Risk Factors For Shoulder Pain Research Articles

Risk factors for shoulder pain and stiffness in adults aged 44 and older: an 11-year longitudinal population-based study

Objective We conducted a longitudinal observational study over 11 years to identify the risk factors for developing shoulder pain, stiffness, or both. Method The study population (n = 1645) was identified from Health 2000 Survey, a nationally representative sample of Finns aged ≥ 44 years, without shoulder pain and stiffness at the start of the study based on a questionnaire. The independent variables included age, sex, body mass index (BMI), education level, diabetes, physical work exposures, and Beck’s depression score. We used multinomial logistic regression models to estimate relative risk ratios and 95% confidence intervals for three outcomes: shoulder pain, shoulder stiffness, and both combined. Results We found that excess body mass and depressive symptoms were shared statistically significant risk factors for all three outcomes. However, we also observed distinct risk factor profiles: older age was associated with lower risk of shoulder pain but higher risk for shoulder stiffness with or without pain, while females had a lower risk of shoulder stiffness with or without pain. Participants with diabetes had higher risk of shoulder stiffness only. Physical workload factors predicted an increased risk of the combination of shoulder pain and stiffness. Conclusions Our study identified increased BMI and depressive symptoms as consistent risk factors for shoulder pain, stiffness, or both. Older age increased the risk of shoulder stiffness but lowered the risk of pain alone, while females had a lower risk of stiffness. Diabetes was specifically linked to shoulder stiffness, and physical workload increased the risk of combined pain and stiffness.

Reliability and validity of portable dynamometers in testing shoulder and shoulder girdle strength: A systematic review

Introduction
 The prevalence of shoulder pain is high in overhead athletes and in wheelchair users with a spinal cord injury (SCI). Especially in the latter, shoulder pain can have detrimental consequences for an individual's mobility, participation, and quality of life. Shoulder problems have been associated with high and/or repetitive loads induced by for example overhead activities, as well as manual wheelchair activities (Leong et al., 2019; Morrow et al., 2011). Modifiable risk factors for shoulder pain are related to the capacity of the shoulder musculature and include the relative strength or lack of force in certain shoulder muscles (Mulroy et al., 2015). Although isokinetic dynamometers are considered the gold standard in assessing muscle strength, they are typically not available in a therapy or training setting. Strength measurements with portable dynamometers offer a more feasible and financially affordable alternative. To assess changes in muscle strength over time, reliable and valid shoulder and shoulder girdle muscle strength tests are required. Therefore, the aim of this study was to identify validated and reliable portable dynamometer protocols to assess changes in shoulder strength in the general population and wheelchair users with SCI over time.
 Methods
 A literature search was performed with defined terms from the three main concepts “shoulder joint”, “strength testing” and “reproducibility of results”. The electronic search strategy was developed with the help of a librarian and adapted for the following databases: PubMed (Medline), Cochrane Library (Central register of controlled trials), Web of Science (Core Collection), CINAHL. The population of interest was the general population (≥ 18 years) with and without shoulder pain with a special focus on wheelchair users with SCI. Title and abstract screening, full-text screening, quality assessment and data extraction was performed using Covidence.org. For quality assessment selected boxes from the “COSMIN Risk of Bias tool” were used. Data extraction was performed by two independent authors. The main outcome measures extracted where test-retest reliability (intraclass correlation coefficient, standard error of measurement and minimum detectable difference) and concurrent validity (intraclass correlation coefficient).
 Results
 Trough systematic search 8,020 studies were identified for screening. Initially 2,267 were excluded as duplicates and 5,647 were excluded for not meeting the inclusion criteria. 106 full-texts have been screened. As data extraction is ongoing the results of reliability and validity of portable dynamometer in testing shoulder strength will be presented at the conference.
 Discussion/Conclusion
 As data extraction is ongoing the discussion and conclusion will be presented at the conference.
 References
 Leong, H. T., Fu, S. C., He, X., Oh, J. H., Yamamoto, N., & Yung, S. H. P. (2019). Risk factors for rotator cuff tendinopathy: A systematic review and meta-analysis. Journal of Rehabilitation Medicine, 51(9), 627-637. https://doi.org/10.2340/16501977-2598
 Morrow, M. M. B., Kaufman, K. R., An, K.-N. (2011). Scapula kinematics and associated impingement risk in manual wheelchair users during propulsion and a weight relief lift. Clinical Biomechanics, 26(4), 352-357. https://doi.org/10.1016/j.clinbiomech.2010.12.001
 Mulroy, S. J., Hatchett, P., Eberly, V. J., Lighthall Haubert, L., Conners, S., & Requejo, P. S. (2015). Shoulder strength and physical activity predictors of shoulder pain in people with paraplegia from spinal injury: Prospective cohort study. Physical Therapy, 95(7), 1027-1038. https://doi.org/10.2522/ptj.20130606

