Shoulder Complaints Research Articles

Shoulder complaints in wheelchair athletes: A systematic review.

BackgroundIn recent years the popularity of disabled sports and competition among disabled athletes has grown considerably. With this rise in exposure of, and participation in wheelchair sports comes an increase in related stressors, including musculoskeletal load. External mechanical loading may increase the risk of shoulder complaints. The objective of this literature review was to 1) identify and describe the prevalence and/or incidence of shoulder complaints in wheelchair athletes in the literature, to 2) examine the factors and underlying mechanisms that could be potentially involved, and 3) provide some insights into the development of preventative measures.MethodsA literature search was conducted using PubMed, Scopus and Embase databases, to identify relevant published articles. All articles in the English language that contained any type of shoulder complaint in relation with a wheelchair sports player, at any level of status (recreational to elite), of any sport, were included. Articles were excluded if they did not include any statistical analysis. Articles that included studies with wheelchair athletes in combination with athletes of other disability sports were excluded in order to be able to differentiate between the two. Narrative, exploratory and case studies were also excluded. Two reviewers independently assessed articles for inclusion. Thirteen articles matched the selection criteria. These were judged on their quality by use of an adapted version of the Webster checklist.ResultsOf the included studies the overall quality was low. A relatively high prevalence of complaints was found, ranging from 16% to 76%. Pain was found to be a common complaint in wheelchair athletes. Based on the current literature the cause of shoulder problems is difficult to identify and is likely multifactorial, nevertheless characteristics of the user (i.e. increased years of disability, age and BMI) were shown to increase risk. Preventative measures were indistinct. There may be a role for balanced strength training regimens to decrease risk.ConclusionShoulder complaints in wheelchair athletes are a common problem that must be addressed further. Future studies on shoulder overuse injuries of wheelchair athletes should be directed towards biomechanical modeling to develop knowledge of load and its effects.

Impact of Radiographic Imaging of the Shoulder Joint on Patient Management: An Advanced-Practice Physical Therapist's Approach.

Purpose: Recent care innovations using advanced-practice physical therapists (APPs) as alternative health care providers are promising. However, information related to the clinical decision making of APPs is limited with respect to ordering shoulder-imaging investigations and the impact of these investigations on patient management. The purpose of this study was twofold: (1) to explore the clinical decision making of the APP providing care in a shoulder clinic by examining the relationship between clinical examination findings and reasons for ordering imaging investigations and (2) to examine the impact on patient management of ordered investigations such as plain radiographs, ultrasound (US), magnetic resonance imaging (MRI), and magnetic resonance arthrogram (MRA). Method: This was a prospective study of consecutive patients with shoulder complaints. Results: A total of 300 patients were seen over a period of 12 months. Plain radiographs were ordered for 241 patients (80%); 39 (13%) received MRI, 27 (9%) US, and 7 (2%) MRA. There was a relationship between clinical examination findings and ordering plain radiographs and US (ps=0.047 to <0.0001). Plain radiographs ordered to examine the biomechanics of the glenohumeral joint affected management (χ2 1=8.66, p=0.003). Finding a new diagnosis was strongly correlated with change in management for all imaging investigations (ps=0.001 to <0.0001). Conclusion: Skilled, extended-role physical therapists rely on history and clinical examination without overusing costly imaging. The most important indicator of change in management was finding a new diagnosis, regardless of the type of investigation ordered.

Consistency of commonly used orthopedic special tests of the shoulder when used with the McKenzie system of mechanical diagnosis and therapy

BackgroundShoulder Orthopedic Special Tests (OSTs) are used to assist with diagnosis in shoulder disorders. Issues with reliability and validity exist, making their interpretation challenging. Exploring OST results on repeated testing within Mechanical Diagnosis and Therapy (MDT) shoulder classifications may offer insight into the poor performance of these tests. ObjectivesTo investigate in patients with shoulder complaints, whether MDT classifications affect the agreement of OST results over the course of treatment. MethodsAn international group of MDT clinicians recruited 105 patients with shoulder problems. Three commonly used OSTs (Empty Can, Hawkins-Kennedy, and Speed's tests) were utilized. Results of the OSTs were collected at sessions 1, 3, 5 and 8, or at discharge from an MDT classification-based treatment. The Kappa statistic was utilized to determine the agreement of the OST results over time for each of the MDT classifications. ResultsThe overall Kappa values for Empty Can, Hawkins-Kennedy and Speed's tests were 0.28 (SE = 0.07), 0.28 (SE = 0.07) and 0.29 (SE = 0.07), respectively. The highest level of agreement was for Articular Dysfunction for the Empty Can test (0.84, SE = 0.19). For shoulder Derangements, there was no agreement for any of the OSTs (P values > 0.05). ConclusionThe lack of agreement when the OSTs were consecutively tested in the presence of the MDT Derangement classification contrasted with the other MDT classifications. The presence of Derangement was responsible for reducing the overall agreement of commonly used OSTs and may explain the poor consistency for OSTs.

