Presence Of Shoulder Pain Research Articles

High Prevalence and Impact of Shoulder Pain Among Gym Instructors: A Study on Work-Related Musculoskeletal Disorders

INTRODUCTION :- Gym instructors within the fitness industry play a pivotal role in guiding individuals towards achieving a range of health and fitness goals. In addition to muscular and skeletal health, gym instructors are instrumental in boosting the immune system. Even though they help in maintaining the body gym trainers have a limited knowledge of mechanism of injury, neglecting and repetitive movements of the joint leads to worsening of injury and increase in the pain. Musculoskeletal pain can stem from various sources, including uncommon or repetitive activities that strain muscles, tendons, and ligaments. Additionally, it may result from sudden, jerky movements, falls, fractures, or underlying musculoskeletal conditions. The result of repetitive activities that strain the muscles, tendons and sprain the ligaments. Insufficient recovery time, rapid pace work, repetitive motion patterns, heavy weight lifting, forceful manual exertions, mechanical pressure concentrations or whole body vibrations can lead to development of other musculoskeletal disorders. The impact of a musculoskeletal condition on an individual's quality of life is substantial, extending beyond mere physical discomfort. Such conditions not only affect personal well-being but also impose a considerable financial strain, manifested through compensation payments and lost wages. Instances of sick leave, absenteeism, and even job abandonment contribute to diminished job efficiency,further exacerbating the socioeconomic repercussions of these disorders. METHODOLOGY :- A total of 147 participants were selected on the basis of inclusion and exclusion criteria. A consent form was filled by them and the study and questionnaire was explained to them.Self-made Questionnaire was explained to each gym instructors according to language understood by that person as well as google forms were also made available for their convenience.Each gym instructor completed a self administered questionnaire which included information regarding complaints of current shoulder pain. The total data was collected and was statistically analyzed. CONCLUSION :- The Prevalence of shoulder pain in gym instructors is high (78%). The presence of shoulder pain causes a gym instructors to avoid certain activities due to pain which causes a hindrance in their work related activities.

Smartphone use: implications for musculoskeletal symptoms and socio-demographic characteristics in students

Introduction: smartphone use has substantially increased in the past decade, becoming an important part in population's usual activities, but the relationship between smartphone addiction, smartphone use, and neck disability in adults remains uncertain. The objective of this study: (1) investigate the association between neck disability and smartphone use time with socio-demographic characteristics, musculoskeletal symptoms, and smartphone addiction among university students; and (2) assess the association between smartphone addiction with socio-demographic characters, musculoskeletal symptoms. Methods: 228 students (74 males and 154 females; average age 29,41 years old) were enrolled in the study. Participants answered questions about sociodemographic characteristics, smartphone time use, smartphone addiction (SAS-SV), musculoskeletal symptoms in the neck and upper limb, and neck disability (NDI). Results: individuals with neck disability were associated with, gender, general health, presence of neck and shoulder pain, and smartphone addiction. More time spent on smartphones was associated with some socio-demographic characteristics, the presence of shoulder pain, and smartphone addiction. Conclusions: smartphone addiction was associated with lower age, higher educational level, neck disability, and smartphone time use in students.

Intraperitoneal Instillation of Bupivacaine and Hydrocortisone for Postoperative Analgesia in Laparoscopic Cholecystectomy Under Spinal Anaesthesia – A Prospective Randomized Study

Background: Laparoscopic cholecystectomy is a minimally invasive procedure requiring less hospital stay and early mobilization as compared to open procedure. The aim of our study was to compare the efficacy of intraperitoneal instillation of hydrocortisone with bupivacaine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy under spinal anesthesia. Materials and Methods: Sixty patients were enrolled in this prospective randomized study. Patients either received 0.125% bupivacaine (Group B) or 0.125% bupivacaine with 100 mg hydrocortisone (Group H) through intraperitoneal drain at the end of surgery. Pain was evaluated every two hourly using the Visual Analog Scale (VAS) for 24 h. Analgesics were required during this period and the presence of shoulder pain was also noted. Results: Patients in the hydrocortisone group had lower pain scores (2.17 ± 0.47) compared to the bupivacaine group (3.51 ± 1.10). This difference in the mean VAS score was statistically significant (P < 0.01). Similarly, patients requiring rescue analgesia were 60.86% in Group B and 39.14% in Group H and were statistically significant. Time for rescue analgesia was longer in Group H as compared to Group B. Conclusion: Intraperitoneal bupivacaine and hydrocortisone decrease pain and analgesic requirements more effectively than bupivacaine alone after laparoscopic cholecystectomy without causing significant adverse effects.

