Non-specific Shoulder Pain Research Articles

Prevalence and anatomical location of muscle tenderness among adults with nonspecific shoulder/neck pain but without any traumatic injuries and other chronic disease

AIM: The aim of the study is to evaluate the prevalence and anatomical locations of muscle tenderness among adults with nonspecific neck/shoulder pain but without any traumatic injuries and other serious chronic disease. OBJECTIVE : To find various causes for nonspecific neck/shoulder pain. BACKGROUND: Many adults experience bothersome neck/shoulder pain. It is the one of the common symptom in primary care. It can be due to an intrinsic shoulder problem but pain can also be referred from other structure, such as the neck , diaphragm or heart. METHODS: This study required 50 patients those who are suffering from non specific shoulder or neck pain by examining the tenderness for the selected shoulder muscle. Inclusion criteria for this study was confined to the patients with nonspecific shoulder pain with age limit 30-55 ,and duration of pain about more than 6 months. Exclusion criteria for selection of patients for this study were limited to traumatic injuries, any other chronic disease cardiovascular disease, osteoporosis, arthritis and pregnant women. Then examination for muscle tenderness was done by palpating the selected muscles which are Upper Trapezius, Neckextensor, Levator scapulae and Infraspinatus. Based on the patients response during palpation , the examiner used a score of 1-3 corresponding to “ no pain”, moderate pain”, and “ severe pain”. RESULTS: In our present study we found that neck extensors(=0.712>0.500 )and levator scapulae(=0.886>0.500) were significant in Chi square test for muscle tenderness for nonspecific shoulder pain. Whereas Upper trapezius and infra Spinatus are found to be not significant for muscle tenderness .While our study also determined that females have tenderness score much more that males. And while comparing the percentage of tenderness score the muscles between sides (right and left side) upper trapezius and neck extensor were significant at the left side where as the levator scapulae and infra spinatus were more significant in right side of the shoulder. CONCLUSION: Many studies show that only upper trapezius play a major role in shoulder/neck pain.But there are other related muscles that are also significant or a cause for shoulder/neck pain. Therefore as a conclusion of our study ,not only upper trapezius is significant ,but also neck extensor ,levator scapulae and infra spinatus are also significant for tenderness during shoulder/neck pain.Future research should not only focus on upper trapezius but also on levator scapulae, infra spinatus and neck extensor.

First-rib stress fracture in two adolescent swimmers: a case report

ABSTRACTFirst-rib stress fractures have been described in adolescent athletes in various sports, with only one prior case report of first-rib stress fractures in an adolescent female swimmer. There is a need for research on the cause, management, and prevention of these injuries as they lead to significant morbidity and critical time away from sport for these aspiring athletes. We aimed to describe first-rib stress fractures as a potential cause for non-specific atraumatic chronic shoulder pain in adolescent swimmers and to discuss the different presentations, unique risk factors, treatment, and potential injury prevention strategies of such fractures. We discussed two such cases which were successfully treated with activity modification with restriction of all overhead activity, gradually progressive physical therapy and a return to swimming protocol. First-rib stress fractures can vary in presentation and should be in the differential diagnosis in adolescent swimmers with chronic shoulder pain. These injuries can be successfully managed with rest from overhead activities and physical therapy. Gradual return to competitive swimming can be achieved even with non-union of a first-rib stress fracture. Emphasis on balanced strength training in different muscle groups and proper swimming technique is essential to prevent these injuries.

The effectiveness of manual therapy for the management of musculoskeletal disorders of the upper and lower extremities: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

