Non-specific Shoulder Pain Research Articles

A Cross-Sectional Study Exploring the Relationship between Work-Related, Lifestyle Factors and Non-Specific Neck and Shoulder Pain in a Southeast Asian Population.

Non-specific neck and shoulder pain (NSNSP) is prevalent among working adults. The increased use of electronic devices and prevalence of remote working and study following the COVID-19 pandemic have raised concerns about the potential rise in such conditions. This study aims to investigate the associations between work-related, lifestyle factors and NSNSP in the adult Southeast Asian Singaporean population. An online survey was administered electronically to Singaporeans aged 21 and above. Demographic data, NSNSP prevalence, computer and smartphone usage durations, sleep patterns, and exercise frequency were captured after obtaining informed consent (SIT institutional review board approval #2023014). A total of 302 validated responses were recorded, including 212 suffering from NSNSP versus 90 in the comparison group. The NSNSP group showed significantly longer smartphone usage (5.37 ± 3.50 h/day) compared to the comparison group (4.46 ± 3.36 h/day, p = 0.04). Furthermore, the NSNSP group had lower exercise frequency (2.10 ± 1.74 days/week vs. 2.93 ± 2.21 days/week, p < 0.01) and shorter weekly exercise duration (2.69 ± 3.05 h/week vs. 4.11 ± 4.15 h/week, p < 0.01). The average NSNSP severity in this group was 34.9 ± 19.96 out of 100, correlating significantly with age (r = 0.201, p < 0.01) and BMI (r = 0.27, p < 0.01). This preliminary cross-sectional study examines characteristics of adult Southeast Asians with NSNSP post-COVID-19 pandemic. The findings indicate significantly longer smartphone use and less exercise in NSNSP respondents, with both age and body mass index (BMI) demonstrating significant correlations with NSNSP severity.

The Efficacy of Triple Shoulder Injection with Steroids and Ozone in the Treatment of Chronic Shoulder Pain and Range of Motion Limitation

Objective: This study aimed to evaluate and compare the therapeutic effects of fluoroscopy-guided triple shoulder injections with steroids and, a combination of steroids and ozone. Methods: Data were retrospectively collected from the files of 70 patients diagnosed with non-specific chronic shoulder pain and received triple shoulder injections. The patients were divided into two groups. One group included triple shoulder injections with steroids under fluoroscopic guidance, while the other group included combination of steroids and ozone. Pain intensity was evaluated with the Visual Analog Scale (VAS), the patient's quality of life and functionality were assessed using the Shoulder Pain and Disability Index (SPADI), and the active range of motion (ROM) of shoulder abduction, external rotation, and flexion were measured by goniometry. Beck Depression Inventory (BDI) was used to measure the severity of depression before the procedure. All measurements were recorded at baseline and 1, 3, and 6 months after the procedure. Results: Baseline characteristics were similar in both groups. There was no statistical difference in VAS scores between the two groups at baseline, 1st, and 3rd months. However, in the 6th months, the VAS scores of patients treated with steroids plus ozone were significantly lower than those of patients treated with steroids (P&lt;0.001). Both groups showed significant improvements in SPADI pain, disability, and total subscores compared to pre-treatment values (P &lt; 0.001). There was a significant improvement in the ROM of the shoulder joint in both groups (p&lt;0.001). However, patients who received ozone and steroid treatments showed a significantly greater increase in SPADI and ROM of shoulder joints in the 6th months (p&lt;0.001). There was a positive correlation between BDI score and pain duration, and the severity of depression had no statistically significant effect on VAS scores. Conclusion: Results of this study revealed that triple shoulder injection with steroids or a combination of steroids and ozone proved to be an effective therapeutic approach for patients suffering from shoulder pain and limited mobility. The combination of ozone with steroids may lead to better results than using steroids alone. Furthermore, a long duration of pain increases the risk of chronic depression in patients.