Glenohumeral Instability and Arm Pain in Overhead Throwing Athletes: A Correlational Study.

The overhead activity of throwing a baseball is arguably the most demanding athletic endeavor placed on the glenohumeral (GH) joint. Previous studies illustrate that 75-80% of baseball players will experience some degree of upper extremity (UE) pain. GH instability is thought to play a role. The purpose of this study was to investigate the relationship between GH joint hypermobility and instability with measures of arm pain and performance in overhead throwing athletes. Actively competing baseball pitchers were recruited and evaluated once with the anterior-posterior Load and Shift examination procedure, the Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Questionnaire (KJOC), and the Functional Arm Scale for Throwers (FAST). Multivariate analysis was performed to identify correlation between severe GH capsular laxity (GH instability), mild capsular laxity (GH hypermobility), no capsular laxity (GH normal), and presence of shoulder pain when pitching. Cross-sectional Study. Forty-five pitchers were evaluated, 62.2% of throwing shoulders were classified normal stability, 26.7% were classified hypermobile, and 11.1% were classified unstable. Average KJOC scores for pitchers with the three mobility categories were 66.1 (normal), 59.7 (hypermobile), and 45.0 (unstable). Average FAST scores among the pitchers were 19.9 (normal), 34.2 (hypermobile), and 32.2 (unstable). Pitchers with GH instability and GH hypermobility demonstrated increased arm pain compared to athletes with normal GH joints; KJOC scores of 3.2, 5.5, and 7.4 (p = 0.0007), respectively. Pitchers with GH instability and hypermobility demonstrated significantly increased ratings of arm pain compared to pitchers with no capsular laxity. 3b.

Rotator Cuff Tear Progression at 2-year Follow-up in Manual Wheelchair Users with Spinal Cord Injury

<h3>Research Objectives</h3> To investigate rotator cuff tear progression in manual wheelchair (MWC) users with spinal cord injury (SCI) and matched able-bodied individuals. <h3>Design</h3> Longitudinal cohort study, 2-year follow-up. <h3>Setting</h3> Outpatient clinic at a tertiary medical center. <h3>Participants</h3> Thirty-three adult MWC users with SCI (26 men) with an average age (SD) of 42 (12) years and 33 age/sex-matched able-bodied individuals participated in this study. Median time since injury (interquartile ratio) for the SCI participants was 7 (19) years. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Magnetic resonance imaging (MRI) abnormalities of rotator cuff tendons (dominant side) including partial tears (low, intermediate, and high grade) and full tears at baseline and 2-year follow-up visits were graded by a board-certified musculoskeletal radiologist. Presence of shoulder pain was collected. <h3>Results</h3> Fifty-two percent of the MWC users reported shoulder pain at baseline which was significantly higher than able-bodied cohort (10%, P=0.004). The prevalence of any tendon tears across the rotator cuff in MWC users was 61% and 67% at baseline and year 2 visits, respectively, and for able-bodied participants was 45%, and 52%. The MWC users experienced a significant (P=0.001) rotator cuff tear progression from baseline to year 2 (15 participants with worsening score and 2 with improving score). MRI findings did not change significantly for the able-bodied cohort. The MWC user cohort had 3 times (relative risk; 95% CI: 1.23 to 7.30, P = 0.007) higher risk of experiencing rotator cuff tear progression over 2 years in comparison to the able-bodied cohort. <h3>Conclusions</h3> The findings of this study indicate the significantly accelerated rate of rotator cuff degeneration in MWC users with SCI in comparison to able-bodied individuals. <h3>Author(s) Disclosures</h3> National Institutes of Health Funding (grant no. R01 HD84423).

Predictors of high dose of massed practice following stroke.