Sink or Swim? Clinical Objective Tests and Measures Associated with Shoulder Pain in Swimmers of Varied Age Levels of Competition: A Systematic Review.

Swimming is enjoyed by athletes of all ages, and shoulder pain is a common problem. Clinicians identify impairments which impact shoulder pain and these impairments may differ depending on the swimmer's age competition level. The purpose of this study was to investigate objective measures utilized to assess swimmers and assess the relationship of test values to shoulder pain in distinct age groups/competition levels. A secondary aim was to report normative/expected values for these tests. Systematic review. PRISMA methodology was employed to assess studies evaluating clinical tests and measures associated with shoulder pain for swimmers in varied age competition levels. The Methodological Index for Non-Randomized Studies instrument was used to evaluate the quality of the included studies, and a qualitative synthesis of findings was conducted to determine the strength of the evidence in four age competition levels for nine objective measures. Distinct cut points for proposed measures were identified. Twenty-seven studies were included in the analysis and the majority were of moderate quality in adolescent/adult swimmers. Youth swimmers had limited evidence for the development of shoulder pain associated with scapular position/dyskinesia, weakness of periscapular muscles, low endurance of core muscles, and moderate evidence for shoulder pain associated with laxity and altered range of motion (ROM). Adolescent/adult swimmers demonstrated limited evidence for a positive association between developing shoulder pain if there is a low eccentric ER:concentric IR ratio, and moderate evidence for pectoralis minor tightness and glenohumeral laxity. There were limited studies regarding masters swimmers to derive conclusive evidence. Cut points were identified from the included studies but these have not been validated in other studies. Swimmers of various ages may have different objective clinical tests and measures associated with the risk for developing shoulder pain. More studies are needed to fully understand risk factors for shoulder pain in the masters swim competition level, and to validate recommended cut points for various tests and measures. 3, Systematic review of mostly Level 3 studies.

Shoulder Pain in Persons With Tetraplegia and the Association With Force Application During Manual Wheelchair Propulsion

ObjectiveTo investigate the association between propulsion biomechanics, including force application and spatio-temporal characteristics, and shoulder pain in persons with tetraplegia. DesignCross-sectional, observational study. SettingNon-university research institution. Participants16 community dwelling, wheelchair dependent persons with a chronic tetraplegia between C4 and C7, with and without shoulder pain (age, 49.1±11.7 years; 94% men, 23.4±9.5 years past injury). InterventionsNot applicable. Main Outcome MeasuresForce application and spatio-temporal characteristics of wheelchair propulsion on a treadmill (0.56 m/s, 10W and 0.83 m/s, 15W). Participants were stratified in groups with low, moderate, and high pain based on their Wheelchair User Shoulder Pain Index (WUSPI) score on the day of measurement. ResultsThe mixed-effect multilevel analysis showed that wheelchair users with high levels of shoulder pain applied propulsion force more effectively (and with a lower medial component) and over a longer push angle, thus shortening the recovery time as compared with persons with low or moderate levels of shoulder pain. ConclusionsIn contrast with previous results from persons with a paraplegia, persons with tetraplegia and high levels of shoulder pain propel their wheelchair more optimal with regard to risk factors for shoulder pain. Our results therefore affirm that there is a different interaction of shoulder pain and propulsion biomechanics in persons with a tetraplegia which should be considered when further analyzing risk factors for shoulder pain in wheelchair users or applying literature results to different patient populations.