BackgroundMusculoskeletal disorders (MSDs) of the upper and lower extremities are common in the general population and place a significant burden on the health care system. Manual therapy is recommended by clinical practice guidelines for the management of these injuries; however, there is limited evidence to support its effectiveness. The purpose of our review was to investigate the effectiveness of manual therapy in adults or children with MSDs of the upper or lower extremity.MethodsRandomized controlled trials (RCTs), cohort studies, and case–control studies evaluating the effectiveness of manual therapy were eligible. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Paired reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with low risk of bias were synthesized following best-evidence synthesis principles. Where available, we computed mean changes between groups, relative risks and 95 % CI.ResultsWe screened 6047 articles. Seven RCTs were critically appraised and three had low risk of bias. For adults with nonspecific shoulder pain of variable duration, cervicothoracic spinal manipulation and mobilization in addition to usual care may improve self-perceived recovery compared to usual care alone. For adults with subacromial impingement syndrome of variable duration, neck mobilization in addition to a multimodal shoulder program of care provides no added benefit. Finally, for adults with grade I-II ankle sprains of variable duration, lower extremity mobilization in addition to home exercise and advice provides greater short-term improvements in activities and function over home exercise and advice alone. No studies were included that evaluated the effectiveness of manual therapy in children or for the management of other extremity injuries in adults.ConclusionsThe current evidence on the effectiveness of manual therapy for MSDs of the upper and lower extremities is limited. The available evidence supports the use of manual therapy for non-specific shoulder pain and ankle sprains, but not for subacromial impingement syndrome in adults. Future research is needed to determine the effectiveness of manual therapy and guide clinical practice.Systematic review registration numberCRD42014009899

Neck Training @ home with Intelligent Headset

Context: Non-specific neck and shoulder pain (NSS) is an increasingly common disorder in Denmark and has statistically been experienced by half of the adult population within the last six months [1, 2]. The estimated societal and personal costs related to NSS amount to at least 13 billion DKR yearly. The reason for the NSS disorder reaching epidemic levels in Denmark and worldwide is primarily the introduction of computers, tablets and smartphones in peoples’ private and professional lives and the resulting work habits and physical postures imposed by such devices [3]. Curing NSS often requires several visits to physiotherapists or chiropractic clinics and in most cases the patients receive treatment as well as instructions in rehabilitative exercises that can be performed at home. Purpose: With this M.Sc. project we propose a tele-medical training assistant that will instruct and monitor the patient in doing these home exercises in the correct manner. The training assistant consists of the motion-sensor-equipped 3D audio headset, Intelligent Headset, developed by GN [4]. This headset is connected with a smartphone and controlled by the training assistant app developed. Using this headset, we can monitor the head movements of the patient very closely as well as give immediate auditory instructions and feedback. Methods: We first validate the precision of the headset motion sensors and the resulting ability to detect certain patterns of movement using the high-precision 3D motion capture system, Vicon, as a reference. We then develop and implement an application which is able to recognize and give feedback on three common and scientifically approved types of neck rehabilitation exercises. We do this through a user-centred process involving both healthy users and users with neck problems, while receiving continuous feedback from domain experts, such as chiropractors and physiotherapists.

Effectiveness of Soft Tissue Massage for Nonspecific Shoulder Pain: Randomized Controlled Trial.

Soft tissue massage and exercise are commonly used to treat episodes of shoulder pain. The study objective was to compare the effects of soft tissue massage and exercise with those of exercise alone on pain, disability, and range of motion in people with nonspecific shoulder pain. This was a randomized controlled trial. The study was conducted in public hospital physical therapy clinics in Sydney, New South Wales, Australia. The study participants were 80 people with an average age of 62.6 years (SD=12.2) who were referred to physical therapists for treatment of nonspecific shoulder pain. Participants were randomly assigned to either a group that received soft tissue massage around the shoulder and exercises (n=40) or a group that received exercise only (n=40) for 4 weeks. The primary outcome was improvement in pain, as measured on a 100-mm visual analog scale, 1 week after the cessation of treatment. Secondary outcomes were disability and active flexion, abduction, and hand-behind-back range of motion. Measurements were obtained at baseline, 1 week after the cessation of treatment, and 12 weeks after the cessation of treatment. The between-group difference in pain scores from the baseline to 12 weeks after the cessation of treatment demonstrated a small significant difference in favor of the group receiving exercise only (mean difference=14.7 mm). There were no significant differences between groups in any other variable. It was not possible to mask therapists or participants to group allocation. Diagnostic tests were not used on participants to determine specific shoulder pathology. The addition of soft tissue massage to an exercise program for the shoulder conferred no additional benefit for improving pain, disability, or range of motion in people with nonspecific shoulder pain.