ObjectiveThe aim of this study is to determine the factors that affect patients’ ability to carry out high dose of massed practice.MethodsPatients with stroke were included in the study if they had no severe impairment in motor and cognitive functions. Dose of massed practice, motor function, perceived amount and quality of use of the arm in the real world, wrist and elbow flexors spasticity, dominant hand stroke, presence of shoulder pain, and central post-stroke pain were assessed on the first day. Dose of massed practice was assessed again on the second day. The data were analyzed using descriptive statistics and linear multiple regression.ResultsOnly motor function (β = –0.310, r = 0.787, P < 0.001), perceived amount of use (β = 0.300, r = 0.823; 95% CI = 0.34–107.224, P = 0.049), severity of shoulder pain (β = –0.155, r = –0.472, P = 0.019), wrist flexors spasticity (β = –0.154, r = –0.421, P = 0.002), age (β = –0.129, r = –0.366, P = 0.018), dominant hand stroke (β = –0.091, r = –0.075, P = 0.041), and sex (β = –0.090, r = –0.161, P = 0.036) significantly influenced patients’ ability to carry out high dose of massed practice.ConclusionMany factors affect patients’ ability to carry out high dose of massed practice. Understanding these factors can help in designing appropriate rehabilitation.

Progression of rotator cuff tendon pathology in manual wheelchair users with spinal cord injury: A 1-year longitudinal study

Objective To investigate the progression of rotator cuff tendon pathology across one year in manual wheelchair (MWC) users with spinal cord injury (SCI) and matched able-bodied individuals, and to explore the association between pain, age, and duration of wheelchair use with the progression of rotator cuff pathology. Design Longitudinal cohort study, 1-year follow-up. Setting Outpatient clinic at a tertiary medical center. Participants Twenty-four adult MWC users with SCI (20 men) with an average age (SD) of 37(12) years and 24 age and sex-matched able-bodied individuals. Interventions Not applicable. Main outcome measure(s) Presence of shoulder pain was collected. Magnetic resonance imaging (MRI) abnormalities of rotator cuff tendons including tendinopathy and tendon tears at baseline and 1-year follow-up visits were graded by a board-certified musculoskeletal radiologist, and three categories of tendon pathology scores including individual tendon scores, unilateral cuff scores, and bilateral cuff scores were calculated for each participant. Results Fifty-four percent of the MWC users reported shoulder pain at both time points which was significantly higher than able-bodied cohort at baseline (17%, P = 0.012) and year 1 (21%, P = 0.021). Rotator cuff tendon pathology was detected as mainly mild tendinopathies and low-grade partial-thickness tears in both cohorts at both time points but was more common in MWC users. The results for the bilateral cuff scores indicated a significant (P < 0.008) progression of rotator cuff tendon pathology in the MWC users over one year. MRI findings did not change significantly for the able-bodied cohort across time. There was no association of pain, age, or duration of MWC use with progression of rotator cuff pathology in MWC user cohort. Conclusion MWC users had a higher prevalence of pain than matched able-bodied cohort, but pain was minimal and not function-limiting. Bilateral cuff TOTAL scores showed pathology progression in MWC users, but MRI findings remained stable in the able-bodied cohort. MWC users were 3.4 times more likely to experience pathology progression than the able-bodied cohort.

Physical activity levels and shoulder pain in wheelchair users during COVID-19 restrictions

BackgroundManual wheelchair users are at high risk of developing shoulder pain. However, it is not known if restrictions to limit the spread of the COVID-19 virus affected physical activity, wheelchair use and shoulder pain. ObjectiveThe aim of the study is to determine whether COVID-19 related restrictions caused changes in physical activity levels and the presence of shoulder pain in persons who use a wheelchair. MethodsManual wheelchair users completed a survey about the presence and severity of shoulder pain in a cross-sectional study design. Participants completed the Leisure Time Physical Activity Questionnaire and were asked about daily wheelchair activity before and during lockdown. A logistic regression examined the relationship between increase in shoulder pain severity and change in activity levels. ResultsSixty respondents were included for analysis. There was no significant change in physical activity during lockdown. There was a significant reduction in number of hours of daily wheelchair use and number of chair transfers during lockdown. Of the respondents, 67% reported having shoulder pain and 22% reported their shoulder pain becoming more severe during lockdown. No significant relationship was observed between the change in activity levels and increasing severity of shoulder pain. ConclusionRestrictions to reduce the spread of the COVID-19 virus resulted in no changes in physical activity levels in a sample of adult manual wheelchair users; however, there was a reduced time using a wheelchair each day and fewer chair transfers. The changes in wheelchair activities were not related to the worsening of shoulder pain.