Physiotherapy In Primary Care: Piloting of A New Integrated Service&amp;nbsp;

Introduction: In recent years, the prevalence of osteoarticular pain in our society has been following an unstoppable upward curve, with a medium-term forecast that points to it as one of the major causes of disability. The approach to the treatment of these ailments from an exclusively biomedical model, far from resolving them, saturates the health services themselves and fails to add value to the health/disease experience of those who suffer from them.&#x0D; Objectives: To evaluate the implementation of a Physiotherapy service in Osakidetza Primary Care centers for the management of people suffering from osteoarticular pain.&#x0D; Material And Methods: As part of the corporative strategy delineated by Osakidetza for Pirmary Care, the aim was to introduce a new approach to osteoarticular pain based in an integral model using exercise as the instrument to maintain health and prevent relapses, empowering the person in the management of their process, in connection with the municipal sports services. Specifically, it is intended to refer patients from primary care family medicine professionals to physiotherapy, under an agreed treatment protocol and in coordination with the Rehabilitation Service. This process is based on a fundamentally educational approach, consisting in 10 sessions of 1 hour of duration, in groups of 8-10 people, carried out over 2 weeks each group, with specific exercises adapted to their pathology. The piloted evaluation of the program was conducted in 2 gyms located in 2 health centers serving the entire regional population of 312,000 inhabitants, between November 2018 to December 2021. &#x0D; Results: The number of people assessed by 4 physiotherapists during the evaluation period was 4,175. Of these, 3,294 (79%)performed the treatment, 4% were referred to the hospital rehabilitation service after the assessment, 3% of the patients were returned to their Family Doctor due to inadequate referral and 17% refused treatment, in all cases due to the impossibility of reconciling work-family life. In accordance with the available evidence, the most frequent reason for consultation was back pain, in 72% of the cases. In 76% of the cases, the waiting time from the physical therapist's evaluation to access to the treatment was less than 1 month, being in all cases less than 2 months. After participation in the program, 81% of the users treated showed improvement in pain and/or functionality. Regarding satisfaction, 95% found the treatment useful and 100% would recommend the treatment to others, with an average satisfaction of 9.3 out of 10.&#x0D; Conclusions: The approach to non-specific back and shoulder pain in the context of primary care offers a service to the affectd citizens closer in time and space, with an effective resolution of the symptomatology and a highly valued patient experience. The physiotherapist, in addition to leading the whole process, is a key figure of integration between the two levels of care of Primary and Specialized Care. By resolving non-complex pathology in the primary care setting, more space is given to address more complex pathology in the hospital setting.

Abstract 21 — A Cross-Sectional Study on the Prevalence of Non-Specific Neck Pain and Its Association with Lifestyle Factors

Background Non-specific neck and shoulder pain is a prevalent condition among working adults. The surge in remote work and online activities following the COVID-19 pandemic has raised concerns about the potential increase in such pain due to prolonged usage of electronic devices. However, recent literature has introduced the possibility that desk-bound computer work may not necessarily correlate with neck and shoulder pain. This study aims to explore the relationship between the severity of neck and shoulder pain and the duration of electric device usage, alongside other lifestyle factors. Methods An online survey was distributed through email and advertisements to individuals aged 21 and above in Singapore. The survey collected data on participant demographics, the extent of neck and shoulder pain experienced, the duration of computer and smartphone usage, as well as lifestyle factors like sleep duration and exercise frequency. The Institutional Review Board approval number of this study is 2023014. Results A total of 268 valid responses were collected, comprising 182 participants experiencing neck and shoulder pain (I group) and 86 participants without such pain (C group). Both groups exhibited similar demographics. Notably, a significant difference was identified in the exercise frequency per week (I = 2.17 days; C = 2.95 days, p &lt; 0.01), while the difference in sitting duration approached statistical significance (I = 7.13 hrs; C = 6.38 hrs, p = 0.085). No statistically significant differences were observed in the duration of smartphone usage (I = 5.19 hrs; C: 4.62 hrs, p = 0.18), computer use (I = 6.24 hrs; C = 5.94 hrs, p = 0.51), and average daily exercise time (I = 1.87 hrs; C = 1.85 hrs, p = 0.99). Within the group experiencing neck and shoulder pain, a significant correlation emerged between pain levels and age (r = 0.19, p = 0.01). Conversely, no significant correlations were detected between pain levels and computer or smartphone usage duration, prolonged sitting, sleep duration, exercise frequency or duration. Conclusion In this ongoing study, preliminary findings indicate that the existence of neck and shoulder pain does not exhibit a significant association with the duration of sitting work, smartphone or computer use. Interestingly, the exercise frequency might have a potential relationship with neck and shoulder pain. Notably, our data demonstrates a weak yet statistically significant correlation between the severity of neck and shoulder pain and the age of participants but not other lifestyle factors.

