Moderate Shoulder Pain Research Articles

Efficacy of Bowen's Technique on Shoulder Range of Motion, Pain, and Disability in Patients with Frozen Shoulder

BACKGROUND Frozen shoulder is a common debilitating condition characterized by scapulohumeral pain and progressive loss of shoulder movement. The presence of intracapsular fibrosis complicates this condition by affecting range of motion, pain, and inflammation. The Bowen technique is a system of subtle and very precise mobilizations called Bowen moves applied over muscles tendons, nerves, and fascia. The moves are performed using the fingers and thumbs, applying only gentle, non-invasive pressure. OBJECTIVE The objective of the study was to evaluate the effectiveness of Bowen Therapy on range of motion, pain, and disability in patients with Frozen shoulder METHODOLOGY A 35-year old male having frozen shoulder was selected according to inclusive and exclusive criteria. Pre-test for range of motion was assessed by goniometer. Pain and disability by shoulder pain and disability index scale (SPADI). Bowen’s Therapy was given for 4weeks, 5days per week for 1hour of session. Following the intervention after 4weeks, the effect of both the components was assessed by same tool as in pre-test. RESULT There was an increase of 30-40 degrees of range of motion after the treatment compared to its pre-test values where as in pain and disability showed improvement from very severe shoulder pain and disability to moderate shoulder pain and disability. CONCLUSION Bowen Therapy was found to be effective on range of motion, pain, and disability in patients with Frozen shoulder.

Shoulder Pain and Disability Scores and the Factors Influencing Them among Orthopedic Surgeons Working in the Kingdom of Saudi Arabia: A Cross-Sectional Study.

(1) Background: Musculoskeletal pain is common among orthopedic surgeons. Their common musculoskeletal issues include shoulder pain and disability. Many associated factors could lead to this pain and disability; by identifying these, we can prevent orthopedic surgeons' pain and improve their functional capacity. (2) Methods: This study aimed to gather quantitative data regarding the shoulder pain and disability experienced by orthopedic surgeons. It also aimed to explore the potential correlations between demographic characteristics and work-related factors and their pain and disability. This study interviewed 150 orthopedic surgeons working in the Kingdom of Saudi Arabia, asking questions on the Shoulder Pain and Disability Index (SPADI) scale and about their demographic characteristics. (3) Results: All interviewed orthopedic surgeons were male, married, and nonsmokers. Their SPADI pain subsection score was 25.24%, their SPADI disability subsection score was 21.25%, and their total SPADI score was 22.79%. Among the examined demographic characteristics, total SPADI scores have a significant positive correlation with body weight (Spearman's ρ = 0.432; p < 0.05) and body mass index (BMI; ρ = 0.349; p < 0.05). (4) Conclusions: Our findings indicate that all orthopedic surgeons generally suffer from moderate shoulder pain and disability. Body weight and body mass index are important factors that may influence shoulder pain and disability among orthopedic surgeons.

Admitting a patient with musculoskeletal pain following COVID-19 disease

A significant proportion of patients who have had COVID-19 continue to suffer from persistent symptoms such as severe weakness, shortness of breath, joint pain, mood swings and memory impairment during the recovery phase. More than half of the patients experienced joint pain for the first time after recovery from COVID-19. Three months after COVID-19 episode, joint pain continued to occur in more than a third of patients. We observed a 47-year-old patient with moderate shoulder pain that occurred for the first time after COVID-19. The examination also revealed changes in the hip joint. The diagnosis was made: post-COVID syndrome with reactive arthritis of the left shoulder joint, deforming osteoarthritis of the left hip joint stage I, degenerative-dystrophic changes in the lumbosacral spine, lower back pain. The therapy was prescribed – Chondroguard® intramuscularly every other day according to the following scheme: the first three injections (day 1, 3, and 5) 1 ml (100 mg), then, from the fourth injection (day 7) – 2 ml (200 mg) every other day, a course of 30 injections. Positive dynamics were achieved. No adverse events were noted during the treatment. The patient continued taking the nutraceutical Chondroguard® TRIO orally for 2 months. During the observational period, no adverse events were noted. Thus, in cases where post COVID-19 musculoskeletal pain is caused by joint involvement, chondroprotective therapy is effective: stage 1 – injections, stage 2 – oral therapy.