MRI evaluation of shoulder pathologies in wheelchair users with spinal cord injury and the relation to shoulder pain

Objective To describe the number, specifics and co-occurrence of shoulder pathologies detected by MRI in manual wheelchair users with spinal cord injury and to evaluate the association between shoulder pathologies and presence of shoulder pain. Design Cross-sectional observation study. Setting Community. Participants Fifty-one wheelchair-dependent persons with spinal cord injury (44 males, 7 females, median age 50 years (IQR 14), median time since injury 24 years (IQR 16)) were allocated to pain or no-pain group based on the Wheelchair User Shoulder Pain Index. Interventions Not applicable Outcome measures All persons underwent shoulder MRI. Pathologies were scored blinded by two experienced radiologists. Participant characteristics, number and severity of shoulder pathologies were analyzed descriptively. Logistic regression was performed to evaluate the association between MRI findings and shoulder pain. Results The median number of co-occurring MRI findings per person ranged from 0 to 19 (out of 31 possible findings). The cluster of MRI findings occurring most often together were tendon tears of supraspinatus (present in 84%), subscapularis (69%) and biceps (67%) and osteoarthritis of acromioclavicular joint (80%). When correcting for age and time since injury, the logistic regression showed no statistically significant correlation between the individual pathologies and shoulder pain. Conclusion MRI findings of shoulder pathology are very frequent in persons with and without shoulder pain. Therefore, when diagnosing the cause of shoulder pain and planning interventions, health care professionals should keep this finding in mind and MRI should not be interpreted without careful consideration of clinical history and functional testing.

High baseball loads induce shoulder and elbow injuries among high school baseball pitchers: a prospective study

Studies on the relationship between baseball loads (practice, training, and competition hours) and shoulder and elbow injuries among high school pitchers are limited. Therefore, this study included 92 male high school baseball pitchers and evaluated their preseason shoulder and elbow conditions. All participants completed a self-recorded questionnaire regarding baseball load, presence of shoulder pain or elbow pain, or both, and pitching limitations due to shoulder and/or elbow pain experienced daily to determine the occurrence of injuries and record the baseball load. The optimal load cutoff value was determined using a receiver operating characteristic curve analysis. Participants were categorized into high-load and low-load groups according to the aforementioned cutoff value. The Kaplan–Meier method was used to obtain time-to-event curves, and cox proportional hazards models were used to calculate the hazard ratios for injury rates. The cutoff value of the average baseball load was 324.4 min per day. A high load (> 5.5 h/day) led to a 2.6-times greater risk of injuries and 3.3-times earlier occurrence of injuries than a low load (< 5.5 h/day). Therefore, a high load is a risk factor for shoulder and elbow injuries in high school baseball pitchers.

Shoulder magnetic resonance imaging findings in manual wheelchair users with spinal cord injury

Objective: To investigate the prevalence of rotator cuff and long head of the biceps pathologies in manual wheelchair (MWC) users with spinal cord injury (SCI). Design: Cross-sectional study. Setting: Outpatient clinic at a tertiary medical center. Participants: Forty-four adult MWC users with SCI (36 men and 8 women) with an average age (SD) of 42 (13) years. SCI levels ranged from C6 to L1; complete and incomplete SCI. Outcome Measures: Participants’ demographic and anthropometric information, presence of shoulder pain, Wheelchair User’s Pain Index (WUSPI) scores, and magnetic resonance imaging findings of shoulder pathologies including tendinopathy, tendon tears, and muscle atrophy. Results: Fifty-nine percent of the participants reported some shoulder pain. The prevalence of any tendinopathy across the rotator cuff and the long head of biceps tendon was 98%. The prevalence of tendinopathy in the supraspinatus was 86%, infraspinatus was 91%, subscapularis was 75%, and biceps was 57%. The majority of tendinopathies had mild or moderate severity. The prevalence of any tears was 68%. The prevalence of tendon tears in the supraspinatus was 48%, infraspinatus was 36%, subscapularis was 43%, and biceps was 12%. The majority of the tears were partial-thickness tears. Participants without tendon tears were significantly younger (P < 0.001) and had been wheelchair user for a significantly shorter time (P = 0.005) than those with tendon tears. Conclusion: Mild and moderate shoulder tendinopathy and partial-thickness tendon tears were highly prevalent in MWC users with SCI. Additionally, the findings of this study suggest that strategies for monitoring shoulder pathologies in this population should not be overly reliant on patient-reported pain, but perhaps more concerned with years of wheelchair use and age.