Blood Flow Restriction Training in Nonspecific Shoulder Pain: Study Protocol of a Crossover Randomised Controlled Trial.

"Nonspecific shoulder pain" encompasses various non-traumatic musculoskeletal shoulder disorders, diverging from diagnostic terminologies that refer to precise tissue-oriented clinical diagnosis. Blood flow restriction (BFR) training, involving partial arterial inflow and complete venous outflow restriction, has exhibited acute hypoalgesic effects primarily in healthy populations by increasing their pain thresholds. This study aims to examine whether a single BFR session with low-load exercises can alleviate pain perception among nonspecific shoulder pain patients. Conducted as a single-blind crossover randomised clinical trial, 48 adults (age range: 18 to 40) presenting with nonspecific shoulder pain will partake in two trial sessions. Random assignment will place participants into BFR or sham BFR groups and ask them to perform one exercise with BFR. Subsequently, participants will complete a shoulder girdle loading regimen comprising six exercises. The second session will involve participants switching treatment groups. Pain pressure thresholds (PPTs), shoulder pain and disability via the shoulder pain and disability index (SPADI), maximal voluntary isometric contraction (MVIC) of shoulder external rotators, pain during active abduction, and peak pain during shoulder external rotation will be evaluated using the numeric pain rating scale (NPRS). Immediate post-exercise assessments will include patient-perceived pain changes using the global rating of change scale (GROC) and participant-rated perceived exertion (RPE), employing a modified Borg's scale (Borg CR10) post-BFR or sham BFR exercise session. Each session will encompass three assessment periods, and a combination of mixed-effect models and descriptive statistics will underpin the analysis. This protocol was approved by Cyprus National Bioethics Committee (ΕΕΒΚ/2023/48), and was registered in ClinicalTrials.gov (Registration number: NCT05956288). Conclusion: The anticipated outcomes of this study illuminated the acute effects of BFR training on pain perception within the context of nonspecific shoulder pain, potentially advancing strategies for managing pain intensity using BFR techniques.

Doing our bit to save the planet: Identifying and abandoning low value surgery.

Doing our bit to save the planet: Identifying and abandoning low value surgery.

Relationship between Pain Intensity, Physical Factors, Pronociceptive Pain Modulation Profile and Psychological Vulnerability on Upper Limb Disability in Older Patients with Chronic Shoulder Pain.

Chronic shoulder pain is a very prevalent condition causing disability and functional impairment. The purpose of the study was to evaluate the relationship between pain intensity, physical variables, psychological vulnerability, pronociceptive pain modulation profile and disability in older people with chronic shoulder pain. A cross-sectional study was carried out. A total of 56 participants with non-specific chronic shoulder pain of the "Complejo Hospitalario Universitario" (Granada) and 56 healthy controls were included. The outcomes evaluated were pain intensity (visual analogue scale), physical factors (dynamometry for grip strength), psychological vulnerability (Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia), pronociceptive pain modulation profile (pain pressure algometry) and disability (Quick Disability Arm Shoulder Hand questionnaire). Disability showed a positive correlation with pain and psychological vulnerability (p &lt; 0.05) and a negative correlation with pronociceptive pain variables and dynamometry (p &lt; 0.001). Psychological vulnerability also presented a strong negative correlation with proprioceptive pain variables and dynamometry and a positive correlation with pain (p &lt; 0.05). In regard to the pronociceptive pain modulation profile, a strong negative correlation with pain (p &lt; 0.001) and a positive moderate correlation with dynamometry (p &lt; 0.001) were shown. Our results support a strong association between disability, psychological vulnerability and pronociceptive pain modulation profile in older adults with chronic shoulder pain.

Effects Of Home-based Exercise On Non-specific Shoulder Pain: A Systematic Review And Meta-analysis