Influence of extent of surgical resection on post-hepatectomy shoulder pain: an observational study

Shoulder pain frequently follows hepatectomy. However, the influence of surgical procedures on shoulder pain is unclear. In this observational study, patients who underwent hepatectomy were enrolled in Shanghai Cancer Center. Shoulder pain and surgical pain were assessed using the numeric rating scale 2 days after surgery. The incidence of shoulder pain was the outcome of the cohort study. Nested case–control analyses were further applied. Three hundred and twelve patients were finally enrolled in this study. Nested case–control analysis showed that there were no significant differences in the number of surgical segments between the two groups (P = 0.09). In addition, minor hepatectomy did not reduce the incidence of shoulder pain compared with major hepatectomy (P = 0.37). The drainage volume within 2 days after surgery was significantly more in those patients with shoulder pain (P = 0.017). In open surgery, surgical sites involving the right anterior lobe (OR (95% CI) 2.021 (1.075, 3.802), P = 0.029) and right posterior lobe (OR (95% CI) 2.322 (1.193, 4.522), P = 0.013) were both independent risk factors for shoulder pain. Left shoulder pain also occurred in patients who did not receive left lateral hepatectomy. The preventive phrenic nerve block was not suitable for post-hepatectomy shoulder pain. Stronger preventative intervention should be used in those high-risk patients.

Shoulder pain in persons with tetraplegia and the association with force application during manual wheelchair propulsion

Introduction
 Shoulder pain is highly prevalent in persons with spinal cord injury (Liampas et al., 2021) and restricts daily mobility and thus participation and quality of life. Shoulder loading activities, such as manual wheelchair propulsion or transfers, are seen as risk factors for shoulder pain. To minimize the risk for shoulder pain, clinical guidelines instruct persons with spinal cord injury to “use long, smooth strokes that limit high impacts on the pushrim”. Findings supporting this recommendation have been found for persons with paraplegia (Beirens et al., 2021). However, dependent on their lesion level, persons with tetraplegia do not have, full triceps function and are not able to grasp the hand rim properly, which will alter force application and may further impact shoulder pain. The aim of this study was to investigate the association between wheelchair propulsion biomechanics, including force application and spatio-temporal characteristics, and shoulder pain in persons with tetraplegia.
 Methods
 Sixteen community-dwelling, wheelchair dependent participants with tetraplegia (C7-C5, age 49.1 ±2.9 years, 23.4 ±2.4 years since injury, 94% male) were measured during wheelchair propulsion on a treadmill at two speed / power output conditions: 0.56 ms-1/10W and 0.83 ms-1/15W. A Smartwheel was fitted to the personal wheelchair to measure force application. The applied forces, their effectiveness (fraction of effective force) and smoothness (rate of rise of force, jerk), as well as push frequency, push angle and timing of the push cycles were analyzed. Based on the Wheelchair User Shoulder Pain Index (0-150), participants were stratified in groups with low (≤ 7), moderate (8-35) and high (≥ 36) shoulder pain. A mixed-effect multilevel analysis was used to identify the association between the dependent variables (propulsion biomechanics) and group of shoulder pain when controlling for sex, age, time since injury, lesion level, body weight and height.
 Results and Discussion
 The analysis showed that persons with high shoulder pain applied the force over a longer push angle (85.6°) and had a shorter recovery time (0.4s) and applied the force more effective (FEF = 40.7%) than persons with low pain (push angle = 81.2°, recovery time = 0.5s, FEF = 35.2%). In addition, persons with high shoulder pain applied less medial directed force (6.4 N) compared to persons with moderate pain (14.9 N). The results of this cross-sectional study on wheelchair propulsion in persons with tetraplegia are in contradiction to previously reported results in person with paraplegia (Beirens et al., 2021). Interestingly, tetraplegic persons with high shoulder pain are following clinical recommendation on how to propel the wheelchair optimally. These results support the importance of differentiating between lesions levels when further investigating force application as a risk factor for shoulder pain. In addition, the results ask for a close examination and possible adaptation of the clinical guidelines for persons with tetraplegia.
 References
 Beirens, B. J. H., Bossuyt, F. M., Arnet, U., van der Woude, L. H. V., & de Vries, W. H. K. (2021). Shoulder pain is associated with rate of rise and jerk of the applied forces during wheelchair propulsion in individuals with paraplegic spinal cord injury. Archives of Physical Medicine and Rehabilitation, 102(5), 856-864. https://doi.org/10.1016/j.apmr.2020.10.114
 Liampas, A., Neophytou, P., Sokratous, M., Varrassi, G., Ioannou, C., Hadjigeorgiou, G. M., & Zis, P. (2021). Musculoskeletal pain due to wheelchair use: A systematic review and meta-analysis. Pain and Therapy, 10, 973-984. https://doi.org/10.1007/s40122-021-00294-5