Prevelance of upper extremity lymphedema and risk factors in patients with mastectomy: Single-center, observational, cross-sectional study.

Objective:Upper extremity complaints are frequently encountered in breast cancer. It was aimed to investigate the pain, extremity pain, and limitation of motion, lymphedema prevalence, severity, risk factors and quality of life in patients with breast cancer followed by mastectomy in our center.Materials and Methods:The study included 67 patients with mastectomy. The presence of lymphedema, lymphedema duration, and grade of lymphedema were recorded. Grip strength was measured on both hands using a dynamometer; arm, shoulder and hand problems were evaluated using the disabilities of the arm, shoulder, and hand. Quality of life was assessed using the World Health Organization Quality of Life scale-short form.Results:The presence of lymphedema was 23.9%; the most common was international society of lymphology grade 1 (76.1%); the median lymphedema duration was 12 (range, 3-72) months. Radical/modified radical mastectomy (58.2%) was the most common type of surgery. Median pain score in the affected extremity according to the visual analogue scale was 2 (minimum: 0/maximum: 7); the presence of shoulder pain was 40.3%; shoulder movement limitation was 7.5%.Conclusion:It was found that lymphedema had a negative effect on quality of life by affecting shoulder, arm, and hand functions even in the early stages. The recognition of risk factors and signs of upper extremity complications in breast cancer survivors will contribute to rehabilitation success.

The cricketer's shoulder and injury: Asymmetries in range of movement and muscle length.

BackgroundShoulder injuries in cricket are often undetected and untreated.ObjectivesTo determine whether there are associations between shoulder internal and external rotation range of movement (ROM), throwing arc (TA) ROM, glenohumeral internal rotation deficit (GIRD), external rotation gain (ERG), pectoralis minor muscle length and the incidence of shoulder injury during the first 3 months of a cricket season amongst provincial and club cricketers.MethodMale, actively participating, provincial and club cricketers were included in this prospective longitudinal cohort study. The independent variables included shoulder pain, which did not limit participation in cricket training and matches; shoulder external and internal rotation (ROM, TA ROM, GIRD and ERG) and pectoralis minor muscle length. Time-loss dominant shoulder injury was recorded for 3 months.ResultsNine of the 32 participants sustained dominant shoulder injuries. Initial non-time-loss shoulder pain during baseline testing was associated with time-loss in-season shoulder injury (p = 0.007). Statistically significant side-to-side differences were found for all of the independent variables (internal rotation ROM, TA ROM and pectoralis minor muscle length distance), with the exception of external rotation ROM, amongst the uninjured players.ConclusionNon-time-loss-defined shoulder pain in actively participating cricketers seems to be a precursor to time-loss shoulder injury. Asymmetries in ROM and pectoralis minor muscle length in uninjured cricketers may have a protective role to play in the case of shoulder injury.Clinical implicationsThe presence of shoulder pain and asymmetries in ROM should be investigated during the pre-season screening procedures, and early intervention should be implemented where appropriate.

Effect of shoulder pain on energy expenditure among paraplegic individuals: Role of wearable device

Background: Human interactive wearable devices are cutting-edge technologies transforming the health-care system by allowing comfort, convenience, and continuous patient monitoring. Wheelchair use in spinal cord injury is the best form of mobility. Shoulder pain is often the consequence to increased kinetic demands placed on the upper limb. This paper is an endeavour to determine the effect of shoulder pain on energy expenditure amongst manual wheelchair users with an amalgamation of physiological health parameters and advancement in health monitoring technology. Methodology: Forty paraplegics using manual wheelchairs were divided into two groups depending on the presence of shoulder pain. Shoulder pain characteristics were noted using the Wheelchair Users Shoulder Pain Index. Mean heart rate during 6 min propulsion test was determined using the Xiaomi MI fitness band. Physiological Cost Index was established, and the energy expenditure was then compared. Results: Shoulder pain was reported maximum during pushing the wheelchair >10 min (80%) and on-ramps (65%). The energy expenditure showed a statistically significant increase in patients with shoulder pain. Conclusion: The use of Xiaomi MI fitness band is a straightforward and affordable way to obtain the mean exercise heart rate assisting in estimating the energy expenditure. Shoulder pain significantly increases the energy expenditure among manual wheelchair users, and hence should be addressed before wheelchair use for the prevention of injuries.