Plate fixation of the proximal humerus: an international multicentre comparative study of postoperative complications.

The primary aim was to evaluate the number of complications following locking plate fixation of proximal humeral fractures in country X and in country Y. The secondary aim was to identify risk factors for complications. Multicentre retrospective case series of 282 consecutive patients with proximal humeral fractures, treated with a locking plate between 2010 and 2014. two level 1 trauma centres in country X and one in country Y. Data pertaining to demographics, postoperative complications and re-operations were collected. Fractures were classified according to the AO and Hertel classifications and experienced surgeons assessed the quality of reduction and plate fixation on the postoperative X-rays. Outcomes of the two different countries were compared and logistic regression analysis was performed to analyse the relationship between risk factors and complications. During a median follow-up of 370days, 196 complications were encountered in 127 patients (45%). The most frequent complications were: screw perforation in the glenohumeral joint (23%), persistent shoulder complaints (16%), avascular necrosis of the humeral head (10%) and secondary fracture displacement (5%). In 80 patients (28%), 132 re-operations were performed. The patients operated in country X had significantly more complications compared with the patientsoperated in country Y. For implant-related complications, advanced age, non-anatomic reduction of the greater tuberosity, and country of operation were risk factors. The use of locking plates for proximal humeral fractures was associated with a high number of complications in both countries; the patients operated in country Y, however, had better results compared with the patients operated in country X. IV.

Mechanisms of trunk stabilization during gait termination in young and older women: A neuromechanical analysis

Altered scapular kinematics have been associated with shoulder pain and functional limitations. To understand kinematics in persons with spinal cord injury during manual handrim wheelchair propulsion, a description of normal scapular behaviour in able-bodied persons during this specific task is a prerequisite for accurate interpretation. The primary aim of this study is to describe scapular kinematics in able-bodied persons during manual wheelchair propulsion.Sixteen able-bodied, novice wheelchair users without shoulder complaints participated in the study. Kinematic and kinetic data were collected during a standardized pose in the anatomic posture, frontal-plane arm elevation and low-intensity steady-state handrim wheelchair propulsion and upper-body Euler angles were calculated.Scapulothoracic joint orientations in a static position were 36.7° (SD 5.4°), 6.4° (SD 9.1°) and 9.1° (SD 5.7°) for respectively protraction, lateral rotation and anterior tilt. At 80° of arm elevation in the frontal plane, the respective values of 33.4° (SD 8.0°), 23.9° (SD 5.4°) and 4.1° (SD 11.3°) were found. During the push phase of manual wheelchair propulsion, the mean scapular rotations were respectively 32.7° (SD 7.1°), 7.1° (SD 9.2°) and 9.8° (SD 8.3°).The orientation of the scapula in a static pose, during arm elevation and in manual wheelchair propulsion in able-bodied participants showed similar patterns to a previous study in persons with para- and tetraplegia. These values provide a reference for the investigation of the scapular movement pattern in wheelchair-dependent persons and its relation to shoulder complex abnormalities.

Risk factors for neck and shoulder pain among schoolchildren and adolescents.

To evaluate the potential risk factors for neck and shoulder pain among schoolchildren. Demographic, physical/leisure activity, school-related and psychosocial factors for neck/shoulder pain were evaluated in a cross-sectional study of 1611 schoolchildren aged 11-14 years. Neck and shoulder complaints were reported in 27.9 and 19.0% of the sample, respectively. According to multivariate logistic regression models, high desk height (odds ratio (OR) = 2.23, 95% confidence interval (CI): 1.22-4.07), forward-inclined seat pan (OR = 2.38, 95% CI: 1.40-4.05), time spent (30-60 min/day) carrying school bag (OR = 1.61, 95% CI: 1.16-2.23) and psychosocial factors (OR = 1.95, 95% CI: 1.03-3.72) independently increased the risk of neck pain, while low body mass index (OR = 0.63, 95% CI: 0.42-0.95) decreased it. Time spent on watching TV (OR = 1.45, 95% CI: 1.02-2.06), backward-inclined seat backrest (OR = 1.62, 95% CI: 1.02-2.58), curved seat backrest (OR = 1.80, 95% CI: 1.05-3.08), too much homework (OR = 1.45, 95% CI: 1.03-2.03) and psychosocial factors (conduct problems) (OR = 1.63, 95% CI: 1.07-2.46) independently increased the risk of shoulder pain, while prosocial behaviour (OR = 0.56, 95% CI: 0.35-0.90) decreased it. Both physical and psychosocial factors influenced the risk for neck/shoulder pain in school-aged children, suggesting that they should be considered in assessment and treatment of such symptoms in this population.