Correlation of Glenohumeral Internal Rotation Deficit With Shoulder Pain in Elite Table Tennis Players.

The aims of the study were (1) to investigate glenohumeral internal rotation deficit (a difference in internal rotation of 15.6 degrees or more between dominant and nondominant shoulders) and its correlation with self-reported shoulder pain in table tennis players and (2) to find the optimal cutoff point for the difference in the internal rotation range of motion between dominant and nondominant shoulders of self-reported shoulder pain. The internal rotation range of motion of both shoulders of 46 table tennis players was measured in the supine and side-lying positions, and the external rotation range of motion was measured in the supine position. Significant differences existed in internal rotation range of motion between the two sides in the supine ( z = 6.53, P < 0.001) and side-lying positions ( z = 5.67, P < 0.001). Self-reported shoulder pain was associated with glenohumeral internal rotation deficit (odds ratio = 6.86, 95% confidence interval = 1.752-26.832, P = 0.006). The cutoff points for the difference in internal rotation range of motion between the sides of self-reported shoulder pain were 17.9 degrees in the supine position and 11.1 degrees in the side-lying position. Table tennis players exhibited glenohumeral internal rotation deficit. There was a correlation between glenohumeral internal rotation deficit and self-reported shoulder pain in the past year; therefore, glenohumeral internal rotation deficit may be a risk factor for shoulder pain in table tennis players.

Incidence and risk factors for acute shoulder pain after hepatectomy: a nested case-control study

BackgroundShoulder pain is commonly reported after hepatic surgery; however, the factors affecting post-hepatectomy shoulder pain remain unclear. This study aimed to determine the incidence and risk factors of shoulder pain after hepatectomy.MethodsThis prospective cohort study recruited 218 patients who underwent hepatic resection at our hospital from June to September 2022. Data were obtained from electronic medical records and follow-up assessments on the second postoperative day. All patients denied chronic pain before surgery. In this cohort study, patients were grouped according to the appearance of shoulder pain. Demographic information and perioperative data were compared between the two groups. The relationship between shoulder pain and independent variables was assessed using univariate binary logistic regression analysis. The potential risk factors were analyzed using multivariable binary logistic regression.ResultsOf the 218 patients enrolled in this cohort study, 91 (41.7%) reported shoulder pain. Patients in the case group were significantly younger than those in the control group (P = 0.001). Epidural anesthesia was used more frequently in the case group (P = 0.012). Patients over 60 years of age showed a lower incidence of shoulder pain than younger patients (P = 0.028). According to multivariable binary logistic regression analysis, advanced age and epidural anesthesia were associated with risk of shoulder pain (advanced age: odds ratio [OR] [95% confidence interval (CI)]: 0.96 [0.94, 0.99], P = 0.002; epidural anesthesia: OR [95% CI]: 2.08 [1.18, 3.69], P = 0.012).ConclusionsThe incidence of acute shoulder pain after hepatectomy is 41.7%. The application of epidural anesthesia is an independent risk factor for shoulder pain after hepatectomy, whereas advanced age is a protective factor.

Shoulder Internal Rotator Strength as Risk Factor for Shoulder Pain in Volleyball Players.