Scapular kinematic variability during wheelchair propulsion is associated with shoulder pain in wheelchair users

The purpose of this study was to investigate whether wheelchair propulsion biomechanics differ between individuals with different magnitudes of shoulder pain. Forty (age 36 ± 11 years) manual wheelchair users propelled their own daily living wheelchair at 1.11 m·s−1 for three minutes on a dual-roller ergometer. Shoulder pain was evaluated using the Performance Corrected Wheelchair User’s Shoulder Pain Index (PC-WUSPI). Correlation analyses between spatio-temporal, kinetic and upper limb kinematic variables during wheelchair propulsion and PC-WUSPI scores were assessed. Furthermore, kinematic differences between wheelchair users with no or mild shoulder pain (n = 33) and moderate pain (n = 7) were investigated using statistical parametric mapping. Participant mean PC-WUSPI scores were 20.3 ± 26.3 points and varied from zero up to 104 points. No significant correlations were observed between kinetic or spatio-temporal parameters of wheelchair propulsion and shoulder pain. However, lower inter-cycle variability of scapular internal/external rotation was associated with greater levels of shoulder pain (r = 0.35, P = 0.03). Wheelchair users with moderate pain displayed significantly lower scapular kinematic variability compared to those with mild or no pain between 17 and 51% of the push phase for internal rotation, between 31–42% and 77–100% of the push phase for downward rotation and between 28–36% and 53–65% of the push phase for posterior tilt. Lower scapular variability displayed by wheelchair users with moderate shoulder pain may reflect a more uniform distribution of repeated subacromial tissue stress imposed by propulsion. This suggests that lower scapular kinematic variability during propulsion may contribute towards the development of chronic shoulder pain.

Ultrasound-Guided Percutaneous Tenotomy of the Long Head of Biceps Tendon in Patients with Symptomatic Complete Rotator Cuff Tear: In Vivo Non-contRolled Prospective Study.

Background: We prospectively tested technical feasibility and clinical outcome of percutaneous ultrasound-guided tenotomy of long head of biceps tendon (LHBT). Methods: We included 11 patients (6 women; age: 73 ± 8.6 years) with symptomatic full-thickness rotator cuff tear and intact LHBT, in whom surgical repair was not possible/refused. After ultrasound-guided injection of local anesthetic, the LHBT was cut with a scalpel under continuous ultrasound monitoring until it became no longer visible. Pain was recorded before and at least six months after procedure. An eight-item questionnaire was administered to patients at follow-up. Results: A median of 4 tendon cuts were needed to ensure complete tenotomy. Mean procedure duration was 65 ± 5.7 s. Mean length of skin incision was 5.8 ± 0.6 mm. Pre-tenotomy VAS score was 8.2 ± 0.7, post-tenotomy VAS was 2.8 ± 0.6 (p < 0.001). At follow-up, 5/11 patients were very satisfied, 5/11 satisfied and 1/11 neutral. One patient experienced cramping and very minimal pain in the biceps. Six patients had still moderate shoulder pain, 1/11 minimal pain, 2/11 very minimal pain, while 2/11 had no pain. No patients had weakness in elbow flexion nor limits of daily activities due to LHBT. One patient showed Popeye deformity. All patients would undergo ultrasound-guided tenotomy again. Conclusion: ultrasound-guided percutaneous LHBT tenotomy is technically feasible and effective.

Measurement of muscle thickness of the serratus anterior and lower trapezius using ultrasound imaging in competitive recreational adult swimmers, with and without current shoulder pain

ObjectivesTo compare serratus anterior and lower trapezius muscle thickness between swimmers with and without current shoulder pain, and between sides when measured by real-time ultrasound imaging. DesignA single blinded age and gender-matched case-control study with 26 symptomatic and 26 asymptomatic recreational swimmers. MethodsMuscle thickness of serratus anterior and lower trapezius were measured using previously validated real-time ultrasound imaging protocols. Serratus anterior thickness was measured in side lying with 90° of glenohumeral flexion at rest and during a scapular protraction contraction. Lower trapezius thickness was measured in prone with 145° of glenohumeral abduction whilst at rest and when holding the weight of the arm. ResultsThere was no statistically significant difference between the muscle thickness of serratus anterior and lower trapezius between the symptomatic shoulder and the dominance-matched shoulder in the asymptomatic group of swimmers. There was also no significant difference in muscle thickness between the symptomatic side and asymptomatic side within the symptomatic group. ConclusionsThere appears to be no difference in serratus anterior and lower trapezius thickness between swimmers who have mild to moderate shoulder pain, who continue to swim and those who do not have shoulder pain. When imaging the serratus anterior and lower trapezius in swimmers with mild shoulder pain, clinicians should expect no differences between sides. If muscle thickness differences between sides are detected in recreational swimmers, this may indicate that the swimmer is participating in other asymmetrical activities or has a higher level of shoulder pain.