Is exercise effective for the management of subacromial impingement syndrome and other soft tissue injuries of the shoulder? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

BackgroundExercise is a key component of rehabilitation for soft tissue injuries of the shoulder; however its effectiveness remains unclear. ObjectiveDetermine the effectiveness of exercise for shoulder pain. MethodsWe searched seven databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort and case control studies comparing exercise to other interventions for shoulder pain. We critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. We synthesized findings from scientifically admissible studies using best-evidence synthesis methodology. ResultsWe retrieved 4853 articles. Eleven RCTs were appraised and five had a low risk of bias. Four studies addressed subacromial impingement syndrome. One study addressed nonspecific shoulder pain. For variable duration subacromial impingement syndrome: 1) supervised strengthening leads to greater short-term improvement in pain and disability over wait listing; and 2) supervised and home-based strengthening and stretching leads to greater short-term improvement in pain and disability compared to no treatment. For persistent subacromial impingement syndrome: 1) supervised and home-based strengthening leads to similar outcomes as surgery; and 2) home-based heavy load eccentric training does not add benefits to home-based rotator cuff strengthening and physiotherapy. For variable duration low-grade nonspecific shoulder pain, supervised strengthening and stretching leads to similar short-term outcomes as corticosteroid injections or multimodal care. ConclusionThe evidence suggests that supervised and home-based progressive shoulder strengthening and stretching are effective for the management of subacromial impingement syndrome. For low-grade nonspecific shoulder pain, supervised strengthening and stretching are equally effective to corticosteroid injections or multimodal care. Systematic review registration numberCRD42013003928.

Thoracic manual therapy in the management of non-specific shoulder pain: a systematic review

Objectives:Non-specific shoulder pain (NSSP) is often persistent and disabling leading to high socioeconomic costs. Cervical manipulation has demonstrated improvements in patients with NSSP, although risks associated with thrust techniques are documented. Thoracic manual therapy (TMT) may utilise similar neurophysiological effects with less risk. The current evidence for TMT in treating NSSP is limited to systematic reviews of manual therapy (MT) applied to the upper quadrant. These reviews included trials that used shoulder girdle manual therapy (SG-MT) in the TMT group. This limits the scope of their conclusions with regard to the exclusive effectiveness of TMT for NSSP.Methods:This review used a steering group for subject and methodological expertise and was reported in line with Preferred Reporting items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Key databases were searched (1990–2014) using relevant search terms and medical subject headings (MeSH); eligibility was evaluated independently by two reviewers based on pre-defined criteria. Study participants had NSSP including impingement syndrome and excluding cervical pain. Interventions included cervicothoracic junction and TMT with or without supplementary exercises. Studies that included MT applied to the shoulder girdle including the glenohumeral joint, acromioclavicular joint or sternoclavicular joint in the TMT group, without a control, were excluded. Included studies utilised outcome measures that monitored pain and disability scores. Randomized controlled trials (RCTs) and clinical studies were eligible. Using a standardised form, each reviewer independently extracted data. Risk of bias was assessed using GRADE and PEDro scale. Results were tabulated for semi-quantitative comparison.Results:Over 912 articles were retrieved: three RCTs, one single-arm trial and three pre–post test studies were eligible. Studies varied from poor to high quality. Three RCTs demonstrated that TMT reduced pain and disability at 6, 26 and 52 weeks compared with usual care. Two pre–post test studies found between 76% and 100% of patients experienced significant pain reduction immediately post-TMT. An additional pre–post test study and a single-arm trial showed reductions in pain and disability scores 48 hours post-TMT.Discussion:Thoracic manual therapy accelerated recovery and reduced pain and disability immediately and for up to 52 weeks compared with usual care for NSSP. Further, high-quality RCTs investigating the effect of TMT in isolation for the treatment of patients with NSSP are now required.