Non-specific should pain (NSSP) refers to shoulder pain experienced without clearly defined pathology or physical signs. Compared with other conservative treatments, home-based exercise could be more cost-effective and more flexible in time. Yet, the effect of home-based exercise on NSSP is unclear. PURPOSE: To evaluate the effect of home-based exercise on the management of NSSP. METHODS: EMBASE, MEDLINE, CENTRAL, CINAHL and PEDro were searched from inception to January 2021. Following PRISMA guidelines, two independent reviewers selected randomized clinical trials comparing home-based exercise alone with other conservative treatments (i.e., other types of active or passive physical therapy interventions, pharmacological interventions, or multimodal conservative interventions) in adults with NSSP. Outcome measures included pain intensity and functional disability. The meta-analysis was conducted using RevMan V.5.4 software to calculate standardized mean difference (SMD) and corresponding 95% confidence interval (CI). The risk of bias was assessed using the PEDro scale, and the overall quality of the evidence was assessed using the GRADE approach. RESULTS: Nine studies involving 748 participants were included. Overall, there is moderate-quality of evidence that home-based exercise and other conservative treatments have no significant differences in reducing pain (SMD = 0.14; 95% CI: -0.01 to 0.28; I2 = 29%; p = 0.06) and improving function (SMD = 0.06; 95% CI: -0.35 to 0.47; I2 = 65%; p = 0.78). CONCLUSIONS: Home-based exercise and other conservative treatments appear to be equally effective for the management of NSSP. Therefore, for individuals with NSSP, home-based exercise may be a suitable alternative therapeutic method to replace other conservative treatments.

Real versus Sham Manual Therapy in Addition to Therapeutic Exercise in the Treatment of Non-Specific Shoulder Pain: A Randomized Controlled Trial.

The aim of this study was to evaluate if manual therapy added to a therapeutic exercise program produced greater improvements than a sham manual therapy added to same exercise program in patients with non-specific shoulder pain. This was an evaluator-blinded randomized controlled trial. Forty-five subjects were randomly allocated into one of three groups: manual therapy (glenohumeral mobilization technique and rib-cage technique); thoracic sham manual therapy (glenohumeral mobilization technique and rib-cage sham technique); or sham manual therapy (sham glenohumeral mobilization technique and rib-cage sham technique). All groups also received a therapeutic exercise program. Pain intensity, disability and pain-free active shoulder range of motion were measured post treatment and at 4-week and 12-week follow-ups. Mixed-model analyses of variance and post hoc pairwise comparisons with Bonferroni corrections were constructed for the analysis of the outcome measures. All groups reported improved pain intensity, disability and pain-free active shoulder range of motion. However, there were no between-group differences in these outcome measures. The addition of the manual therapy techniques applied in the present study to a therapeutic exercise protocol did not seem to add benefits to the management of subjects with non-specific shoulder pain.

Photobiomodulation Therapy Combined with Static Magnetic Field Reduces Pain in Patients with Chronic Nonspecific Neck and/or Shoulder Pain: A Randomized, Triple-Blinded, Placebo-Controlled Trial.

Photobiomodulation therapy (PBMT) has been used to treat patients with chronic neck and/or shoulder pain. However, it is unknown whether the concurrent use of PBMT and static magnetic field (PBMT-sMF) also has positive effects in these patients. The aim of this study was to investigate the effects of PBMT-sMF versus placebo on pain intensity, range of motion (ROM) and treatment satisfaction in patients with chronic nonspecific neck and/or shoulder pain. A randomized controlled trial, with blinded assessors, therapists and patients was carried out. Seventy-two patients with chronic nonspecific neck and/or shoulder pain were randomized to either active PBMT-sMF (n = 36) or placebo PBMT-sMF (n = 36). Patients were treated twice weekly, over 3 weeks. Primary outcome was pain intensity, measured 15 min after the last treatment session and at 24-, 48-, 72-h, and 7-days after the last treatment. Secondary outcomes were ROM, patient’ treatment satisfaction, and adverse effects. PBMT-sMF was able to reduce pain intensity in all time points tested compared to placebo (p < 0.05). There was no difference between groups in the secondary outcomes (p > 0.05). Our results suggest that PBMT-sMF is better than placebo to reduce pain in patients with chronic nonspecific neck and/or shoulder pain at short-term.

'Down to the person, the individual patient themselves': A qualitative study of treatment decision-making for shoulder pain.