Low Range of Shoulders Horizontal Abduction Predisposes for Shoulder Pain in Competitive Young Swimmers.

The prevalence of shoulder pain (SP) among competitive swimmers is high, and may profoundly restrict their ability to compete. This prospective cohort study investigated the association between 3 blocks of performance factors (anthropometric characteristics, sport experience and training regimen) and the presence of SP. The aims of the present study were: (a): to determine the profile of shoulder flexibility in young swimmers, (b) to analyze whether a restricted range of movement (ROM) could be a predictor of subsequent SP in young swimmers. 24 competitive young swimmers were measured in the 2016 pre-season. Measures of passive maximal shoulder extension (SE), flexion (SF), horizontal abduction (SHAB), abduction (SAB), horizontal adduction (SHADD), external (SER) and internal (SIR) rotation ROMs were taken. SP was prospectively monitored during the subsequent season using questionnaires. The data was analyzed via a binary logistic regression and ROC curves were calculated. At the follow-up, 16 swimmers (50%) had developed unilateral SP. Only reduced SHAB ROM was associated with SP [SP group 36.6° vs. pain-free group 41.5°; p = 0.005, d = -0.96 (moderate effect sizes)]. Using the coordinates of the curves, the angle of SHAB ROM that most accurately identified individuals at risk of developing SP was determined to be 39° (sensibility 0.656 and 0.375 specificity). Swimmers with limited ROM (≤39°) have 3.6 times higher risk of developing SP than swimmers with normal ROM (>39°). This study clearly shows that low range of SHAB is a risk factor for developing SP in competitive young swimmers. In the studied data, a SHAB range of 39° was found to be the most appropriate cut-off point for prognostic screening.

A prospective randomised controlled study for evaluation of high-volume low-concentration intraperitoneal bupivacaine for post-laparoscopic cholecystectomy analgesia.

Background and Aims:Low-volume high-concentration bupivacaine irrigation of the peritoneal cavity has been reported to be ineffective for short-term analgesia after laparoscopic cholecystectomy (LC). This study was conducted to evaluate the effectiveness of intraperitoneal instillation of high-volume low-concentration bupivacaine for post-operative analgesia in LC.Methods:Sixty patients undergoing LC were included in this prospective, double-blind, randomised study. Patients were divided into two (n = 30) groups. In Group S, intraperitoneal irrigation was done with 500 ml of normal saline. In Group B, 20 ml of 0.5% (100 mg) bupivacaine was added to 480 ml of normal saline for intraperitoneal irrigation during and after surgery. Post-operative pain was assessed by numeric pain rating scale (NRS) at fixed time intervals. Duration of analgesia (DOA), total rescue analgesic requirement (intravenous tramadol), presence of shoulder pain, nausea and vomiting were recorded for the initial 24 h post-operatively.Results:Mean DOA in Group S was 0.06 ± 0.172 h (3.6 ± 10.32 min) and that in Group B was 19.35 ± 8.64 h (P = 0.000). Cumulative requirement of rescue analgesic in 24 h in Group S was 123.33 ± 43.01 mg and that in Group B was 23.33 ± 43.01 mg (P = 0.000). There was no significant difference in incidence of shoulder pain, nausea and vomiting between the groups.Conclusion:High-volume low-concentration of intraperitoneal bupivacaine significantly increases post-operative DOA and reduces opioid requirement after LC.

Clinical characteristics affecting motor recovery and ambulation in stroke patients

[Purpose] To describe the clinical characteristics affecting motor recovery and ambulation in stroke patients. [Subjects and Methods] Demographic and clinical characteristics of 53 stroke patients (31 M, 22 F), such as age, gender, etiology, hemiplegic side, Brunnstrom stage, functional ambulation scale scores, history of rehabilitation, and presence of shoulder pain and complex regional pain syndrome were evaluated. [Results] The etiology was ischemic in 79.2% of patients and hemorrhagic in 20.8%. Brunnstrom hand and upper extremity values in females were lower than in males. Complex regional pain syndrome was observed at a level of 18.9% in all patients (more common in females). Brunnstrom hand stage was lower in complex regional pain syndrome patients than in those without the syndrome. Shoulder pain was present in 44.4% of patients. Brunnstrom lower extremity values and functional ambulation scale scores were higher in rehabilitated than in non-rehabilitated cases. [Conclusion] Brunnstrom stages of hand and upper extremity were lower and complex regional pain syndrome was more common in female stroke patients. Shoulder pain and lower Brunnstrom hand stages were related to the presence of complex regional pain syndrome.