Shoulder Pain and Regional Interdependence: Contributions of the Cervicothoracic Spine

Copyright: © 2014 Mintken P. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Shoulder pain is common, with a reported prevalence between 2033% [1]. Additionally, the incidence of shoulder pain in the general population appears to be increasing [2]. The prognosis for patients with a new onset of shoulder pain is generally poor, with recovery rates of only 49-59% at an 18-month follow-up [3,4]. Recurrence rates are also high, as Rekola et al. [5] reported that 1 in 4 individuals with shoulder or neck pain will experience at least one episode of recurrence within 12 months of onset. In the year 2000, the direct costs for the treatment of shoulder pain in the United States topped $7 billion, [6] and Kuijpers et al. [7] reported that 74% of the total costs for managing shoulder pain are attributable to individuals with persistent or recurrent symptoms. Shoulder pain can be challenging for both patients and health care providers. A study by Ostor et al. [8] on non-specific shoulder pain reported that 77% were diagnosed with more than one shoulder problem. Many shoulder pathologies present with similar examination findings, but vary widely in their outcomes and require different intervention approaches [9]. Specific diagnosis and classification can be difficult, as de Winter et al. [10] reported only moderate agreement on the classification of shoulder disorders. Given that shoulder pain is difficult to accurately diagnose, Dinant et al. [11] argue that we need a shift from diagnostic to prognostic research.

Valoración del dolor crónico de hombro en población mayor: un enfoque biopsicosocial

IntroductionThe prevalence of chronic shoulder pain within the elderly population is very high. This study has aimed to establish the clinical profile of patients with chronic shoulder pain, incorporating a biopsychosocial approach for the assessment and to study the relationship between disability and physical and psychological variables. Material and methodsA descriptive survey in which 76 participants aged over 60 years old who came to rehabilitation in the hospital with non-specific chronic shoulder pain without motor comorbidities associated to the upper limbs and with a duration of more than 3 months was performed. A physical therapist assessed the physical variables regarding range of motion, dynamometry, algometry, and pain intensity. The participants also filled out a questionnaire on fear-avoidance beliefs, kinesiophobia, and perception of disability. A correlation analysis was conducted to determine the interaction between these variables. ResultsA significant negative significant (P<.05) correlation was found between the physical variables and psychological aspects regarding the fear avoidance questionnaire and the Kinesiophobia scale. There was a significant correlation (P<.001) between disability and physical and psychological variables. ConclusionOur results support the existence of a strong association between disability and psychological and physical variables in chronic shoulder pain. These findings reinforce the idea that a biopsychosocial approach is necessary to adapt the therapy to the patient

Acute Multifocal Osteomyelitis Following Acupuncture: A Case Report.

Osteomyelitis was not listed as a complication of acupuncture in a recent review of one million self-reported treatments1 and has not been identified in limited safety data on acupuncture from randomized trials2. The aims of this case report are to highlight a rarely recognized instigator of acute osteomyelitis and stress the importance of a thorough history, physical examination, and radiographic evaluation in patients presenting with signs and symptoms of osteomyelitis following acupuncture. The authors obtained the patient’s informed consent for publication of this case report. A fifteen-year-old previously healthy adolescent male basketball player presented with right shoulder pain and a fever of four days’ duration. During a basketball game three weeks prior to presentation, the patient sustained a right shoulder “strain” for which he did not seek medical treatment. Because of continued discomfort with activity, he underwent acupuncture five days prior to presentation to us; ten separate needles were inserted into the skin overlying both shoulders and upper extremities. According to the acupuncturist, meridians of Chinese acupuncture postulated to alleviate shoulder pain were chosen as locations for needle insertion, including five separate areas overlying the clavicle, acromion, and scapula on both sides. The treatment areas were prepared with alcohol-based cleaning wipes prior to the insertion of disposable 2-in stainless-steel needles. Each needle remained in the skin for approximately thirty minutes. On awakening the following morning, the patient felt subjectively febrile and noticed a “stinging” quality to the right shoulder pain. The pain increased progressively and was not relieved with nonsteroidal anti-inflammatory medication. At initial presentation to us, the patient described sharp, nonradiating right shoulder pain, rated 8 of 10 and exacerbated erythrocytewith movement. There was also mild, nonspecific left shoulder pain. Examination was notable for a fever of 39.4°C and diffuse …

