Presence Of Shoulder Pain Research Articles

Shoulder pain and jerk during recovery phase of manual wheelchair propulsion

Repetitive loading of the upper limb due to wheelchair propulsion plays a leading role in the development of shoulder pain in manual wheelchair users (mWCUs). There has been minimal inquiry on understanding wheelchair propulsion kinematics from a human movement ergonomics perspective. This investigation employs an ergonomic metric, jerk, to characterize the recovery phase kinematics of two recommended manual wheelchair propulsion patterns: semi-circular and the double loop. Further it examines if jerk is related to shoulder pain in mWCUs. Data from 22 experienced adult mWCUs was analyzed for this study (semi-circular: n=12 (pain/without-pain:6/6); double-loop: n=10 (pain/without-pain:4/6)). Participants propelled their own wheelchair fitted with SMARTWheels on a roller dynamometer at 1.1m/s for 3min. Kinematic and kinetic data of the upper limbs were recorded. Three dimensional absolute jerk experienced at the shoulder, elbow and wrist joint during the recovery phase of wheelchair propulsion were computed. Two-way ANOVAs were conducted with the recovery pattern type and shoulder pain as between group factors. Findings: (1) Individuals using a semi-circular pattern experienced lower jerk at their arm joints than those using a double loop pattern (P<0.05, η2=0.32)wrist;(P=0.05, η2=0.19)elbow;(P<0.05, η2=0.34)shoulder and (2) individuals with shoulder pain had lower peak jerk magnitude during the recovery phase (P≤0.05, η2=0.36)wrist;(P≤0.05, η2=0.30)elbow;(P≤0.05, η2=0.31)shoulder. Conclusions: Jerk during wheelchair propulsion was able to distinguish between pattern types (semi-circular and double loop) and the presence of shoulder pain. Jerk provides novel insights into wheelchair propulsion kinematics and in the future it may be beneficial to incorporate jerk based metric into rehabilitation practice.

Prevalence of the Rotator Cuff Tear Increases With Weakness in Hemiplegic Shoulder

ObjectiveTo investigate the relationship between the rotator cuff tear (RCT) and the muscle strength in hemiplegic side, and the effects of paralysis on the affected shoulders in hemiplegic patients.MethodsA cross-sectional observational study performed in a university hospital was presented. The study enrolled 55 participants with hemiplegia of diverse degree of motor paresis, excluding those with bilateral lesions, history of major trauma or other co-existing musculoskeletal disorders of the shoulder. The main outcome measurements were muscle strength of the affected upper extremity (based on Medical Research Council scale), RCTs of the bilateral shoulders (by ultrasonography), and presence of shoulder pain, subluxation of the glenohumeral joint, passive range of motions, and subacromial spurs.ResultsComparing each side of the shoulders, the prevalence of shoulder pain and supraspinatus muscle tear was higher (p<0.0001, p=0.007), and the range of motion was restricted (p<0.0001, p<0.0001, p<0.0001, p<0.0001) in the affected side. There was a significant trend toward higher prevalence of RCT and shoulder subluxation in the weaker shoulder (p=0.019, p<0.0001). In a multivariate analysis, Manual Muscle Test grade of less than three was an independent risk factor for RCT (p=0.025).ConclusionRCT in hemiplegia had a linear trend with muscle weakness in the affected side and the degree of weakness was an independent risk factor for the occurrence of RCT. In addition, shoulder pain, limitation of range of motions, and RCT were more frequent on the hemiplegic side of the shoulders. It is the first study to reveal a linear trend between RCT and upper extremity weakness and will provide physicians an insight to the management of RCTs in hemiplegic patients.

Asymptomatic rotator cuff tears: Patient demographics and baseline shoulder function

The purpose of this study is to characterize the demographic features and physical function of subjects with asymptomatic rotator cuff tears and to compare their shoulder function with control subjects with an intact rotator cuff. This study enrolled 196 subjects with an asymptomatic rotator cuff tear and 54 subjects with an intact rotator cuff presenting with a painful rotator cuff tear in the contralateral shoulder. Various demographic features, shoulder function (American Shoulder and Elbow Surgeons score and Simple Shoulder Test score), range of motion, and strength were compared. The demographic features of the study and control groups were similar. Hand dominance was associated with the presence of shoulder pain (P < .05). Subjects with an intact rotator cuff had greater but clinically insignificant American Shoulder and Elbow Surgeons (P < .05) and Simple Shoulder Test (P < .05) scores than those with an asymptomatic tear. No differences in functional scores, range of motion, or strength were seen between partial-thickness tears (n = 61) and full-thickness tears (n = 135). Of the full-thickness tears, 36 (27%) were classified as small, 85 (63%) as medium, and 14 (10%) as large. No differences were seen in functional scores among full-thickness tears of various sizes. When asymptomatic, a rotator cuff tear is associated with a clinically insignificant loss of shoulder function compared with an intact rotator cuff. Therefore a clinically detectable decline in shoulder function may indicate an "at-risk" asymptomatic tear. The presence of pain is important in cuff-deficient shoulders for creating a measurable loss of shoulder function. Hand dominance appears to be an important risk factor for pain.

Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks

Forward head and rounded shoulder posture (FHRSP) is theorized to contribute to alterations in scapular kinematics and muscle activity leading to the development of shoulder pain. However, reported differences in scapular kinematics and muscle activity in those with forward head and rounded shoulder posture are confounded by the presence of shoulder pain. Therefore, the purpose of this study was to compare scapular kinematics and muscle activity in individuals free from shoulder pain, with and without FHRSP. Eighty volunteers were classified as having FHRSP or ideal posture. Scapular kinematics were collected concurrently with muscle activity from the upper and lower trapezius as well as the serratus anterior muscles during a loaded flexion and overhead reaching task using an electromagnetic tracking system and surface electromyography. Separate mixed model analyses of variance were used to compare three-dimensional scapular kinematics and muscle activity during the ascending phases of both tasks. Individuals with FHRSP displayed significantly greater scapular internal rotation with less serratus anterior activity, during both tasks as well as greater scapular upward rotation, anterior tilting during the flexion task when compared with the ideal posture group. These results provide support for the clinical hypothesis that FHRSP impacts shoulder mechanics independent of shoulder pain.

Passive shoulder range of motion impairment in spinal cord injury during and one year after rehabilitation

To investigate the prevalence and course of pass notive shoulder range of motion in people with a spinal cord injury and the relationships between shoulder range of motion limitations and personal and lesion characteristics. Multicentre longitudinal study. A total of 199 subjects with spinal cord injury admitted to specialized rehabilitation centres. Assessments of shoulder range of motion at the start of active rehabilitation, 3 months later, at discharge and one year after discharge. Up to 70% (95% confidence interval (CI): 57-81) of the subjects with tetraplegia and 29% (95% CI: 20-38) of those with paraplegia experienced a limited range of motion of the shoulder during, or in the first year after, inpatient rehabilitation. Shoulder flexion was affected most. Up to 26% (95% CI: 20-37) of subjects had a shoulder range of motion limitation on both sides. Increased age, tetraplegia, spasticity of elbow extensors and longer duration between injury and start of active rehabilitation increased the risk. Presence of shoulder pain is associated with limited shoulder range of motion. Limited shoulder range of motion is common following spinal cord injury. Tetraplegia, increased age, spasticity of elbow extensors, longer duration between injury and start of active rehabilitation and shoulder pain are associated with an increased risk for shoulder range of motion problems and require extra attention.

Spinal Accessory Nerve Neuropathies Followng Neck Dissection

Objective To evaluate through electromyography (EMG) the injury to the 11th cranial nerve following neck dissection. Methods Prospective study with 60 patients submitted to neck dissection as part of treatment of head and neck tumors. All the cases underwent physiotherapic evaluation of shoulder dysfunction. Nerve integrity was evaluated pre- and postoperatively through surface EMG registering the electric activity of descendent fibers of trapezius muscle during maximal isometric voluntary contraction. The patients were grouped according the type of neck dissection, presence of shoulder pain, impairment during abduction movement, and hypotrophy or atrophy of trapezius muscle. Results The action potential had mean and standard deviation of 61,7±31,6mcV in preoperative evaluation and 15,6±12,4mcV in postoperative evaluation (p&lt;0.001). According to the neck dissection extension, there were mean values of 18,8±14,2mcV after dissection includiog level IIb and 18,8±14,2 mcV after dissection including levels IIb and V (p&lt;0.002). Conclusions Surface EMG is a sensitive and painless for 11th cranial nerve disfunction evaluation. In all cases, the superior fibers of trapezius muscle were affected with presence of pain and impairment abduction movement of the arm. The results suggest the benefit of trapezius muscle EMG to confirm the diagnosis and early physiotherapic intervention in neuropathies of the 11th cranial nerve.

Administração intraperitoneal da mistura com excesso enantiomérico de 50% de bupivacaína (S75-R25) para analgesia pós-operatória em colecistectomias videolaparoscópicas

The analgesic effect of intraperitoneal administration of local anesthetics after laparoscopic cholecystectomy is a controversial issue, and the results described vary from considerable pain relief to little reduction in pain. The objective of this study was to evaluate the efficacy of the intraperitoneal administration of 50% enantiomeric excess bupivacaine (S75-R25) for the postoperative pain relief of laparoscopic cholecystectomy. A randomized, double blind, placebo controlled study was conducted with 40 patients undergoing laparoscopic cholecystectomy, who were divided in two groups: GI (n = 20) received 80 mL of intraperitoneal 0,125% S75-R25 bupivacaine at the end of the procedure; and GII (n = 20) received 80 mL of intraperitoneal normal saline. Both groups received 40 mg of tenoxicam and 30 mg.kg-1 of intravenous dypirone shortly before the end of the surgery. Tramadol was used for postoperative analgesia (PO). Pain scores were evaluated at rest, sitting up, and during the Valsalva maneuver, according to a numeric scale upon waking up and 2, 4, 8, 12, and 24 hours postoperatively; the presence of shoulder pain was assessed, as well as the length of time until the first request of analgesic and its cumulative consumption. There was a statistically significant difference in resting pain scores at 12 hours PO (GI < GII). The length of time until the first request of tramadol was greater in GI and this group presented smaller consumption of this drug, but these differences were not statistically significant. The intraperitoneal instillation of 80 mL of 0.125% S75-R25 bupivacaine provided for lower resting pain scores, which was statistically significant only at the 12th postoperative hour.