Youth Baseball Players with Elbow and Shoulder Pain Have Both Low Back and Knee Pain: A Cross-sectional Study

Objectives:Serious arm injuries in youth baseball players have been increasing. Though a breakage in the kinetic chain could affect arm injuries, an association between arm injuries and insufficient support of the trunk and lower extremities have not been well understood. The purpose of this study was to investigate the association of low back and knee pain with elbow and/or shoulder complaints among youth baseball players.Methods:Study participants were mostly school-aged athletes belonging to Junior Sports Club Association of Miyagi prefecture (aged 6 to 15 years old). A self-administered questionnaire and informed consent document were mailed to25,469 registered athletes. Of those, 7,333 athletes replied both written informed consent and questionnaire (response rate was 28.8%). Those who did not play baseball (n = 5,577) and played both baseball and the other sports (n = 26) were excluded from this study. Missing data on variables (n = 192) were also excluded. The final study population was comprised of 1,535 players. We used multiple logistic regression analysis to examine the association of low back and knee pain with elbow and/or shoulder pain. Variables considered in the models were sex, age, BMI, years of athletic experience, position, team level, the amount of practice, participating day in team practice and game per week, frequency of participation in games, and practice intensity.Results:The frequency of elbow and/or shoulder pain was 24.8% (n= 393); that of elbow pain, 14.3% (n = 226); that of shoulder pain, 17.3 % (n = 273); that of both elbow and shoulder pain, 6.6% (n = 105); and that of low back and knee pain were 8.4% (n= 134) and 13.1% (n = 208), respectively. The frequency of elbow and/or shoulder pain who had low back and knee pain were 61.2% (n = 82) and 51.9% (n= 108) (p<0.001), respectively. The presence of low back and knee pain were strongly associated with elbow and/or shoulder pain (adjusted ORs (95%CI): 4.23 (2.83 - 6.34), p<0.001 and 3.11 (2.24 - 4.31), p<0.001, respectively), elbow (adjusted ORs (95%CI): 3.19 (1.74 - 5.83), p<0.001 and 2.45 (1.47 - 4.07), p=0.001, respectively), shoulder (adjusted ORs (95%CI): 4.25 (2.59 - 7.29), p<0.001 and 3.31 (2.17 - 5.05), p<0.001, respectively), and both elbow and shoulder pain (adjusted ORs (95%CI): 5.49 (3.08 - 9.79), p<0.001 and 3.52 (2.12 - 5.85), p<0.001, respectively).Conclusion:Both low back and knee pain were significantly associated with elbow and/or shoulder pain in youth baseball players. This result suggests that checking the trunk and lower extremities as well as elbows and shoulders are important for preventing sever injuries in youth baseball players.

Seeing the Future: Predicting a Patient’s Need for Shoulder Surgery before the First Encounter