Avoidable costs of physical treatments for chronic back, neck and shoulder pain within the Spanish National Health Service: a cross-sectional study

BackgroundBack, neck and shoulder pain are the most common causes of occupational disability. They reduce health-related quality of life and have a significant economic impact. Many different forms of physical treatment are routinely used. The objective of this study was to estimate the cost of physical treatments which, despite the absence of evidence supporting their effectiveness, were used between 2004 and 2007 for chronic and non-specific neck pain (NP), back pain (BP) and shoulder pain (SP), within the Spanish National Health Service in the Canary Islands (SNHSCI).MethodsChronic patients referred from the SNHSCI to private physical therapy centres for NP, BP or SP, between 2004 and 2007, were identified. The cost of providing physical therapies to these patients was estimated. Systematic reviews (SRs) and clinical practice guidelines (CPGs) for NP, BP and SP available in the same period were searched for and rated according to the Oxman and AGREE criteria, respectively. Those rated positively for ≥70% of the criteria, were used to categorise physical therapies as Effective; Ineffective; Inconclusive; and Insufficiently Assessed. The main outcome was the cost of physical therapies included in each of these categories.Results8,308 chronic cases of NP, 4,693 of BP and 5,035 of SP, were included in this study. Among prescribed treatments, 39.88% were considered Effective (physical exercise and manual therapy with mobilization); 23.06% Ineffective; 13.38% Inconclusive, and 23.66% Insufficiently Assessed. The total cost of treatments was € 5,107,720. Effective therapies accounted for € 2,069,932.ConclusionsSixty percent of the resources allocated by the SNHSCI to fund physical treatment for NP, BP and SP in private practices are spent on forms of treatment proven to be ineffective, or for which there is no evidence of effectiveness.

Implementation of neck/shoulder exercises for pain relief among industrial workers: A randomized controlled trial

BackgroundAlthough leisure-time physical activity is important for health, adherence to regular exercise is challenging for many adults. The workplace may provide an optimal setting to reach a large proportion of the adult population needing regular physical exercise. This study evaluates the effect of implementing strength training at the workplace on non-specific neck and shoulder pain among industrial workers.MethodsCluster-randomized controlled trial involving 537 adults from occupations with high prevalence of neck and shoulder pain (industrial production units). Participants were randomized to 20 weeks of high-intensity strength training for the neck and shoulders three times a week (n = 282) or a control group receiving advice to stay physically active (n = 255). The strength training program followed principles of progressive overload and periodization. The primary outcome was changes in self-reported neck and shoulder pain intensity (scale 0-9).Results85% of the participants followed the strength training program on a weekly basis. In the training group compared with the control group, neck pain intensity decreased significantly (-0.6, 95% CI -1.0 to -0.1) and shoulder pain intensity tended to decrease (-0.2, 95% CI -0.5 to 0.1, P = 0.07). For pain-cases at baseline (pain intensity > = 3) the odds ratio - in the training group compared with the control group - for being a non-case at follow-up (pain intensity < 3) was 2.0 (95% CI 1.0 to 4.2) for the neck and 3.9 (95% CI 1.7 to 9.4) for the shoulders.ConclusionHigh-intensity strength training relying on principles of progressive overload can be successfully implemented at industrial workplaces, and results in significant reductions of neck and shoulder pain.Trial registrationNCT01071980.

견갑하근의 건 부분에 대한 자기공명영상을 이용한 분석

Purpose: The purpose of this study was to document the structural features of the tendinous portions within the non-pathologic subscapularis muscle by performing high resolution MR imaging of the shoulder. Materials and Methods: Between April 2007 and May 2010, we retrospectively obtained the MR scans of 88 consecutive young patients (88 shoulders) who were in their twenties. MRI and MR arthrography were performed using a 3.0-T system for the evaluation of glenohumeral instability and nonspecific shoulder pain. None of the patient in this study had any evidence of injury to the tendon or muscle belly of the subscapularis. On MR images, we recorded the transverse length of a stout tendinous band and the total tendinous portion of the subscapularis. In addition, we recorded the number of intramuscular tendinous slips of the susbscapularis. Results: The mean transverse length of the tendinous band was 15.0 mm (range: 8 to 20 mm). The mean transverse length of the total tendinous portion was 48.9 mm (range: 40 to 60 mm). The number of intramuscular tendinous slips on the base of the glenoid fossa was 3 in 20 (22.72%), 4 in 45 (51.14%) and 5 in 23 shoulders (26.14%). On the lateral portion, the intramuscular tendinous slips became gradually rounder and thicker and they gave converge in the superior direction. Conclusion: In this study, the structural features of the tendinous portions of the subscapularis on the MR scans were identified. This will in return give good justification for the lines to be pulled during biomechanical stimulation and also for the surgical approach to restore the biomechanical function.