The aim of this study was to identify the intrinsic factors that could increase risk of shoulder pain in adolescent volleyball players. Twenty-eight young male volleyball players (between 14 and 18 years old) participated in this study. Athletes were submitted to: isokinetic muscle strength assessment of shoulder rotator muscles, ball service speed assessment, anterior and posterior drawer test, apprehension test, groove sign and scapular dyskinesia test. Athletes were followed for 16 weeks to monitor the presence of shoulder pain. All athletes were submitted to the same training protocol. During the 16 weeks, 28.5% of the athletes (n=8) experienced shoulder pain in the dominant limb higher than 3 according to Numerical Rating Scale criteria; 71.5% of the athletes (n=20) did not experience pain, or pain equal or lower than 3. The main result of our study was that the odds of feeling pain higher than 3 was significantly higher among players who presented higher values for internal rotation peak torque (OR=1.113, CI 95%=1.006 to 1.232 and p=0.038). The odds of feeling pain increased by 11% for every N·m of the internal rotator muscles. Pre-season isokinetic rotator strength assessments can help identify adolescent volleyball players at increased risk of a shoulder injury.

"Risk Factors for Shoulder Pain in the Practice of Wheelchair Basketball in Burkina Faso"

"Risk Factors for Shoulder Pain in the Practice of Wheelchair Basketball in Burkina Faso"

The Effect of Exercise Therapy Interventions on Shoulder Pain and Musculoskeletal Risk Factors for Shoulder Pain in Competitive Swimmers: A Scoping Review.

Shoulder pain is the main cause of missed or modified training in competitive swimmers. Exercise therapy can improve the outcomes, yet uncertainty exists regarding the characteristics of these interventions. The primary aim was to describe the evidence base relating to the effectiveness of exercise therapy interventions on shoulder pain and shoulder musculoskeletal risk factors for shoulder pain in swimmers. The secondary aim was to identify gaps in the literature and provide recommendations for future research and practice. A scoping review methodology was applied through the search of MEDLINE, PubMed, Scopus, Web of Science, and CINAHL databases. The authors included any research studies (except clinical commentaries and conference papers) that assess the effect of exercise therapy on shoulder pain and musculoskeletal risk factors for shoulder pain in swimmers. The literature was critically appraised using the Modified Down and Black checklist. From 452 papers identified, 14 studies were included in this review. An exercise program of 6 to 8 weeks, including strengthening exercises (shoulder external rotator and scapula retractor muscles) and stretches (pectoral muscles), can decrease the incidence of shoulder pain in swimmers. Furthermore, a combination of exercises and stretches with manual therapy techniques can help to decrease shoulder pain in injured swimmers. Regarding risk factors, a strengthening program of more than 12weeks increased shoulder external rotation peak force, endurance, and external rotation/internal rotation ratio; however, this was not associated to decreases in pain. Finally, open kinetic chain exercises and a dry-land program are superior to close kinetic exercises and water training for improving shoulder external rotation strength and endurance. Exercise therapy has positive effects on reducing the incidence of shoulder pain, the management of shoulder pain, and improving shoulder musculoskeletal risk factors in competitive swimmers. However, due to methodological limitations of the studies, caution must be used when applying these results in practice. Future research should focus on high-quality randomized controlled trials for prevention and management of shoulder pain in swimmers.

Hypomobility in Males and Hypermobility in Females are Risk Factors for Shoulder Pain Among Young Swimmers.

The range of shoulder rotation is associated with shoulder pain in young male and female swimmers. However, the association between shoulder pain and shoulder complex mobility of the scapulothoracic and acromioclavicular joints has not yet been examined. Moreover, shoulder pain occurs more frequently in females than in males, but only a few studies have examined the relationship between shoulder pain and sex as a risk factor. This study aims to determine the association between shoulder complex mobility and shoulder pain in young male and female swimmers. Prospective cohort design. The participants were competitive swimmers (n = 76; 37 males and 39 females) with a mean age of 14 years in Japan. The shoulder rotation width, which was the index of shoulder complex mobility, shoulder internal and external rotation range, and middle finger distance of the back-scratch test were measured. An examiner regularly visited the swimming clubs to evaluate the development of shoulder pain and swimming distance. Logistic regression analysis was used to determine the physical characteristics related to the overall development of shoulder pain in both female and male swimmers. The cutoff value was calculated using receiver operating characteristic curves. Sixteen participants, composed of 8 males and 8 females, developed shoulder pain. The overall swimming distance of the male (odds ratio [OR]: 1.0007, P = .01) and female (OR: 1.0018, P = .02) swimmers and the shoulder rotation width of the male (OR: 1.0952, P = .04) and female (OR: 0.888, P = .03) swimmers were identified as risk factors for shoulder pain. The cutoff value for swimming distance was 6000m. Shoulder rotation width was more than 88cm in males and <54cm in females. Hypomobility and hypermobility of the shoulder complex were identified as risk factors for shoulder pain in male and female swimmers, respectively.