Objectives:The aim of this study was to determine the likelihood of shoulder surgery based on a pre-visit branching questionnaire implemented prospectively at the time of initial visit scheduling.Methods:Patients calling a large regional sports health institution with shoulder complaints between Jan 2015 and June 2016 were asked a series of questions according to a branching logic algorithm at the time of initial appointment scheduling (Fig. 1). All patients had appointments scheduled regardless of their responses. In July 2016, a retrospective chart review was conducted to determine which patients were recommended for shoulder surgery. Multivariate regression models were constructed to determine the combination of questions that were asked, or could be asked, that would lead to the highest and most accurate predictive value of recommended surgery. Patient records were excluded if the patients were younger than 13 or over 75, if the appointment was cancelled or scheduled after April 2015, and if the treatment was not yet determined at the time of chart review.Results:After chart review of included patients, 760 records were available for analysis. The multivariate regression model that best matched the data and produced the highest predictive value for surgery had a concordance index of 0.688, representing the rate at which the model correctly assigned a higher surgical risk to patients that were ultimately recommended for surgery against those who were not. Significant variables in this model were if a previous provider ordered an MRI for the patient, injury status, and patient sex. The odds ratios for a patient requiring surgery based on their status in those areas are shown in Table 1. Having an MRI ordered by a previous provider (OR=4.45) and male sex (OR=1.6) were both positive predictors of needing surgery. Indication of injury with a primary complaint of weakness or instability carried the strongest predictive effect of surgery. (OR=1, reference) The odds of surgery decreased if the patient’s primary complaint was pain or if the patient followed the answer pathway: Pain—Not Crushing Pain—Injury—No ER Visit—No Pain Raising Arm. The model can predict between a 7.5% and 95% chance of needing surgery (20% of the population required surgery). A nomogram was constructed from the model such that a patient’s response to each question correlated to a point value, and the total of those points correlated to a probability of needing surgery.Conclusion:Based on patient’s response to the questionnaire, we have constructed a model that can both quickly and easily estimate the probability that the patient will require surgery. Our model can predict up to a 95% likelihood of needing surgery and down to a 7.5% likelihood of needing surgery. We believe that this information can guide and improve future scheduling practices and will help patients see the appropriate provider sooner, reduce cost, and improve patient and physician satisfaction.Table 1.Odds Ratios, ModelPoints, and SurgicalRiskfor Predictive Model including Sex, MRI status, and Injury statusFactor/VariableOdds Ratio95% CI on Odds Ratiop-valuePoints from affirmative responseSurgical Risk Intercept ––0.733N/A MRI ordered by other provider 4.45(2.79, 7.10)<0.00153 Male (vs. Female) 1.6(1.05, 2.49)0.03117 Indicated Injury Indicated Injury on Weakness or Instability Branch1RefRef100Indicated injury on AP: Pain—Not Crushing Pain—Injury (excluding the AP below)0.167(0.033, 0.659)0.01636Did not encounter an injury question0.129(0.0243, 0.544)0.00827Indicated no injury0.0797(0.0161, 0.308)<0.00110Indicated injury on AP: Pain—Not Crushing Pain—Injury—No ER Visit—No Pain Raising Aim0.0603(0.011, 0.264)<0.0010 TotalPoints 20.075420.2910.51410.81960.95

Validity and Responsiveness of the Single Alpha-numeric Evaluation (sane) for Shoulder Patients

Objectives:The is an ever-increasing demand within the emerging health care arena to demonstrate the efficacy of orthopedic interventions. Widespread implementation of patient reported outcomes are limited in part due to the barriers of clinical infrastructure and resources in a busy orthopedic practice. Prior studies have shown the single alpha-numeric evaluation (SANE) score to correlate at a single point in time with the American Shoulder and Elbow Surgeons(ASES) score. However, no study has validated the SANE in terms of test-retest reliability, responsiveness or clinical utility. Therefore, the purpose of this study was to validate SANE compared to the ASES across a sample of patients with the most common orthopedic shoulder diagnoses.Methods:Shoulder patients (n=105 age=52.7 ± 1.2; female=67) undergoing rotator cuff repair (cuff=44), total shoulder replacement (TSA=23), or physical therapy (PT=38) were administered the SANE and ASES less than 14 days apart prior to surgery and again at their 3 month follow up from initial care or surgery. Interclass Correlation Coefficients (ICC(2,1)) and standard error of the measure(SEM) were used to evaluate the test-retest reliability of the SANE and the validity between the SANE and ASES scores. An ANOVA (treatment group by time) was used to evaluate the responsiveness to treatment, and a Receiver Operating Curve was used to establish the minimally important clinical difference (MCID) for the SANE compared to the ASES (α =0.05).Results:The SANE demonstrated good reliability (ICC(2,1) =0.76 ± 3.4) similar to the ASES (ICC(2,1) =0.82 ± 3.4) pre-treatment. The SANE demonstrated good agreement with the SANE across all treatment groups (Cuff= ICC(2,1) 0.85 ± 3.4; TSA- ICC(2,1) =0.72 ± 5.2;PT- ICC(2,1) =0.82 ± 2.9) pre and post treatment. The SANE displayed similar responsiveness to the ASES after treatment (Figure 1) with similar mean change and standard deviations within each treatment group. The ROC curve revealed an area under the curve of .79 (SE, 0.62; P<.001) and a cutoff of 9.5% on the SANE with a sensitivity of 83% and a specificity of 31% to establish the MCID.Conclusion:Our study is the first to demonstrate the SANE is valid across a range of common shoulder diagnoses to assess patient outcomes across operative and non-operative treatment for shoulder complaints. The MCID of 9.5% is similar to the ASES (11%) suggesting that the SANE is a simple and efficient tool to assess treatment effects for shoulder disorders. Future studies are warranted to confirm these results and compare across other body parts and diagnoses.