Elastofibroma dorsi: a case report

Elastofibroma dorsi is a rare, benign, soft tissue lesion which is usually located in the infrascapular region between the muscles. It is often asymptomatic; however, it may cause moderate shoulder pain during the movement of the scapula. Clinical findings and imaging methods are useful for the diagnosis. Elastofibroma dorsi should be considered in the differential diagnosis of a soft tissue mass in the scapular region of the back associated with shoulder pain. Herein, we present a 57-year-old male case admitted to our outpatient clinic and diagnosed with a unilateral elastofibroma dorsi.

Transfer component skill deficit rates among Veterans who use wheelchairs.

The purpose of this study was to quantify the deficit rates for transfer component skills in a Veteran cohort and explore the relationship between deficit rates and subject characteristics. Seventy-four men and 18 women performed up to four transfers independently from their wheelchair to a mat table while a therapist evaluated their transfer techniques using the Transfer Assessment Instrument. The highest deficit rates concerned the improper use of handgrips (63%). Other common problems included not setting the wheelchair up at the proper angle (50%) and not removing the armrest (58%). Veterans over 60 yr old and Veterans with moderate shoulder pain were more likely to set up their wheelchairs inappropriately than younger Veterans (p = 0.003) and Veterans with mild shoulder pain (p = 0.004). Women were less likely to remove their armrests than men (p = 0.03). Subjects with disabilities other than spinal cord injury were less inclined to set themselves up for a safe and easy transfer than the subjects with spinal cord injury (p ≤ 0.001). The results provide insight into the disparities present in transfer skills among Veterans and will inform the development of future transfer training programs both within and outside of the Department of Veterans Affairs.

Treatment of Rockwood type III acromioclavicular joint dislocation using autogenous semitendinosus tendon graft and endobutton technique.

BackgroundThe aim of this study was to evaluate the therapeutic effect of autogenous semitendinosus graft and endobutton technique, and compare with hook plate in treatment of Rockwood type III acromioclavicular (AC) joint dislocation.MethodsFrom April 2012 to April 2013, we treated 46 patients with Rockwood type III AC joint dislocation. Patients were randomly divided into two groups: Group A was treated using a hook plate and Group B with autogenous semitendinosus graft and endobutton technique. All participants were followed up for 12 months. Radiographic examinations were performed every 2 months postoperatively, and clinical evaluation was performed using the Constant–Murley score at the last follow-up.ResultsResults indicated that patients in Group B showed higher mean scores (90.3±5.4) than Group A (80.4±11.5) in terms of Constant–Murley score (P=0.001). Group B patients scored higher in terms of pain (P=0.002), activities (P=0.02), range of motion (P<0.001), and strength (P=0.004). In Group A, moderate pain was reported by 2 (8.7%) and mild pain by 8 (34.8%) patients. Mild pain was reported by 1 (4.3%) patient in Group B. All patients in Group B maintained complete reduction, while 2 (8.7%) patients in Group A experienced partial reduction loss. Two patients (8.7%) encountered acromial osteolysis on latest radiographs, with moderate shoulder pain and limited range of motion.ConclusionAutogenous semitendinosus graft and endobutton technique showed better results compared with the hook plate method and exhibited advantages of fewer complications such as permanent pain and acromial osteolysis.

Shoulder Dysfunction after Selective Neck Dissection in Recurrent Nasopharyngeal Carcinoma.

To investigate the incidence of occult nodal metastasis and severity of shoulder dysfunction after selective neck dissection (SND) for recurrent nasopharyngeal carcinoma (NPC) with N0 status. Prospective, single-group, pre/post test design. Academic medical center. Between 1998 and 2012, 46 patients who had recurrent NPC and N0 status were recruited. They subsequently received salvage nasopharyngectomy and SND, removing ipsilateral level I to III and V lymphatics. The incidence of occult nodal metastasis was noted. All patients underwent standardized physiotherapy after surgery. Postoperative shoulder function was measured using the Disability of Arm, Shoulder, and Hand (DASH) questionnaire. The incidence of microscopic nodal metastasis was 15.2%. For first year posttreatment, the mean DASH score was 44.2. With time, there was no improvement in shoulder function despite targeted physiotherapy (P = .09), and the second postoperative year mean DASH score was 46.3. The degree of daily activity affected was rated as moderate to very limited, and 30% of the patients had at least moderate shoulder pain at rest. Shoulder dysfunction after SND for recurrent NPC is significant and persistent. Given the low incidence of microscopic nodal metastasis in such circumstances, routine SND is not recommended.