IntroductionMany inconsistencies have been identified in the translation of evidence‐based treatment recommendations for musculoskeletal shoulder pain into healthcare services, with little known about factors influencing decision‐making. The objective of this study was to explore the views and experiences of healthcare providers (HCPs) and people living with shoulder pain on treatment decision‐making.MethodsAdopting a qualitative design, purposeful sampling was employed to recruit 13 individuals with nonspecific musculoskeletal shoulder pain and 30 HCPs. Data were collected through 1:1 semi‐structured interviews and analysed using an approach informed by Constructivist Grounded Theory. To facilitate analysis, two patient and public involvement (PPI) meetings were conducted.ResultsMost participants (69%) had shoulder pain of ≥1‐year duration. Biomechanical beliefs about shoulder pain predominated and were heavily influential in decision‐making for both patients and HCPs. Despite a consensus that therapeutic alliance facilitated decision‐making, the extent of collaboration between HCPs and patients in treatment decision‐making was rather limited. In addition to condition‐specific factors, Individual patient characteristics and resources also influenced treatment decisions.ConclusionFindings revealed the complexity of the decision‐making process for both patients and HCPs, exposing substantial gaps between the reported views and experiences of participants and the principles of client‐centred and evidence‐based practice. There is a pressing need to enhance the translation of evidence‐based knowledge into practice in this clinical area.Patient or Public ContributionIn line with a consultative approach to collaborative data analysis, a subgroup of participants attended two PPI meetings to provide commentary and feedback on preliminary findings.

Terapi Bekam Basah Dalam Menurunkan Nyeri Leher Dan Bahu Pada Pekerja Kantor

Wet cupping is a traditional complementary method recommended to reduce the symptoms of many diseases and is used in pain treatment The purpose of the study: knowing the effects of wet cupping therapy on the neck and upper shoulder pain PeneliHiin Method: 61 qualified office worker participants with nonspecific neck and upper shoulder pain complaints for 3 years Last month. The Numerical Rating Scale (NRS) is used to assess pain scores. Pain scores were measured before and after wet cupping therapy. Hasll research: The average score of pain letter in the case group of 7.02 (SD 1/4 1fi) and 3JO (SD 1/4 22) after cupping therapy. Decrease in pain before and after scores is statistically significant (p &lt; 0.05). Discussion: It can be stated that wet cupping therapy has a potential therapeutic effect on non-specific neck and upper shoulder pain. Experimental research with respondents who have full-scale controlled pain complaints needs to be done to prove the effectiveness of this intervention.

Changing our Diagnostic Paradigm Part II: Movement System Diagnostic Classification.

Diagnostic classification is a foundational underpinning of providing care of the highest quality and value. Diagnosis is pattern recognition that can result in categories of conditions that ideally direct treatment. While pathoanatomic diagnoses are common and traditional in orthopaedic practice, they often are limited with regard to directing best practice physical therapy intervention. Replacement of pathoanatomic labels with non-specific regional pain labels has been proposed, and occurs frequently in clinical practice. For example non-specific low back pain or shoulder pain of unknown origin. These labels avoid some disadvantages of tissue specific pathoanatomic labels, but are not specific enough to direct treatment. A previously introduced movement system diagnostic framework is proposed and updated with application to shoulder conditions. This framework has potential for broad development and application across musculoskeletal physical therapist practice. Movement system diagnostic classification can advance and streamline practice if considered while recognizing the inherent movement variability across individuals.

Efficacy assessment of shoulder rehabilitation with Contrex MJ robot in patients with periarthritis humeroscapularis

Objective: To assess the efficacy of shoulder rehabilitation program incorporating exercise with Contrex MJ robot in patients with periarthritis humeroscapularis. Subject and method: We evaluated a total of 62 patients (n = 62) suffered from the non-specific shoulder pain and frozen shoulder, who were admitted to our medical institution between June of 2016 and May of 2017. In these patients, the efficacy outcome measures were improved in Visual Analogue Scale, Range of motion. Result and conclusion: There were improvements of periarthritis humeroscapularis from five to fifteen day treatment period (p=0.04), there were not any cases with complications in our subjects.