Shoulder subluxation after stroke: relationships with pain and motor recovery

Glenohumeral subluxation (GHS) is a frequent complication in patients with post-stroke hemiplegia, but its role in functional recovery is still unclear. The aim of the present investigation was to understand the relationship of GHS with shoulder pain and arm motor recovery. A case-control study design was used. A sample of 107 hemiplegic adults with recent stroke (less than 30 days from onset) was differentiated into two groups according to the presence of GHS. Motor recovery was assessed using the upper extremity part of the Fugl-Meyer Assessment Scale and the presence of shoulder pain was recorded at admission (T1), at discharge (T2) and at follow-up, 30-40 days after discharge (T3). GHS was present in 52 patients (48.6%) and correlated significantly to shoulder pain at TI, at T2 and at T3 (p < 0.001). Moreover, GHS at admission accounted for nearly 50% of shoulder pain at T3 (adjusted R2 = 0.458; p < 0.001). The presence of GHS was independently associated with the upper extremity score of the Fugl-Meyer Assessment Scale at follow-up (adjusted R2 = 0.766; p < 0.001). GHS is a factor associated with shoulder pain development and with arm motor recovery and should be treated in the acute stage of hemiplegia.

Manipulation following regional interscalene anesthetic block for shoulder adhesive capsulitis: a case series

Adhesive capulitis (AC) of the glenhumeral joint, commonly known as ‘‘frozen shoulder’’, is a prevalent condition that is frequently treated by physical therapists (Dockrell and Wiseman, 1995; Holmes et al., 1997; van der Heijden et al., 1997; Winters et al., 1997; Connolly, 1998; Pearsall and Speer, 1998; Schwitalle et al., 1998; van der Windt et al., 1998; Siegel et al., 1999; Sandor, 2000; Bentley and Tasto, 2001; Green et al., 2001; Vermeulen et al., 2000). AC is more prevalent in women and in middle-aged individuals (Nevaiser, 1983,1987; Siegel et al., 1999), in the diabetic patient population, with a rate of 2–5% in the non-diabetic population and 10–20% patients with non-insulin dependant diabetes mellitus (Siegel et al., 1999; Carette, 2000; Bentley and Tasto, 2001). Patients with glenohumeral AC typically suffer from significant pain and progressively diminishing shoulder function (Nevaiser, 1983,1987; Roubal et al., 1996; Placzek et al., 1998; Sandor, 2000). In a recent review on interventions for shoulder pain by the Cochrane Collaboration, Green et al. (2001), define AC as the presence of shoulder pain with restriction of passive and active glenohumeral motion. However, in their review of the literature, these same researchers found no standardized definitions for AC and reported conflicting criteria defining AC in the clinical trials reviewed. The recommended course of treatment for patients with adhesive capsulitis is highly variable (Thomas et al., 1981; Nevaiser, 1983,1987; Parker et al., 1989; Grubbs, 1993; Dockrell and Wiseman, 1995; Holmes et al., 1997; van der Heijden et al., 1997; Winters et al., 1997;

Early and Late Occurrences of Destructive Spondyloarthropathy in Haemodialysed Patients

In a series of 100 patients dialysed for 3 months to 17 years destructive spondyloarthropathy was diagnosed in 11 cases. Lower cervical spine was involved in ten and dorsal spine in one. When compared to patients without arthropathy, spinal involvement was associated with longer duration of dialysis and greater prevalence of parathyroidectomy. The patients with destructive spondyloarthropathy were divided into two groups: Group 1, four patients, in whom arthropathy occurred within the first 41 months of dialysis, and Group 2, seven patients, in whom arthropathy occurred after 106 months of dialysis. Group 1 was associated with greater age, chondrocalcinosis (2 of 4), absence of overt osteoarticular bone defects, and absence of carpal-tunnel syndrome. Parathyroidectomy (PTx) was performed in one patient. Amyloidosis was not found in one patient who came to autopsy. Group 2 was associated with presence of shoulder pain (6 of 7), juxtaarticular bone cysts (6 of 7) and CTS (6 of 7), and absence of radiological chondrocalcinosis. PTx was performed in six of seven patients and amyloidosis was found in three. In conclusion, destructive spondyloarthropathy may be seen early in the course of dialysis, apart from general amyloid involvement of accelereted hyperparathyroidism. A specific finding of this study was the discovery of radiological chondrocalcinosis in association with early arthropathy, which is a well-recognised feature in non-uraemic subjects.