Prevalence of shoulder pain and disability in young Saudi bodybuilders, Riyadh, Saudi Arabia

Background: The shoulder complex has been alluded to as one of the most common regions of sports injury. Bodybuilding is getting more popular among Saudi youth in recent years. A vast number of bodybuilders suffer from pain during bodybuilding training. The aim of the study is to assess the prevalence and risk factors of shoulder pain and disability in young Saudi bodybuilders, Riyadh, Saudi Arabia.Materials and Methods: this is a cross-sectional study that included subjects from multiple large gyms that offer bodybuilding equipment throughout Riyadh city. All subjects were sampled conveniently. Collected data included demographical data and a disability and pain tools (Disability of the Arm, Shoulder and Hand [DASH], and Penn Shoulder Score [PSS] scales).Results: A total of 363 subjects participated in this study. the point, last month, last 6 months, last year, and lifetime prevalence of shoulder pain among bodybuilders were 23.4%, 35.5%, 51.4%, 57.6%, and 67.2%, respectively. 111 (30.6%) received treatment because of a shoulder injury and they either received medication, physiotherapy, or surgery with 37%, 57%, and 6%, respectively. Positive DASH sports disability has a significant higher prevalence of shoulder pain of all types (P < 0.001). Using the categorization of the pain score, bodybuilders with a positive PSS have significantly higher prevalence of shoulder pain of all types (P < 0.001).Conclusions: Shoulder pain and disability are very prevalent in bodybuilding reaching up to 67.2% in lifetime prevalence of bodybuilders.

Risk factors for shoulder pain after stroke: A clinical study.

ABSTRACTObjectives:To investigate the risk factors for shoulder pain after stroke, and prevent its occurrence effectively.Methods:The patients with stroke treated in our hospital between September 2016 and October 2020 were reviewed retrospectively. The medical records of the included patients including age, gender, lesion side, stroke duration, hospital stay, diabetes, hypertension, heart disease, limitation of shoulder joint activity, alcohol abuse, smoking, type of stroke, Ashworth scale, Brunnstrom stage, sensory disorders, and motor arm score of National Institutes of Health Stroke Scale (NIHSS) were collected and analyzed to determine the risk factors for shoulder pain after stroke.Results:A total of 1390 patients were included based on the inclusion and exclusion criteria, consisting of 162 patients with shoulder pain after stroke and the prevalence was 11.6%. The included patients were divided into shoulder pain group and non-shoulder pain group. There were significant differences in age, stroke duration, hospital stay, diabetes, limitation of shoulder joint activity, Ashworth scale, Brunnstrom stage, sensory disorders, and motor arm score of NIHSS between the two groups (P < 0.05). Based on the multivariate regression analysis, the independent risk factors for shoulder pain after stroke included diabetes, limited shoulder joint activity, Brunnstrom grade I-III period, Ashworth 3-4 grade, motor arm score of NIHSS 3-4 points, and sensory disturbance.Conclusion:Great emphasis should be placed on the stroke patients with diabetes, limited shoulder joint activity, Brunnstrom grade I-III period, Ashworth 3-4 grade, motor arm score of NIHSS 3-4 points, or sensory disturbance, as these patients have higher risks for shoulder pain after stroke.

Shoulder pain and ultrasound findings: A comparison study of wheelchair athletes, nonathletic wheelchair users, and nonwheelchair users.