An alternative approach to the diagnosis and management of non-specific shoulder pain with case examples

Shoulder problems are a common musculoskeletal complaint, which present a difficult diagnostic challenge. Many orthopaedic tests for the shoulder are not specific for any one pathological condition and two or more conditions often co-exist, therefore, it is not surprising that clinicians are often unable to accurately diagnose shoulder joint pathology. Once shoulder pain due to conditions such as tumour, infection, trauma, systemic inflammatory disorders and referred pain from elsewhere has been ruled out, a more global and functional approach to diagnosis and management of non-specific shoulder pain is advocated. This paper presents an alternative diagnostic and therapeutic approach used to manage non-specific shoulder pain illustrated by three cases.

The clinical effectiveness of a myofeedback-based teletreatment service in patients with non-specific neck and shoulder pain: a randomized controlled trial

We investigated the effectiveness and efficiency of a four-week myofeedback-based teletreatment service in subjects with non-specific neck and shoulder pain. Subjects were recruited in Belgium, Germany and the Netherlands and randomly allocated to the intervention or conventional care. Subjects in the intervention group received four weeks of myofeedback training. Pain intensity and disability were evaluated by questionnaires at baseline, immediately after four weeks of treatment and at follow-up 3 months later. To investigate efficiency, the time-investment of both therapists and patients were assessed. Seventy-one subjects were included in the study (36 in the intervention group and 35 in the conventional care group). Myofeedback-based teletreatment was at least as effective clinically as conventional care. Pain intensity and disability decreased after 4 weeks of treatment in both groups and part of the effect remained at 3 months' follow-up. The teletreatment also increased efficiency for therapists by almost 20% and patients experienced the benefits of less travel time and travel costs by remote consultation. Myofeedback-based teletreatment has the potential to ensure more efficient treatment for patients with non-specific neck and shoulder pain.

Prognostic factors for the effect of a myofeedback-based teletreatment service

We investigated the potential prognostic factors for clinically relevant improvements in pain intensity and pain-related disability after myofeedback-based teletreatment. Sixty-five female computer users, 56 female patients with whiplash-associated disorders and 18 female patients with non-specific neck and shoulder pain participated in the study. They received myofeedback-based teletreatment or usual treatment. Questionnaires concerning prognostic factors, pain and disability were completed before the start of the intervention (baseline) and at follow-ups at the end of the intervention, and after 3 and 6 months. Logistic regression analyses were performed in order to investigate prognostic factors for clinically relevant improvement. In the intervention group, improvement in pain intensity was predicted by baseline pain intensity. Baseline pain intensity and disability, and fear-avoidance and endurance related pain coping responses were prognostic factors for outcome in pain-related disability in this group. There were few differences between the intervention groups; fear-avoidance coping responses influenced the outcome after teletreatment only. Myofeedback-based teletreatment appears to be an useful telemedicine intervention, especially for participants with moderate to high levels of pain and disability, high perceived help/hopelessness, and those who tend to deal with their pain by avoiding social and physical activities.