Critical shoulder angle combined with age predict five shoulder pathologies: a retrospective analysis of 1000 cases

BackgroundAcromial morphology has previously been defined as a risk factor for some shoulder pathologies. Yet, study results are inconclusive and not all major shoulder diseases have been sufficiently investigated. Thus, the aim of the present study was to analyze predictive value of three radiological parameters including the critical shoulder angle, acromion index, and lateral acromion angle in relationship to symptomatic patients with either cuff tear arthropathy, glenohumeral osteoarthritis, rotator cuff tear, impingement, and tendinitis calcarea.MethodsA total of 1000 patients’ standardized true-anteroposterior radiographs were retrospectively assessed. Receiver-operating curve analyses and multinomial logistic regression were used to examine the association between shoulder pathologies and acromion morphology. The prediction model was derived from a development cohort and applied to a validation cohort. Prediction model’s performance was statistically evaluated.ResultsThe majority of radiological measurements were significantly different between shoulder pathologies, but the critical shoulder angle was an overall better parameter to predict and distinguish between the different pathologies than the acromion index or lateral acromion angle. Typical critical shoulder angle-age patterns for the different shoulder pathologies could be detected. Patients diagnosed with rotator cuff tears had the highest, whereas patients with osteoarthritis had the lowest critical shoulder angle. The youngest patients were in the tendinitis calcarea and the oldest in the cuff tear arthropathy group.ConclusionsThe present study showed that critical shoulder angle and age, two easily assessable variables, adequately predict different shoulder pathologies in patients with shoulder complaints.

The influence of expectations on improvements in pain and function in patients with neck/back/shoulder complaints: a cohort study.

In musculoskeletal research, patients' expectations have recently received increased attention. However, few prospective studies have investigated these expectations or their prognostic significance and possible clinical value. To investigate the influence of patients' expectations on improvements in pain and functional status six months after an outpatient physical medicine assessment. Prospective cohort study. Physical Medicine and Rehabilitation (PMR) outpatient clinic. Patients with neck, back, or shoulder complaints. Pain, during rest and activity, and functional status (PainFunction) were assessed using numerical rating scales (NRSs; 0 to 11) prior to a PMR consultation and after six months. At baseline, the patients were asked to define their expectations (Exp) regarding pain and functional status at six months using equivalent NRSs. The influence of Exp on PainFunction at six months was assessed through multiple regression analysis, controlling for demographic factors. A total of 256 patients were included between January and June 2013, and 181 were followed up at six months. PainFunction improved statistically significant between baseline and six months (P<0.001). Approximately 40% of the patients expected (Exp) an improvement, while 29% reported an improvement at six months, reflected by a minimum of two points improvement in PainFunction. The regression analysis revealed that sick leave and the number of pain sites, but not expectations (Exp), influenced improvement in PainFunction at six months. The present study does not support the suggested influence of expectations on pain and functional improvement in patients with neck, back or shoulder complaints. The patients' expectations were more positive than their actual pain and functional improvements. However, their expectations did not significantly influence the study outcomes.

Application of the McKenzie system of Mechanical Diagnosis and Therapy (MDT) in patients with shoulder pain; a prospective longitudinal study

Objectives: The primary objective was to determine if the pain and function response to the McKenzie system of Mechanical Diagnosis and Therapy (MDT) differs by MDT classification category at two and four weeks following the start of MDT treatment for shoulder complaints. The secondary objective was to describe the frequency of discharge over time by MDT classification.Methods: International, MDT-trained study collaborators recruited 93 patients attending physiotherapy for rehabilitation of a shoulder problem. The Numeric Pain Rating Scale (NPRS) and the Upper Extremity Functional Index (UEFI) were collected at the initial assessment and two and four weeks after treatment commenced. A two-way mixed model analysis of variance with planned pairwise comparisons was performed to identify where the differences between MDT classification groups actually existed.Results: The Derangement and Spinal classifications had significantly lower NPRS scores than the Dysfunction group at week 2 and week 4 (p < 0.05). The Derangement and Spinal classifications had significantly higher UEFI scores than the Dysfunction group at week 2 and week 4 (p < 0.05). The frequency of discharge at week 2 was 37% for both Derangement and Spinal classifications, with no discharges for the Dysfunction classification at this time point. The frequency of discharge at week 4 was 83, 82 and 15% for the Derangement, Spinal and Dysfunction classifications, respectively.Discussion: Classifying patients with shoulder pain using the MDT system can impact treatment outcomes and the frequency of discharge. When MDT-trained clinicians are allowed to match the intervention to a specific MDT classification, the outcome is aligned with the response expectation of the classification.Level of Evidence: 2b