Shoulder pain is one of the most common musculoskeletal concerns in manual wheelchair users including among athletes. However, there is a paucity of research characterizing both shoulder pain and shoulder pathology in this population. To characterize and compare the prevalence of current shoulder pain and ultrasound metrics of shoulder pathology between wheelchair athletes, nonathletic wheelchair users, and nonwheelchair users. Cross-sectional. Chicago-area adaptive sport teams/programs and musculoskeletal clinics. Thirty-four wheelchair athletes, six nonathletic wheelchair users, and 12 nonwheelchair users. Self-reported shoulder pain was assessed by questionnaire and Wheelchair User Shoulder Pain Index (WUSPI). Shoulder physiology and pathology were assessed by physical and ultrasound evaluation of both shoulders by a sports medicine physician. Questionnaire outcomes: Prevalence of current shoulder pain, total WUSPI score. Physical examination outcomes: total Physical Examination of Shoulder Scale (PESS) score. Sonographic outcomes: Acromiohumeral distance (AHD) and presence of shoulder pathology. The majority of wheelchair athletes (68%) and nonathletic wheelchair users (67%) experienced shoulder pain since using a manual wheelchair. Wheelchair basketball players had a mean WUPSI score of 17.2 (SD = 21.8), and athletes participating in handcycling, sled hockey, and quad rugby had mean scores of 4.91 (SD = 8.32), 7.76 (SD = 13.1), and 4.29 (SD = 7.75), respectively. Shoulder pathology was observed in 14 of 31 (45%) wheelchair athletes and 4 of 6 (67%) nonathletic wheelchair users (p = .41). Although wheelchair use is a risk factor for shoulder pain, participation in amateur wheelchair sports may not be associated with increased risk of shoulder pain. It is possible that overhead sports such as wheelchair basketball may define a unique high-risk group. Further study is needed to examine this relationship and to determine whether there are differences between specific wheelchair sports.

Epidemiology and pain in elementary school-aged players: a survey of Japanese badminton players participating in the national tournament

Pain is common in athletes which should be well managed. To identify risk factors for shoulder pain, and the association between shoulder pain, lower back pain and knee pain among elementary school-aged badminton players, we conducted a cross-sectional study to collect data of the past year among 611 elementary school age (7–12 years old) badminton players belonging to the Japan Schoolchildren Badminton Federation using a questionnaire. Odds ratio (OR) and 95% confidence interval (CI) were estimated by multivariate logistic regression analysis. The overall incidence rate of shoulder injuries, lower back injuries and knee injuries was 0.38 injuries per 1000 h of badminton training. Players with training time per day > 2.5 h were 2.64 times (95% CI 1.03–6.78, p = 0.043) more likely to sustain shoulder pain than those with training time per day ≤ 2.5 h. A significant association was revealed between shoulder pain and knee pain as well as between lower back pain and knee pain as training hours per day > 2.5 h. Moreover, lower back pain was significantly associated with shoulder pain independent of training hours per day (≤ 2.5 h: p = 0.001; > 2.5 h: p < 0.001). These findings indicate that training time per day is risk factor, and shoulder pain, lower back pain and knee pain were associated with each other in elementary school-aged badminton players.

Quantifying the Burden of Shoulder and Hip Pain In Water Polo Players Across Different Playing Levels

BackgroundWater polo is characterised by unique skills and movements with high demands of both the upper and lower limb. There is growing recognition of the problems of shoulder and hip/groin symptoms in this population.PurposeTo quantify the prevalence of shoulder and hip/groin pain in water polo players, and to describe how performance and participation were impacted. Secondary aims investigated whether demographic or training variables were associated with levels of symptoms.DesignIn-season, cross-sectional questionnaire studyMethodsAn online questionnaire was distributed to all adult levels of the Australian water polo community. Participants were asked about demographic and playing history, and then specific injury history at both the shoulder and hip/groin. Each respondent completed an Oslo Sports Trauma Research Centre (OSTRC) overuse injury questionnaire for the shoulder and hip/groin. Point prevalence and past history were calculated, as well as a morbidity score from OSTRC responses. Risk ratios were used to determine differences between playing levels and sex.ResultsOne hundred, fifty-three respondents completed the questionnaire (57% female). High rates of shoulder pain were reported (38.1% current, 81.2% past history), as well as hip/groin pain (33.1% current, 60.4% past history). Current shoulder pain was a risk factor for hip/groin pain (RR 1.99 (95%CI 1.27-3.12), and hip/groin pain was a risk factor for shoulder pain (RR 1.70 (95%CI 1.23-2.35). Elite-level athletes had higher prevalence (RR 1.87 [95%CI 1.01-3.46]) and past history of hip/groin pain (RR 1.76 [95%CI 1.32-2.36]).ConclusionsThis is the first study to quantify high self-reported levels of hip/groin pain in water polo athletes. Such high levels may be explained by high amounts of eggbeater kick, especially during skeletal development in adolescence. Shoulder pain continues to be the most common source of injury burden in water polo. Future research should determine whether any modifiable risk factors exist that may reduce the burden of injury in this population.Level of Evidence2b