Practice Habits and Attitudes and Behaviors Concerning Shoulder Pain in High School Competitive Club Swimmers

The objective of this study is to describe the practice habits, injury frequency, and attitudes and behaviors concerning shoulder pain in high school-aged competitive swimmers and describe the relationship between attitudes and behaviors. Cross-sectional research design. Local swimming clubs. One hundred two swimmers, aged 13-18 years, at the top training level of their club team were included in the study. Participants were given a survey with questions regarding swimming practice and attitudes and behaviors concerning shoulder pain. Practice habits (yards/week, practice/week, dry-land and weight/week, and months swimming/year) and attitudes and behaviors concerning shoulder pain. Subjects completed an average of 6.89 ± 1.41 swimming practices/wk of 6000 to 7000 yd/practice. The majority of swimmers believe that mild and moderate shoulder pain is normal in swimming and should be tolerated to complete practice, while a majority responded that they swim with shoulder pain. Seventy-three percent of swimmers reported using pain medication to manage their shoulder pain. There was a significant correlation between attitude and behaviors of moderate and severe shoulder pain. Club swimmers have a high frequency of practices, comparable to collegiate and professional swimmers. They believe that shoulder pain is normal and should be tolerated to complete practice. The association between the swimmers' attitudes and behaviors indicates that the interventions that educate the swimmers, coaches, and parents may be effective in changing their attitudes and ultimately their behaviors, decreasing the number of athletes who train with shoulder pain.

Acromial apophysitis in a 13-year-old adolescent boy: a common condition in an uncommon location

ObjectiveTraction apophysitis is a common condition in physically active and skeletally immature adolescents. This case study describes the clinical presentation and plain film imaging of traction apophysitis of the acromion process of the scapula. Clinical FeaturesA physically active 13-year-old adolescent boy presented to a chiropractic physician with an acute onset of moderate shoulder pain. Plain film radiographs of the shoulder were performed that revealed fragmentation, sclerosis, and irregularity of the left acromial apophysis. Intervention and OutcomeThe patient was treated with conservative therapy for 10 weeks, with complete resolution of symptoms. Follow-up radiographs 9 weeks later revealed no radiographic change in the appearance of the apophysis; however, clinical symptoms were absent. The apophyseal growth cartilage is the most vulnerable site in the muscle-tendon unit in the skeletally immature patient and is more susceptible to very small avulsion fractures. Repetitive microtrauma following chronic overuse at a tendon insertion site in a skeletally immature patient may result in traction apophysitis. ConclusionsAcromial apophysitis should be included in the differential diagnosis when presented with a young active patient with shoulder pain. Early treatment with restriction of activities is important in the prevention of permanent injury to the acromial cartilaginous growth plate. This case demonstrates that a prompt diagnosis can be made with a careful history, physical examination, and conventional imaging.

Management and Outcomes of 42 Surgical Suprascapular Nerve Injuries and Entrapments

Retrospective chart reviews of 42 patients with surgical suprascapular nerve (SSN) injury/entrapment were performed. Presenting symptoms, findings, operative approach, and results are documented. Forty-two patients with SSN injuries/entrapments underwent operations between 1970 and 2002. Charts were retrospectively reviewed for the presence of shoulder pain; spinati muscle function was evaluated with the Louisiana State University Health Sciences Center grading system. Side of lesion and sex were equally represented; mean follow-up was 18 months (range, 12-48 mo). SSN injuries/entrapments were associated with occupational overuse, sports-related injury, direct trauma and ganglion cysts. Thirty-one (79%) of 39 patients with suprascapular notch SSN injuries/entrapments, excluding ganglion cysts, presented with mild to moderate shoulder pain and spinati weakness. Motor function for these 31 patients was graded on a scale of 0 to 5. Preoperatively, patients had supraspinatus function Grades 0 to 2 and infraspinatus function Grades 0 to 2. Supraspinatus function improved postoperatively to Grade 4 or better in 28 patients (90%) and to Grades 2 to 3 in 3 patients (10%). Infraspinatus function improved to better than Grade 3 in 10 patients (32%), to Grades 2 to 3 in 14 patients (45%), and to Grade 1 in 7 patients (23%). Preoperatively, eight (21%) of 39 patients presenting with persistent severe pain had Grade 3 spinati strength. Of these eight patients, seven (88%) had an improvement in pain postoperatively. Strength in this group remained the same or improved to Grade 4. Postoperatively, three patients with ganglion cysts had good improvement in spinati function. Although SSN injury/entrapment is rare, 42 patients are presented who responded well to SSN release. Supraspinatus muscle improvement was as good as or better than that achieved in the infraspinatus.