Shoulder patients in primary and specialist health care. A cross-sectional study

Shoulder pain is a prevalent problem and has a considerable impact on the use of primary and specialist health care in Norway. It is important to improve short-term recovery and reduce long-term consequences regarding pain and disability, the high costs of treatment and the amount of sick-leave. Treatment for non-specific shoulder pain is mainly non-operative. The aims of this study were to investigate if there are differences in main characteristics, pain and disability (SPADI-score) and psycho-social factors between patients in primary and specialist health care. This cross-sectional study included patients consulting physiotherapy in primary health care and patients at an outpatient clinic in specialist health care. Well-known and tested questionnaires for these populations were used and variables were divided into clinical, sociodemographic, psycho-social, and shoulder pain and disability. Descriptive statistics were applied. Two-sample t-test and linear regression were used for continuous data whereas chi-square tests and logistic regression were applied to test differences in categorical data between the two study populations. Two hundred and 36 patients were recruited from primary health care (FYSIOPRIM, Physiotherapy In Primary Care) and 167 from specialist health care. Patients in primary health care reported less regular use of pain medication (30.7 vs. 61.3%) and fewer patients had symptom duration >12months (41.9 vs. 51.0%). Furthermore, they reported lower pain intensity, less shoulder pain and disability (SPADI-score), lower scores on psycho-social factors, but higher on expectations of recovery. Patients with shoulder pain treated in primary health care and in specialist health care are different according to factors such as duration of symptoms, pain and disability, and some of the psycho-social variables. However, the differences are small and the variations within the two study samples is large. Patients treated in primary health care seemed to be less affected and to have higher expectations concerning their recovery. However, based on our results we may question why many patients are referred to specialist health care rather than continuing treatment in primary health care.

Measurement properties of translated versions of the Shoulder Pain and Disability Index: A systematic review

Purpose: To summarise measurement properties of translated versions of the Shoulder Pain and Disability Index (SPADI) and to assess their methodological quality. Methods: Relevant studies testing measurement properties of translated versions of the SPADI in non-specific shoulder pain participants were included from 11 databases (August 2020). Two reviewers independently screened articles and assessed individual measurement property risk of bias using the COSMIN checklist as very good, adequate, doubtful or inadequate. For each measurement property results were pooled and rated sufficient, insufficient, or inconsistent. Synthesised evidence was graded as high, moderate, low or very low (GRADE approach). Results: Thirty-four studies (21 languages and 26 different versions) were included from 4402 articles. A total of 141 measurement properties were reported with 60 rated as very good or adequate. These included; internal consistency (19), test-retest reliability (4), construct validity (6), structural validity (10), measurement error (5), responsiveness (9), and cross-cultural validity (2). Comprehensibility was adequate in the Chinese, German, Nepali, Spanish and Urdu versions. Only the Danish, Dutch and Nepali versions confirmed all, or all but one, of their measurement properties with sound methodology. Pooled results of all measurement properties except structural validity were rated as sufficient. Quality of evidence was graded moderate to high with downgrading due to inconsistent results. Conclusion: Overall evidence suggests the SPADI is valid, reliable and responsive in translated form but less than half the measurement properties tested were of adequate quality. Further testing is required in many languages particularly in; test-retest reliability, measurement error and construct validity.

Reply to comment on "Shoulder Pain and Disability Index: Italian cross-cultural validation in patients with non-specific shoulder pain".

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Shoulder Pain and Disability Index: Italian cross-cultural validation in patients with non-specific shoulder pain.

Health-related patient reported outcome measures are considered essential to determine the impact of disease on the life of individuals. Aim of this study is to culturally adapt the Italian version of the Shoulder Pain and Disability Index (SPADI). The secondary aim is to evaluate psychometric proprieties in patients with non-specific shoulder pain. The current study is an analysis of a sample of 59 adult patients with non-specific shoulder pain. The SPADI was translated and cross-culturally adapted, and then psychometric properties were tested. Participants completed the Shoulder Pain and Disability Index-Italian (SPADI-I), 36-item short form health survey, the Oxford Shoulder Score, the Disability of Arm, Shoulder, and Hand scale and a pain intensity visual analogue scale. SPADI-I included two domains. Internal consistency analysis showed good values for total (α = 0.84) and subscales (α = 0.94 and α = 0.76). For construct validity, there was good correlation between the visual analogue scale, the Oxford Shoulder Score, the DASH and the SPADI-I total score and subscales. Standard error of measurement and minimally detectable change were calculated. The SPADI-I was culturally adapted into Italian. SPADI-I is centred on pain and disability of the shoulder only and can be considered as a useful tool in daily clinical practice for assessing musculoskeletal non-specific shoulder pain because of its good internal consistency and validity. Further studies should focus on other psychometric proprieties such as test re-test reliability, responsiveness and clinical interpretability to improve the available clinimetrics of the tool.