Reproducibility of scapular muscle activity in isokinetic shoulder flexion and extension

Repetitive overhead movements have been identified as a main risk factor to develop shoulder complaints with scapular muscle activity being altered. Reliable assessment of muscle activity is essential to differentiate between symptomatic and asymptomatic individuals. Therefore, the present study aimed to investigate the intra- and inter-session reliability of scapular muscle activity during maximal isokinetic shoulder flexion and extension. Eleven asymptomatic adults performed maximum effort isokinetic shoulder flexion and extension (concentric and eccentric at 60°/s) in a test-retest design. Muscle activity of the upper and lower trapezius and serratus anterior was assessed by sEMG. Root Mean Square was calculated for whole ROM and single movement phases of absolute and normalized muscle activity. Absolute (Bland-Altman analysis (Bias, LoA), Minimal detectable change (MDC)) and relative reliability parameters (Intraclass correlation coefficient (ICC), coefficient of variation (CV)/test-retest variability (TRV)) were utilized for the evaluation of reproducibility. Intra-session reliability revealed ICCs between 0.56 and 0.98, averaged CVs of 18% and average MDCs of 81mV. Inter-session reliability resulted in ICCs between 0.13 and 0.93, averaged TRVs of 21%, average MDCs of 15% and systematic and random error between −8±60% and 12±36%. Scapular muscle activity assessed in overhead movements can be measured reliably under maximum load conditions, though variability is dependent on the movement phase. Measurement variability does not exceed magnitudes of altered scapular muscle activities as reported in previous studies. Therefore, maximum load application is a promising approach for the evaluation of changes in scapular control related to pathologies.

Referred Pain Patterns of the Infraspinatus Muscle Elicited by Deep Dry Needling and Manual Palpation.

To identify the most common referred pain (ReP) pattern of the infraspinatus myofascial trigger point (MTrP) and compare its coincidence with the original ReP pattern, to verify whether there are any significant differences by sex and types of technique and to determine the observed signs and symptoms evoked by deep dry needling (DDN) and manual palpation (MPal). A cohort study of patients randomized to two different examination methods (July and August 2016). Students and staff recruited from Miguel Hernandez University (Southeast Spain). One hundred thirty-three participants (70.7% women) with shoulder complaints were randomly assigned to either an MPal (n = 67) or DDN group (n = 66). The same physiotherapist carried out the techniques on all participants, and the same protocol was followed for both the DDN and MPal groups. The physiotherapist did not ask participants about their pain features or other relevant issues. Local twitch response (LTR) and ReP assessed through a visual analogue scale and features of ReP of the infraspinatus muscle. The areas with the highest percentage of ReP were the front (area 3; 27.1%) and back (area 11; 21.1%) of the arm, anterior (area 4; 36.1%) and posterior (area 12; 42.1%) shoulder, and infraspinatus muscle area. DDN proved to be significantly easier than MPal in evoking an LTR (p ≤ 0.001). There were significant differences between sexes in zone 2 (p = 0.041) and no statistically significant differences were found by technique. The ReP pattern of the infraspinatus muscle coincides with the original pattern described by Travell and Simons, although the neck area should be questioned. The study found no significant differences in the ReP pattern by sex and when comparing MPal with DDN of MTrP of the infraspinatus muscle. DDN proved to be significantly easier than MPal in evoking an LTR.

Care of Shoulder Pain in the Overhead Athlete.

Shoulder complaints are common in the overhead athlete. Understanding the biomechanics of throwing and swimming requires understanding the importance of maintaining the glenohumeral relationship of the shoulder. Capsular laxity, humeral retrotorsion, glenoid retroversion, glenohumeral internal rotation deficit, and scapular dyskinesis can all contribute to shoulder dysfunction and pain. Injuries are more likely during peak height velocity, especially when coupled with overuse, previous injuries not adequately treated, or change in the demands on the shoulder such as a new technique, bigger field, or longer race. Working with physical therapists, athletic trainers, and coaches to identify and treat the etiology of the shoulder dysfunction will help pediatricians return the athlete to activity and prevent future injury. [Pediatr Ann. 2017;46(3):e112-e119.].

The Pediatric/Adolescent Shoulder Survey (PASS): A Reliable Youth Questionnaire With Discriminant Validity and Responsiveness to Change.

