback.With the research evidence evolving at a rapid rate a new version of the complete guidelines will be published in 2003.

Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Shoulder Pain

A structured and rigorous methodology was developed for the formulation of evidence-based clinical practice guidelines (EBCPGs), then was used to develop EBCPGs for selected rehabilitation interventions for the management of shoulder pain. Evidence from randomized controlled trials (RCTs) and observational studies was identified and synthesized using methods defined by the Cochrane Collaboration that minimize bias by using a systematic approach to literature search, study selection, data extraction, and data synthesis. Meta-analysis was conducted where possible. The strength of evidence was graded as level I for RCTs or level II for nonrandomized studies. An expert panel was formed by inviting stakeholder professional organizations to nominate a representative. This panel developed a set of criteria for grading the strength of both the evidence and the recommendation. The panel decided that evidence of clinically important benefit (defined as 15% greater relative to a control based on panel expertise and empiric results) in patient-important outcomes was required for a recommendation. Statistical significance was also required but was insufficient alone. Patient-important outcomes were decided by consensus as being pain, function, patient global assessment, quality of life, and return to work, providing that these outcomes were assessed with a scale for which measurement reliability and validity have been established. A feedback survey questionnaire was sent to 324 practitioners from 6 professional organizations. The response rate was 51%. Only 1 positive recommendation of clinical benefit was developed. Ultrasound provided clinically important pain relief relative to a control for patients with calcific tendinitis in the short term (less than 2 months). There was good agreement with this recommendation from practitioners (75%). For several interventions and indications (eg, thermotherapy, therapeutic exercise, massage, electrical stimulation, mechanical traction), there was a lack of evidence regarding efficacy. This methodology of developing EBCPGs provides a structured approach to assessing the literature and developing EBCPGs that incorporates clinicians' feedback and is widely acceptable to practicing clinicians. Further well-designed RCTs are warranted regarding the use of several interventions for patients with shoulder pain where evidence was insufficient to make recommendations.

MRI and arthroscopic surgery: a combined breakthrough in management of shoulder pain.

MRI and arthroscopic surgery: a combined breakthrough in management of shoulder pain.

Shoulder pain in stroke patients and its effects on rehabilitation

The purpose of this study was to examine whether prompt diagnosis and management of shoulder pain is beneficial in decreasing pain and increasing range of motion and functional recovery. Among 116 stroke patients receiving outpatient rehabilitation, 48 had shoulder pain. Twenty-eight of the patients with shoulder pain received occupational therapy and physiatric management. Five of the 28 patients had specific diagnoses. Etiology of the pain in the remaining 23 patients (Group 1) was not known, and these patients were treated with nonsteroidal antiinflammatory drugs (NSAIDs). The remaining 20 (Group 2) received only occupational therapy and were used as the control group. Pain relief, range of motion (ROM) in flexion, and abduction and functional recovery were compared in the two groups. Results show that a significantly higher percentage of Group 1 was found to have pain relief; 91% versus 15% with p < 0.00001 for the difference. A significant number of patients improved ROM for flexion and abduction in Group 1 versus Group 2 (p < 0.006 and p < 0.055 for the difference for flexion and abduction, respectively). Functional recovery was highly significant for Group 1,100% compared to 55% for Group 2, with p < 0.0001 for the difference. These results emphasize the importance of management of shoulder pain with NSAIDs along with ROM exercises for successful rehabilitation of hemiplegic patients.

Endoscopic Management of Shoulder Pain in Long-Term Haemodialysis Patients

In this study a simple rat model for evaluating the ultrafiltration by peritoneal dialysis solutions is described. Anaesthetised male Sprague-Dawley rats were injected intraperitoneally with dialysis solutions. Zero, 1, 3, or 6 h later, the dialysate volume was determined directly: the abdomen was carefully opened, the intraperitoneal liquid was withdrawn with a syringe and its volume was measured. Good recovery of dialysate, highly reproducible results, and the similarity between the ultrafiltration profiles in rats and published profiles in CAPD patients for control solutions, indicate that the model is valid. The model was then used to evaluate peritoneal dialysis solutions containing a mixture of glycerol and amino acids. Both osmotic agents are chemically compatible and these mixtures provide amino acids and carbohydrates in a single solution. For three mixtures, intraperitoneal dialysate volume were determined as a function of dwell time and the formulation with the desired ultrafiltration could be selected.

Endoscopic Management of Shoulder Pain in Long-Term Haemodialysis Patients

In 48 shoulders of 29 patients receiving long-term haemodialysis and complaining of intolerable shoulder pain, endoscopic resection of the coracoacromial ligament was performed under local anaesthesia on an outpatient basis, using the Universal Subcutaneous Endoscope system. Predominant endoscopic findings were proliferation of the subacromial bursae and popping between the coracoacromial ligament and the rotator cuff. Amyloid originating from beta 2 microglobulin (beta 2-M) was demonstrated in 87% of the resected coracoacromial ligaments and 86% of the subacromial bursae. Resection of the coracoacromial ligament relieved the shoulder pain in all patients.

An Aid for the Management of Shoulder Pain in Hemiplegia

This article describes the manufacture and use of a splint jacket which has proved to be of great value in the relief of severe shoulder pain in a hemiplegic person. It may be of use to others with this problem.

高校スポーツ選手における肩関節障害

The aim of our study was to demonstrate the ratio and the management of shoulder pain in high school athletes by questionnaires and interviews. In our study, we asked 2, 209 athletes (1, 299 male, 910 female) about their shoulder pain by questionnaires. And we asked the managers how many athletes who had complained of their shoulder pain and how to deal with their shoulder pain in interviews. 42.2% of male and 32.3% of female, 38.1% of the athletes in total had experienced shoulder pain in their sport lives. Among the athletes who had complained of shoulder pain in questionnaires, only a few really complained of their shoulder pain to their managers. Most of the managers ordered their players to refrain from training, but a few of them left it to the player's measure. Both the players and their managers tend to make light of shoulder pain, therefore, the degree of the shoulder disorders had become worse at the time of the treatment. So, we must make the appropriate prophy-lactics to prevent the incidence of sever shoulder disorders.

Office Evaluation and Management of Shoulder Pain

Office Evaluation and Management of Shoulder Pain