Cross-cultural adaptation, reliability, and validity of the Italian version of the Shoulder Disability Questionnaire

BackgroundThe Shoulder Disability Questionnaire (SDQ) demonstrated promising psychometric properties, but currently there is no evidence of an Italian version. ObjectiveTo cross-culturally adapt the Italian version of the SDQ (SDQ-I) and to explore its psychometric properties in patients with non-specific shoulder pain (SP). MethodsThe SDQ-I was translated according to international guidelines and administered to 105 patients with SP. The SDQ-I scores were compared with Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), Numerical Pain Rating Scale (NPRS), and 36-item Short Form Health Survey (SF-36). Structural validity (Exploratory Factor Analysis [EFA]), internal consistency (Cronbach's alpha), test-retest reliability (Intraclass Correlation Coefficient [ICC]), measurement error (Standard Error of the Measurement [SEM], Minimal Detectable Change [MDC]), and construct validity (hypothesis testing with correlation of the DASH, NPRS, and SF-36) were explored. ResultsThe EFA identified two subscales (activity and participation-psychosocial factors). The internal consistency was supported for activity (α = 0.78), but not for participation-psychosocial subscales (α = 0.45). Both subscales demonstrated high test-retest reliability (ICC = 0.97 [95%CI = 0.96–0.98] and ICC = 0.95 [95%CI = 0.93–0.97]), a SEM of 5.8% and 7.0%, and a MDC of 15% and 19% for the first and second subscale, respectively. Construct validity was satisfactory, as >75% of the expected correlations were met for each subscale. ConclusionsThe SDQ-I was successfully cross-cultural adapted into Italian and proved to be valid for patients with non-specific SP, but its reliability should be further assessed, as internal consistency of the participation-psychosocial subscale showed some psychometric flaws. Further research is needed to refine the instrument.

Diagnostic performance of 3D-multi-Echo-data-image-combination (MEDIC) for evaluating SLAP lesions of the shoulder

BackgroundSuperior labral anterior to posterior (SLAP) lesions remain a clinical and diagnostic challenge in routine (non-arthrographic) MR examinations of the shoulder. This study prospectively evaluated the ability of 3D-Multi-Echo-Data-Image-Combination (MEDIC) compared to that of routine high resolution 2D-proton-density weighted fat-saturated (PD fs) sequence using 3 T-MRI to detect SLAP lesions using arthroscopy as gold standard.MethodsSeventeen consecutive patients (mean age, 51.6 ± 14.8 years, 11 males) with shoulder pain underwent 3 T MRI including 3D-MEDIC and 2D-PD fs followed by arthroscopy. The presence or absence of SLAP lesions was evaluated using both sequences by two independent raters with 4 and 14 years of experience in musculoskeletal MRI, respectively. During arthroscopy, SLAP lesions were classified according to Snyder’s criteria by two certified orthopedic shoulder surgeons. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 3D-MEDIC and 2D-PD fs for detection of SLAP lesions were calculated with reference to arthroscopy as a gold standard. Interreader agreement and sequence correlation were analyzed using Cohen’s kappa coefficient.Figure 1 demonstrates the excellent visibility of a proven SLAP lesion using the 3D-MEDIC and Fig. 2 demonstrates a false-positive case.ResultsArthroscopy revealed SLAP lesions in 11/17 patients. Using 3D-MEDIC, SLAP lesions were diagnosed in 14/17 patients by reader 1 and in 13/17 patients by reader 2. Using 2D-PD fs, SLAP lesions were diagnosed in 11/17 patients by reader 1 and 12/17 patients for reader 2. Sensitivity, specificity, PPV, and NPV of 3D-MEDIC were 100.0, 50.0, 78.6, and 100.0% for reader 1; and 100.0, 66.7, 84.6, and 100% for reader 2, respectively. Sensitivity, specificity, PPV, and NPV of 2D-PD fs were 90.9, 83.3, 90.9, and 83.3% for reader 1 and 100.0, 83.3, 91.7, and 100.0% for reader 2. The combination of 2D-PD fs and 3D-MEDIC increased specificity from 50.0 to 83.3% for reader 1 and from 66.7 to 100.0% for reader 2. Interreader agreement was almost perfect with a Cohen’s kappa of 0.82 for 3D-MEDIC and 0.87 for PD fs.ConclusionsWith its high sensitivity and NPV, 3D-MEDIC is a valuable tool for the evaluation of SLAP lesions. As the combination with routine 2D-PD fs further increases specificity, we recommend incorporation of 3D-MEDIC as an additional sequence in conventional shoulder protocols in patients with non-specific shoulder pain.