Background:Health-related quality of life tools for shoulder pathology in adults have been developed, such as the Disabilities of the Arm, Shoulder, and Hand (DASH) or QuickDASH. However, some content is not applicable to or readily grasped by a younger population.Purpose:To evaluate the psychometric properties of a new 13-item pediatric/adolescent shoulder survey (PASS).Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:An initial development cohort of children was given the PASS, QuickDASH, and single assessment numeric evaluation (SANE) in a prospective fashion. Internal reliability and concurrent validity were evaluated. Subsequent to this, the PASS, along with the QuickDASH, was incorporated into routine clinical evaluation of shoulder injuries. The secondary cohort was established via a retrospective review of patients (age <18 years) evaluated in our sports clinics for shoulder complaints. Discriminant validity and floor/ceiling effects were evaluated. A subset of patients with scores available both pre- and within 6 months postoperatively was analyzed to assess responsiveness to treatment.Results:Overall internal reliability of the shoulder survey was good in the development cohort of 127 patients, with Cronbach α = 0.86. Total score averaged 59.7% ± 17.9% in this cohort (range, 18.75%-100%). Significant correlations between all surveys were observed (r = 0.51-0.79, P < .05). A total of 127 surveys were available for the secondary cohort. The QuickDASH demonstrated significant differences between sexes with regard to scores (P < .05). Both tools were able to discriminate between patients with acute injuries and diminished clinical examinations (P < .05). A significant correlation was observed between duration of symptoms and scores on the PASS. The subset of 25 patients with pre- and postoperative data showed significant change in total score and the symptoms/limitations domain of the PASS, with significant correlation with length of time since surgery.Conclusion:This 13-question pediatric/adolescent-focused shoulder survey shows excellent psychometric properties, good discriminant ability, and early evidence of responsiveness to change, especially when compared with an adult-formatted questionnaire.

Staged decrease of physical ability on the locomotive syndrome risk test is related to neuropathic pain, nociceptive pain, shoulder complaints, and quality of life in middle-aged and elderly people – The utility of the locomotive syndrome risk test

Objectives: A locomotive syndrome (LS) risk test for evaluation of physical ability is recently proposed. The objective of this study is to evaluate the utility of this test by examining physical ability, neuropathic pain, nociceptive pain, shoulder complaints, and quality of life (QOL).Methods: A prospective cohort study was conducted in 523 subjects (240 males, 283 females; mean age: 63.3 years) at a health checkup. Data collected using visual analog scales (VAS) for shoulder pain, low back pain, sciatica, and knee pain, neuropathic pain, shoulder complaint, body mass index (BMI), osteoporosis, and SF-36 were compared among three LS risk stages.Results: Subjects in LS risk stage 1 (24%) had significantly more osteoporosis, slower gait speed, weaker muscle strength and higher VAS, with no difference in age and BMI compared to those with no LS risk (50%). Subjects in stage 2 (26%) had significantly poorer results for all items. Shoulder complaint, neuropathic pain and QOL differed significantly among all three groups and worsened with decline in mobility on the LS risk test.Conclusions: LS risk test is easy and useful screening tool for evaluation of mobility and for screening for pain and complaint associated with activity of daily living and QOL.

SHOULDER FUNCTION AND SHOULDER COMPLAINTS IN DANISH ELITE BADMINTON PLAYERS

BackgroundShoulder function and the prevalence of shoulder complaints in elite badminton are not well described.ObjectiveThe aims of this study were to compare players who reported previous or present shoulder complaints...