Ultrasonographic assessment of the shoulder in patients with carpal tunnel syndrome

Objectives: To detect the causes of shoulder pain with shoulder ultrasonography in patients with carpal tunnel syndrome (CTS)and compare the findings of the patients with CTS to healthy controls.Patients and Methods: Patients with CTS and healthy controls were evaluated clinically, electrophysiologically and ultrasonographically by three masked researchers.Electrophysiological assessment consisted median and ulnar nerve conduction studies (NCS). In ultrasonographic assessment, crosssectionalareas of the median nerve were measured at hamatum hook, psiform bone, radio-ulnar joint levels. Shoulder joint, axial and longitudinal biceps tendon, subscapularis tendon, supraspinatus tendon, infraspinatus tendon, rotator cuff, acromioclavicular joint were evaluated by a standardized protocol.Results: The study was completed with 30 patients with CTS and 30 healthy subjects. The presence of shoulder pain in the last week was 53.3% in the CTS group and 30% in the control group but there was no statistically significant difference between the groups (p=0.16; p>0.05). Subdeltoid bursitis was significantly more common in CTS group when compared to the control group (p=0.03) in ultrasonographic assessment, and there was no significant difference between the two groups for other parameters.Conclusion: Shoulder pain and subdeltoid bursitis were common in patients with CTS however, shoulder pain was not directly related to shoulder problems alone. Central sensitization may play a role for shoulder pain rather than shoulder problems.Keywords: Ultrasonography, Carpal tunnel syndrome, Shoulderpain, Central sensitization

Effects of breast cancer related lymphedema on hand muscle strength, hand functions and sensory loss of hand

Purpose: In this study, we aimed to investigate clinical features of patients with breast cancer related lymphedema (BCRL) and effects of BCRL on hand muscle strength and function. Materials and Methods: Patients applying to oncologic rehabilitation polyclinic with right hand dominancy were included in the study. Clinical and demographic data of all patients were noted, physical examinations were performed. The presence of shoulder pain was questioned. To determine the hand grip strength Jamar hand dynamometer and to evaluate the tip pinch strength pinchmeter were used. Sensory loss was assessed with Semmes-Weinstein monofilament test, hand volume measurement was made with hand volumeter. Results: Thirty two female patients with mean age 54.5 ± 11.4 (mean ± SD) were included in the study. Axillary dissection was performed in all patients. 62.5% of patients received radiotherapy in post-operative period, 96.9% received chemotherapy. 78.1% of patients reported that they had shoulder pain on the affected side. In the right side affected group and the left side affected group, there were no significant differences in grip strengths, hand functions, sensory loss and volumes between right and left hands. The tip pinch strength of the right hand was higher than the left side in the left side affected group. Conclusion: In patients with BCRL, having axillary dissection, receiving chemotherapy and radiotherapy in post-operative period, obesity and shoulder pain are common. Evaluation of patients with BCRL should be made in details, should be versatile and should include questioning shoulder pain and hand evaluation.

Spinal accessory nerve neuropathy following neck dissection

The most common complication of neck dissection is shoulder dysfunction due to manipulation of spinal accessory nerve, resulting in trapezius muscle atrophy mainly in procedures involving the posterior neck triangle. AimThis study used electromyography to evaluate the injury to the spinal accessory nerve following neck dissection. Materials and methodsProspective case series of 51 patients submitted to 60 neck dissections followed by physical therapy evaluation of shoulder dysfunction. Nerve integrity was evaluated before and after the surgery by means of surface EMG registering the electric activity of the trapezius muscle during voluntary contraction. The patients were grouped according to the type of neck dissection, presence of shoulder pain, impairment during abduction movement and hypotrophy/ atrophy of the trapezius muscle. ResultsAction potential had median values of 54.3 microV before surgery and 11.6 microV after it (p<0.001). There was a mean decrease of 70% comparing to preoperative values. The median was 12.5 microV after dissection including level IIb, and 8.9 microV after dissection including levels IIb and V (p<0.002). ConclusionSurface EMG is a sensitive and painless method for spinal accessory nerve dysfunction evaluation. The results suggest the usefulness of the trapezius muscle electromyography to confirm diagnosis and early physical therapy intervention in neuropathies of the spinal accessory nerve.