Development of a short and effective shoulder external rotation strength program in handball: A delphi study

BackgroundWeakness of the shoulder external rotators (ER) is one of the main risk factors for shoulder pain in handball. Short, effective shoulder ER strength programs the players will adhere to are lacking. Objectivesto develop a short and effective shoulder ER strength program, handball players will adhere to. MethodsWe conducted a modified Delphi study, including experts in the field of shoulder, strength training and handball. In the first round, the experts were asked to rate eight pre-defined shoulder ER exercises on efficacy and adherence and to suggest other preferred exercises. In round two, they were asked to rate the new exercises from round one. In round three, they received a statistical summary of the panels scores, their own score and a summary of the suggestions. Based on the feedback, the experts were asked to revise their response. ResultsSixteen experts completed three rounds with 100% response rate. Twenty-eight exercises were rated. We reached consensus for both efficacy and adherence for two exercises, ER in 90° abduction in a bent-over squat position and ER in 90° abduction combined with horizontal abduction and trunk rotation in a push-up position. ConclusionWe reached consensus for both efficacy and adherence for two exercises.

Shoulder Pain and Rotational Range of Motion of the Trunk, Shoulder, and Hip in Baseball Players.

Deficient glenohumeral rotational range of motion (ROM) is a risk factor for shoulder pain. Adapted ROM of the trunk and hip in response to loss of glenohumeral ROM has been suggested, as the nature of baseball leads to ROM adaptations. To compare the bilateral rotational ROM values of the trunk and glenohumeral and hip joints in adolescent baseball players with or without shoulder pain and to measure the correlation between shoulder-pain intensity and bilateral rotational ROM values for each body area. Cross-sectional study. Research laboratory. Ninety-five adolescent baseball players (60 with shoulder pain, 35 without shoulder pain). Bilateral trunk rotation and internal rotation, external rotation, and total rotation of the dominant and nondominant glenohumeral and hip joints. Glenohumeral and hip ROM did not differ between groups, and pain intensity and rotational ROM were not related in either joint. Trunk rotational ROM was greater in the pain group than in the control group (dominant side = 48.8° ± 14.2° versus 41.8° ± 11.9°, respectively; nondominant side = 45.1° ± 14.2° versus 38.9° ± 7.7°, respectively; P values < .05), although the difference was clinically small (mean differences = 7.0° ± 2.7° [95% confidence interval = 1.7, 12.4] on the dominant side, P = .01, and 6.1° ± 2.7° [95% confidence interval = 0.8, 11.5] on the nondominant side, P = .03). Positive but low correlations in all players (ρ = 0.27, P = .01) and in those with shoulder pain (ρ = 0.36, P = .001) were present between shoulder-pain intensity and trunk rotational ROM toward the dominant side. We found no clinical relationship between shoulder pain and rotational ROM and no clinical differences in rotational ROM values between players with and those without shoulder pain.

Shoulder Pain and the Weight-bearing Shoulder in the Wheelchair Athlete.

Shoulder pain is one of the most common complaints amongst wheelchair athletes. There are many debated potential risk factors for shoulder pain in this population including inherent anatomy, increased loading forces, overuse, age, wheelchair use duration, trunk control, and sport played. Proper identification of etiology of shoulder pain with a thorough history and physical examination is important for management purposes. Treatment can be challenging as complete rest from exacerbating activities is often difficult as upper extremity use is necessary for everyday life activities such as mobility and transfers. Addition of shoulder maintenance strengthening program focusing on strengthening adductors, external rotators, and scapular retractors is important to keep shoulder muscles well-balanced to prevent injury.