Feldenkrais ® therapy as group treatment for chronic pain – A qualitative evaluation

This qualitative study describes and analyses the experiences and self-reported effects of those participating in a Feldenkrais group intervention. Fourteen women with non-specific neck and shoulder pain participated in a group treatment design using the Feldenkrais Awareness Through Movement (ATM) method. Data were collected in two ways: diary notes directly after the sessions and thematic interviews 4-6 months after the intervention. Data were analysed with a Grounded Theory approach. One core category and two sub-categories emerged. The core category "Feldenkrais is wholesome, but difficult" represents the participants' major opinions about the group intervention. The sub-categories "More erect without effort", and "Extended space for myself", represent participants' descriptions of effects of the movement therapy. The women described changes in posture and balance, a feeling of release and increased self-confidence. Some ambivalence about the method was expressed, especially regarding the difficulty to continue the exercises at home. The women feelings of improved body awareness remained after 4-6 months. They were also more aware of their attitudes towards activities in daily life. This resulted in them not "sacrificing themselves" as they did before. In addition, the bodily and psychological changes and the concept of empowerment are discussed. Positive experiences from the Feldenkrais group treatment were reported, especially concerning movement ability and body awareness. The exercises were however regarded as difficult to perform as self-training on a daily basis.

Subscapularis muscle metastases of duodenal adenocarcinoma: A case report

In view of the rarity of metastases to the muscles from a gastrointestinal malignant tumor and the lack of any reports of metastases to the subscapularis muscle from the gastrointestinal tract in the literature, we report a very rare case of subscapularis muscle metastases of duodenal adenocarcinoma in an elderly female patient with nonspecific anterior shoulder pain.

Prevalence of Self-Reported Neck-Shoulder-Arm Pain and Concurrent Low Back Pain or Psychological Distress

Analysis of repeated cross-sectional surveys. To investigate the prevalence of neck-shoulder-arm pain and concurrent low back pain and psychological distress in a geographical area over a 16-year period. A large number of studies have shown that nonspecific neck, shoulder, and arm pain is a very common symptom in the general population. However, few studies have followed the prevalence of neck-shoulder-arm pain within a geographical area, in order to investigate time-trends. This study provides an analysis of questionnaire data collected every 4 years between 1990 and 2006 on the prevalence of neck-shoulder-arm pain and concurrent low back pain or psychological distress in the County of Stockholm, Sweden (response rate: 61%-69%). All individuals aged 21 to 64 years (n = 1976-26,611) were included in the study. Over the 16-year period, the prevalence of self-reported neck-shoulder-arm pain rose slightly, from 22.8% to 25.0% among females (prevalence rate ratio [PRR]: 1.10) and from 12.8% to 15.4% among males (PRR: 1.21). The prevalence of neck-shoulder-arm pain with concurrent low back pain also rose slightly, from 8.4% to 10.8% among females (PRR: 1.28) and from 5.3% to 6.6% among males (PRR: 1.24). In contrast, the prevalence of neck-shoulder-arm pain with concurrent psychological distress rose more substantially, from 4.4% to 8.5% among females (PRR: 1.91) and from 2.0% to 4.3% among males (PRR: 2.18). All prevalence rates rose between 1990 and 2002, and decreased in 2006 compared to 2002. The gender gap in prevalence did not change over time. Although the prevalence of neck-shoulder-arm pain and concurrent symptoms decreased in 2006 compared to 2002, it is still too early to conclude that we have reached and passed the peak of the "epidemic" of neck-shoulder-arm pain.

Case Reports: Unusual Cause of Shoulder Pain in a Collegiate Baseball Player

The objective of reporting this case was to introduce a unique cause of shoulder pain in a high-level Division I NCAA collegiate baseball player. Various neurovascular causes of shoulder pain have been described in the overhead athlete, including quadrilateral space syndrome, thoracic outlet syndrome, effort thrombosis, and suprascapular nerve entrapment. All of these syndromes are uncommon and frequently are missed as a result of their rarity and the need for specialized tests to confirm the diagnosis. This pitcher presented with nonspecific posterior shoulder pain that was so severe he could not throw more than 50 feet. Eventually, intermittent axillary artery compression with the arm in abduction resulting from hypertrophy of the pectoralis minor and scalene muscles was documented by performing arteriography with the arm in 120 degrees abduction. MRI-MR angiographic evaluation revealed no anatomic abnormalities. The patient was treated successfully with a nonoperative rehabilitation program and after 6 months was able to successfully compete at the same level without pain.