뇌손상 가족 간병인의 근골격계 자각증상과 관련요인

본 연구는 뇌손상 진단을 받고 병원에서 재활치료를 실시하고 있는 환자의 가족 간병인 340명을 대상으로 근골격계증상을 알아보고 그 관련요인을 파악하고자 자기 기입식 설문조사를 실시하였다. 설문조사 내용은 일반적 특성, 간병활동 특성, 근골격계 자각 증상이였다. 본 연구의 조사 기간은 2014년 3월부터 4월이며, 재활병원 및 요양병원에서 수집하였다. 연구결과 독립변수에 따른 자각증상 호소율은 신체부위별로 다르게 나타났다. 요인분석의 결과는 목의 경우 초졸의 학력이 영향을 끼쳤고, 어깨의 경우 여자, 나이 50~59세, 학력 중졸, 간병기간 1년 이내와 1년 7개월 이상 2년 이내가 영향을 끼쳤다. 팔/팔꿈치의 경우 나이 40~49세, 학력 대졸, 간병기간 1년 이내와 1년 7개월 이상 2년 이내 변인이 유의한 영향을 끼쳤다. 손/손목/손가락의 경우 나이 50~59세, 간병기간 1년 이내와 1년 7개월 이상 2년 이내 변인이 통증에 유의한 영향을 끼쳤다. 다리/발의 경우 나이 50~59세, 간병기간 6개월 이내 변인이 통증에 유의한 영향을 미치는 것으로 나타났다. 허리의 경우 학력 초졸 중졸 고졸, 간병기간 1년 이내와 1년 7개월 이상 2년 이내, 독립보행 불가능 변인이 통증에 유의한 영향을 미치는 것으로 나타났다. 진단명 별 간병활동 특성에서 근골격계 자각증상 호소율은 통계적으로 유의하지 않았다. 근골격계 자각증상 호소에 가장 영향을 미치는 간병활동 동작으로는 이동하기와 보행이었다. 근골격계 자각증상에 영향을 미치는 전체 요인에 대해서는 간병 기간 1년 이내가 전체 통증에 유의한(p<.05) 영향을 미치는 것으로 나타났다. 본 연구의 결론으로는 뇌손상 환자의 가족 간병인은 환자를 간병하는 간병활동 특성에서 근골격계 질환의 위험에 노출되어 생활하는 것을 알 수 있었다. 또한 뇌손상 환자를 돌보는 가족 간병인의 신체부위별 근골격계 증상에 영향을 미치는 요인이 다르므로 이러한 요인에 대한 체계적이며 종합적인 예방 교육과 연구가 마련되어야 할 것이다. This study was conducted to identify factors related to the musculoskeletal symptoms of 340 family caregivers who have a patient with brain damage based on self-administered questionnaires. The questionnaires included general characteristics, characteristics of care activities and caregivers' musculoskeletal symptoms. Data were collected from many long-term care hospitals and rehabilitation centers during March 17 to March 21, 2014. The results indicated that complaint rates of work-related musculoskeletal systems of the body sites differed. Factor analysis revealed that neck complaints were related to education (under mid), while shoulder complaints were related to sex (female), age (50-59), education (mid) and duration of care (< 2 years). Arm/elbow complaints were related to age (40-49), education (high) and duration of care (12-24). Complaints regarding the hand/wrist/finger were related to age (50-59) and duration of care (12-24), while those associated with the legs/feet were related to age (50-59) and duration of care (< 6[ED highlight - years? Please specify.]). Back problems were related to education (under mid, mid stage, high) and gait. The complaint rate regarding musculoskeletal symptoms during daily life was not statistically significant. Logistic regression analysis of significant factors related to subjective musculoskeletal symptoms identified ambulation and gait as having the greatest influence and complaint factor among family caregivers. The complaint rate of family caregivers differed among body parts. Being a caregiver for less than one year was found to have a significant impact on pain. Overall, long term family caregivers could be faced with risk factors for musculoskeletal problems, but there are many different factors that affect musculoskeletal symptoms with regards to their activities. Accordingly, comprehensive and systematic prevention plans for family caregivers who have patients with brain damage should be developed.

Expectations of pain and functioning in patients with musculoskeletal disorders: a cross-sectional study

BackgroundResearch has suggested that patient expectations are associated with treatment outcome and evolve along with patient communication within the musculoskeletal field. However, few studies have investigated if or how physical medicine and rehabilitation (PMR) consultations affect the attending patients’ expectations regarding pain and functional improvement. Hence, the aims of the present study were to compare patient expectations regarding pain and functional improvement before and after a PMR consultation and to assess patient characteristics, including diagnosis, that could perhaps predict changes in expectations.MethodsThe study design was cross-sectional. Eligible participants were first-time patients with neck/back or shoulder complaints who were referred to a PMR outpatient clinic between January and June 2013. Questionnaires (the Patient Shoulder Outcome Expectancies, or PSOE, questionnaire and a numeric rating scale, or NRS) focused on expectations regarding pain and functioning were completed immediately prior to and after a consultation with a PMR specialist.ResultsIn total, 257 patients were included. In total, 24% of the subjects expected a more positive outcome after the PMR consultation compared with before the consultation, while 10% of the subjects exhibited a negative change in expectations. Few patient characteristics other than sick leave were associated with changes in expectations; however, patients with shoulder complaints seemed to be more optimistic than patients with neck/back complaints.ConclusionExpectations can be influenced by a single specialist consultation. Among clinical prognostic factors, only sick leave influenced the change expectations. However, patients with shoulder complaints seemed to be more optimistic than patients with neck/back complaints.Trial registrationThe study was approved by the Data Protection Office at Oslo University Hospital, 2012/2574. ISRCTN registration: 40963362 (registered retrospectively 12.12.2016)